Long-term Care Leaders Research Articles

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.

Influence of Sociodemographic, Organizational, and Social Factors on the Engagement of Long-Term Care Employees

Abstract Aim. The aim of the study was to identify the most important macro-, meso-, and micro-level factors influencing work engagement and motivation for employment in long-term care (LTC) in Slovenia. Material and methods. A correlational cross-sectional survey design with a self-reported standardized online questionnaire was used among Slovenian workers (N = 452LTC). Results. The results show that LTC workers generally enjoy going to work (68%), feel enthusiasm for their work (61%), and take great pride in their work (90%). Enjoyment increases with age, and is correlated with education and position. Joy is the lowest among those working in nursing homes. However, nursing and care teams show the greatest enthusiasm for and pride in the work done. Those who believe that their work is valued by society and their family enjoy going to work more. Although income is the most important factor in leaving the LTC sector, there are no differences in work engagement regarding the level of monthly income. Over 58% of the variance in work engagement was explained by the influence of sociodemographic characteristics, social recognition, and work environment.. Conclusions. To promote employee engagement, LTC leaders should provide a better work environment and social recognition.

Post-Acute and Long-Term Care Leaders' Perspectives on Leading During COVID-19.

Post-acute and long-term care (PALTC) delivery is complex, and the COVID-19 pandemic created additional complexities. This qualitative study investigates how PALTC administrators responded to the pandemic, factors that impacted their leadership role and decision-making. Participants from North Carolina (N = 15) and Pennsylvania (N = 6) were interviewed using an interview guide containing open-ended questions. The results revealed three themes: (1) critical knowledge and competencies; (2) resources, supports and essential actions taken; and (3) psychosocial impact. The findings suggest communication and relationship building were the most useful competencies. Lack of staff was a primary stress point during and after the pandemic.

Assessing the implementation of nurse practitioner-led huddles in long-term care using the Consolidated Framework for Implementation Research (CFIR)

BackgroundThe COVID-19 pandemic created major challenges in long-term care (LTC) homes across Canada and globally. A nurse practitioner-led interdisciplinary huddle intervention was developed to support staff wellbeing in two LTC homes in Ontario, Canada. The objective of this study was to identify the constructs strongly influencing the process of implementation of huddles across both sites, capturing the overall barriers and facilitators and the intervention’s intrinsic properties.MethodsNineteen participants were interviewed about their experiences, pre-, post-, and during huddle implementation. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. CFIR rating rules and a cross-comparison analysis was used to identify differentiating factors between sites. A novel extension to the CFIR analysis process was designed to assess commonly influential factors across both sites.ResultsNineteen of twenty selected CFIR constructs were coded in interviews from both sites. Five constructs were determined to be strongly influential across both implementation sites and a detailed description is provided: evidence strength and quality; needs and resources of those served by the organization; leadership engagement; relative priority; and champions. A summary of ratings and an illustrative quote are provided for each construct.ConclusionSuccessful huddles require long-term care leaders to consider their involvement, the inclusion all team members to help build relationships and foster cohesion, and the integration of nurse practitioners as full-time staff members within LTC homes to support staff and facilitate initiatives for wellbeing. This research provides an example of a novel approach using the CFIR methodology, extending its use to identify significant factors for implementation when it is not possible to compare differences in success.

NORTH CAROLINA NURSING HOME AND PUBLIC HEALTH RESILIENCE DURING 2021 OF THE COVID-19 PANDEMIC

Abstract Since the onset of the COVID-19 pandemic many healthcare organizations have operated in a climate of uncertainty. Building resilience is one method used to survive and thrive during periods of uncertainty. Measuring an organization’s resilience (ability to prepare for, respond and adapt during time of change) allows the organization to identify its vulnerabilities and set priorities to avert negative outcomes during an untoward event. Through collaboration with four long-term care professional associations, the Benchmark Resilience Tool (BRT-13) resilience survey was disseminated to North Carolina long-term care leaders in April 2021. The BRT-13 survey was also sent to North Carolina public health officials via email during the same timeframe. The BRT-13 contains 13 resilience (RES) items divided into two factors of adaptive capacity (AC) and planning (PL) on a five-point Likert scale of strongly disagree (1) to strongly agree (5). Organizational factors surveyed included type of facility, rural-urban classification area designation, ownership type, level of debt, level of profitability, and employee satisfaction. A total of 142 completed surveys were received, 101 (71%) from long-term care leaders and 41 (28.9%) from Public Health officials. Overall average resilience scores ranged from 3.96 for public health respondents to 4.46 for continuing care retirement communities (CCRC) respondents. Analysis of Variance (ANOVA) was employed to compare the three factors (AC, PL, and RES) to the organizational factors. Resilience was significantly associated with one factor, employee satisfaction. Our findings indicate that organizations can build resilience through processes that contribute to staff satisfaction.

Maintaining Long-Term Care Administration Internship Placements and Partners in the Face Of COVID-19

Most long-term care administration programs require an internship as a graduation requirement. The [institution's] [program name] interns are highly valued by partner sites, hosting students annually. Administrators, serving as preceptors, recognize students have a solid foundational education and receive continual support from the program throughout their year-long internship. They appreciate the contributions interns make (to organizations and residents) and the opportunity to help develop future long-term care leaders.

Buoyancy Amid the Pandemic: Resilience in Rough Waters

Buoyancy Amid the Pandemic: Resilience in Rough Waters

A cross-sectional survey assessing the preparedness of the long-term care sector to respond to the COVID-19 pandemic in Ontario, Canada

BackgroundThe COVID-19 pandemic is a significant public health emergency that impacts all sectors of healthcare. The negative health outcomes for the COVID-19 infection have been most severe in the frail elderly dwelling in Canadian long-term care (LTC) homes.MethodsAn online cross-sectional survey of Ontario LTC Clinicians working in LTC homes in Ontario Canada was conducted to provide the clinician perspective on the preparedness and engagement of the LTC sector during the COVID-19 pandemic. The survey questionnaire was developed in collaboration with the Ontario Long-Term Care Clinicians organization (OLTCC) and was distributed between March 30, 2020 to May 25, 2020. All registered members of the OLTCC and Nurse-led LTC Outreach Teams were invited to participate. The primary outcomes were: 1) the descriptive report of the screening measures implemented, communication and information received, and the preparation of the respondent’s LTC home to a potential COVID-19 outbreak; and 2) the level of agreement, as reported using a five-point Likert scale), to COVID-19 preparedness statements for the respondent’s LTC home was also assessed.ResultsThe overall response rate was 54% (160/294). LTC homes implemented a wide range of important interventions (e.g. instituting established respiratory isolation protocols, active screening of new LTC admissions, increasing education on infection control processes, encouraging sick staff to take time off, etc). Ample communications pertinent to the pandemic were received from provincial LTC organizations, the government and public health officials. However, the feasibility of implementing public health recommendations, as well as the engagement of the LTC sector in pandemic planning were identified as areas of concern. Medical director status was associated with an increased knowledge of local implementation of interventions to mitigate COVID-19, as well as endorsing increased access to reliable COVID-19 information and resources to manage a potential COVID-19 outbreak in their LTC home.ConclusionsThis study highlights the communication and implementation of recommendations in the Ontario LTC sector, despite some concerns regarding feasibility. Importantly, LTC clinician respondents clearly indicated that better engagement with LTC leaders is needed to plan a coordinated pandemic response.

Honesty Is the Best Policy

Honesty Is the Best Policy

Developing Future Public Health Leaders Trained in Long-term Care Administration.

Background:America's population is rapidly aging. Long-term care leaders have not been considered part of the public health workforce. The enumeration of long-term care into the public health workforce taxonomy has not occurred. This article examines the extent of graduate public health education oriented to long-term care and provides a case study of a successful curriculum at East Carolina University (ECU).Method:Web sites displaying the curriculum of 135 graduate programs/schools accredited by the Council on Education for Public Health (CEPH) were analyzed for graduate long-term care orientation. A case-study approach was used to describe the integration of long-term care into the Master of Public Health (MPH) Health Policy Administration & Leadership concentration at ECU.Results:A review of 135 CEPH graduate MPH programs from January to July 2019 found that only 8 institutions offered graduate courses in long-term care administration. Of the 8, ECU Brody School of Medicine Department of Public Health was the only program directly linking coursework to licensure as a long-term care administrator. Program graduates total 30, which include 5 MPH students currently completing their Administrator in Training. At time of graduation, 17 students had obtained North Carolina licensure.Conclusions:Because of increases in population aging, this requires a public health workforce with skills and training in the care of older adults. Formal recognition of long-term care workers as an integral part of the public health workforce is needed. The Institute of Medicine called for this action more than a decade ago.

Decreasing preventable emergency department transfers for long-term care residents using PREVIEW-ED©.

Healthcare organizations and governments are exploring new methods to deliver cost-effective, quality care to the frail elderly. Given the projected increase in Canada's elderly population, ensuring that residents receive the right care, at the right time, in the right location is pivotal to this goal. Practical Routine Elder Variants Indicate Early Warning for Emergency Department has been developed as a quality improvement tool. Two pilot studies, one in Ontario and one in British Columbia, have shown promising results. Health leaders in acute care will benefit from improved Emergency Department (ED) utilization and less congested bed flow. Long-term care leaders can achieve fewer transfers to the ED, better quality outcomes, reduced costs from ED-acquired iatrogenic complications, enhanced communication with families, and improved staff confidence and morale. The health system benefits include reduced costs from fewer transfers and complications and enhanced collaboration between healthcare sectors.

Operationalizing person-centered care practices in long-term care: recommendations from a “Resident for a Day” experience

As the senior population continues to age, long-term care is positioned for growth and care recipients are demanding more person-centered care. While long-term care leaders may understand and believe in the value of person-centered care, sometimes operationalizing practices to ensure its delivery can be challenging. Using an ethnographic approach, over three years, 159 long-term care administrator-in-training practicum students each lived as a resident for 24 hours in a nursing home. Following the experience, using the Picker Institute’s framework, each participant identified and justified an Always Experience® – an optimal experience they believed should routinely occur for every long-term care resident. They then developed an action plan that identified several specific operational practices and measures to ensure that Always Experiences® could always occur for residents. A thematic analysis of these Always Experience® action plans was conducted. As a result, six amalgam exemplar Always Experience® action plans – for Admissions, Care Planning, Care, Dining, Activities, and Responsiveness – with desired objectives, specific operational practices, and relevant measures to evaluate outcomes were developed. These easy-to-implement action plans can help long-term care administrators put necessary practices into place to ensure they are consistently delivering high quality, patient-centered care to long-term care residents.

The need for leadership training in long-term care settings.

Purpose Globally, in 1980, approximately 5.8 per cent of the world population was 65 years old and older. By 2050, this number will more than triple to 16 per cent. From a leadership perspective, there is at least one challenge (among many others challenges) to consider. This paper (viewpoint) aims to provide support for the growing need for academically prepared managers. Design/methodology/approach This paper is a viewpoint which presents several characteristics of the long-term care (LTC) field that support the need for academically trained leaders. Findings LTC leaders in all countries must be sufficiently versed in numerous management areas to provide leadership when called on by those assigned to their care. Given local area variations in population needs present across all countries, it may be unwise to advocate for national, countrywide standardization of requirements. Yet, older adults accessing LTC services should expect a minimum level of knowledge from all of their providers - not just those who provide direct, hands-on care. However, similar to those who provide direct care, leaders should receive competency-based education with specific attention to effective communication skills, team-based approaches to care delivery, information technologies and population health. Originality/value Although much of the extant literature focuses on the delivery of care to older persons, there is a dearth of literature addressing the role of LTC leaders in light of global aging. Establishing a minimum level of academic training and increasing transparency focused on the positive experiences of elders residing in LTC facilities should help dispel the notion that placement in an LTC facility reflects filial failure.

Short- and Long-Term Effects of Workshop-Style Educational Program on Long-Term Care Leaders’ Attitudes toward Facility End-of-Life Care

Background: Although the proper training of caring staff is required, very few studies have actually focused on the effects of caring staff educational programs on end-of-life care at long-term care facilities. The aim of the present study was to test a pilot caring staff education program emphasizing quality end-of-life care for elderly residents at long-term care facilities. Method: The workshop program was designed by an expert panel made up of long-term care educational leaders from 8 selected long-term care facilities. The topics of the program were: (1) definition of end of life of the elderly, (2) signs and symptoms of imminent death, (3) advanced care planning, (4) issues related to tube feeding, (5) communication with family members of end-of-life residents, (6) communication with bed-ridden elderly, and (7) staff education concerning key elements in the provision of end-of-life care for elderly residents. Study questionnaires were administered to participants both before and after the educational intervention. The questionnaires included two major sets of questions: the Frommelt Attitude toward Care of the Dying scale, Form B, Japanese version and the Death Attitude Inventory. Six months after the intervention, the same questionnaire was mailed to the participants. Result: A total of two hundred and forty seven care leaders participated in the program. Two hundred and forty care leaders completed pre- and post-questionnaires. Out of these, 226 completed a follow-up questionnaire six months after the program. Our six month follow-up data confirms improvements in the participants’ attitudes toward end-of-life care provision at long-term care facilities. Our data also indicates an improved outlook on caring for the dying patient and the maintenance of a positive perception of patient- and family-centered care. Conclusion: Our workshop-style educational program had positive short- and long-term effects on long-term care leaders’ attitudes toward facility end-of-life care.

A Qualitative Study of Long-term Care Leaders’ Experiences of End-of-Life Care Provision at Long-term Care Facilities in Japan

Several studies have highlighted the fact that long-term care facilities and caring staff are not ready for quality endof- life care provision. The present study is aimed at shedding light on how caring staff provide care at the end of life and the emotions they experience in the provision of this care. Study participants were 4 long-term care leaders from different long-term care facilities. The subject for focus group discussion was end-of-life care at long-term care facilities. We used the KJ method (Kawakita Jiro’s initials) as a qualitative research tool, which is widely employed in Japan. The emotions and experiences were organized into 9 groups (including 2 loner labels): 1) Active family involvement is important to successful end-of-life care; 2 Caring staff want to provide end-of-life care with compassion as well as logic; 3 Caring staff would rather avoid facing death or dealing with dying residents; 4 Caring staff are at a loss as to how to behave around the time of a resident’s death; 5) There are language and psychological communication barriers among members of the end-of-life care team; 6) Caring staff get used to death through repetition; 7) End-of-life care for the elderly is challenging work. The loner labels were “A person who can remain calm and collected when facing the death of a resident” and “There are no complete manuals on providing end-of-life care due to the diversity in dying processes of elderly residents”. The present study reveals that long-term care leaders require a person who is able to remain composed in a demanding and emotional end-of-life care environment. Also, they thought that such a cool-headed person is best suited to tend to the needs of caring staff and residents’ family and to promote communication among end-of-life care team.

Collaboration Can Redefine Long-Term Care

Collaboration Can Redefine Long-Term Care

Factors Affecting Electronic Health Record Adoption in Long-Term Care Facilities

Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers.

Call to Improve LTC Leadership Development

Call to Improve LTC Leadership Development

National Leadership Summit Promotes Consumer-Driven Options in LTC

National Leadership Summit Promotes Consumer-Driven Options in LTC

Paradigm Shift Has Implications for Leaders

Paradigm Shift Has Implications for Leaders