Long-term Care Administrators Research Articles

Sexual Expression in Long-Term Care Institutions: Are We Ready for the Baby Boomer Generation?

Baby boomers were at the forefront of profound social changes in sexual attitudes and many have expressed a desire to remain sexually active throughout their life course. The purpose of this survey study was to assess the perceived preparedness of Ontario's long-term care (LTC) homes to meet the changing sexuality needs and expectations of LTC residents. We examined sexuality-related attitudes, including in the context of dementia, among 150 LTC administrators. Participants also completed a questionnaire assessing their experiences and perceptions regarding existing and anticipated supports, barriers, and priorities. Most participants demonstrated positive sexual attitudes; however, multiple challenges to meeting residents' sexuality needs were noted, including assessing capacity to consent, limited privacy, staff training, conflicting attitudes, and a lack of adequate policy and guidelines. Challenges are broad and significant and considerable attention is required to meet the expectations of the next generation of LTC residents, including gender and sexual minority elders.

Factors influencing health-related quality of life among long-term care residents experiencing pain: a systematic review protocol

BackgroundPain is highly burdensome, affecting over 30% of long-term care (LTC) residents. Pain significantly reduces residents’ health-related quality of life (HRQoL), limits their ability to perform activities of daily living (ADLs), restricts their social activities, and can lead to hopelessness, depression, and unnecessary healthcare costs. Although pain can generally be prevented or treated, eliminating pain may not always be possible, especially when residents have multiple chronic conditions. Therefore, improving the HRQoL of LTC residents with pain is a priority goal. Understanding factors influencing HRQoL of LTC residents with pain is imperative to designing and evaluating targeted interventions that complement pain management to improve residents’ HRQoL. However, these factors are poorly understood, and we lack syntheses of available research on this topic. This systematic review protocol outlines the methods to identify, synthesize, and evaluate the available evidence on these factors.MethodsThis mixed methods review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will systematically search Medline, EMBASE, PsycINFO, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ProQuest Dissertation and Thesis Global from database inception. We will include primary studies and systematically conducted reviews without restrictions to language, publication date, and study design. We will also include gray literature (dissertation and reports) and search relevant reviews and reference lists of all included studies. Two reviewers will independently screen articles, conduct quality appraisal, and extract data. We will synthesize results thematically and conduct meta-analyses if statistical pooling is possible. Residents and family/friend caregivers will assist with interpreting the findings.DiscussionThis proposed systematic review will address an important knowledge gap related to the available evidence on factors influencing HRQoL of LTC residents with pain. Findings will be crucial for researchers, LTC administrators, and policy makers in uncovering research needs and in planning, developing, and evaluating strategies in addition to and complementary with pain management to help improve HRQoL among LTC residents with pain.Systematic review registrationPROSPERO CRD42023405425

LEADERSHIP IN LONG-TERM CARE LEADERSHIP: THE NURSING HOME ADMINISTRATOR’S JOURNEY DURING THE COVID-19 PANDEMIC

Abstract The COVID-19 pandemic has impacted long-term care (LTC) leadership and has made us all aware of the preciousness of life and the resilience it takes to keep moving forward during challenging times. This study aimed to understand how long-term care administrators have experienced changes in their leadership abilities and explore what resources they have drawn on to manage the COVID-19 pandemic. A qualitative research design included individual interviews (n = 20) conducted with LTC Administrators serving in leadership roles during the COVID-19 pandemic. The data were subjected to thematic analysis. Three categories related to long-term care administrators’ experiences of leading during the COVID-19 pandemic were identified: (1) changes in leadership behavior and decision-making styles, (2) transformational experiences of leadership during COVID-19, and (c) important lessons learned during a pandemic. We found that LTC leaders have responded to the COVID-19 pandemic by adapting, navigating, and creating new ways to be leaders in an environment of rapidly changing regulations. Findings illustrate how LTC leadership has experienced nursing home and assisted living administrators during the COVID-19 pandemic. There have been innovative changes in care processes, workflows, and responses to regulation. Long-term care leaders have been forced to create new ways to lead, resulting in new leadership styles emerging.

IMPLEMENTATION SCIENCE IN THE DEVELOPMENT OF RECRUITMENT PROCEDURES AND MATERIALS: A CASE STUDY

Abstract Recruiting long-term care organizations, administrators, and direct-care staff to participate in research has become increasingly challenging after the pandemic due to staffing shortages, limited resources, and numerous competing priorities. In light of these challenges, it is especially important to develop recruitment procedures and materials that are fine-tuned to the participant group based on best practices. This presentation will describe the use of implementation science principles and an expert focus group in the design of recruitment procedures and materials for a NIA-funded clinical trial “Evaluating a National Person-Centered Training Program to Strengthen the Dementia Care Workforce.” The project is especially well-suited to employ and critique best practices given that recruitment is at both the organizational-level (assisted living communities) and the person-level (staff within those communities). Recruitment materials were designed in accordance with the Considering Determinants of Diffusion, Dissemination, and Implementation of Innovations in Health Service Delivery and Organization conceptual model, which emphasizes highlighting the advantages of the training, how the training fits into existing systems, the process of training, the endorsement of organizational leaders, and the transfer of the knowledge conveyed by the training into practice. Best practices from the literature were discussed with a focus group of assisted living experts to evaluate the draft procedures and materials. This presentation will share the resulting procedures and materials and explain their evolution to their final form; the process and results are widely applicable to other clinical trials and other studies. Funded by a grant from the National Institute on Aging (R01 AG079124).

Long-Term Care Administrator Perspectives on an Essential Family Caregiver Policy.

Characterize the implementation, benefits, and challenges of an Essential Family Caregiver (EFC) program, a novel policy implemented in long-term care (LTC) settings during the COVID-19 pandemic in Indiana. Characterize LTC administrator perspectives on family/caregiver involvement in the LTC setting. Semi-structured qualitative interviews. Administrators from 4 Indiana LTC facilities. In this qualitative study, a convenience sample of 4 LTC administrators was recruited. Each participant completed 1 interview during January to May 2021. Following transcription, a thematic analysis approach with 2 cycles of qualitative coding identified relevant themes. Four LTC administrators participated, representing both urban and rural nonprofit nursing homes. Participants spoke positively of the program despite implementation challenges including perceived infection risk, policy interpretation, and logistical challenges. The psychological impact of isolation for nursing home residents was emphasized as a critical consideration alongside physical health concerns. LTC administrators desired to support resident well-being while maintaining good standing with regulatory agencies. Based on a limited sample, Indiana's EFC policy was viewed favorably by LTC administrators as a tool to balance resident and family psychosocial needs with infection-related health risks. LTC administrators desired a collaborative approach from regulators as they worked to implement a novel policy. Consistent with participant desire for broader caregiver access to residents, more recent policymaking has reflected growing recognition of the critical role of family members not only as companions but also as care providers, even in a structured care environment.

EXPERIENTIAL ASSESSMENT OF AN INNOVATIVE DEMENTIA CARE TRAINING SEQUENCE FOR HEALTH AND HUMAN SERVICES WORKERS

Abstract This poster presents results of an assessment of an interdisciplinary dementia care training titled Dementia Reconsidered (DR). In contrast to disease and deficit-focused training curricula, DR incorporates and emphasizes the strengths and humanity of people living with dementia and focuses on person-directed support for, and care of, persons living with dementia. For example, DR makes the case for an approach to shared and supported decision-making that optimizes the individual’s— and significant others’—abilities. The on-line lectures were chunked to accommodate cognitive load and active learning; 20-30 second stretch breaks were interspersed to facilitate attention. This may account for the higher retention and utilization rates of DR than are often found in one-off trainings. A retrospective pre-post survey administered at the conclusion of DR sessions measured participant learning outcomes. Participants in DR sessions were representative of the fields of social work (42%), nursing (21%), and a significant “other” category (28%), mostly long-term care administrators. Among post-training survey respondents (N=36), 77% improved their knowledge of the key principles of person-directed dementia care; 73% (N=37) showed improved comfort in supporting residents with dementia during the CoVID-19 pandemic; 83% (N=24) showed improvement in ability to distinguish capacity and competency; and 83% (N=23) reported increased comfort in supporting people with dementia in making decisions in the face of diminished capacity. At six month follow-up, 63% (N=33) had used a skill gained from their training (17% no, 20% not sure). Implications for training in dementia care practices will be discussed.

“A GLARING OMISSION”: BARRIERS TO INCLUDING LONG-TERM CARE RESIDENTS’ VOICES IN THE NEWS MEDIA

Abstract News media stories on residential long-term care (LTC) are mostly negative in tone, and the increase in news coverage of residential LTC during the COVID-19 pandemic intensified the pessimistic tone with panicked and accusatory reporting. Although there has been an increase in the amount of news coverage on residential LTC over the last two years, the perspectives of the residents themselves have been largely overlooked and excluded. The aim of this study is to identify and understand the barriers and embedded institutional logics in the news reporting process of LTC that prevent residents from being included and interviewed. Using a purposive sampling strategy, the researchers conducted 26 semi-structured interviews with LTC administrators (n=7), journalists on the topics of aging and LTC (n=7), and older residents living in LTC settings (n=12) in the United States. Thematic analysis is applied to the data to qualitatively extract the guiding logics frameworks of each stakeholder group. Findings are grouped into the following four themes: (1) residents are not considered "experts" by reporters and are therefore not a prioritized source of information; (2) facility administrators fear for the facility's public image & reputation and do not enthusiastically cooperate with inquiring reporters; (3) facilities were in physical lockdown for several months during the COVID-19 pandemic, and (4) residents feel forgotten and unheard. Implications of this study point to the social exclusion of older residents living in LTC and reductive reporting that fails to capture their nuanced and dynamic lived experiences.

ASSISTED LIVING ADMINISTRATORS’ JOB SATISFACTION, WORK STRESSORS, AND INTENT TO LEAVE DURING THE COVID-19 PANDEMIC

Abstract This study examines how job satisfaction in six sub-scales and selected stressors and demographic covariates influenced assisted living administrators’ (ALF) intentions to quit during the COVID-19 pandemic. Quantitative and qualitative data were collected from 103 ALF administrators as part of a national study of long-term care administrators’ intent to quit during the COVID-19 pandemic funded by the Foundation of the National Association of Long-Term Care Administrator Boards in Washington, DC. Descriptive statistics were collected for the sample, and correlations between variables were examined, as well as responses from 3 open-ended questions that were coded for analysis. Although generally satisfied, roughly 41 percent of ALF administrators reported that they were intending to quit. Qualitative data suggested that job satisfaction was influenced by a more nuanced interpretation of job characteristics and work environment intrinsic factors such as adequacy of staffing and resources, changing regulations during the COVID-19 pandemic, and external supports such as family and friends. Given the limited research on the impact of the COVID-19 pandemic on assisted living communities and their administrators, the results of this study can help to inform policies and strategies for providing support for this segment of long-term services and its workforce during widespread disasters.

Smoke-Free Policy Disparities in Long-Term Care Facilities.

Older adults in long-term care (LTC) facilities suffer disproportionately from health conditions caused or worsened by secondhand smoke. Long-term care facilities in many states and municipalities permit smoking. Americans for Nonsmokers' Rights compiles data on smoke-free policies only in institutional facilities (e.g., nursing homes), but not in transitional (e.g., independent living) or community-based settings (e.g., adult day). A cross-sectional, observational study was conducted of smoke-free policies using cluster random sampling in Kentucky to compare differences in policy location of coverage and strength of smoke-free policies in institutional, transitional, and community-based LTC facilities by rural/urban status. Online or phone surveys of LTC administrators representing 306 facilities were conducted. Of the facilities sampled, 35.5% were institutional, 33.4% transitional, 25.1% community-based, and 6.0% multi-type. Only one in five (19.6%) facilities restricted smoking indoors and outdoors. Only 17.3% of the policies were comprehensive (i.e., prohibiting use of all tobacco products by all persons living, frequenting, or working in LTC facilities). Compared to transitional facilities, institutional and community-based facilities were more likely to have comprehensive policies and restrict smoking indoors and outdoors. Facilities located in rural communities were less likely to restrict smoking indoors or outdoors and less likely to have comprehensive smoke-free policies, reflecting a disparity in policy protections. Strong, consistent smoke-free policies and policy enforcement are needed to reduce the disparity in smoke-free protections for older adults, LTC employees, and visitors. More research is needed to investigate the best strategies for implementing and enforcing policies that completely restrict smoking in all LTC facilities.

COVID-19's Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators.

BackgroundThe prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them.ObjectiveThis study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic.MethodsLTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic.ResultsLTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents’ use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents’ use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology.ConclusionsOur results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents’ engagement and communication opportunities, such as another pandemic.

Information and Communication Technology Changes in Long-Term Care Due to COVID-19

Residents of long-term care (LTC) facilities (e.g., nursing homes, assisted living facilities) have historically been vulnerable to feelings of loneliness and social isolation. Due to the COVID-19 pandemic, LTC facilities were required to restrict public access in March 2020. LTC communities were not prepared for the residents’ increased socioemotional needs which arose because of the mandated facility lockdown. This study investigated ICT use in LTC facilities and how ICTs are being used by residents since the onset of the COVID19 pandemic. Seventy LTC administrators in South Carolina (12 nursing homes and 58 assisted living facilities) completed an online survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of COVID-19. Administrators from fifty-three percent of LTC facilities reported purchasing ICTs for their residents to use for communicating with family members and telehealth since the onset of COVID-19. LTC administrators reported that using the ICTs helped residents to socialize more frequently and feel more socially connected to their family members, friends and/or other residents. Barriers to ICT use included staff not having time to assist residents with technology, broken technology, and residents not wanting to share technology. LTC facilities were not adequately prepared to support the socioemotional needs of their residents in the event of a federally mandated facility lockdown. Future research should investigate the ICTs available for residents’ use in a national sample of LTC facilities and how LTC administrators adapted the ICTs available as a result of their experiences with COVID-19.

Burnout, Compassion Satisfaction, and Personality Among Nursing Assistants: Who is at Risk?

It is well established that the health professional workforce is not adequately prepared to meet the demands of an aging older population. Caregivers are often the backbone supplemental workforce for seniors, providing daily care with assistance with activities of daily living, with little training. Part of the mission of the South Florida Geriatric Workforce Enhancement Program (SFGWEP) is to support and empower caregivers through community based training programs. Between January 1 2020 to January 31, 2021 SFGWEP provided education to more than 340 caregivers on topics related to opioid use, effective communication with individuals with dementia and other topics. Attendees responded to a short evaluation survey, which included three multiple-choice questions on if attending was a good use of their time, if they gained knowledge and if they plan to apply material, and two open-ended questions to identify opportunities for improvement in future trainings. Responses were overwhelmingly positive (>98% for multiple-choice questions.) There were also three open-ended questions that were analyzed using a modified thematic approach. The three questions covered what attendees learned, what they wanted to learn more about and suggestions for improvement. Analysis suggests that attendees plan to be more mindful about communication (e.g. improve eye contact, listen more) and that they want more information on neurocognitive disorders and resent research, including psychological changes due to disease and medication side effects. In terms of improvement, attendees said the program should allow more time for questions and should use more engaging materials (polls, posters, flyers and case studies).

Informal Caregivers' Perspectives on the Mandated No Visitation Policy During COVID-19 Pandemic in Long-Term Care: A Qualitative Study.

The current descriptive qualitative study aimed to explore how informal caregivers of persons residing in long-term care (LTC) facilities are coping with the no visitation policy during the coronavirus disease 2019 (COVID-19) pandemic. Semi-structured interviews were conducted approximately 1 month after the no visitation policy was implemented. Interview questions explored how informal caregivers are feeling, coping, and staying connected and involved with loved ones residing in LTC. Recruitment (N = 14) occurred through social media, email, and word of mouth. To maintain social distance and reduce transmission risk, interviews were conducted by phone. Through systematic data reduction, six themes emerged: (a) Reminiscing About Life Before COVID-19, (b) Feelings Related to Physical Separation, (c) Our Loved Ones Are Lonely and Don't Understand, (d) Creating Ways to Stay Connected, (e) Recognition and Concern for LTC Staff, and (f) Coping During Future No Visitation Mandates. Results of this study may assist LTC administrators and nurses if no visitation policies are required in the future. [Journal of Gerontological Nursing, 47(12), 19-26.].

Internship Partners for Long-Term Care Administrators – A Model Sustainable Through COVID-19 Is a Model for the Future

Most long-term care administration programs require an internship as a graduation requirement. The University of Wisconsin – Eau Claire’s Health Care Administration interns are highly valued by partner sites, hosting students annually. In the 2019-2020 academic year, 59 students were nine months into their internship experience when COVID-19 disruptions became widespread. This paper describes the program’s immediate and multifaceted response, which led to exceptional outcomes. Lessons learned suggest that through effective planning and exceptional reaction in the face of adversity, strong academic programs and partnerships play a key role in alleviating long-term care workforce challenges by producing extraordinarily prepared future leaders.

Protecting Frail Older Adults: Long-Term Care Administrators' Satisfaction With Public Emergency Management Organizations During Hurricane Irma and COVID-19.

Protecting Frail Older Adults: Long-Term Care Administrators' Satisfaction With Public Emergency Management Organizations During Hurricane Irma and COVID-19.

Influence, Value, and Community: The Futures Program Sets a Graduate Up for Success

Influence, Value, and Community: The Futures Program Sets a Graduate Up for Success

Applied Scholarship in LGBTQ Aging: Implications for Policy and Practice

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) elders have shown considerable strength while aging in a society predicated on heteronormative and binary expectations for gender and sexuality. The life trajectories of LGBTQ older adults are shaped by discrimination and stigmatization, and the embodied resistance that comes with demanding their full participation and recognition in society. This symposium highlights the innovative scholarship of emerging scholars in the field of LGBTQ aging who are engaging in diverse substantive and methodological investigations. The first study takes a comparative cohort approach to explore differences in stressors and depressive symptomatology between younger and older sexual minorities, highlighting the significance of cohort effects among LGBTQ people. The second paper uses data from the Health and Retirement Study to examine anticipated nursing home placement needs between LGB and heterosexual adults with suggestions to better prepare aging service networks. The third describes the influence of state legislature mandating LGBTQ-sensitivity training by examining differences in provider baseline knowledge and attitudes toward LGBTQ older adults in two states, one mandating LGBTQ-sensitivity training and one not. The final paper highlights findings from a multi-methods study that explores how long-term care workers, managers, and administrators respond when staff, visitors, or residents challenge LGBTQ rights for religious and moral reasons. Although substantively and methodologically varied, these studies all demonstrate the importance of applied scholarship that builds knowledge in support of policies and practices that promote equity among LGBTQ individuals across the life course. Rainbow Research Group Interest Group Sponsored Symposium.

Navigating Religious and Moral Exemptions in Serving LGBTQ Residents in Long-Term Care Facilities

Almost immediately after the U.S. Supreme Court mandated marriage equality, a surge in policies carved out exceptions to LGBTQ rights for religious or moral reasons. This study examines how long-term care workers, managers, and administrators respond when staff, visitors, or residents challenge LGBTQ rights based on these exemptions. Building on street-level bureaucracy theory, this study employs an advanced multi-method qualitative design with semi-structured staff interviews (n=85), content analysis of facility policies (n=110), and observation of two facilities. Data analysis revealed three key themes: visibility, bodily autonomy/respect, and safety. While nearly all workers expressed universal concern for LGBTQ rights, direct care workers and managers wavered when religious or moral exemptions arose in serving transgender residents. Workers invoked facility policies regarding gender and bodily care to justify differential treatment. This research provides new knowledge and guidance for workers, facilities, and policymakers and theoretical contributions to street-level bureaucracy. Part of a symposium sponsored by Rainbow Research Group Interest Group.

Using Ethics and Law to Address Sexuality in Long-Term Care

Issues concerning the sexuality of older adults in long-term care have long presented an array of thorny conundrums for long-term care staff and administrators, for friends and family members, and, most importantly, for the residents themselves. At any one time, more than two million older adults reside in nursing homes or assisted living facilities, and the predominant trope of people who are helpless, demented, and asexual is at once inaccurate and unfair. Moreover, the important need for sexual intimacy remains a life-long, even when persons have worsening dementia and chronic illness. This presentation uses bona fide, de-identified case examples as a starting point for consideration. Drawing upon the extant literature, as well as best practices, this presentation applies ethical principalism (i.e., autonomy, beneficence, nonmaleficence, justice) as well as current law to recommend practices and approaches to sexuality in long-term care.

Making Quality Improvement Data Meaningful for Long-Term Care Administrators

Tailoring feedback data to engage end-user stakeholders when sharing organizational context data is a central component of quality improvement and integrated knowledge translation. For over a decade, our research team has collected survey data (using the validated Alberta Context Tool) on modifiable aspects of organizational context from long-term care (LTC) staff (e.g., nurses, unregulated providers) across a representative cohort of 94 LTC facilities in Western Canada. We have fed back data at the facility and care unit level with the goal of making research findings more useful for decision-making and aiding improvement efforts. We have used a binary method (more favourable / less favourable organizational context) to report multidimensional data. While useful to our stakeholders (e.g., administrators) we are continually seeking ways to increase the detail in our reporting, while maintaining usability for stakeholders. We have now developed a more detailed method – the context rank summary, which displays rankings of care units within and across LTC facilities. In this study, we used a qualitative descriptive design to explore perspectives of administrators and managers (leaders) from LTC facilities on the two different methods for reporting survey data. We conducted a total of three focus groups with 16 leaders in the Maritimes and Ontario, Canada. Transcripts were analysed using content analysis. Leaders preferred a feedback report that combines a binary method with the greater detail of the context rank summary. Providing organizational context data that is more meaningful, relevant and actionable could offer an additional path to identifying areas for improvement.