Long-term Care Organizations Research Articles

The role of working environment and employee engagement in person-centred processes for older adults in long-term care services

Background: Assuring high-quality, person-centred practice in long-term care organisations requires attention to the wellbeing of the staff who deliver it – a factor sometimes overlooked amid the increasing challenges such organisations confront internationally. Research has shown that job demands and job resources are distinct aspects of the working environment that interact in predicting staff wellbeing and motivation. Work engagement can serve as a means to improve job motivation and performance, and also potentially facilitates activities that operationalise person-centred practice. Aims: To explore the influence of job demands and job resources on work engagement and person-centred processes, and examine whether engagement moderates or mediates the effects of demands and resources on person-centred processes. Method: A cross-sectional survey design with standardised self-report questionnaires was used to collect data on job resources, job demands, work engagement and person-centred processes from 128 registered nurses and nursing assistants in municipal care homes and nursing homes for older adults in Norway. Findings: Both work engagement and person-centred processes were positively associated with job resources. There was no significant negative association between person-centred processes and job demands. Work engagement was neither a significant moderator nor a mediator between job resources and person-centred processes. Conclusions: Enhancing job resources for nursing staff can positively impact their work engagement and support person-centred processes. In contrast to predictions by the dominant Job Demands-Resources (JD-R) model, work engagement did not moderate nor mediate the influence of job resources on person-centred processes. Implications for practice: Providing job resources such as meaningful tasks, colleague fellowship, development and autonomy is important to enhance nursing staff’s work engagement Improving organisational and psychosocial working conditions could build an organisational culture that is favourable for person-centred processes Building a supportive working environment within long-term care organisations is strategically important to resource-efficient delivery of person-centred care

Self-reported resilience of North Carolina long-term care organizations and public health agencies in the midst of the COVID-19 pandemic

The objective of this study was to determine the self-reported resilience of North Carolina long-term care (LTC) and public health organizations while in the midst of a pandemic. Further, we correlate resilience with several organizational attributes for some insight into the types of organizations that are more resilient. Through collaboration with four LTC professional associations in North Carolina, the Benchmark Resilience Tool-13 (BRT-13) survey was disseminated to LTC leaders across North Carolina, and emailed to Public Health leaders during April 2021. The 13 survey items were divided into adaptive capacity and planning factors. Analysis of variance was used to determine whether organizational factors contributed to resiliency. A total of 142 completed surveys were received, 20 from assisted living administrators, 67 nursing home administrators, 14 from continuing care retirement community leaders, and 41 from public health officials. Average resilience, adaptive capacity, and planning were measured and analyzed against type of facility, RUCA area designation, owner type, level of debt, level of profitability, and employee satisfaction. Average resilience scores were 3.96 (SD = 0.774) for public health, 4.19 (SD = 0.725) for nursing homes, 4.22 (SD = 0.509) for assisted living, and 4.46 (SD = 0.407) for continuing care retirement communities. Results show a significant trend of higher employee satisfaction related to higher adaptive capacity, planning, and overall resilience. A key to organizational resilience in the pandemic was how well an organization cared for their employees. We must prepare before a crisis by being attentive to employee satisfaction and not lose track of employee satisfaction during the crisis. Public health agencies and LTC organizations who maintain high employee satisfaction will be more resilient.

Beyond transformational leadership in nursing: A qualitative study on rebel nurse leadership-as-practice.

Most nurse leadership studies have concentrated on a classical, heroic, and hierarchical view of leadership. However, critical leadership studies have argued the need for more insight into leadership in daily nursing practices. Nurses must align their professional standards and opinions on quality of care with those of other professionals, management, and patients. They want to achieve better outcomes for their patients but also feel disciplined and controlled. To deal with this, nurses challenge the status quo by showing rebel nurse leadership. In this paper, we describe 47 nurses' experiences with rebel nurse leadership from a leadership-as-practice perspective. In eight focus groups, nurses from two hospitals and one long-term care organization shared their experiences of rebel nurse leadership practices. They illustrated the differences between "bad" and "good" rebels. Knowledge, work experience, and patient-driven motivation were considered necessary for "good" rebel leadership. The participants also explained that continuous social influencing is important while exploring and challenging the boundaries set by colleagues and management. Credibility, trust, autonomy, freedom, and preserving relationships determined whether rebel nurses acted visibly or invisibly. Ultimately, this study refines the concept of rebel nurse leadership, gives a better understanding of how this occurs in nursing practice, and give insights into the challenges faced when studying nursing leadership practices.

How to establish workplace learning in long-term care: results from a World Café dialogue

BackgroundAs long-term care continues to change, the traditional way of learning for work purposes is no longer sufficient. Long-term care organisations need to become ‘learning organisations’ and facilitate workplace learning for nursing staff teams. Therefore, insight is needed into what conditions are important for establishing workplace learning. The aim and objective of this article is to gain insight into necessary individual, team and organisational conditions for nursing staff to enhance workplace learning in long-term care settings.MethodsThis study is a qualitative explorative study. A World Café method was used to host group dialogues in which participants (n = 42) discussed certain questions. Group dialogues were held for the nursing home and community care setting separately due to organisational differences. Nursing staff, experts in workplace learning, educational staff, client representatives and experts in the field of work and organisation in healthcare organisations were invited to a Dutch long-term care organisation to discuss questions of interest. Data were analysed using theme-based content analysis.ResultsOverall themes concerning individual, team and organisational conditions for workplace learning included: facilitating characteristics (e.g. to be given time and room for [team] development); behavioural characteristics (e.g. an open attitude); context and culture (e.g. feeling safe); cooperation and communication (e.g. giving/receiving feedback); and knowledge and skills (e.g. acquiring knowledge from each other). No major differences were found between settings.ConclusionsBy assessing the themes at the individual, team and organisational level regarding nursing staff, the current workplace learning situation, and its possible improvements, can be detected.

Perceptions on Oral Care Needs, Barriers, and Practices Among Managers and Staff in Long-Term Care Settings for Older People in Flanders, Belgium: A Cross-sectional Survey.

Background and ObjectivesThis study aimed to explore oral health perception and oral care needs, barriers, and current practices as perceived by managers and staff in long-term care organizations for older people in Flanders.Research Design and MethodsThis is a cross-sectional study where 2 questionnaires were developed, one for managers and one for caregivers, and were validated in Flemish long-term care organizations. Descriptive analyses and multivariable generalized linear models evaluated the main outcomes and their associations with determinants such as the size of the organization, the presence of an oral health policy, collaboration with a dentist, among others.ResultsA total of 145 managers and 197 caregivers completed the questionnaire. More than 50% of caregivers and managers perceived their residents’ oral health as mediocre to good. Collaboration with a dentist (B = 0.84) and oral health care involvement (B = 0.08) within the organization showed a strong association with a positive perception of oral health. Lack of time (57%) and care resistance (70%) were the most important barriers perceived by caregivers. Guidelines concerning oral care were not available or were unknown to 52% of the caregivers. Having an oral health policy within the organization was strongly associated with the correct use of guidelines for daily care of natural teeth (B = 1.25) and of dental prosthesis (B = 1.15).Discussion and ImplicationsThe results emphasize that collaborating with a dentist and the presence of an oral health policy in care organizations are important for a positive perception of the oral health of the residents and for the adoption of guidelines by caregivers and managers. In addition, training on handling care refusal should be included in the overall training. These results are crucial input for the development of a methodology for implementing a structured oral care policy in long-term care facilities.

Distancing Measures and Challenges Discussed by COVID-19 Outbreak Teams of Dutch Nursing Homes: The COVID-19 MINUTES Study.

The most severe COVID-19 infections and highest mortality rates are seen among long-term care residents. To reduce the risk of infection, physical distancing is important. This study investigates what physical distancing measures were discussed by COVID-19 outbreak teams of Dutch long-term care organizations and what challenges they encountered. The COVID-19 MINUTES study is a qualitative multi-center study (n = 41) that collected minutes of COVID-19 outbreak teams from March 2020 to October 2021. Textual units about distancing measures were selected and analyzed using manifest content analysis for the first wave: early March–early May 2020; the intermediate period of 2020: mid-May–mid-September 2020; and the second wave: late September 2020–mid-June 2021. During all periods, COVID-19 outbreak teams often discussed distancing visitors from residents. Moreover, during the first wave they often discussed isolation measures, during the intermediate period they often discussed distancing staff and volunteers from residents, and during both the intermediate period and the second wave they often discussed distancing among residents. During all periods, less often admission measures were discussed. Challenges persisted and included unrest among and conflicts between visitors and staff, visitors violating measures, resident non-adherence to measures, and staffing issues. The discussed distancing measures and corresponding challenges may guide local long-term care and (inter)national policymakers during the further course of the COVID-19 pandemic, outbreaks of other infectious diseases, and long-term care innovations.

‘’We usually choose safety over freedom’’: results from focus groups with professional caregivers in long-term dementia care

BackgroundPeople with dementia living in nursing homes are mostly sedentary, which is a consequence of various personal, environmental and organizational factors. Until now, studies on physical activity and safety in dementia have focused on residents and caregivers from the viewpoint of (individual) care provision and health benefits. There has been little to no focus on the possible influence of group dynamics between care providers with regard to physical activity and safety. The aim of this study is to gain more insight into the viewpoints and intentions of groups of professional caregivers towards safety and physical activity and the potential influence of the group-oriented setting in long-term care on physical activity of individual residents.MethodsA qualitative study comprising three focus group discussions including professional caregivers (n = 15) was conducted within two long-term care organizations in the Netherlands. Focus group discussions were structured using an interview guide derived from a preliminary framework, based on existing literature and complemented with clinical expertise.ResultsSeven themes could be derived from the focus group discussions that influence physical activity and safety: 1) Individual health and abilities; 2) Balancing physical activity and safety; 3) Physical restraints; 4) Group interests versus the individual interests; 5) Organization of care and physical environment; 6) Perceived responsibilities and tasks of professional caregivers and 7) Change is challenging.ConclusionsDue to multiple influencing factors, the balance for care providers in long-term care generally tends towards safety over physical activity. Furthermore, in order to stimulate physical activity various limitations are experienced, including the organization of care, the general health of the residents and difficulty to achieve changes in daily care. Most importantly, the group interests of both the professional caregivers and the residents have a substantial influence on the incorporation of physical activity in daily care.

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.

Activities for Residents of Dutch Nursing Homes during the COVID-19 Pandemic: A Qualitative Study.

To protect nursing home residents from getting infected with COVID-19, several measures have been imposed. The aim of this study was to describe the impact of these measures on activities for Dutch nursing home residents, the conditions under which the activities could take place, and the considerations when making decisions about the (dis)continuation of activities. The study consisted of the data of the qualitative MINUTES-study. Textual units derived from documentation of an outbreak team (OT) meetings on activities, well-being, informal caregivers, and volunteers from 39 long-term care organizations were re-analyzed using a content analysis. The results shows that OTs more often discussed restarting and continuing activities than stopping activities during the COVID-19 pandemic. There were differences between time periods, but activities never completely stopped according to the minutes. Activities were offered in an adapted way, often under certain conditions, such as organizing activities at other locations (e.g., outside), with limited group size, and following specific guidelines. The main focus of the considerations made were the ability to adhere to the guidelines, the well-being of residents, ensuring safety, and balancing benefits versus risks given vaccination availability and coverage. Overall, the study showed that organizing activities for nursing home residents despite COVID-19 measures is possible.

Is the Systemic Agency Capacity of Long-Term Care Organizations Enabling Person-Centered Care during the COVID-19 Pandemic? A Repeated Cross-Sectional Study of Organizational Resilience.

The COVID-19 pandemic has strained long-term care organization staff and placed new demands on them. This study examines the role of the general ability and power of a long-term care organization to act and react collectively as a social system, which is called systemic agency capacity, in safeguarding the provision of person-centered care during a crisis. The question of how the systemic agency capacity of long-term care organizations helps to ensure person-centered care during the pandemic is an open research question. We conducted a pooled cross-sectional study on long-term care organizations in Germany during the first and second waves of the pandemic (April 2020 and December 2020–January 2021). The sample consisted of 503 (first wave) and 294 leaders (second wave) of long-term care organizations. The top managers of these facilities were asked to report their perceptions of their facility’s agency capacity, measured by the AGIL scale, and the extent to which the facility provides person-centered care. We found a significant positive association between the leaders’ perceptions of systemic agency capacity and their perceptions of delivered person-centered care, which did not change over time. The results tentatively support the idea that fostering the systemic agency capacity of long-term care organizations facilitates their ability to provide quality routine care despite environmental shocks such as the COVID-19 pandemic.

Ambulophobia as a Specific Phobia-Defining the Problem Among Patients of Long-Term Care Facilities in Poland.

BackgroundAmbulophobia is a type of specific phobia that involves a fear of walking. This phobia mainly affects older people, who prefer not to leave their bed or home to avoid walking on uneven surfaces and reduce the risk of falling. The problem seems to be very important in terms of public health and the organization of long-term care, as Poland has one of the highest rates of elderly population growth.ObjectivesThe aim of the study was to determine the prevalence of ambulophobia among patients of long-term care facilities in Poland and to identify factors increasing the risk of this specific phobia in the study group.Material and MethodsThe study was conducted between January and July 2021. Data collected from 379 patients of 16 long-term care facilities located in Poland were analyzed. The study used the diagnostic criteria for specific phobias according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, and standardized questionnaires such as MMSE, GDS-16, DOS and ADL. The χ2 test was used to test the significance of differences (p = 0.05).ResultsThe prevalence of ambulophobia in the study group was 30.1%. Ambulophobia significantly more often concerned the female sex (37.7%) and people over 70 years of age (42,1%). Factors such as depression, Parkinson's disease, orthostatic hypotonia, a history of falling or being a witness to another person falling, and disability of at least a moderate degree increased the likelihood of ambulophobia.ConclusionsBased on the obtained results, it was found that the protective factors in the development of ambulophobia are male sex, younger age, high independence, fewer drugs used per day and no previous falls or seeing another person fall.

Seeding a Revolution Post-COVID: Equipping Staff in Long-Term Care to Integrate Palliative Care (FR267)

Outcomes 1. Recognize opportunities in existing long-term care workflows to assess for palliative care or hospice needs and trigger palliative care consultation 2. Describe four key palliative care services that long-term care professionals can be taught and incorporate into their own practice, including timely referral to palliative care or hospice 3. Devise strategies to improve collaborations with long-term care providers in their own communitiesIt is estimated that the majority of people receiving long-term care services have unmet palliative care needs, and for those near the end of life, hospice care remains underused. These disparities were highlighted during the COVID-19 pandemic, and now many long-term care programs and facilities are eager to address the palliative care needs of their patients or residents and avoid unnecessary hospital transfers, but they need to understand this in a way that aligns with their own priorities and operations.Two recent initiatives have provided education, resources, and peer learning to groups of long-term care providers, to expedite the integration of palliative care in long-term care settings. One learning collaborative was led by a local health system aiming to improve outcomes for patients in their community, and one was led by a national organization to improve end-of-life experiences in Programs of All-inclusive Care for the Elderly (PACE) nationwide. Common to both efforts was targeted education, focused on proactively identifying people in need of palliative care and how to incorporate this identification into existing workflows; holding effective goals of care and advance care planning conversations; managing physical and psychosocial symptoms; and facilitating referral to palliative care specialty teams or hospice, as appropriate. Note that creating a strong identification process can be instrumental in ensuring equitable access to palliative care for all populations, especially Black, Indigenous, and other people of color.This session shares the lessons learned from these two initiatives, providing insights for both hospital-based and hospice-based palliative care programs to bolster capabilities as well as timely referrals from the long-term care organizations in their own communities. The session ends with an exercise to help attendees devise their own efforts.

Creating Trauma-Informed Long-Term Care Organizations

Creating Trauma-Informed Long-Term Care Organizations

Self-Reported Resilience of North Carolina Long-Term Care Organizations and Public Health Agencies in the Midst of the COVID-19 Pandemic

Self-Reported Resilience of North Carolina Long-Term Care Organizations and Public Health Agencies in the Midst of the COVID-19 Pandemic

Stigma of Dementia During COVID-19: First Insights From a Twitter Study

To evaluate the feasibility of delivering the Live Long Walk Strong (LLWS) rehabilitation program among community dwelling, mobility limited older Veterans in the VA Boston Healthcare System. Community dwelling Veterans 50 years and older identified as being at high risk for mobility decline based on self-report task modification and AM-PAC mobility questions. All Veterans received 10 sessions over 8 weeks of LLWS Physical Therapy care focusing on novel impairments related to mobility decline and behavioral change strategies. Sessions were delivered 1:1 with a Physical Therapist over 45 minutes. To assess feasibility, we tracked recruitment and retention metrics. We assessed length of each session, number of sessions attended, and any reason for withdrawal. To examine technological feasibility, we recorded number and type of issue along with resolution of the issue. A total of 178 Veterans were contacted to participate. Twenty Veterans were enrolled into the LLWS virtual pilot between October 2020 – May 2021. Among our 20 enrolled, 5 did not complete the program. Reasons for not completing included: being enrolled in another exercise study simultaneously and non-related medical complications. Among those completing, an average of 9.7 out of 10 intervention sessions were completed. An average of 1.8 technology difficulties per Veteran was experienced within the intervention. The most frequent technology issues experienced were related to camera positioning and Wi-Fi bandwidth resulting in delayed video and audio. LLWS is feasible to deliver as a virtual mode of care in middle and older aged Veterans at high risk for mobility decline.

Better Brain Health through Equity: Addressing Health and Economic Disparities in Dementia

Dementia disproportionately impacts the health and financial security of women and certain minority groups. Long-standing inequities create distrust of the medical system, fewer treatment options, and reduced access to care. Research predicts that from 2020 to 2060, the number of African Americans and Latinx living with dementia will grow by nearly 200 percent and 440 percent, respectively, while prevalence among non-Hispanic Whites will increase by 69 percent. As the prevalence of dementia rises, so will the costs associated with dementia care. African Americans bear 1/3 of the costs associated with dementia. And the costs for Latinx living with Alzheimer’s disease are expected to exceed $100 billion by 2060. To mitigate these growing health and economic concerns, efforts to improve dementia care must put equity front and center. This presentation highlights five actionable recommendations to build health equity by reducing disparities in dementia prevention, detection, diagnosis, and care. These recommendations center around two overarching themes: (1) Strengthening the infrastructure among health-care, long-term care, and community-based organizations to achieve greater health equity for people living with dementia and their caregivers and (2) Expanding dementia-friendly networks and workplaces in racially and ethnically diverse communities. The recommendations discussed in this presentation will offer guidance for policymakers, health services researchers, businesses, health systems, and communities to reduce the inequitable impact of dementia on African Americans and Latinx, which is even more vital amid demographic trends showing a population growing older and more racially and ethnically diverse.

LTSS Direct Care Worker Employment During COVID-19

The crisis of COVID-19 in long-term care services and supports (LTSS) has brought attention to challenges in staffing long-term care organizations, as shortages of direct care workers led to a dramatic inability to provide needed care for many residents in nursing homes and other residential care settings. In this study, we examine unemployment among LTSS direct care workers during the crisis and recovery. This study uses monthly data from January 2019 to December 2020 from the Current Population Survey, a monthly household survey collected by the Bureau of Labor Statistics, and we compare an individual’s 2019 monthly employment patterns to their 2020 monthly employment. Long-term care workers had an unemployment rate of 2.8% in April 2020, when unemployment rates in the US reached a peak; however, new unemployment among long-term care workers has not declined as consistently as in other settings. Female health care workers were significantly more likely to be unemployed compared to their male counterparts, a trend that is consistent with the overall economy, and workers who earned the lowest wages were more likely to have transitioned to unemployment. COVID-19 has added significant complexity to the provision of direct care services, making LTSS a hazardous place to work. Concerns remain about unemployment in long-term care where demand for workers remains high; additional measures need to be taken to ensure that direct care workers have the resources they need to remain employed.

Use of Benzodiazepines and Z-Drugs in Nursing Home Residents with Dementia: Prevalence and Appropriateness.

Background:Guidelines worldwide recommend restricted prescription of benzodiazepine receptor agonists (BZRAs), i.e., benzodiazepines and Z-drugs, for the treatment of dementia-associated behavioral and psychological symptoms and insomnia.Objective:To assess the prevalence and appropriateness of BZRA use among nursing home residents with dementia.Methods:This is a post-hoc analysis of BZRA prescriptions from two intervention studies on psychotropic drug use, conducted from 2016 to 2018. It includes 1,111 residents of dementia special care units from 24 Dutch long-term care organizations. We assessed the prevalence of use of continuous and as-needed BZRA prescriptions and their association with registered symptoms. Continuous BZRA prescriptions were evaluated for appropriateness, i.e., whether indication, dosage, duration, and evaluation accorded with guidelines for the treatment of challenging behavior in dementia and sleep disorders.Results:The prevalence of BZRA use is 39.2% (95% CI: 36.3%–42.0%): continuous 22.9%; only as-needed 16.3%. Combinations of preferred BZRAs and appropriate indications occur in 19.0% of continuous anxiolytic prescriptions and 44.8% of hypnotic prescriptions. Frequently registered inappropriate indications are aggression/agitation for anxiolytics (continuous: 75.7%; as-needed: 75.2%) and nighttime agitation for hypnotics (continuous: 40.3%; as-needed: 26.7%). None of the continuous prescriptions with appropriate indications were appropriate for all other items. For most of the prescriptions, duration and time to evaluation exceeded 4 weeks.Conclusion:BZRA use in nursing home residents with dementia is highly frequent. A large proportion of prescriptions do not follow the guidelines with regard to indication, exceed the recommended duration and are not evaluated in a timely manner. The discrepancy between evidence-based guidelines and daily practice calls for an exploration of factors maintaining inappropriate use.

COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study

ObjectivesNursing homes are hit relatively hard by the COVID-19 pandemic. Dutch long-term care (LTC) organisations installed outbreak teams (OTs) to coordinate COVID-19 infection prevention and control. LTC organisations and relevant...

519 - PET@home: Research protocol for a toolkit to improve care for non-residential long term care clients owning pets

BackgroundOver half of the households in The Netherlands have one or more pets. In elderly people, owning a pet is associated with a better quality of life and less loneliness, anxiety, depression and agitation. Many non-residential long term care (LTC) clients rely on support of others to take care of their pets. However, that may place a significant burden on the social support network of the LTC client. Issues relevant to keeping pets are not explicitly incorporated in the Dutch Long-term Care Act. Many LTC organizations have no instruments for care workers, clients and their family (1) to consolidate the positive role of pets for clients’ quality of life and (2) to address whether it is possible to keep the pets and to organize care accordingly.Research ObjectivesTo help care workers, clients and their family to gain insight into the role of the pets in the clients’ life and their social support network; to develop practical instruments that help making decisions about owning and caring for pets.MethodPLAN: In months 0-16, a narrative systematic review will be conducted (STUDY 1.1) on the meaning of pets for elderly people in general. A qualitative STUDY 1.2 with LTC clients, their informal carers and care professionals will validate and further explore the topic. STUDY 1.3 and 1.4 develop and (cognitively) validate work cards for interviews of clients and relatives by care providers. In months 17-29, an Experience based co-design method (STUDIES 2.1-2.3) will be used to develop the PET@home toolkit. The method includes (1) discovery interviews (10 clients and their family), (2) focus groups with healthcare providers (N = 2x6); (3) focus groups with 6-8 clients and informal and professional carers. In STUDY 3.1, potential users will pre-test the Toolkit. In months 30-34, a process evaluation (STUDY 3.2) is performed in 10-15 clients. A dissemination and an implementation plan will be developed.ConclusionsThe project will result in an innovative PET@home toolkit that will help to assess the pets role in the clients’ quality of life and support network, and will help making decisions about owning and caring for pets.