Long-term Care Organizations Research Articles

Preventive Resilience: The Role of Long-Term Care Organizations’ Collective Agency Capacity

Abstract Background The COVID-19 pandemic has intensified pressure on healthcare organizations (HCOs), particularly long-term care organizations (LTCOs. An HCO’s resilience is closely linked to its proactive ability to address and manage both novel and persistent stressors. This proactive approach, termed ‘preventive resilience,’ involves preemptively averting stressors to safeguard the organization’s resilience mechanisms. Objectives The aim of this presentation is to examine the hypothesis asserting that preventive resilience is, to a significant extent, nurtured by the collective capacity of a Long-Term Care Organization (LTCO) to act and react as a cohesive social system. This collective agency capacity of an LTCO is posited to play a pivotal role in fortifying preventive resilience of HCOs. Methods We conducted a pooled cross-sectional study on long-term care organizations in Germany during the initial (April 2020) and subsequent waves of the pandemic (December 2020-January 2021). Our sample comprised 503 leaders during the first wave and 294 leaders during the second wave from various long-term care organizations. The study involved top managers of these facilities reporting their perceptions of the collective agency capacity of the LTCO, assessed using the AGIL short scale. Additionally, they were asked to gauge the facility’s exposure to both general non-pandemic demands and pandemic-specific demands. Results We discovered a notable inverse relationship between leaders’ perceptions of the collective agency capacity within their Long-Term Care Organizations (LTCO) and their assessments of general demands. However, no significant association was observed between the agency capacity and the magnitude of pandemic-specific demands. Conclusions The findings tentatively endorse the notion that cultivating the collective agency capacity of nursing facilities enhances their resilience to familiar general demands, particularly during periods of exceptional stress. Key messages • Cultivating the collective agency capacity of nursing facilities enhances their resilience to familiar general demands. • The collective capacity to act and react in a cohesive way is a general resistance resource of healthcare organizations.

Antimicrobial resistance and infection prevention in care for people with intellectual disabilities

Abstract Background Antimicrobial resistance (AMR) has become one of the major public health threats worldwide. However, little is known about antimicrobial resistance and infection prevention and control (IPC) in long-term care facilities for people with intellectual disabilities. This study aims to assess knowledge, attitudes and perceptions towards AMR and IPC among healthcare professionals working in long-term care facilities for people with intellectual disabilities (ID-LTCFs) in the Netherlands. Methods We conducted a web-based cross-sectional survey study among medical and nonmedical trained healthcare professionals working in ID-LTCFs in the Netherlands. The survey study was carried out between July and November 2023 and consisted of validated survey items expanded with expert opinion and setting-specific items. Results In total, 109 medical and nonmedical trained healthcare professionals working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. Overall, knowledge levels about AMR and IPC differed between medical and nonmedical trained healthcare professionals working in ID-LCTFs, with medically trained professionals having a significant overall higher score on both topics. Knowledge regarding the perceived protective value of glove use was found to be insufficient. Moreover, healthcare professionals expressed a need for easy-to-read resources and tailored setting-specific information on AMR and IPC targeting both healthcare professionals as well as people with disabilities. Conclusions There is room for improvement regarding setting-specific IPC and hygiene policies, such as appropriate glove use in ID-LTCFs. As nonmedically trained professionals comprise most of the workforce within this setting, it is important to further tailor follow-up studies to the underlying factors that influence knowledge, attitudes and perceptions of these specific professionals within ID-LTCFs. Key messages • Developing setting and context-specific policies for infection prevention and control is crucial, particularly in long-term care facilities for people with intellectual disabilities. • Inclusive policy-making is key to combating antimicrobial resistance, and improving infection prevention and control in long-term care facilities for people with intellectual disabilities.

Towards Regional Population Health Management: A Prospective Analysis Using the Adjusted Clinical Groups Classification.

This research seeks to assess the potential of regionally integrated health management for specific sub-populations, including the incorporation of self-management initiatives. It will achieve this by conducting a thorough stratification analysis of hospital data, utilizing the Adjusted Clinical Groups (ACG) classification system. The approach involves a retrospective review of healthcare data spanning five years, which includes patient demographics, health outcomes, and healthcare utilization metrics. We intend to use the ACG method to classify the patient population into pertinent groups that mirror their health requirements and resource use. The insights obtained from this analysis will be used to create a localized adaptation of the Kaiser Permanente Pyramid Model of Care. This adaptation aims to identify the distribution of costs among patients treated in the Rivierenland Hospital. We anticipate that stratifying data with the ACG method will identify distinct multimorbid subgroups. These subgroups will have unique healthcare requirements. Early interventions and customized health management strategies, based on these insights, could enhance health outcomes and resource efficiency for high-risk patients. This analysis will serve as a foundation for constructive discussions with hospital management and clinical staff, fostering a deeper comprehension of the patients' burden of disease. It might also foster multidisciplinary collaboration opportunities between medical specialties as with regional healthcare partners such as general practitioners (GPs), mental health and other long-term care organizations. Moreover, we anticipate that self-care initiatives, supported by customized health information, will encourage increased patient engagement and strategies for enhancing lifestyle improvements. This strategy is expected to enable the personalization of advanced care planning based on individual needs profiles, thereby improving the management of complex and chronic conditions, and encouraging self-care practices. Our anticipated findings highlight the potential benefits of a data-informed approach to advancing healthcare outcomes and present opportunities for future investigations to refine and implement such integrated care models across the region.

"We just take care after each other": Relational health strategies of nurses and nursing aides working in residential long-term care as a mechanism of in- and exclusion in care teams.

The health of care workers in residential long-term care (LTC) is under pressure. Scholars emphasize the importance of gender-sensitive and intersectional approaches to occupational health. To unravel how the health of nurses and nursing aides is shaped by gender, class, age, sexuality and race. A qualitative participatory study. A participatory research team, consisting of academic scholars and nursing aides, conducted semi-structures interviews (N = 20) and one natural group discussion (N = 8 participants) to validate our findings. Thematic data-analysis was guided by gender and intersectionality theory. Empirical findings suggest that gendered norms limit possibilities for self-care for female nurses and nursing aides. Feeling uncared for by society and LTC organizations, paid care workers describe how they take care of each other. These relational health strategies require a feeling of sameness, limiting space for diversity and disability within care teams. Care workers seen as 'cultural other', or those who experienced (chronic) health issues, financial struggles or informal caregiving, risked being excluded from relational care within care teams, which negatively impacted their health. Care workers' relational health strategies are a gendered and care ethical response to the lack of societal and political care for LTC, but can become mechanisms of exclusion within care teams. This can be understood as a sign of exhaustion, shaped by adverse working conditions and leading to moral stress. The lack of societal appreciation needs to be addressed by occupational health physicians and LTC organizations, to counter mechanisms of exclusion among paid care workers.

Mind the gap: knowledge, attitudes and perceptions on antimicrobial resistance, antimicrobial stewardship and infection prevention and control in long-term care facilities for people with disabilities in the Netherlands

BackgroundAntimicrobial resistance (AMR) has become one of the major public health threats worldwide, emphasizing the necessity of preventing the development and transmission of drug resistant microorganisms. This is particularly important for people with vulnerable health conditions, such as people with intellectual disabilities (ID) and long-term care residents. This study aimed to assess the current status of AMR, antimicrobial stewardship (AMS) and infection prevention and control (IPC) in Dutch long-term care facilities for people with intellectual disabilities (ID-LTCFs).MethodsA web-based cross-sectional survey distributed between July and November 2023, targeting (both nonmedically and medically trained) healthcare professionals working in ID-LTCFs in The Netherlands, to study knowledge, attitudes and perceptions regarding AMR, AMS and IPC.ResultsIn total, 109 participants working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. The knowledge levels of AMR and IPC among nonmedically trained professionals (e.g., social care professionals) were lower than those among medically trained professionals (p = 0.026). In particular regarding the perceived protective value of glove use, insufficient knowledge levels were found. Furthermore, there was a lack of easy-read resources and useful information regarding IPC and AMR, for both healthcare professionals as well as people with disabilities. The majority of the participants (> 90%) reported that AMR and IPC need more attention within the disability care sector, but paradoxically, only 38.5% mentioned that they would like to receive additional information and training about IPC, and 72.5% would like to receive additional information and training about AMR.ConclusionAlthough the importance of AMR and IPC is acknowledged by professionals working in ID-LTCFs, there is room for improvement in regards to appropriate glove use and setting-specific IPC and hygiene policies. As nonmedically trained professionals comprise most of the workforce within ID-LTCFs, it is also important to evaluate their needs. This can have a substantial impact on developing and implementing AMR, AMS and/or IPC guidelines and policies in ID-LTCFs.

A Nurse Practitioner-Driven Palliative and Supportive Care Service in Nursing Homes: Evaluation of a Quality Improvement Project.

This article describes a quality improvement project implemented by a national postacute long-term care organization aimed at enhancing the provision of palliative care to nursing home residents. The project focused on improving advance care planning, end-of-life care, symptom management, and care of people living with serious illness. Both generalist and specialist palliative care training were provided to nurse practitioners in addition to implementing a system to identify residents most likely to benefit from a palliative approach to care. To evaluate the nurse practitioner experiences of the program, survey data were collected from nurse practitioners (N = 7) involved in the project at 5 months after implementation. Nurse practitioners reported the program was well received by nursing home staff, families, and residents. Most nurse practitioners felt more confident managing residents' symptoms and complex care needs; however, some reported needing additional resources for palliative care delivery. Most common symptoms that were managed included pain, delirium, and dyspnea; most common diagnoses cared for were dementia and chronic organ failure (eg, cardiac, lung, renal, and neurological diseases). In the next steps, the project will be expanded throughout the organization, and person- and family-centered outcomes will be evaluated.

Sustainable employability of long-term care staff in self-managing teams: A qualitative study.

To discover what long-term care (LTC) staff working in self-managing teams consider necessary to remain sustainably employable. Qualitative study with semi-structured interviews. In 2020, semi-structured interviews were conducted one-on-one with 25 LTC workers from a medium-large Dutch organization providing long-term care. All interviews were audio-recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti. LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence. In order to remain willing and able to work, LTC workers in self-managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs. It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs. A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self-managing teams in LTC organizations, understanding what workers in self-managing teams need in order to remain sustainably employable is crucial. For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs. The outcomes of this study primarily impact workers and management within LTC organizations with self-managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector. The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used. Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study.

The Diversity Compass: a clinical ethics support instrument for dialogues on diversity in healthcare organizations

BackgroundIncreasing social pluralism adds to the already existing variety of heterogeneous moral perspectives on good care, health, and quality of life. Pluralism in social identities is also connected to health and care disparities for minoritized patient (i.e. care receiver) populations, and to specific diversity-related moral challenges of healthcare professionals and organizations that aim to deliver diversity-responsive care in an inclusive work environment. Clinical ethics support (CES) services and instruments may help with adequately responding to these diversity-related moral challenges. However, although various CES instruments exist to support healthcare professionals with dealing well with morally challenging situations in healthcare, current tools do not address challenges specifically related to moral pluralism and intersectional aspects of diversity and social justice issues. This article describes the content and developmental process of a novel CES instrument called the Diversity Compass. This instrument was designed with and for healthcare professionals to dialogically address and reflect on moral challenges related to intersectional aspects of diversity and social justice issues that they experience in daily practice.MethodsWe used a participatory development design to develop the Diversity Compass at a large long-term care organization in a major city in the Netherlands. Over a period of thirteen months, we conducted seven focus groups with healthcare professionals and peer-experts, carried out five expert interviews, and facilitated four meetings with a community of practice consisting of various healthcare professionals who developed and tested preliminary versions of the instrument throughout three cycles of iterative co-creation.ResultsThe Diversity Compass is a practical, dialogical CES instrument that is designed as a small booklet and includes an eight-step deliberation method, as well as a guideline with seven recommendations to support professionals with engaging in dialogue when they are confronted with diversity-related moral challenges. The seven recommendations are key components in working toward creating an inclusive and safe space for dialogue to occur.ConclusionsThe Diversity Compass seeks to support healthcare professionals and organizations in their efforts to facilitate awareness, moral learning and joint reflection on moral challenges related to diversity and social justice issues. It is the first dialogical CES instrument that specifically acknowledges the role of social location in shaping moral perspectives or experiences with systemic injustices. However, to make healthcare more just, an instrument like the Diversity Compass is not enough on its own. In addition to the Diversity Compass, a systemic and structural approach to social justice issues in healthcare organizations is needed in order to foster a more inclusive, safe and diversity-responsive care and work environment in health care organizations.

SCIENCE AND CARE PARTNERSHIPS: THE ROLE OF THE SCIENTIFIC LINKING PIN RESEARCHER

Abstract Background Science and care partnerships work on promoting quality of life, care and work in long-term-care (LTC) settings. The Scientific Linking Pin (SLP) is an academic employed by a university and works one day per week in a LTC organisation. The SLP role is pivotal to the success of partnerships; the nature of this role has not yet been captured. Methods Fifteen SLPs took part in semi-structured interviews. Data were thematically analysed. Results Data are presented over two themes. The first theme, the SLP experience, outlines that SLPs have rich insights into what matters to, and the challenges experienced in LTC organisations. SLPs are well positioned to impact practice, and develop their professional careers. SLPs do experience doubts and insecurities and require mentorship/supervision. The second theme, navigating in a SLP role, outlines the multifaceted tasks involved: relationship building, raising awareness, identifying priorities, generating research questions, building committees, brokering knowledge, developing research studies, generating academic output, building links and connections, and assisting with internal projects. The challenges SLPs face in their work include mistrust and poor engagement from care staff, working with staff from different professional backgrounds, research not being a priority, multiple and rapidly changing priorities, and differences in expectations. Relationship building, creating a ‘safe’ space for care staff, building engagement, and expectation management helped to address these challenges. Conclusion Partnership working in the care sector is gaining international recognition and adoption. This study described one key role that contributes to the success of the partnership model: the SLP.

FOSTERING CONSISTENT AND ENGAGING CARE FOR PEOPLE WITH DEMENTIA IN LONG-TERM CARE

Abstract Maintaining a stable and qualified direct care workforce in long-term care organizations has become increasingly difficult as shortages intensify, turnover increases, and the use of agency staff remains at high levels. Efforts to improve this situation need to include high quality training that is incorporated into onboarding, ongoing continuing education, and infused into the culture of the organization. Using data from our ongoing NIA-funded study, “Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia,” we describe the competencies used by direct care workers (DCWs) with exceptional capacity, or ability and resources to engage people with dementia, and the factors that promote or limit the development and use of these competencies. Focal residents with dementia (N=66) were followed at eight diverse assisted living communities for one year and 53 DCW were interviewed across three waves of data collection. Interview transcripts and fieldnotes from more than 2000 hours of observation were analyzed using a grounded theory approach. Organized by four engagement approaches: knowing the person, connecting with and meeting people where they are, being in the moment, and viewing all encounters as opportunities, we identified competencies and the multiple intersecting factors which impact meaningful engagement and competency development including community staffing, consistent assignment, scheduling, DCW training, DCW tenure, and community resources. Implications for practice, which emphasize the elaboration of specific competencies, have the potential to inform the development of DCW training, the promotion of supportive work environments, and social policy that support person-centered dementia care.

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

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

DEVELOPMENT OF AN EVIDENCE-BASED FRAMEWORK FOR INNOVATION READINESS OF LONG-TERM CARE ORGANIZATIONS

Abstract Increasing innovation readiness of long-term care organizations is vital to ensure future provision and affordability of care delivery. Against this background, there is a need to obtain more insight into the factors that may lead to innovation readiness of long-term care organizations. Therefore, we conducted a scoping review and an interview study. The scoping review was based on the framework from Arksey and O’Malley and included 44 studies. The interview study was conducted with 16 stakeholders having a professional role in long-term care for older adults in the Netherlands: academics, (top)management, innovation managers and consultants. Based on the results of both studies, we propose a framework of factors contributing to innovation readiness. The framework consists of five main factors enabling innovation readiness of long-term care organizations for older adults: 1) strategic course for innovation 2) innovation journey 3) leadership for innovation 4) learning for innovation and 5) innovative organizational culture. The collective findings support the notion that for innovation readiness the interplay of main factors is vital and benefits from an approach at the individual, team, organizational and inter-organizational levels. Furthermore, our findings indicate that some factors might be more conditional and other factors might play a more supportive role. Research into innovation readiness of health care organizations is a rather new field. Further research directed toward a framework for innovation readiness might deliver a structured approach for managers of long-term care organizations to embed and assess innovation readiness.

On the factors determining the health profiles and care needs of institutionalized elders

In many developed countries, population aging raises a number of issues related to the organization and financing of long-term care. While the determinants of the overall burden and cost of care are well understood, the organization of institutionalized long-term care must meet the needs of the elderly. One way to optimize management is to use information on health problems to assess the infrastructure needed, the qualifications of staff, and the allocation of new entrants. In this research, we determine the typical health profiles of institutionalized elderly using novel longitudinal data from nursing homes in the canton of Geneva, Switzerland. Our data contain comprehensive information on health factors such as impairments of psychological and sensory functions, levels of limitations, and pathologies for 21549 individuals covering the period from 1996 to 2018. First, we perform a spectral clustering algorithm and determine the profiles of the institutionalized individuals. Then, we use multinomial logistic regression to study the effects of the factors that determine these health profiles. Our main findings include eight typical health profiles: the largest group consists of the most “healthy” individuals, who, on average, require the least amount of help with their daily needs and who stay in the institution the longest. We show that, in contrast to age at admission and gender, the limitations and the set of pathologies are relevant factors in determining the profile. Our study sheds light on the typical structures of elderly' health profiles, which can be used by institutions to organize their resources and by insurance companies to derive profile-based products that provide additional insurance coverage in case of special needs.

Towards data-informed shared decision making: what do we need?

Background:The increasing availability of data offers new possibilities for supporting quality of care in long-term care (LTC) for older adults, also for dementia care units in nursing homes. Examples are quantitative data in electronic health records (i.e. medication), data collected by technological devices such as sensors and wearables (i.e. data related to psychical and mental health including for example heart rate and sleeping patterns), but also qualitative data stored in texts (e.g. transcribed conversations about perceived quality of life). LTC organisations currently lack tools to interpret and integrate the data in the shared decision-making (SDM) process. This project investigates the necessities for data-informed SDM.Methods:The study was conducted in co-design with the knowledge group ‘Data Science’ residing in the Living Lab in Ageing and Long-Term Care, Maastricht. A focus group-setting, in which a diverse set of stakeholders, including data/ICT-specialists, care managers and client representatives, took place to discuss bottlenecks, possibilities and solutions related to data-informed SDM.Results:In total, representatives (n=18) from 7 care organisations participated in three separated focus groups. This resulted in several themes that were deemed necessary for data-informed SDM: 1) an organisational vision on data and data-informed SDM, 2) investment in data-driven care SDM, 3) the instalment of multidisciplinary teams, including clients, informal and formal caregivers, 4) a planned implementation process is needed, and 5) the use of living lab constructions.Conclusion:A well-thought-out, integral learning process, including a vision statement on data and the installation of multidisciplinary teams working on data-problems, is deemed necessary in order for LTC organisations to accomplish data-informed SDM. A concrete step-by-step plan, which can provide LTC organizations with tools to embed data in the current SDM process, is suggested to help organisations in their quest to data-informed personal care.

Emerging Strategies for Developing Highly Engaging Dementia Care Intervention for Paid Care Workers in Long‐Term Care (LTC) Settings

AbstractBackgroundThere is widespread agreement about the need for strengthening the dementia‐capable workforce to increase the accessibility of online dementia care training programs for paid care workers (PCW) in LTC. Through three NIH‐funded research projects, we are forming an approach to the development of digital dementia training interventions based on two main strategies: a) improving ‘engage‐ability’ by using an engagement design centering on the concepts of motivation (key needs of the user), satisfaction (positive experience with the intervention), and interactivity (connection from one session to another); and b) integrating domain‐specific employee training with a generic employee wellness program.MethodStudy 1 evaluates a self‐directed learning (SDL) digital dementia care training intervention to increase ‘engage‐ability’ by addressing PCWs’ needs for improved knowledge and competence for caregiving while maintaining a sense of control in the learning process (motivation); by enhancing the ease of use through scenario‐based audiovisual modules (satisfaction); and, by using post‐session quizzes and pre‐session reminder messages (interactivity). Study 2 developed a worksite digital health risk assessment combined with a wellness improvement program that enabled a workplace counselor to deliver health education materials to increase healthy lifestyle behaviors in preretirement adult workers aged 55 and above. Study 3 combines the SDL dementia care training with the wellness program for PCWs in LTC settings in order to achieve high ‘engage‐ability’ and acceptability of the intervention.ResultA pre‐post evaluation of the SDL program (Study 1) revealed a significant reduction in stress and improved self‐efficacy in providing dementia care among PCWs (Study 1). Formative research demonstrated moderate usability and acceptability from the pre‐retirement workers who participated in Study 2. In Study 3, focus groups with PCWs and managers from LTC organizations showed high endorsement of integrated dementia care training and wellness programs with organizational support for the delivery of the training intervention for PCWs in LTC settings.ConclusionA successful digital training program for PCWs providing dementia care in LTC systems requires an integration of dementia‐specific training and the tools for wellness critical for supporting PCWs’ overall well‐being while securing support from the LTC organizations for PCW participation in the program.

Member success stories: Improving care of older adults with the niche practice model

Nurses Improving Care for Healthsystem Elders (NICHE), a program of NYU Rory Meyers College of Nursing, is a national quality and safety program that enhances clinical nursing in the care of older adults. Hospitals, long-term care, and hospice organizations adopt the NICHE practice model to advance professional practice, improve quality of care, and expand capacity to meet the growing demand for age-friendly care. In this month's column, I highlight three clinical improvement projects that were developed during the NICHE Leadership Training Program. These projects represent the range of nurse-led services and clinical interventions that are the foundation of the NICHE philosophy and practice model.

What Should Be the Scope of Long-Term Care Organizations' Obligations to Offer Culturally and Linguistically Appropriate Services to Patients?

Limited access to health services, decreased quality of care, and worse health outcomes are well documented barriers people with limited English proficiency (LEP) face in US health care. Laws enacted since the 1964 Civil Rights Act recognize such barriers and have helped generate demand for culturally respectful health service provision, assessment of cross-cultural relations, and adaptation of services that fail to meet persons' needs and improve quality of life. Yet, as this commentary on a case considers, even with legal protections for language services for patients with LEP, long-term care facilities face limited resources and thus have limited capacity to offer such services.

Insight into the experiences of caregivers of older adults in long-term care homes: A photovoice study.

To explore the lived experiences of caregivers of people living in long-term care (LTC) homes during the initial phases of the COVID-19 pandemic and potential supports and resources needed to improve caregivers' quality of life. Carers (or care partners) of adults in LTC contribute substantially to the health and well-being of their loved ones by providing physical care, emotional support and companionship. Despite their critical role, little is known about how caregivers have been impacted by the pandemic. An interpretive descriptive approach that incorporated the photovoice method was used. Using a purposive sampling strategy, six family carers in Ontario, Canada were recruited between September and December 2021. Over a 4-week period, caregivers took pictures depicting their experience of the pandemic that were shared in a virtual focus group. Visual and text data were analysed using thematic analysis with an inductive approach. Caregivers expressed feelings of frustration, confusion and joy. Emerging themes included: (i) feeling like a 'criminal' amidst visitor restrictions and rules; (ii) experiencing uncertainty and disappointment in the quality of care of long-term care homes; (iii) going through burnout; and (iv) focusing on small joys and cherished memories. The combination of visual and textual methods provided unique insight into the mental distress, isolation and intense emotional burdens experienced by caregivers during the pandemic. Our findings underscore the need for LTC organizations to work in unison with caregivers to optimize the care of residents and support the mental health of caregivers. This work adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist. The caregivers included in the study were involved in the co-creative process as active contributors informing the design and validation of the codes and themes.

Preventive Resilience: The Role of the Agency Capacity of Long-term Care Organizations

Preventive Resilience: The Role of the Agency Capacity of Long-term Care Organizations

Coping with uncertainties: challenges for decision makers in healthcare

Purpose Health care organizations’ decision-making for the future relies on anticipating changes. Reliable predictions are becoming increasingly difficult, creating anxiety and requires long-term adaptive planning to cope with unforeseen circumstances. The purpose of this study is to gain insights into the awareness of uncertainties that decision makers in healthcare have, particularly when making long-term investments. Design/methodology/approach This is a qualitative study with an explorative purpose. The data were collected through semi-structured and open interviews with board members of long-term care organizations. Findings The study revealed that respondents are most uncertain about the future financing of their real estate system. Another concern revealed is about the shortage of care professionals combined with an increasing demand for future care. Despite most decision makers do recognize uncertainties during the decision-making process, decision makers hardly address the level of these uncertainties. Although this study did find that some decision makers are aware of deep uncertainties, in terms of “unknown unknowns,” they have no actual approaches for dealing with such situations. Originality/value Decision makers at healthcare organizations are uncertain as to their ability to anticipate technological, economic, social and political developments, as well as predict future healthcare system transformations. Some decision makers are aware of deep uncertainties, in terms of “unknown unknowns” and “unidentified unknowns,” but they lack an actual approach to deal with such situations. This study examines how strategies adapt to unforeseen developments or how to deal with deep uncertainties in healthcare as complex adaptive system.