Home-like Environment Research Articles

Culture Change and Quality of Care Among High Medicaid Nursing Homes: Does Earlier Adoption Matter?

High Medicaid nursing homes are associated with lower resident quality of care due to fewer nurses, lower occupancy rates, and lower proportion of Medicare and private pay residents. Culture change is a movement to transition nursing homes to more home-like environments to improve quality of life and care of residents. The literature on culture change initiatives indicates a positive relationship on outcomes, however little to no literature on the use of culture change initiatives in high Medicaid nursing homes and quality. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid (85% or higher) nursing homes. The outcome of interest was the overall nursing home star rating obtained from the Nursing Home Compare Five-Star Quality Rating System. The primary independent variable of interest was the years of involvement in culture change initiatives among nursing homes, which was obtained from the nursing home administrator survey. The final model consisted of an ordinal logistic regression with state-level fixed effects. High-Medicaid nursing homes with six or more years in culture change initiatives had an increased log-odds of having a higher star rating, while facilities with one year or less had significantly lower log-odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility-A qualitative analysis.

Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. A qualitative study involving semistructured interviews. One vSNF in the Chicago, Illinois, metropolitan region. The study included 17 healthcare personnel representing management, nursing, and nursing assistants. We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were 'invisible' and potentially 'threatening.' Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

"So delightful a temporary home": The Material Culture of Domesticity in Late Nineteenth-century English Convalescent Institutions.

This article examines the material culture of domesticity in late nineteenth-century English convalescent institutions. Convalescent homes drew on powerful Victorian ideas about the physical and moral benefits of "home-like" domestic comfort, which they contrasted with the "institutional" environment of hospitals and the degrading surroundings of urban slums. Administrative records, press accounts, photographs, and patient letters reveal how convalescent homes cultivated temporary home-like environments through architecture, interior decoration, and behavioral expectations and routines. Convalescent homes drew on heterogeneous models of domesticity, including the grand architecture of country estates, the possession-packed spaces of middle-class homes, and the recreational spaces of male social clubs. Nevertheless, they shared a belief in the power of domestic spaces, comforts, and practices to support the recovery of convalescents and to influence their identity and behavior. The material culture and practices of domesticity deployed in convalescent homes encouraged reflection, self-improvement, and self-control-qualities essential to the cultivation of respectable, self-governing, liberal citizens. Nevertheless, the meanings and experiences of these spaces were also shaped by inmates, whose expectations and experiences did not always align with the ideal image of home that authorities wished to create.

Self-reliance and belonging: Guest experiences of a peer respite.

Objective: A peer respite is a voluntary, short-term, overnight program that provides community-based mutual support to people experiencing a mental health crisis. This qualitative study of guest experiences at 1 peer respite examines its role in fostering recovery and wellbeing. Method: Conventional content analysis of interviews with 20 peer respite guests resulted in a thematic framework containing 7 "clusters" of themes with related subthemes. Results: The following themes emerged from the analysis and include both positive and negative experiences: belongingness, confidence and hope, crisis self-management, experiencing mutual support, freedom and responsibility, linking to community, and conflict and confrontation. Some guests endorsed the peer respite as a temporary break from stressful life situations, a homelike space for mutual support and community, and a preferred alternative to traditional crisis services. Others struggled with the unstructured environment and expectations for shared responsibility and self-reliance. Conclusions and Implications for Practice: Peer respites strengthen self-reliance and social connectedness and offer a viable alternative to traditional crisis services for some people some of the time. The results suggest potential "key ingredients" for peer respites, including a homelike environment, voluntary and self-determined supports, and peer support staff who possess the capacity for developing healing and genuine connections with guests while also promoting shared responsibility and self-reliance. Future research should further develop this theory of change and establish peer respite fidelity criteria based on program elements that seem to contribute to positive outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

‘인간중심 돌봄’적인 측면에서의 치매친화환경지침 비교검토

Purpose: This study aims to examine how Person-Centered Care approach has affected the long-term elderly care facility design guidelines related to the dementia friendly environment, by examining the literature on ‘Person-Centered Care’ highlighted in research; to address the policy implications for dementia-friendly environment on basis of Person-centered approach. Method: The concept of Person-centered Care was defined, and the principles and the design features of Person-centered care were derived from literature review focused on person-centered Care and the design of environments for people with dementia highlighted in research. Based on the facts, this study examines how much Person-Centered Care approach affects the design guidelines for dementia-friendly environments by comparative review. Result: The result shows that the principles and design features of Person-centered Care influence on that of the selected design guidelines for dementia-friendly elderly care environments directly through comparative review. The viewpoint to dementia care environments has changed from person-centered care approach for dementia patients based on homelike environment to that expanded dementia patients’ families and staffs who take care of them, based on community. In Korea, the direction of dementia care policy is in the process of gradually changing from a medical approach to an expanded social and person-centered care approach. There is a strong need to establish the design guideline for dementia-friendly environments to apply the efficient change.

Exploring determinants of hand hygiene compliance in LTCFs: a qualitative study using Flottorps\u2019 integrated checklist of determinants of practice

BackgroundElderly residents in long-term care facilities (LTCFs) are vulnerable to healthcare-associated infections. Although hand hygiene is a leading measure for preventing infection, the compliance of healthcare workers is low. The aim of this study is to identify determinants that influence hand hygiene compliance of nursing staff in LTCFs. This information on determinants can eventually be used to develop a tailored implementation strategy for LTCFs.MethodsThis is an explorative, descriptive study using qualitative methods. We performed semi-structured focus group discussions with 31 nurses and nurse assistants from five Dutch LTCFs. Our focus group discussions continued until no new information could be identified from the data. We used Flottorps’ comprehensive checklist for identifying determinants of practice (the TICD checklist) to guide data collection and analysis. The audiotapes were transcribed verbatim and two authors independently analysed the transcripts with Atlas.ti software.ResultsLTCFs for the elderly have setting specific determinants that are decisive in explaining hand hygiene compliance. Most of these determinants are related to the residents with whom nurses build close relationships and for whom they want to create a homelike atmosphere. Residents can complicate the provision of care with unpredictable behaviour, being unwilling to receive care or use shared facilities. Our study also discovered setting-transcending determinants related to knowledge, professional interactions, guidelines, and incentives/resources.ConclusionsNurses in LTCFs are constantly pursuing a balance between working hygienically, responding adequately to acute care needs, and maintaining a homelike environment for their residents. As a result, setting-specific determinants affect hand hygiene compliance, as do the known determinants that are important in other care settings. To improve compliance in LTCFs, interventions should be selected on a theoretical base while linking these determinants to change interventions.Trial registration Registration number 50-53000-98-113, Compliance With Hand Hygiene in Nursing Homes: Go for a Sustainable Effect (CHANGE) on ClinicalTrials.gov. Date of registration 28-6-2016.

Do Nursing Home Culture Change Practices Improve Residents’ Quality of Life and Promote a Person-Centered Climate?

Background and Purpose: Although nursing home culture change models (e.g., Green House, The Pioneer Network) in the U.S. have been proven to improve the quality of life of the residents by providing person-centered care and home-like environment, limited efforts have been made to implement a model in Korea. The purpose of this study was to examine whether the adapted culture change model would improve the quality of life of the residents and strengthen the person-centered climate. Methods: Employing a quasi-experimental design, the PI developed and implemented a 12-session culture change enhancement program to 32 staff in four nursing homes. Data were collected from 109 nursing home residents before and after the intervention, and key measures included the quality of life scale and the person-centered climate. The paired t-test analyses were performed with SPSS 26.0. Results: Paired samples t-tests showed that the culture change intervention significantly improved the quality of life of the residents. There were significant differences in the scores for privacy at pretest (M=2.63) and posttest (M=3.21); autonomy at pretest (M= 3.20) and posttest (M= 3.43); relationships at pretest (M= 2.88) and posttest (M= 3.36); individuality at pretest (M=3.26) and posttest (M=3.61). An average score for person-centered climate (M=6.25) were significantly higher than that of pretest (M=5.96) (p <.01). Conclusions and Implications: This study suggests that providing support and education to nursing home staff about the culture change strategies is essential to provide personalized services to nursing home residents and encourage residents to participate in the decision-making process.

Culture Change Initiatives in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

Racial/ethnic disparities have been well documented in long-term care literature. As the population ages and becomes more diverse over time, it is essential to identify mechanisms that may eliminate or mitigate racial/ethnic disparities. Culture change is a movement to transition nursing homes to more home-like environments. The literature on culture change initiatives and quality has been mixed, with little to no literature on the use of culture change initiatives in high Medicaid nursing homes and quality. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid (85% or higher) nursing homes. The outcome of interest was the overall nursing home star rating obtained from the Nursing Home Compare Five-Star Quality Rating System. The primary independent variable of interest was the years of involvement in culture change initiatives among nursing homes, which was obtained from the nursing home administrator survey. The final model consisted of an ordinal logistic regression with state-level fixed effects. High-Medicaid nursing homes with six or more years in culture change initiatives had higher odds of having a higher star rating, while facilities with one year or less had significantly lower odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

Culture Change and Quality Star Ratings in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

Racial/ethnic disparities have been well documented in long-term care literature. Culture change is a movement to transition nursing homes to more home-like environments to improve the quality of care for all residents. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid facilities. The final model consisted of an ordinal logistic regression. High-Medicaid nursing homes with six or more years in culture change initiatives had higher odds of having a higher star rating, while facilities with one year or less had significantly lower odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

“It's a lot!” the universal worker model and dementia care in assisted living

The culture change movement aims to create a more home-like environment in long-term care settings, promote person-centered care, and support the well-being of staff and residents. One feature of Culture Change is the Universal Worker (UW) model where direct care workers (DCWs) are responsible for housekeeping, laundry, and activities in addition to administering medication and personal support. The longitudinal approach in the ethnographic study on which this paper is based compares data collected from one assisted living across three NIA-supported research grants. This paper focuses on modifications to the UW model following the implementation of culture change over a period of ten years. As DCWs cared for residents with increasing levels of dementia, time constraints under the UW model led to sporadic attention to housekeeping chores and challenged person-centered care. Modifying the UW model, by using dedicated cleaning staff and other support workers, better preserves the intent of the culture change movement.

The impact of green care farms and other innovative nursing home models on BPSD symptoms in everyday life for people with dementia

AbstractBackgroundMany countries are introducing small‐scale, home‐like care facilities that represent a radically new approach to nursing home care for people with dementia. These facilities emphasize person‐centered care, focus on remaining strengths and value autonomy. Originated outside of the healthcare sector, green care farms (GCFs) are a new type of nursing home in the Netherlands. GCFs provide care in small‐scale, homelike environment, in which agricultural activities are combined with care and support services for a variety of client groups, including people with dementia. This study investigated effect of GCFs on residents, in particular on behavioral and psychological symptoms.MethodIn total, 115 residents with a formal diagnosis of dementia were included, living at GCFs (n=34), regular small‐scale living facilities (n=52) and traditional nursing homes (n=29). Residents were matched regarding cognitive status (S‐MMSE). Ecological momentary assessments (n=16,860) were conducted using the Maastricht Electronic Daily Life Observation Tool, assessing activity engagement, social interaction and emotional well‐being. Furthermore, neuropsychiatric symptoms (NPI‐NH), agitation (CMAI), depressive symptoms (CSDD), quality of life (Qol‐AD and QUALIDEM) and social engagement (RISE) were measured.ResultThe daily life of residents living at GCFs was significantly different compared with traditional nursing homes. Residents were significantly more active (p&lt;0.05, SE=0.9) and socially engaged (p&lt;0.05) at GCFs compared with traditional nursing home wards. Furthermore, residents living at GCFs scored significantly higher on the Qol‐AD (p&lt;0.05, ES=0.8) and on three domains of the Qualidem: positive affect, social relations and having something to do (p&lt;0.05, ES&gt;0.7) compared with traditional nursing homes. No significant differences were found regarding neuropsychiatric symptoms (mean NPI‐NH score 15.4), agitation (mean CMAI score 41.9) and depressive symptoms (mean CSDD score 5.4).ConclusionThis study showed that GCFs provide an attractive, homelike environment and activities that positively influence engagement and social interaction. GCFs appear to be a valuable alternative to existing nursing homes. This is important as people with dementia are a heterogeneous group with varying needs. In order to provide tailored care there also is a need for a variety of living environments.

The DemWG study: reducing the risk of hospitalisation through a complex intervention for people with dementia and mild cognitive impairment (MCI) in German shared-housing arrangements: study protocol of a prospective, mixed-methods, multicentre, cluster-randomised controlled trial

IntroductionShared-housing arrangements (SHAs) are small, home-like care environments in Germany. Residents are predominantly people with dementia. The risk for all-cause hospitalisation is consistently higher for people with dementia compared with...

A Vision for Post-Acute and Long-Term Care From AMDA Leaders

A Vision for Post-Acute and Long-Term Care From AMDA Leaders

Protocol for PD SENSORS: Parkinson’s Disease Symptom Evaluation in a Naturalistic Setting producing Outcome measuRes using SPHERE technology. An observational feasibility study of multi-modal multi-sensor technology to measure symptoms and activities of daily living in Parkinson’s disease

IntroductionThe impact of disease-modifying agents on disease progression in Parkinson’s disease is largely assessed in clinical trials using clinical rating scales. These scales have drawbacks in terms of their ability...

106 - Environmental Influences on the Cognitive and Psychological Well Being of Older Adults with Dementia

This symposium will review the latest data on the influence of environmental design and its attributes on the cognitive and psychological wellbeing of older adults living with dementia. The presenters will cover the myriad ways in which the physical environment of care can adapt to the changing demands of older adults with sensory, motor and cognitive deficits and foster optimal functioning and quality of life. The role of emerging technologies will also be reviewed as they complement the contribution of the design of the physical environment to the wellbeing of older adults with cognitive impairment. Information will be offered through a review of the existing research literature as well as case studies that illustrate the impact of environmental modification on fostering wellbeing and minimizing the emergence of the behavioral and psychological symptoms of dementia. The presenters will represent and integrate sensibilities that have emerged from the fields of architecture, cognitive neuroscience and psychology.How the Principles of the Culture Change Movement Inform Environmental Design and the Application of Technology in the Care of Older Adults Living with DementiaWilliam E. ReichmanThe culture change movement informs a number of principles that have been applied to more contemporary design concepts for the congregate care of older adults living with dementia. This talk will review the core tenets of the Culture Change Movement as exemplified by the Greenhouse, Dementia Village and other innovative models of congregate long-term care. Specific reference will be made to how these tenets have been operationalized around the world into the design of programming and the creation of residential care environments that foster a better quality of life for older adults and an enhanced work environment for care providers. This talk will also include the emerging role of technologies that complement innovative design of the environment and which foster optimized social and recreational functioning of older adults living with dementia.A Better Life Through a Better Nursing Home DesignL. Bradford PerkinsOver the last 20 years there has been extensive experimentation related to the role of the environment in the housing, care and treatment of persons with Alzheimer’s and other age related dementias. Prior to that time the typical housing and care environment was a locked unit in a skilled nursing or other restrictive senior living facility. In 1991 the Presbyterian Association on Aging in Western Pennsylvania opened Woodside Place on its Oakmont campus. This small 36 bed facility was designed to incorporate the latest research and care experience with persons suffering from these issues. This one small project, as well as the long post occupancy research led by Carnegie Mellon University, clearly demonstrated that individuals with Alzheimer’s and related forms of dementia could lead a healthier, happier, higher quality of life in a more residential, less restrictive environment. Not everything in this pioneering project worked, and five generations of living and care models have followed that have refined the ideas first demonstrated by Woodside Place. Bradford Perkins, whose firm designed Woodside Place and over 100 other related projects, will discuss what was learned from Woodside Place as well as the five generations of projects (and post occupancy research) that followed.Innovative dementia care environments as alternatives for traditional nursing homes: evidence and experiences from the NetherlandsHilde VerbeekKey goals of the dementia care environment focus on increasing autonomy, supporting independence and trying to enable one’s own lifestyle for as long as possible. To meet these goals, innovative, small-scale and homelike care environments have been developed that have radically changed the physical, social and organizational aspects of long-term care in the Netherlands. This presentation discusses various Dutch models that have implemented small-scale and homelike care environments, including green care farms, dementia village and citizen initiatives. The models reflect a common care concept, focusing on residents’ remaining strengths, providing opportunity for choice and aiming to sustain a sense of self and control. A small number of residents (usually 6 to 8) live together in a homelike environment and nursing staff are part of the household. Residents are encouraged to participate in daily household activities, emphasizing normalization of daily life with person-centred care. The physical environment resembles an archetypal home. This talk presents the scientific evidence on the impact and effects of these small-scale, homelike models on residents, their family caregivers and staff. Furthermore, the presentation will highlight working approaches and how these initiatives have positively influenced routine care across the long-term care spectrum.

Healthcare Worker Experiences Implementing CRE Infection Control Measures at a vSNF—A Qualitative Analysis

Background: During 2017–2019 in the Chicago region, several ventilator-capable skilled nursing facilities (vSNFs) participated in a quality improvement project to control the spread of highly prevalent carbapenem-resistant Enterobacteriaceae (CRE). With guidance from regional project coordinators and public health departments that involved education, assistance with implementation, and adherence monitoring, the facilities implemented a CRE prevention bundle that included a hand hygiene campaign that promoted alcohol-based hand rub, contact precautions (personal protective equipment with glove/gown) for care of CRE-colonized residents, and 2% chlorhexidine gluconate (CHG) wipes for routine resident bathing. We conducted a qualitative study to better understand the ways that vSNF employees engage with the implementation of such infection control measures. Methods: A PhD-candidate medical anthropologist conducted semistructured interviews with management (N = 5), nursing staff (N = 6), and certified nursing assistants (N = 6) at a vSNF in the Chicago region (Illinois) between September 2018 and November 2018. More than 11 hours of semistructured interviews were collected and transcribed. Data collection and analysis focused on identifying healthcare worker experiences during an infection control intervention. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Healthcare workers described the facility using language associated with a family environment (Table 1). Furthermore, healthcare workers demonstrated motivation to implement infection control policies (Table 2). However, healthcare workers expressed cultural and structural challenges encountered during implementation, such as their belief that some infection control measures discouraged maintenance of a home-like environment, lack of time, and understaffing. Some healthcare workers perceived that alcohol-based hand rub was ineffective over time and left unpleasant textures on the skin. Additionally, some workers did not trust the available gown and gloves used to prevent transmission. Lastly, healthcare workers typically did not prefer 2% CHG wipes over soap and water, citing residual resident postbathing smell as one indicator of CHG ineffectiveness. Conclusions: In a vSNF we found both considerable support and challenges implementing a CRE prevention bundle from the healthcare worker perspective. Healthcare workers were dedicated to recreating a home-like environment for their residents, which sometimes felt at odds with infection control interventions. Residual misconceptions (eg, alcohol-based hand rub is not effective) and negative worker perceptions (eg, permeability of contact precaution gowns and/or residue from alcohol-based hand rub) suggest that ongoing education and participation by healthcare workers in evaluating infection control products for interventions is critical.Funding: NoneDisclosures: None

RGB-D Object SLAM Using Quadrics for Indoor Environments

Indoor service robots need to build an object-centric semantic map to understand and execute human instructions. Conventional visual simultaneous localization and mapping (SLAM) systems build a map using geometric features such as points, lines, and planes as landmarks. However, they lack a semantic understanding of the environment. This paper proposes an object-level semantic SLAM algorithm based on RGB-D data, which uses a quadric surface as an object model to compactly represent the object’s position, orientation, and shape. This paper proposes and derives two types of RGB-D camera-quadric observation models: a complete model and a partial model. The complete model combines object detection and point cloud data to estimate a complete ellipsoid in a single RGB-D frame. The partial model is activated when the depth data is severely missing because of illuminations or occlusions, which uses bounding boxes from object detection to constrain objects. Compared with the state-of-the-art quadric SLAM algorithms that use a monocular observation model, the RGB-D observation model reduces the requirements of the observation number and viewing angle changes, which helps improve the accuracy and robustness. This paper introduces a nonparametric pose graph to solve data associations in the back end, and innovatively applies it to the quadric surface model. We thoroughly evaluated the algorithm on two public datasets and an author-collected mobile robot dataset in a home-like environment. We obtained obvious improvements on the localization accuracy and mapping effects compared with two state-of-the-art object SLAM algorithms.

What matters to you when the nursing home is your home: a qualitative study on the views of residents with dementia living in nursing homes

BackgroundDementia is recognised as one of the greatest global public health challenges. A central tenet of national health and social care policy is to ensure that services support people in achieving their personal well-being and outcomes, defined as the things important to people in their lives, also people with dementia. The aim of this study is to explore what matters to nursing home residents with dementia based on their perceptions of nursing homes as home.MethodsThere were conducted 35 interviews with people with dementia in nursing homes. We conducted the in-depth unstructured qualitative interviews. Thematic analysis was applied to analyse the data.ResultsThe analysis resulted in one over-arching theme “tension between the experiences of a nursing home being a home and an institution” and five themes; “myself and my relationships with fellow residents", “creation of individualised living spaces”, "single rooms with personal decor that enhances a sense of connectedness”, “transition between the old home and the new home” and “significant activities providing meaning”. The participants stated that the transition to the supported, structured living environment in nursing homes to be a clear need based on immediate, serious safety concerns. They went from being masters of their own lives to adhering to nursing home routines. Fellow residents could be both resources and burdens, creating feelings of security and insecurity. A home-like environment was created by allowing the participants to bring their important personal belongings into private spaces. The participants said they needed to be able to decorate their rooms to their own specifications. They wanted involvement in meaningful activities.ConclusionsThe findings showed that ‘home’ was an emotive word that awakened many associations. The participants reported mixed feelings and stated that they could thrive even if they missed their old homes. What mattered was that the participants felt safe, had single rooms where they could retire from the community, their own belongings and did activities. The participants wanted greater possibilities for meaningful relations. They appreciate that nursing home were similar to their previous homes. They desired opportunities to continue some activities they did in their former home.

Two decades of Birth Centre and midwifery-led care in South Australia, 1998–2016

BackgroundBirth Centres (BC) are underpinned by a philosophy of woman- centred care and were pivotal in growing models of midwifery-led care in South Australia (SA). AimTo describe BC utilisation and the growth of midwifery-led care in SA over the past two decades. MethodsThe SA Perinatal Statistics Collection was used to describe women birthing from 1998 to 2016. Number of births through midwifery-led services from 2004 to 2016 were obtained from unit managers. Analyses are descriptive. FindingsWomen who birthed in BC in SA from 1998 to 2016 comprised approximately 6% of all births per year, and numbers have remained static. Three BC models operate in SA, all with different capacity. Proportionally, women not born in Australia are as likely to birth in BC as labour wards. The proportion of women who received midwifery-led care (whether affiliated with a BC or not), increased from 8.3% in 1998 to 19.2% of all births in 2016. Of the women who received midwifery-led care in 2016, 15.3% went on to birth in a midwifery-led model of care. ConclusionWhilst the overall number of BC births has not increased, women seeking midwifery-led care has more than doubled over the past two decades. BC encompass the midwifery philosophy, quality of care, and a physical home-like environment. The BC models in SA are managed through the three tertiary maternity units enabling women to access publicly funded midwifery care and should be more widely available.

Understanding the influence of “feeling at home” on healthcare travelers’ well-being: a comparison of Airbnb and hotel homescapes

ABSTRACT Although there is the saying “there’s no place like home”, research on a traveler’s sense of feeling at home in an accommodation and its influence on their well-being is underrepresented. Particularly, given the increase of peer-to-peer accommodations and healthcare travel segment, this gap is notable. Analyzing data including 420 respondents who stayed at an Airbnb and 320 who stayed at hotel accommodations, structural equation modeling tested the effect of an “accommodations homescape” on a healthcare traveler’s sense of feeling at home and well-being. The findings have strategic implications that emphasize the need to engineer home-like environments for particular traveler segments.