Long-term Care Experience Research Articles

Concept Analysis: The Occupational Experiences of Long-Term Care Nurses-Navigating Fragmented Transitions.

Transitions are broadly defined as movements from one place, stage, or subject to another. However, transitions which are broken and incomplete are referred to fragmented transitions. The aims of this concept analysis were to analyze the navigation of fragmented occupational transitions among long-term care nurses and to develop a working conceptual definition of fragmented occupational transitions to inform diverse stakeholders. Concept analysis. Google Scholar, PubMed, and the Cumulative Index of Nursing and Allied Health Literature databases were accessed. Identified sources were interprofessional scholarly literature published between January 1, 2018, and January 1, 2024, and seminal references. Walker and Avant's eight-stage concept analysis method. Occupational transitions in long-term care are fragmented leading to grievous challenges across multiple aspects of nurses' lives. An analysis of the literature using a Transitions Theory lens reveals that their thoughts, feelings and ethical decisions are influenced over time by these transitions. Cardinal attributes include: (1) Fragmentation, (2) Ill-timing, (3) Disruption, (4) Liminality, (5) Ambiguity, (6) Ambivalence and (7) Facilitators/Inhibitors. Antecedents stem from external sources and facility-led initiatives. Consequences encompass product and process outcomes. Product outcomes include physical and psychological conditions, and process outcomes encompass resilience, flexibility, connection, coping, creativity, and communication. This concept analysis advances the science for understanding nurses' occupational transitional experiences in long-term care. It will assist in risk assessment and instrument development ultimately improving the quality of long-term care. Fragmented occupational transitions in long-term care are multifaceted and complex phenomena that require distinct responses from government, healthcare leaders, and scholars to improve the plight of long-term care nurses and stakeholders. Dr. A. I. Meleis contributed to this article by sharing her vast insight into transitions.

Healthcare professionals' experience with nutritional care beyond formal quality systems - A qualitative study.

Numerous formal strategies, screening tools, and interventions have been used to prevent malnutrition in long-term care patients. Despite these efforts, the proportion of screened patients is low, and a large proportion are malnourished. Previous research has revealed that healthcare professionals use a broad approach in their nutritional care but has also emphasised the need for further investigation into these approaches. To explore how healthcare professionals working in long-term care experience and apply nutritional care. A descriptive, exploratory, qualitative design containing 240 h of participant observation, 12 focus groups and 2 individual interviews. Twelve nursing homes and home care units in three Norwegian municipalities. Participant observation of interactions between healthcare professionals and patients. Forty-three registered nurses participated in focus group or individual interviews. The data were analysed using inductive thematic analysis. The analysis identified three themes: The first theme, limited significance of nutritional screening, showed that healthcare professionals experienced the limited value of nutritional screening, as it often did not capture patients' nutritional challenges. They also perceived nutritional screening as unsuitable for patients at the end of their lives, those with overweight-related complications, or undergoing rehabilitation. In addition, nutritional screening was perceived as something healthcare professionals did for their managers or administrators, not because it was crucial to providing good nutritional care. The second theme, provision of individualised food, captures the healthcare professionals' efforts in adapting and preparing food according to the patient's preferences. Facilitation to enable patients to make individual food choices and the use of food cards or lists were two approaches to individualising nutrition care. The third theme, making meals more than about food, elucidated how healthcare professionals used meals to help patients cope with their situations and experience social belonging. Conversations about or around meals were used to provide patients with a sense of belonging to their past or present situation. The meals were also used as a diversion strategy for patients with unrest, as arenas for daily activity training, and for meaningful social interactions between patients around the tables. Nutritional screening and prevention of malnutrition are only one part of healthcare professionals' nutritional care. Individualised food and meals that create coping, a sense of belonging, and social experiences are equally important parts of their care. Emphasising healthcare professional's person-centred approach to nutritional care would be beneficial, as it could strengthen and further develop long-term nutritional care services.

Individual and organizational interventions to promote staff health and well-being in residential long-term care: a systematic review of randomized controlled trials over the past 20 years

BackgroundStaff in residential long-term care (RLTC) experience significant physical and mental work demands. However, research on specific interventions to promote staff health and well-being in RLTC facilities is limited. This systematic review aimed to synthesize the current evidence on health promotion interventions among RLTC staff.MethodsA comprehensive systematic literature review was conducted on studies published between January 2000 and April 2023. Four electronic databases were searched, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PsychArticles via EBSCO. The review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The methodological quality of the included studies was assessed using the Risk of Bias Assessment tool (RoB 2).ResultsA total of 26 publications, referring to 23 different interventions with a randomized controlled design were included. Among these interventions, ten used training/educational approaches, six used behavioral approaches, and seven employed a multimodal approach. Significant improvements in health and well-being outcomes were found in four interventions using a training/educational approach, three interventions using a behavioral approach, and four interventions using a multimodal approach. Within the interventions studied, twelve specifically targeted the reduction of job demands, while only one intervention exclusively addressed job resources among RLTC staff. Furthermore, ten interventions addressed primary outcomes that encompassed both job demands and job resources.ConclusionCurrent evidence for health promotion interventions among RLTC staff is still limited, but research suggests that there is potential to improve certain outcomes related to RLTC staff health and well-being. Future research is recommended to contemplate a tailored intervention design that encompasses both individual-level and organizational-level approaches, and gender-specific physiological and sociological characteristics of RLTC staff. Moreover, detailed reporting of the development process, and research on the interaction between job demands and resources of RLTC staff are also recommended.

Understanding Employee Voice Behavior Through the Use of Digital Voice Channel in Long-Term Care: Protocol for an Embedded Multiple-Case Study.

Specific challenges in the health care sector, such as hierarchical structures, shortages of nursing staff, and high turnover of nursing staff, can be addressed by a change process of organizational culture into shared governance. Data from business organizations show that the use of digital voice channels provides employee voice. This approach makes concrete the opportunity for employees to raise their voices by answering surveys and making comments in an anonymous forum, which subsequently positively influences staff turnover and sick leave. Since there is no clear understanding of how a digital voice channel can be used in long-term care to address employee voice, a research gap has been identified. The purpose of ADVICE (Understanding Employee Voice Behavior; the acronym for this study) is to understand how the use of a digital voice channel performs in long-term care (residential long-term care and home care facilities). The aim of this study is to understand how the digital voice channel can support staff in making their voices heard and to see what managers need to use the voice channel to change the work environment. An embedded multiple-case study will be used to explore the experiences of 2 health care providers who have already implemented a digital voice channel. ADVICE is organized into two main phases: (1) a scoping review and (2) an embedded multiple-case study. For this purpose, focus group interviews with employees, discursive-dialogical interviews with managers, meeting protocols, and data from the digital voice channel will be analyzed. First, all units of analysis from every embedded unit will be separately analyzed and then comprehensively analyzed to obtain a case vignette from every embedded unit (within-analysis). In the second stage, the analyzed data from the embedded units will be compared with each other in a comparative analysis (cross-analysis). The results will provide insight into how digital voice channels can be used in long-term care to address employee voice. We expect to find how the digital voice channel can empower nurses to speak up and, consequently, create a better work environment. Data collection began in August 2023, and from a current perspective, the first results are expected in summer 2024. In summary, the results may help to better understand the use of a digital voice channel in the health care sector and its transformative potential for leadership. At the organizational level, research can help to improve the attractiveness of the workplace by understanding how to give employees a voice. PRR1-10.2196/48601.

IMPLICATIONS OF RESIDENT AND ENVIRONMENTAL CHARACTERISTICS ON RESIDENT-TO-RESIDENT AGGRESSION

Abstract This study examines factors associated with resident-to-resident aggression (RRA) in long term care facilities in Hong Kong. A total of 800 personal care worker participated. Participants averaged 42.03 years of age (SD=7.63), were mostly female (92.7%), married (79.1%) and reported an average of 6.28 years of experience in long term care. 96.9 percent of the participants provided care to residents with dementia but 58.9% considered the training they received insufficient. RRA was common: All participants reported having witnessed verbal aggression (100%), 18% disruptive behaviors, 11.8% physical violence, and 3.1% sexual aggression. The following analysis used a subset of 412 participant from 29 long term care facilities where environmental assessments were conducted. General linear model analysis showed that RRA was associated with both resident and environmental characteristics. Victims’ neuropsychiatry symptoms, perpetrator male gender and neuropsychiatric symptoms were associated with higher RRA. Separation of residents with and without dementia, inappropriate use of nursing unit for residents as measured by Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH), lack of functional and attractiveness courtyard, less cleanliness of spaces, insufficient lighting and insufficient orientation / cueing as measured by Professional Environmental Assessment Procedure (PEAP) were also associated with higher RRA. There is an urgent need to prevent and intervene RRA in long term care facilities. Improving management of neuropsychiatric symptoms and creating a supportive and accommodating environment could be helpful in this regard.

Insights into the lived experience of Long-Term Care and End of Life Transitions in Malta

In this keynote presentation, I explore the profound implications of the global demographic shift towards an ageing population. I delve into the challenges and opportunities presented by this shift, using Malta as a unique case study with 25% of its citizens aged 60 and older. The dense population poses challenges for infrastructure, healthcare access, and the overall well-being of older individuals.

156-LB: Nursing Burden Administering/Monitoring Complex Insulin Regimens vs. Basal Insulin/GLP-1 RA Fixed-Ratio Combinations (FRCs) for People with Type 2 Diabetes (PWT2D) in Long-Term Care (LTC)

Aim: Management of older PWT2D in LTC is challenging due to comorbidity, functional dependence, and hypoglycemia risk, and is further complicated by nurse shortages. This cross-sectional survey emailed to LTC nurses assessed perceived nursing burden associated with complex insulin regimens (basal-bolus [BB], sliding scale insulin [SSI]) vs FRCs. Methods: The survey comprised 3 hypothetical cases of PWT2D receiving BB, SSI, or FRC. Perceived burden was assessed using the unweighted NASA-Task Load Index (TLX). Responses for the 6 TLX subscales (mental, physical, and temporal demand; effort, frustration, performance) and perceived frequency of fingerstick use were summarized descriptively. Results: 10,982 nurses received the survey. Of the 250 who qualified (administered BB/SSI/FRC in past 90 days), 87% were female, 51% were ≥45 y, 49% had ≥11 y experience in LTC. TLX scores (max 20 higher = worse) were lower for FRCs vs BB or SSI (Table). Nurses perceived FRCs to require fewer fingersticks vs BB or SSI (Table). Conclusions: FRCs were perceived to reduce nursing burden and fingerstick use compared with complex insulin regimens. These findings, coupled with the lower hypoglycemia risk for FRCs vs complex insulin regimens reported in clinical trials suggest that use of FRCs in LTC has potential to reduce nursing workload. Disclosure H. E. Davidson: Research Support; Sanofi-Aventis U. S. A. Nelson: Research Support; Sanofi-Aventis U. S. L. F. Han: Research Support; Sanofi-Aventis U. S. M. Lamantia: Research Support; Sanofi-Aventis U. S. K. Desai: Employee; Sanofi. X. Li: Employee; Sanofi-Aventis U. S. T. A. Dex: Employee; Sanofi-Aventis U. S., Stock/Shareholder; Pfizer Inc., Viatris Inc., Teva Pharmaceutical Industries Ltd. J. F. Vance: None. K. Overbeck: None. Funding Sanofi

The lived experience of long-term follow-up clinical care for haematopoietic stem cell recipients in England: a qualitative exploration

PurposeDespite a haematopoietic stem cell transplant (HSCT) being a potentially curative treatment option for malignant and non-malignant disorders, patients may develop complex physical and psychological post-transplant complications. Consequently, transplant centres remain responsible for patients’ life-long monitoring and screening practices. We sought to describe how HSCT survivors experience long-term follow-up (LTFU) monitoring clinics in England.MethodA qualitative approach was adopted with data collected from written accounts. Seventeen transplant recipients were recruited from across England, and the data was analysed using thematic analysis.ResultsData analysis elicited four themes: Transfer to LTFU care: ‘will there be a change in my care, or will appointments just become less frequent?’; Care Coordination: ‘it is good to know I am still in the system’; Relationship continuity: ‘a good knowledge of me, my health and what is important to me’; and Late-effects Screening: ‘there was not much information about what to expect or be aware of’.ConclusionsHSCT survivors in England experience uncertainty and lack of information regarding the transfer from acute to long-term care and clinic screening practices. However, patients gain reassurance from remaining on a healthcare pathway and maintaining relationships with healthcare professionals.Implications for cancer survivorsHSCT recipients entering LTFU monitoring clinics are a growing population of cancer survivors. Understanding and acknowledging this cohort of patients’ needs may inform the development of tailored support to help patients navigate the complicated healthcare pathway.

The impact of assistive living technology on perceived independence of people with a physical disability in executing daily activities: a systematic literature review

Purpose People with physical disabilities often require lifetime support and experience challenges to maintain or (re)define their level of independence. Assistive living technologies (ALT) are promising to increase independent living and execution of activities of daily living (ADL). This paper provides a systematic literature review that aims to analyse the present state of the literature about the impact of ALT on perceived independence of people with a physical disability receiving long-term care. Materials and methods Databases Embase, Medline, and Web of Science were searched for eligible studies from 2010 or later. Results Nine studies were included, of which seven qualitative, one quantitative, and one mixed methods. Quality was generally high. ALT enabled participants to execute ADL. We found six themes for the impact of ALT on perceived independence: feeling enabled, choice and control, feeling secure, time alone, feeling less needy, and participation. Conclusions ALT appears to impact perceived independence in many ways, exceeding merely the executional aspect of independence. Existing research is limited and quite one-sided. More large-scale studies are needed in order to inform care organisations how to implement ALT, especially considering societal developments and challenges impacting long-term care.

RESIDENT-TO-RESIDENT AGGRESSION: PREVALENCE AND RISK FACTORS

Abstract This study examines the rates and risk factors of resident-to-resident aggression in long term care facilities in Hong Kong. A total of 800 personal care worker participated. Participants averaged 42.03 years of age (SD=7.63), were mostly female (92.7%), married (79.1%) and reported an average of 6.28 years of experience in long term care. 96.9 percent of the participants provided care to residents with dementia but 58.9% considered the training they received insufficient. Resident-to-resident aggression was common: All participants reported having witnessed verbal aggression (100%), 18% disruptive behaviors, 11.8% physical violence, and 3.1% sexual aggression.Resident-to-staff aggression was commonly reported with verbal aggression being the most common (97.6%) following by other disruptive behaviors (13.7%), physical violence (10.7%), and sexual aggression (8.5%). Logistic regression analysis indicated that disruptive behaviors and physical violence were associated with perpetrator male gender, dementia, and neuropsychiatry symptoms, as well as staff prior and current experience of taking care of persons with dementia, not having received training in dementia care, and perceived insufficiency of training. Sexual aggression was associated with perpetrator male gender and staff female gender. There is an urgent need to provide supportive services to prevent and intervene resident-to-resident aggression in long term care facilities. Improving management of behavioral and psychological symptoms of dementia through sufficient staff training and adequate staffing ration may be helpful in this aspect.

PLACE, TIME, AND STRUCTURAL RACISM: GLOBAL PERSPECTIVES FOR REIMAGINING AGING

Abstract Racism is embedded throughout society, producing enduring health inequities. Structural racism is pervasive across racial or ethnic groups and at the intersection of racism, ageism, and sexism. However, only the tip of the iceberg is visible in the literature or media. This presentation highlights aging and long-term care experiences of racial and ethnic groups that are often invisible in structural racism discussions (e.g., Asians). It also features direct care workers, many of whom are minorities or immigrants. I present a conceptual model of how structural racism (institutionalized, personally mediated, internalized) impacts well-being (mental, physical, cognitive, social). The model integrates the concepts of “place” (where we live, work, play, learn), “time” (effects of history, cohort, age), and invisibility. Global perspectives of structural racism will help engage gerontologists, policy makers, practitioners, and the public to maximize everyone’s opportunities to live meaningful lives.

CHANGING FAMILY DESTINIES, DIVERGENT FAMILY CAREGIVING PATTERNS: DO BIRTH COHORTS, GENDER, RACE, AND SES MATTER?

Abstract Over the past few decades, Americans have experienced a series of demographic transitions include prolonged longevity and rise in the complexities of family structures. The Baby Boomer cohort is at the forefront of these transitions, which has profound implications on their later-life family relations and practices of family caregiving. Most caregiving literature has focused on static care experiences over a short time, while neglecting long-term care experiences. Using 10 waves of longitudinal data from HRS (2000-2018) and latent profile analysis, I identified five prominent long-term caregiving patterns: light parental caregivers (44.1%), intensive spousal caregivers (5.6%), sandwiched caregivers (5.5%), light grandchildren caregivers (38.7%), and heavy grandchildren caregivers (6.2%). Further, I conduct multinominal logistic regression to investigate how birth cohorts, gender, race, and education shaped these patterns. Results suggested that later cohorts have seen a decline in intensive spousal caregivers, light and heavy grandchildren caregivers, but an increase in light parental caregivers. Women are more likely to be sandwiched caregivers than men, and black caregivers are more likely to be intensive spousal caregivers, heavy grandchildren caregivers, and sandwiched caregivers than white. By contrast, white and more educated caregivers are more likely to be light parental caregivers, and this pattern becomes more pronounced in later cohorts. The findings suggest divergent destinies of family caregiving patterns among later cohorts. More disadvantaged groups are shouldering heavier care responsibilities than advantaged groups. Targeted care services should be implemented to ease the care burdens of the vulnerable population.

Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

IntroductionPoor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. We aimed to understand the mealtime experience in long-term residential care by exploring (missed) opportunities for person-centred care in different settings.MethodsAs part of the TRANS-SENIOR research network, rapid ethnographies, were conducted across multiple sites (including interviews, observations and informal conversations), in a long-term residential care home in the UK, Switzerland and the Netherlands between October 2020 and December 2021. ResultsFollowing analysis and interpretation of observations, interviews and informal conversations, the following themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed: 1) considering the setting, 2) listening to and implementing resident choice, 3) enabling residents to help/care for themselves and others, 4) providing individualised care in a communal setting, and 5) knowing the person in the past and present. Residents experienced moments of participatory choice, interaction, independence and dignity, but opportunities for these were often missed due to organisational or policy constraints.ConclusionsThere are opportunities for person-centred moments during the mealtime, some of which are taken and some missed. This largely depended on the setting observed, which includes the overall environment (size of dining area, seating arrangements etc.) and allocation of staff resources, and the level of resident involvement in mealtimes, from preparation to the actual activity.

Factors influencing professional quality of life of nurses in long-term care hospitals: A cross-sectional study

Purpose: The purpose of this study was to identify factors related to the professional quality of life of nurses in long-term care hospitals. Methods: A descriptive survey was conducted among 144 nurses with more than 3 months of work experience in five long-term care hospitals in B metropolitan city. Data were collected from April 15 to 30, 2022 and analyzed using the independent t-test, one-way ANOVA, Mann-Whitney test, Pearson’s correlation coefficients, and stepwise multiple regression. Results: The regression model explained 51% of the variance of long-term care hospital nurses' compassion satisfaction (F=35.72, <i>p</i><.001). Significant factors were dementia attitude (β=.23, <i>p</i>=.001), professional self-concept (β=.51, <i>p</i><.001), marital status (married) (β=.16, <i>p</i>=.019) and more than 10 years of clinical experience at a long-term care hospital (β=-.29, <i>p</i><.001). The regression model explained 36% of the variance of long-term care hospital nurses' compassion fatigue (F=12.93, <i>p</i><.001). Significant factors were dementia attitude (β=-.27, <i>p</i>=.001), burden on behavioral psychological symptoms of dementia (β=.38, <i>p</i><.001), women (β=.20, <i>p</i>=.005), more than 10 years of clinical experience at a long-term care hospital (β=.20, <i>p</i>=.004) and experience in education about dementia (yes) (β=-.16, <i>p</i>=.029). Conclusion: This study revealed several factors that are correlated with the professional quality of life of long-term care hospital nurses. To improve their quality of life, hospitals should help nurses have a positive attitude toward dementia, reduce the burden of behavioral psychological symptoms of dementia, and provide dementia care training.

I am a freedom fighter.

![Figure][1]</img> I am a freedom fighter. No, I haven’t been part of a flag-bearing convoy of protesting truckers.[1][2] I am a doctor. I have been in general practice for nearly 20 years with experience in long-term care, heart health, sleep medicine, and, most recently, addiction medicine. If

The Experience and Enlightenment of the Community-Based Long-Term Care in Japan.

(1) Background: China’s population aging situation is severe, but the construction of the long-term care insurance system is still in its infancy. Through summarizing the long-term care experience in Japan, this paper explores the suggestions for the development of long-term care in China. (2) Methods: Based on literature research and policy review, we sorted out the relevant practices and safeguard measures of the long-term care insurance system in Japan, and summarized the characteristics of Japanese community care. (3) Results: In the development of long-term care services, Japan has gradually established a multi-level, systematic, and precise elderly care service model. Its community care has the characteristics of policy support, intensive intervention, complete elements, and strict evaluation. China’s long-term care services should learn from Japan’s experience, strengthen institutional guarantees, improve relevant supporting policies, encourage multiple subjects to participate in community care based on integrating community resources, and establish community care evaluation mechanism.

Older people’s long-term care experiences during the COVID-19 pandemic in Ghana: a qualitative descriptive study

This study explores older people’s long-term care experiences during the COVID-19 pandemic in Ghana. A qualitative descriptive approach employing semi-structured interviews was used to collect data from 15 older people from Southern Ghana. Analysis of interview data resulted in five interrelated themes: (1) sources and type of long-term care; (2) older people’s satisfaction with the long-term care received; (3) changes in their long-term care; (4) feelings of neglect regarding long-term care; and (5) older people’s resilience in long-term care. The sustainability of long-term care depends on the state’s ability to devise innovative long-term care policies and programmes to promote older people’s and their carers’ well-being.

Evaluation of SARS-CoV-2 antibody persistence and viral spread in stool: a long-term care experience before COVID-19 vaccination.

BackgroundDue to elderly residents, nursing homes/assisted living facilities were the most affected places in COVID-19 pandemic. Besides symptomatic patients, asymptomatic patients were detected during routine screening.AimThis study aims to determine the factors that affect antibody response and viral shedding in stool samples after natural exposure to the virus in residents and staff who recovered from COVID-19 before the vaccine was available.MethodsThis prospective cross-sectional study was conducted at the nation’s highest-capacity Residential and Nursing Home. Blood samples were collected between December 15, 2020 and January 15, 2021 from participating residents and staff for anti-SARS-CoV-2 antibody testing. Stool samples were obtained for SARS-CoV-2 PCR testing 2 months after COVID-19. The Social Sciences (SPSS) program version 15.0 was used for statistical analysis. The Mann–Whitney U test compared SARS‐CoV‐2 antibody concentration between two groups.ResultsFour hundred sixty-four (52.3%) residents and 424 (47.7%) staff participated. Entirely 259 (29.2%) participants were anti-SARS-CoV-2 IgG (+) and 255 (28.7%) were SARS-CoV-2 PCR (+). Both antibody and PCR positivity was detected in 196 (76.9%). In PCR (−) group, 63 (10.0%) participants were SARS-CoV‐2 IgG (+). Antibody titers were found highest in SARS-CoV-2 PCR (+) male residents. SARS-CoV-2 IgG titers were significantly high in SARS-CoV-2 PCR (+) and hospitalized participants regardless of age. Stool samples were obtained from 61(23.9%) participants and were found negative.ConclusionA durable SARS-CoV‐2 IgG antibody response was monitored at least 9 months after the participants were diagnosed with COVID-19. SARS-CoV-2 antibody positivity was detected 76.9% in PCR (+) and 10.0% in PCR (−) participants. Knowing the duration of detectable antibodies is an important finding for developing disease prevention and public health strategies.

A team level participatory approach aimed at improving sustainable employability of long-term care workers: a study protocol of a randomised controlled trial

BackgroundStaff currently working in long-term care experience several difficulties. Shortage of staff and poor working conditions are amongst the most prominent, which pose a threat to staff’s sustainable employability. To improve their sustainable employability it is important to create working conditions that fulfil workers’ basic psychological need for autonomy, relatedness and competence in line with Self-Determination Theory. Since many long-term care organisations work with self-managing teams, challenges exist at team level. Therefore, there is a need to implement an intervention aimed at maintaining and improving the sustainable employability of staff on team level.MethodsWe developed a participatory workplace intervention, the Healthy Working Approach. In this intervention teams will uncover what problems they face related to autonomy, relatedness and competence in their team, come up with solutions for those problems and evaluate the effects of these solutions. We will evaluate this intervention by means of a two-arm randomized controlled trial with a follow-up of one year. One arm includes the intervention group and one includes the waitlist control group, each consisting of about 100 participants. The primary outcome is need for recovery as proxy for sustainable employability. Intervention effects will be analysed by linear mixed model analyses. A process evaluation with key figures will provide insight into barriers and facilitators of the intervention implementation. The Ethical Committee Social Sciences of the Radboud University approved the study.DiscussionThis study will provide insight in both the effectiveness, and the barriers/facilitators of the implementation process of the Healthy Working Approach. The approach is co-created with long-term care workers, focuses on team-specific challenges, and is rooted in the evidence-based participatory workplace approach and Self-Determination Theory. First results are expected in 2022.Trial registrationNetherlands Trial Register, NL9627. Registered 29 July 2021 - Retrospectively registered.

Staff perceptions of the consequences of COVID-19 on quality of dementia care for residents in Ontario long-term care homes.

ObjectivesThe first wave of the COVID‐19 pandemic necessitated extensive infection control measures in long‐term care (LTC) and had a significant impact on staffing and services. Anecdotal reports indicate that this negatively affected LTC residents' quality of care and wellbeing, but there is scarce evidence on the effects of COVID‐19 on quality of dementia care in LTC.MethodsFrom December 2020 to March 2021, we conducted a cross‐sectional online survey among staff who worked in LTC homes in Ontario, Canada. Survey questions examined staffs' perceptions of the impact of COVID‐19 on dementia quality of care during the initial wave of the COVID‐19 pandemic (beginning 1 March 2020).ResultsThere were a total of 227 survey respondents; more than half reported both worsened overall quality of care (51.3%) and worsening of a majority of specific quality of care measures (55.5%). Measures of cognitive functioning, mobility and behavioural symptoms were most frequently described as worsened. Medical and allied/support staff had the highest odds of reporting overall worsened quality of care, while specialized behavioural care staff and those with more experience in LTC were less likely to. LTC home factors including rural location and smaller size, staffing challenges, higher number of outbreaks and less COVID‐19 preparedness were associated with increased odds of perceived worsening of quality of dementia care outcomes.ConclusionsThese findings suggest that COVID‐19 pandemic restrictions and related effects such as inadequate staffing may have contributed to poor quality of care and outcomes for those with dementia in LTC.