Long-term Care Experience Research Articles

The End-of-Life Experience in Long-Term Care: Five Themes Identified From Focus Groups With Residents, Family Members, and Staff

We designed this study to examine the end-of-life (EOL) experience in long-term care (LTC) based on input from key stakeholders. The study consisted of 10 homogeneous focus groups drawn from a purposive sample of LTC residents (2 groups; total n = 11), family caregivers (2 groups; total n = 19), paraprofessional staff (3 groups; total n = 20), and licensed/registered staff (3 groups; total n = 15) from five nursing homes and eight residential care/assisted living communities in North Carolina. We analyzed data by using grounded theory techniques to elicit manifest and latent themes. Five overarching themes emerged: (a) components of a good death in LTC, (b) normalcy of dying in LTC, (c) the role of relationships in the provision and receipt of care, (d) hospice contributions to care at the EOL in LTC, and (e) stakeholder recommendations for enhancing EOL care in these settings. Underlying these themes was one central category, closeness, based on physical proximity and frequency of contact. Findings suggest that promoting collaborative relationships among the four stakeholder groups, increasing social worker involvement, and removing barriers to hospice may enhance the EOL experience in LTC.

The End-of-Life Experience in Long-Term Care: Five Themes Identified From Focus Groups With Residents, Family Members, and Staff

The End-of-Life Experience in Long-Term Care: Five Themes Identified From Focus Groups With Residents, Family Members, and Staff

Geropsychology practice: One psychologist's experience in long-term care.

Geropsychology practice: One psychologist's experience in long-term care.

Long-term Care: Preparing Students for Clinical Practice

Katalanos, Nikki PhD, PA-C1; Barcega, Jose MHS, PA-C2; Kinzel, Julie MEd, PA-C2 Author Information

Measuring the Quality of Dying in Long‐Term Care

To describe two versions of a new measure, The Quality of Dying in Long-Term Care, for postdeath administration to surrogate respondents (staff and family caregivers) of all decedents (QOD-LTC) and of cognitively intact decedents (QOD-LTC-C) who die in nursing homes (NHs) and residential care or assisted living (RC/AL) facilities. Using two levels of exploratory factor analysis, 15 candidate items for the QOD-LTC and 36 candidate items for the QOD-LTC-C were tested using multiple criteria to determine factor structure and interpretability of the quality of dying in long-term care (LTC). One hundred seventeen RC/AL facilities and 31 NHs in FL, MD, NC, and NJ. Family (n=439) and staff (n=332) caregivers of 633 decedents from a stratified random sample from RC/AL facilities and NHs in four states. Trained interviewers asked respondents to rate statements describing potentially important aspects of the quality of dying using a 5-point Likert scale. The scale items were analyzed using exploratory factor analysis with communalities set to unity using a Promax rotation. The 11-item QOD-LTC (alpha=0.66), appropriate for surrogate respondents for all decedents, consists of three domains (personhood, closure, preparatory tasks). The 23-item instrument for surrogate respondents of cognitively intact decedents, the QOD-LTC-C (alpha=0.85), consists of five domains (sense of purpose, closure, control, social connection, preparatory tasks). The QOD-LTC and QOD-LTC-C are psychometrically acceptable measures of the quality of the dying experience, developed for and tested in LTC settings. Use of these measures can increase understanding of the dying experience in LTC.

Nurses' experiences of practice and political reform in long-term aged care in Australia: implications for the retention of nursing personnel

The aim of the study was to explore registered nurses' experiences in long-term aged care in light of the political reform of aged care services in Australia. In Australia, the aged care industry has undergone a lengthy period of political and structural reform. Despite reviews into various aspects of these reforms, there has been little consideration of the effect these are having on the practice experiences and retention of nursing staff in long-term care. In this critical hermeneutic study, 14 nurses from long-term care facilities in Australia were interviewed about their experiences during the reform period. The data revealed a sense of tension and conflict between nurses' traditional values, roles and responsibilities and those supported by the reforms. Nurses struggled to re-negotiate both their practice roles and values as the reforms were implemented and the system evolved. Nursing management support was an important aspect in mediating the effect of reforms on nursing staff. This research highlights both the tensions experienced by nurses in long-term aged care in Australia and the need to re-negotiate nursing roles, responsibilities and values within an evolving care system. This research supports a role for sensitive and proactive nursing management during periods of industry reform as a retention strategy for qualified nursing personnel.

Being a man in long term care

Purpose Men tend to represent a distinct minority in long term care (LTC) facilities. Here we explore men's seldom examined experience in LTC. Design and methods As part of a major study of Bereavement in Long Term Care, we focus on 21 men who live in five LTC facilities (assisted living facilities and nursing homes). Transcribed qualitative, in-person interviews are examined using standard qualitative analytic methods. Results Through multiple rounds of coding three inter-related themes emerged as salient. (1) Men's work experience as central to their sense of identity. (2) The presence of a wife often is associated with men's sense of couplehood and of feeling protective. (3) Men often regulate their relationships with other LTC residents. Implications Discussion examines how these three themes are related to men's maintenance of a masculine role in LTC.

Searching for value: The influence of policy and reform on nurses’ sense of value in long‐term aged care in Australia

Contemporary literature on long-term aged care focuses heavily on issues associated with the recruitment and retention of nursing staff, such as job satisfaction and attitudes towards caring for older people. This paper aims to highlight one aspect of a larger study of registered nurses' experiences in long-term aged care in Australia and the influence that government policy and reform has in shaping that experience. This insight into aspects of nurses' everyday experience also contributes to a broader understanding of job satisfaction in long-term care. Findings from this study suggest that registered nurses experience tension in their search for value in their practice, which incorporates professional, political and social mediators of value and worth. These issues are discussed in relation to the impact of policy and reform on nurses' sense of value in long-term aged care and highlight the need for sensitive policy initiatives that support issues of value in nursing practice.

A Call to Improve Part D Implementation

A Call to Improve Part D Implementation

A Physician’s Perspective on the Dining Experience in Long-Term Care

Unfortunately, weight loss is frequently an expected part of a patient's normal nursing home residential trajectory. However, the clinical team should determine if the weight loss is reversible. The patient's clinical condition is often such that weight loss cannot be reversed or improved. Currently, life expectancy for a patient who has been admitted to a nursing home is approximately 2.2 years. These patients have been suffering from multiple medical conditions that have ravaged their body and mind and left them in a frail condition. Food has many personal meanings to each resident that can improve the quality of a person's few remaining years. While many specialty diets are available to patients in a hospital, many of these diets may not be appropriate for patients who reside in a nursing home. Careful attention should be given to the prescription and preparation of meals in long-term care facilities. A focus on liberalizing diets in long-term care facilities can lead to improved quality of life for many patients.

Nutrition and the Dining Experience in Long-Term Care: Critical Indicators of Nursing Home Quality of Care

nursing care in particular, are at a crossroads. With the predicted growth of the older adult population, and the population of older adults who will require dementia-specific care, long-term care facilities face a probable and rapid increase in the need and demand for skilled nursing services. In fact, the number of adults over the age of 65 in nursing facilities* is predicted to double by 2020. Currently, there are 16,032 nursing facilities in the United States with more than 1.4 million residents. In North Carolina, there are 424 nursing facilities with capacity for 42,897 residents. In the face of the changing demographics in our society, nursing facilities are re-engineering to embrace the future and successfully meet these challenges. Part of the re-engineering will involve modifications of the physical plant, new construction and innovations in technology and services to match the evolving needs of residents. This issue of the North Carolina Medical Journal focuses on one of the most salient aspects of long-term care quality—food and the dining experience (as well as hydration and fluid intake). Nutrition is one of the major determinants of successful aging and, for most, eating is one of life’s most pleasant daily experiences. In the long-term care setting, the medical-nutritional needs of nursing facility residents are often competing with the provision of “consumer-defined” quality of care. To begin with, nursing facility residents often have complex healthcare conditions that limit their function, depress their senses of taste and smell, require multiple medications, and necessitate therapeutic or mechanically altered diets. These treatments can limit independence, choice, and pleasure and, thus, have a negative effect on quality of life. In the interest of preserving both the health and happiness of their residents, long-term care facilities are trying to find a balance between the residents’ required medical treatments and personal preferences. North Carolina’s nursing facilities are finding ways to achieve this balance as they also juggle the logistic challenges of feeding large numbers people in a highly regulated industry. Many of these specific efforts are described in the commentary by Nadine Pfeiffer, BSN, RN, and her colleagues in this issue of the Journal.

Family-Based Intervention in Residential Long-Term Care

Family care for older adults is often conceptualized as a 'career,' and one of the key transitions that may occur during the course of caregiving is the placement of an older relative in a residential long-term care facility (most commonly a nursing home). This literature review critiques and synthesizes existing intervention strategies designed to promote family involvement following institutionalization. In particular, two types of family-based interventions are identified that have received scientific evaluations in the literature: group-based and family-staff partnership approaches. Specific studies on each of these types (N= 11) are summarized and critiqued. Key research and practice recommendations are also offered to guide the future evaluation of programs to assist families adapt to the long-term care experience.

A qualitative study of the experiences of long-term care for residents with dementia, their relatives and staff

Most older people living in 24-hour care settings have dementia. We employed qualitative interviews to explore positive and negative aspects of the experience of family carers, staff and people with dementia living in 10 homes in London and West Essex, selected to cover the full range of 24-hour long-term care settings. The interview used open semi-structured questions. We interviewed 21 residents, 17 relatives and 30 staff and five main themes were identified: Privacy and choice; relationships (abuse and vulnerability); activities; physical environment; and expectations of a care environment by carers, should they one day live in long-term care themselves. Despite being no longer responsible for the day-to-day care of the residents there was a continuing level of psychological distress among some relatives. We found that residents with a range of severity of dementia were able to participate. The most striking theme from their interviews was the need for choice. All groups talked about improving lines of communication amongst residents, relatives and staff and about the importance of activities. We recommend that homes should set up formal structures for engaging with user and carer views at all levels. This would mean relatives on the board, and regular meetings for residents, relatives, advocates and staff. This should lead to cultural changes where residents are perceived as individuals and care is provided in a more flexible way. There should be a programme of activities in each 24-hour care setting, which all care staff are given time to implement. These activities need to be tailored to the individual resident rather than the whole group.

Nursing Home Staff Characteristics and Knowledge Gain from a Didactic Workshop on Depression and Behavior Management

Depression is a prevalent and serious problem among nursing home residents. Nursing home staff members are gatekeepers for mental health treatment for residents, but may know little about depression and its management. We evaluated a didactic workshop for nursing home staff on depressive symptoms and management. Results for 58 staff participants showed significant gains in knowledge about depression diagnosis and management after the workshop. A regression predicting pre-test knowledge indicated that significant contributors were age (beta = .27;p < .05), education (beta = .28, p = < .05), and experience in long-term care (beta = −.53, p < .01). Results provide preliminary support for didactic training about depression, but suggest that differences in staff knowledge related to experience should be addressed in training.

Enhancing the Dining Experience in Long-Term Care

Nursing home residents nationwide are at nutritional risk as the result of physical, social and environmental factors. The Dining with Dignity program integrates long-term care residents, staff, community volunteers and occupational therapy students to improve residents nutritional intake. Volunteers are trained to provide one-on-one assistance during meals and to promote a positive dining experience as organized by the theory of Social Support. Resident satisfaction with meals and improved nutritional status are important outcomes as is volunteer commitment to the program.

AMDA Foundation Research Network

Preface: The AMDA Foundation's Long-term Care Research Network was officially launched in September 2000 and held its first annual meeting in Dallas, Texas, on November 3–4, 2001. The conference, “Uniting Practice and Research in Long-term Care,” consisted of a day and a half meeting in which participants gathered in small brainstorming sessions to generate topics for possible research projects. The participants were American Medical Directors Association members who had responded to a call to join this emerging network as well as faculty members and facilitators with research experience in long-term care and knowledge and skill in the development and maintenance of national research networks.

Long-Term Care Experience in an Internal Medicine Residency Program

To assess the impact of long- term care experience on internal medicine residents through prequestionnaires and postquestionnaires. A prospective study conducted from February 1999 to March 2000. "Daughters of Israel," a 300-bed, long-term care institution in West Orange, New Jersey. Twenty-five 3rd-year medical residents (PGY3) from Saint Barnabas Medical Center, Livingston, and Newark Beth Israel Medical Center, Newark, New Jersey, who each rotated in a long-term care setting. Medical residents completed validated questionnaires before and after their rotation. The questionnaire integrated three subcategories: self-reported skills, knowledge, and attitudes. Self-reported skills in performing: (a) Histories and physicals increased from mean of 3.65 to 4.48 (1 = low; 5 = high). P < 0.0005; (b) Functional assessment from mean of 3.47 to 4.53, P < 0.0005; and (c) Advance directive discussion from 3.78 to 4.37, P < 0.0005. All self-reported measures of knowledge in geriatrics increased significantly. All self-reported measures of attitudes toward the elderly also improved significantly. Career choice of geriatrics was not significantly altered by this experience. There was improvement in self-reported skills, knowledge, and attitudes for medical residents completing a rotation in the nursing home. These conclusions were based on validated questionnaires and prospective data. Our results support recommendations by the American Medical Directors Association (AMDA)the American Geriatric Society (AGS) to include the long-term care setting as a site for the geriatric education of medical residents.

Long-Term Care Experience in an Internal Medicine Residency Program

Long-Term Care Experience in an Internal Medicine Residency Program

Physicians Reflect on Their Lived Experiences in Long-Term AIDS Care

Throughout the history of the acquired immunodeficiency syndrome (AIDS) epidemic, the theoretical and empirical literature has emphasized the stressors related to the care of patients with AIDS, and the reluctance of health professionals, including physicians, to provide care to patients with AIDS. However, from the beginning, there have been individuals who have dedicated themselves to the care of patients with AIDS. This descriptive, qualitative study explores the perceptions and experiences of five physicians, specializing in AIDS care, within a large medical center in New York City. Using principles of qualitative data analyses set forth by Carini, the data reveal important themes related to how they became involved in AIDS care; the stresses associated with AIDS caregiving and ways of coping; the rewards of AIDS care; aspects of the physician-AIDS patient relationship and patient characteristics that promote their willingness to care; and recommendations to fellow physicians in caring for patients with AIDS. From what they have said, and not said, palliative care clinicians, educators, and administrators can learn ways of promoting physicians' caregiving potential, and understand the value and intimacy of the physician-patient relationship, particularly within the context of life-threatening illness. This has further implications in promoting the quality of care offered to patients with AIDS and to all patients with an incurable illness, as well as insuring "safe passage" for patients and for the physicians committed to their care.

Self-protection in adolescents in foster care.

Adolescents in long-term foster care experience significant health and mental health problems. Little is known about their perceptions of the impact of foster care. Seventeen adolescents were interviewed in their foster group homes. Dimensional analysis was used to develop theory on the impact of foster care. Adolescents in foster care engaged in self-protection strategies secondary to experiences of devaluation and uncertainty in foster care, including guarding foster child status, maintaining a defensive posture, distancing self, and keeping relationships superficial. Self-protection resulted in a veneer of self-reliance and social detachment. Strategies are suggested to address devaluing experiences and promote positive identity development in foster care.