Dementia In Long-term Care Facilities Research Articles

Providing Care for Older Residents With Dementia in Nursing Homes in China: Through the Lens of Adaptive Leadership

This study aims to understand staff’s experiences of providing direct care for older residents with advanced dementia in long-term care facilities through the lens of Adaptive Leadership Framework for Chronic Illness (ALFCI). Semi-structured interviews were conducted with health care aides (N=35) from 2 government-owned and 2 private long-term care facilities in urban China. Directed and conventional content analysis were used, drawing upon core constructs of ALFCI. We found that health care aides are confronted with multiple challenges such as high intensity of work, stress from managing older residents’ behavioral and psychological symptoms of dementia (BPSD), a lack of access to on-the-job dementia-specific training, and a lack of support from nurses and managing team. Some of the health care aides demonstrated use of their strengths and doing adaptive work to improve work life and care for older residents by using communication cues, enhancing person-centeredness in their care, and facilitate peer interactions.

Effectiveness of reminiscence therapy in reducing agitation and depression and improving quality of life and cognition in long-term care residents with dementia: A systematic review and meta-analysis

This paper assesses the effectiveness of reminiscence therapy (RT) in people with mild to moderate dementia in long-term care facilities. A literature search was conducted in CINAHL, MEDLINE, PsychINFO, and Embase from inception to December 2020. Five RCTs with 267 participants were included; two were meta-analysed. Cochrane collaboration's risk of bias tool was used to evaluate the methodological quality of the included RCTs, and the risk of bias across studies was assessed using the GRADE method. The overall quality of evidence was moderate to low. Among the five trials, none measured the efficacy of RT on agitation. Reminiscence therapy was effective in reducing depression and improving autobiographical memory, but its effects were inconsistent. There was a significant improvement in quality of life (QoL) following RT. The meta-analysis showed no statistical significance on the pre-post intervention differences in depression (SMD -0.28, 95%CI -0.91–0.35, p > 0.05) and autobiographical memory scores (SMD 0.57, 95%CI -0.07–1.21, p > 0.05). Reminiscence therapy may have some benefits in reducing depression and improving the QoL and cognition in this population; however, its effectiveness should be tested further.

Strategies for implementing music-based interventions for people with dementia in long-term care facilities: A systematic review.

Research has found that music-based interventions can decrease behavioral and psychological symptoms of dementia or behaviors that challenge (BPSD/BtC). However, how to effectively implement these interventions is unclear. This study synthesizes available evidence regarding implementation strategies and outcomes of music-based interventions for people with dementia at residential long-term care facilities. Study registered with PROSPERO (registration number: CRD42020194354). We searched the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included articles targeting music-based interventions conducted for people with dementia, studies conducted in residential long-term care facilities, and articles that reported implementation strategies and outcomes of the intervention. Of the included eight studies, half were studies of music therapy and the other half were on individualized music. 49 implementation strategies were reported. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. The most frequently reported implementation outcomes were appropriateness (27.3%), followed by adoption (22.7%), fidelity (22.7%), acceptability (9.1%), sustainability (9.1%), and cost (9.1%). No studies measured feasibility or penetration. Although various effective implementation strategies were identified, we were unable to examine the effectiveness of individual implementation strategies due to the designs of the selected studies. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on structural aspects.

522 - Role of Physical Environment on Quality of Life among Older Adults with Dementia in Long-Term Care Facilities in Canada and Sweden: A Longitudinal Study

Reduction in competence makes older adults with dementia more sensitive to the influence of the physical environment. The aim of the longitudinal study was to examine whether residents with dementia in long-term facilities with variability in physical environmental characteristics in Vancouver (N=11), Canada and Stockholm (N=13), Sweden had a difference in their quality of life (QoL). QoL was assessed using Dementia Care Mapping (DCM) tool three times over one year for the reliability of data. DCM is a technique and observational framework devised to systematically investigate QoL from the perspective of the older adults with dementia. The results of the study demonstrated that the residents with dementia living in a homelike and positive stimulating setting showed a higher level of potential positive engagement, and less agitated and withdrawn behaviors compared to those in the large-scale institutional setting. Residents living in a large-scale institutional setting in Canada showed so far as five times more agitated/distressed behaviors and twice more withdrawal compared to the ones living in a small-scale homelike setting in Sweden. The study supports that the large-scale institutional environment was considerably associated with levels of lower quality of life among the residents with dementia.

Eating Difficulties among Older Adults with Dementia in Long-Term Care Facilities: A Scoping Review.

This paper reports a scoping review of the literature on eating difficulties among older adults with dementia in long-term care facilities to identify key concepts, methods of measuring outcomes, interventions, and related factors. A scoping review was performed using the bibliographic databases PubMed, CINAHL, PsycINFO, and Cochrane Library. A combination of keywords and subject headings related to eating or feeding difficulties was used. Inclusion criteria were limited to materials published in English. A total of 1070 references were retrieved, of which 39 articles were selected after applying the inclusion and exclusion criteria. Articles that met the criteria were published between 1987 and 2020. “Eating disabilities” have been defined as problems related to choosing food and/or the ability to get food to one’s mouth, chew, and swallow. Interventions for eating difficulties described in the literature include spaced retrieval training, Montessori training, and feeding skill training. Intrapersonal, interpersonal, and environmental factors related to eating difficulties were identified. This scoping review will provide direct care workers, nursing educators, and administrators with an overview of eating performance and a broad understanding of eating difficulties for older adults with dementia in long-term care facilities.

Effect of Dementia Training on Knowledge and Attitude Among Long-Term Care Staff in Yogyakarta, Indonesia

BACKGROUND: The number of patients with dementia has increased globally. Caring for these patients is very challenging and demanding. There are many patients with dementia in long-term care facilities in Yogyakarta, Indonesia. However, most staff members do not have proper training regarding how to care for patients with dementia. AIM: This research aimed to investigate the effect of dementia care skills training on knowledge and attitudes about dementia among long-term care staff in Yogyakarta, Indonesia. METHODS: A pre-experimental study was conducted using a one-group pre-test and post-test method. There were 30 staff members in a long-term care facility in Yogyakarta, Indonesia, who participated in this study in July 2019. Training given was the Dementia Care Skills 18 h version for care workers provided by Alzheimer’s Indonesia by two certified trainers. Outcomes measured were knowledge and attitudes of the participants, which were measured using the Dementia Knowledge Assessment Scale and Dementia Attitude Scale. Data were analyzed using paired and independent t-tests as well as Pearson correlation tests. RESULTS: The results showed that staff knowledge of dementia (t = 4.78, p = 0.000) and attitudes toward persons with dementia (t = 3.27, p = 0.003) were improved significantly after the dementia training provided by the Alzheimer’s Indonesia trainers. CONCLUSIONS: Training in dementia care can improve knowledge and attitude of long-term care staff. This study recommends that dementia care skills training be provided for staff and nurses in long-term care to improve their knowledge and attitudes regarding patients with dementia and their care.

Factors associated with eating performance in older adults with dementia in long-term care facilities: a cross-sectional study

BackgroundThe purpose of this study was to investigate factors influencing eating performance in older adults with dementia (OAWDs) in long-term care (LTC) facilities.MethodsThis cross-sectional study examined risk factors for compromised eating performance by comparing both independent and dependent older adults with dementia. The study participants were 117 OAWDs in LTC facilities in South Korea. Measurements included (a) general characteristics, (b) activities of daily living (ADL) including eating performance, (c) cognitive function, (d) physical capability, (e) grip strength, (f) Behavioral Psychological Symptoms of Dementia (BPSD), and (g) depression. Data were analyzed by the percentage, mean and standard deviation, Chi-square test, t-test, and logistic regression.ResultsThe eating independent group had more comorbidities than the dependent group (t = 2.793, p < .006); had significantly higher cognition (t = 4.108, p < .001) and physical capability (t = 5.258, p < .001); and had stronger grip strength (t = 2.887, p = .005). Comorbidities and physical capability were determinants for independent eating performance (Odds Ratio [OR] = 1.969, p = .014; OR = 1.324, p < .001).ConclusionsIt is suggested that maintaining physical capability should be encouraged to support independent eating performance by OAWDs in LTC facilities. The results of this study could serve as a basis for developing function-focused care to maintain the residual eating performance of OAWDs in Korean LTC facilities. This is a subject area that has not been fully explored.

Hearing and vision health for people with dementia in residential long term care: Knowledge, attitudes and practice in England, South Korea, India, Greece, Indonesia and Australia.

ObjectivesUp to 90% of people with dementia in long term care (LTC) have hearing and/or vision impairment. Hearing/vision difficulties are frequently under‐recognised or incompletely managed. The impacts of hearing/vision impairment include more rapid cognitive decline, behavioural disturbances, reduced quality of life, and greater care burden. This research investigated LTC staff knowledge, attitudes and practice regarding hearing/vision care needs for residents with dementia.MethodsA survey of staff in LTC facilities in England, South Korea, India, Greece, Indonesia and Australia. Respondents used a five‐point scale to indicate agreement or YES/NO response to questions regarding sensory‐cognitive care knowledge (what is known); attitudes (what is thought); practice (what is done).ResultsRespondents reported high awareness of hearing/vision care needs, although awareness of how to identify hearing/vison difficulties or refer for assessment was low. Most felt that residents were not able to use hearing/vision devices effectively due to poor fit, being poorly tolerated or lost or broken devices. A substantial minority of respondents reported low confidence in supporting use of assistive hearing/vision devices, with lack of training the main reason. Most staff did not undertake routine checking of hearing/vision devices, and it was rare for facilities to have designated staff responsible for sensory needs. Variation among countries was not significant after accounting for staff experience and having received dementia training.ConclusionsThere is a need to improve sensory support for people with dementia in LTC facilities internationally. Practice guidelines and training to enhance sensory‐cognitive knowledge, attitudes and practice in professional care teams is called for.

Dementia Enlightened?! A Systematic Literature Review of the Influence of Indoor Environmental Light on the Health of Older Persons with Dementia in Long-Term Care Facilities.

Light therapy for older persons with dementia is often administered with light boxes, even though indoor ambient light may more comfortably support the diverse lighting needs of this population. Our objective is to investigate the influence of indoor daylight and lighting on the health of older adults with dementia living in long-term care facilities. A systematic literature search was performed within PubMed, CINAHL, PsycINFO, Web of Science and Scopus databases. The included articles (n=37) were published from 1991 to 2020. These articles researched the influence of existing and changed indoor light conditions on health and resulted in seven categories of health outcomes. Although no conclusive evidence was found to support the ability of indoor light to decrease challenging behaviors or improve circadian rhythms, findings of two studies indicate that exposure to (very) cool light of moderate intensity diminished agitation. Promising effects of indoor light were to reduce depressive symptoms and facilitate spatial orientation. Furthermore, there were indications that indoor light improved one’s quality of life. Despite interventions with dynamic lighting having yielded little evidence of its efficacy, its potential has been insufficiently researched among this study population. This review provides a clear and comprehensive description of the impact of diverse indoor light conditions on the health of older adults with dementia living in long-term care facilities. Variation was seen in terms of research methods, (the description of) light conditions, and participants’ characteristics (types and severity of dementia), thus confounding the reliability of the findings. The authors recommend further research to corroborate the beneficial effects of indoor light on depression and to clarify its role in supporting everyday activities of this population. An implication for practice in long-term care facilities is raising the awareness of the increased lighting needs of aged residents.

Trends of Nursing Research on Accidental Falls: A Topic Modeling Analysis.

This descriptive study analyzed 1849 international and 212 Korean studies to explore the main topics of nursing research on accidental falls. We extracted only nouns from each abstract, and four topics were identified through topic modeling, which were divided into aspects of fall prevention and its consequences. “Fall prevention program and scale” is popular among studies on the validity of fall risk assessment tools and the development of exercise and education programs. “Nursing strategy for fall prevention” is common in studies on nurse education programs and practice guidelines to improve the quality of patient safety care. “Hospitalization by fall injury” is used in studies about delayed discharge, increased costs, and deaths of subjects with fall risk factors hospitalized at medical institutions due to fall-related injuries. “Long-term care facility falls” is popular in studies about interventions to prevent fall injuries that occur in conjunction with dementia in long-term care facilities. It is necessary to establish a system and policy for fall prevention in Korean medical institutions. This study confirms the trends in domestic and international fall-related research, suggesting the need for studies to address insufficient fall-related policies and systems and translational research to be applied in clinical trials.

Effects of Physical Environment on Quality of Life among Residents with Dementia in Long-Term Care Facilities in Canada and Sweden: A longitudinal study in a large-scale institutional setting versus a small-scale homelike setting

Effects of Physical Environment on Quality of Life among Residents with Dementia in Long-Term Care Facilities in Canada and Sweden: A longitudinal study in a large-scale institutional setting versus a small-scale homelike setting

The Art of Body Movement: Health Impact on Older Adults With Disability and Dementia

Body-movement is an art form of self-expression and health promotion. This presentation will provide an overview of studies that employ the use of “movement activities” or “exercise” as non-pharmacological modalities to improve activities of daily living and functional fitness (e.g., cardiopulmonary function, body flexibility, range of joint motion, and muscle strength and endurance) of older adults with disability. These studies have also been shown to decrease depression state and behavior symptoms of older adults with dementia in long-term care facilities. Moreover, the Wheelchair-bound Senior Elastic Band (WSEB) exercise program will be described that are of relevance to the older adults with disability and dementia.

Feasibility of a Mobile Meal Assistance Program for Direct Care Workers in Long-Term Care Facilities in South Korea.

PurposeThe purpose of this study was to assess the feasibility and examine the preliminary effectiveness of a mobile application-based meal assistant training program (APP) for use by direct care workers (CAs) assisting residents with dementia in long-term care facilities in South Korea.MethodsWe adopted a mixed methods research design, which included a pre- and post-intervention study and focus group interviews for the feasibility assessment. Participants included 23 dyads of older adults with dementia and their CAs from a long-term care facility in South Korea. Upon completion of the APP intervention, focused group interviews were conducted with six CAs and five nurses.ResultsThe results of paired t-tests showed that the effects of the APP intervention on the older adults with dementia and their CAs were not significant; however, the results of the focused group interviews support the potential usefulness of the APP for CAs.ConclusionThe APP may be applicable to long-term care workers who need meal assistant skills education.

The relationship between personality traits, caring characteristics and abuse tendency among professional caregivers of older people with dementia in long-term care facilities.

To explore the relationship between personality traits, caring characteristics and abuse tendency among professional caregivers of older people with dementia in long-term care facilities in China. Elder abuse is a serious global health problem and human right violation with high incidence among older people with dementia. There are many investigations about impact factors of risk of abuse among family caregivers of older people with dementia. However, in long-term care facilities, the situation of abuse tendency needs further investigation. Cross-sectional study. An observational survey was conducted according to the STROBE checklist. We investigated 156 professional caregivers of older people with dementia in three long-term care facilities in Guangzhou, China. Participants completed a demographic questionnaire, the Caregiver Abuse Screen (CASE) and the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI). Data were analysed using Mann-Whitney U tests, Kruskal-Wallis tests, Spearman's rank correlation and logistic regression analyses. Over half of the participants (51.9%) reported abuse tendency to the older people with dementia. There was a significant negative correlation between the caregivers' agreeableness scores of NEO-FFI and their CASE scores. Multivariate logistic regression analyses highlighted that protective factors of abuse tendency were caregivers' agreeableness, care recipients' source of finances and their duration of dementia while higher care difficulty and presence of older people's behavioural and psychological symptoms of dementia (BPSD) were the risk factors. Caregivers' agreeableness personality trait and the caring characteristics of older people with dementia may be relevant to abuse tendency in long-term care facilities. Further study with a larger sample size is needed to validate such a correlation. Older people with dementia are at high risk for abuse. Prospective caregivers could pay more attention to developing their own agreeableness. The managers might establish monitoring system for reducing the abuse.

Effects of non-facilitated meaningful activities for people with dementia in long-term care facilities: A systematic review

This systematic review sought to evaluate the effectiveness of non-facilitated meaningful activities for older people with dementia in long-term care facilities. Searches were conducted in PubMed; CINAHL; EMBASE; Web of science; PsycINFO; Cochrane; ProQuest; and ClinicalTrials.gov to identify articles published between January 2004 and October 2019. A total of six studies were included. Results implied that current randomised controlled trials or controlled trials about non-facilitated meaningful activities for people with living dementia in long-term care facilitates are limited, but those included in this review were of adequate methodological quality. Meaningful non-facilitated activities, such as music, stimulated family presence, animal-like social robot PARO/plush toy and lifelike dolls, may have beneficial effects on agitation, emotional well-being, feelings of pleasure, engagement, and sleep quality. However, there remains a lack of conclusive and robust evidence to support these psychological and physiological effects of non-facilitated meaningful activities for older people with dementia living in long-term care facilities by care staff.

Separation characterized by responsibility and guilt: Family caregivers' experiences with palliative care for a close family member with severe dementia in long-term care facilities.

The aim of this study was to explore family caregivers' experiences with palliative care for a close family member with severe dementia in long-term care facilities. Dementia not only affects individuals but also affects and changes the lives of close family members. An increasing number of dementia-related deaths occur in long-term care facilities; therefore, it is critical to understand how healthcare professionals support and care for residents with dementia and their families at the end of life. A qualitative design with a phenomenological approach was adopted. In-depth interviews were performed with 10 family caregivers of residents in 3 Norwegian long-term care facilities. The family caregivers' experiences with palliative care for a close family member with severe dementia in long-term care facilities were characterized by responsibility and guilt. Admission to a long-term care facility became a painful relief for the family caregivers due to their experiences with the poor quality of palliative care provided. The lack of meaningful activities and unsatisfactory pain relief enhanced the feelings of responsibility and guilt among the family caregivers. Despite the feelings of insecurity regarding the treatment and care given during the early phase of the stay, the family caregivers observed that their close family member received high-quality palliative care during the terminal phase. The family caregivers wanted to be involved in the care and treatment, but some felt that it became a heavy responsibility to participate in ethical decision-making concerning life-prolonging treatment. The family caregivers experienced ongoing responsibility for their close family members due to painful experiences with the poor quality of the palliative care provided. When their expectations regarding the quality of care were not met, the palliative care that was offered increased their feeling of guilt in an already high-pressure situation characterized by mistrust.

The prognostic predictors of six-month mortality for residents with advanced dementia in long-term care facilities in Taiwan: A prospective cohort study

BackgroundAlthough hospice or palliative care for patients with advanced dementia has been implemented for more than 30 years, few studies have investigated the prognostic predictors of 6-month mortality in these patients. Prognostication has been a major obstacle, and 6-month prognostic predictors for patients with advanced dementia are still considered elusive. ObjectivesTo better understand the dying trajectories of patients with advanced dementia, we performed a longitudinal prospective cohort study to investigate the predictors of 6-month mortality for residents with advanced dementia in long-term care facilities in Taiwan. DesignProspective cohort study. SettingThis study took place in 32 long-term care facilities selected from northern, central, and southern Taiwan. ParticipantsThe study included 320 residents with advanced dementia. MeasurementsMeasurements were obtained after determining study eligibility; the participants underwent follow-up assessments once every 3 months for 6 months or died during follow-up. The assessments included demographic characteristics, health and medical status characteristics, and death-related information. The Kaplan-Meier survival function estimation and the Cox proportional hazards model were used to estimate the survival rate and predict the prognostic factors. ResultsBaseline data from 320 residents with advanced dementia in long-term care facilities were obtained. The mean age was 82.7 years and 61.6% were female. The 6-month survival rate was 78.1%. The major cause of death was multiple organ failure related to pneumonia. The 6-month prognostic predictors were pneumonia (adjusted hazard ratio, 5.56; 95% confidence interval, 2.46–12.6; p-value < .001), reduction in nutrient intake >25% (adjusted hazard ratio, 5.05; 95% confidence interval, 2.37–10.8; p-value < .001), oxygen dependency (adjusted hazard ratio, 2.58; 95% confidence interval, 1.51–4.39; p-value = .001), treatment for electrolyte abnormalities (adjusted hazard ratio, 2.14; 95% confidence interval, 1.10–4.14; p-value = .025), severe pressure injuries (adjusted hazard ratio, 2.04; 95% confidence interval, 1.13–3.67; p-value = .018), and long-term indwelling urinary catheters (adjusted hazard ratio, 1.80; 95% confidence interval, 1.09–2.96; p-value = .021). ConclusionOur results identified six prognostic predictors of 6-month mortality among residents with advanced dementia in Taiwan. These predictors may serve as risk assessment indicators for nursing staff who provide clinical care and can enable the identification of patients in recognized terminal decline, thereby allowing access to hospice palliative services.

A Systematic Review of Studies Using Video-recording to Capture Interactions between Staff and Persons with Dementia in Long-term Care Facilities

Purpose: The use of video-recording offers important advantages in observing and assessing the relationship between specific behaviors in health care settings. The purpose of this systematic review is to investigate and synthesize the methodological characteristics of studies using video-technology for measuring interactions with the older persons with dementia and staff in long-term care facilities. Methods: We searched Medline, Embase and CINHAL databases for published articles in English using a video-recording method for both staff and the residents with dementia. Quantitative research design studies (e.g., descriptive or experimental studies) were included. Results: Among 5,605 searched papers, a total of 20 studies were selected for this review. Situations of videorecording were providing personal care (n=12), mealtime (n=6), and conversation (n=3). Concepts measured by video-recording were classified into two groups: 1) Staff [care practice by staff (n=13) and communication by staff (n=11)] and 2) residents [communication by resident (n=4), activities of daily life function of resident (n=8), and behavioral and psychological symptoms of dementia (n=10)]. Conclusion: This review demonstrates that video technologies are actively used to evaluate the relationship between quality of care and health outcomes of the elderly with dementia in many international nursing studies. This study provides the foundation for a future research using video-recording technologies to examine the interactions and relationships between staff and the residents in Korean long-term care settings.

Mixed-methods single-arm repeated measures study evaluating the feasibility of a web-based intervention to support family carers of persons with dementia in long-term care facilities

BackgroundFollowing institutionalization of a relative with Alzheimer disease and related dementias (ADRD), family carers continue to provide care. They must learn to negotiate with staff and navigate the system all of which can affect their mental health. A web-based intervention, My Tools 4 Care-In Care (MT4C-In Care) was developed by the research team to aid carers through the transitions experienced when their relative/friend with ADRD resides in a long-term care (LTC) facility. The purpose of this study was to evaluate MT4C-In Care for feasibility, acceptability, ease of use, and satisfaction, along with its potential to help decrease carer’s feelings of grief and improve their hope, general self-efficacy, and health-related quality of life.MethodsThe study was a mixed-methods single-arm repeated measures feasibility study. Participants accessed MT4C-In Care over a 2-month period. Data were collected at baseline and 1 and 2 months. Using a checklist, participants evaluated MT4C-In Care for ease of use, feasibility, acceptability, and satisfaction. Measures were also used to assess the effectiveness of the MT4C-In Care in improving hope (Herth Hope Index), general self-efficacy (GSES), loss and grief (NDRGEI), and health-related quality of life (SF12v2) of participants. Qualitative data were collected at 2 months and informed quantitative findings.ResultsThe majority of the 37 participants were female (65%; 24/37), married (73%; 27/37), and had a mean age of 63.24 years (SD = 11.68). Participants reported that MT4C-In Care was easy to use, feasible, and acceptable. Repeated measures ANOVA identified a statistically significant increase over time in participants hope scores (p = 0.03) and a significant decrease in grief (< 0.001). Although significant differences in mental health were not detected, hope (r = 0.43, p = 0.03) and grief (r = − 0.66, p < 0.001) were significantly related to mental health quality of life.ConclusionMT4C-In Care is feasible, acceptable, and easy to use and shows promise to help carers of family members with ADRD residing in LTC increase their hope and decrease their grief. This study provides the foundation for a future pragmatic trial to determine the efficacy of MT4C-In Care.Trial registrationClinicalTrials.gov NCT03571165. June 30, 2018 (retrospectively registered).

Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals\u2019 experiences

BackgroundDementia has become a major public health issue worldwide due to its rapidly increasing prevalence and an increasing number of dementia-related deaths in long-term care facilities. The aim of this study was to examine health professionals’ experiences of potential barriers and facilitators in providing palliative care for people with severe dementia in long-term care facilities.MethodsThis was a qualitative descriptive study. The data were collected from four focus groups and 20 individual in-depth interviews with healthcare professionals from four Norwegian nursing homes. The data were analysed by thematic text analysis, as described by Braun and Clarke.ResultsThe major findings indicate that healthcare professionals experience a lack of continuity as the main barrier to facilitating palliative care. Time pressure and increased efficiency requirements especially affect the weakest and bedridden residents with dementia. The healthcare professionals feel conflicted between wanting to spend more time caring for each individual resident and feeling pressure to help everyone. Although resources are scarce, dying residents are always given priority by healthcare professionals, either by the hiring of extra personnel or the reorganization of tasks in a way that facilitates someone staying with the terminal resident. Advanced care planning was highlighted as a facilitator in providing palliative care, but the extensive use of temporary staff among nurses and doctors and the relocation between the sheltered and long-term wards threaten the continuity in planning and providing palliative care.ConclusionsThe findings indicate that healthcare professionals experienced several structural barriers that prevented the provision of palliative care to people with severe dementia in long-term care facilities. Increasing demands for economic rationality lead to a lack of continuity of care. Organizational changes, such as measures to increase the competence and the proportion of permanent employees and the prevention of burdensome end-of-life transitions, should be implemented to improve continuity and quality of care.