Long-term Care Practice Research Articles

“A Crazy Roller Coaster at the End”: A Qualitative Study of Death Preparedness With Caregivers of Persons With Dementia

IntroductionCaregivers of persons with dementia experience challenges that can make preparing for end-of-life particularly difficult. Feeling prepared for death is associated with caregiver well-being in bereavement and is promoted by strategies supporting a palliative approach. Further conceptualization of caregiver preparedness for death of persons with dementia is needed to guide the practice of healthcare providers and to inform development of a preparedness questionnaire.ObjectivesWe aimed to: 1) explore the end-of-life experiences of caregivers of persons with dementia to understand factors perceived as influencing preparedness; and 2) identify the core concepts (i.e., components), barriers and facilitators of preparedness for death.MethodsThis study used an interpretive descriptive design. Semi-structured interviews were conducted with sixteen bereaved caregivers of persons with dementia, recruited from long-term care homes in Ontario. Data was analyzed through reflexive thematic analysis.FindingsFour themes were interpreted including: ‘A crazy rollercoaster at the end’ which described the journey of caregivers at end-of-life. The journey provided context for the development of core concepts (i.e., components) of preparedness represented by three themes: ‘A sense of control, ‘Doing right’ and ‘Coming to terms’.ConclusionThe study findings serve to expand the conceptualization of preparedness and can guide improvements to practice in long-term care. Core concepts, facilitators and influential factors of preparedness will provide the conceptual basis and content to develop the Caring Ahead: Preparing for End-of-Life with Dementia questionnaire.

Unresponsive wakefulness syndrome: Outcomes from a vicious circle.

Unresponsive wakefulness syndrome: Outcomes from a vicious circle.

PALTC Steps Up Strategies to Attract Nurses

PALTC Steps Up Strategies to Attract Nurses

Concepts of health in long-term home care: An empirical-ethical exploration

Concepts of health have been widely discussed in the philosophy and ethics of medicine. Parallel to these theoretical debates, numerous empirical research projects have focused on subjective concepts of health and shown their significance for individuals and society at various levels. Only a few studies have so far investigated the concepts of health of non-professionals and professionals involved in long-term home care and discussed these empirical perspectives regarding moral responsibilities. To identify the subjective concepts of the health of non-professionals (care recipients, informal caregivers) and professionals (registered nurses) involved in long-term home care and to discuss them against the background of existing normative guidelines addressing non-professionals and professionals' responsibilities and rights concerning health. A qualitative design was chosen to explore subjective concepts of health. Data were collected by semi-structured interviews; content analysis was applied according to Mayring. Twenty-eight interviews were conducted with non-professionals and professionals in long-term home care arrangements in Northern Germany. Ethics approval was obtained from the Institutional Review Board at the University Medicine Greifswald (BB123/16). Non-professionals and professionals consider health as a capability that enables them to participate in social activities and live their own lives according to their preferences. The former regard health particularly as a feeling and an attitude, the latter as the absence of disease with a focus on mental and emotional well-being. Both groups highlight the unsurpassable value of health and the personal responsibility for it. Normative guidelines applicable to practice in long-term home care discuss responsibilities and rights unevenly and raise several problems regarding non-professionals and professionals' subjective concepts of health. Individuals' concepts of health are relevant for the subsequent interpretation of rights and responsibilities and should, thus, be reflected upon to address health-related needs effectively.

A cross-validation study of the incident-reporting attitude scale for staff in long-term care facilities-A cross-sectional study.

To test the construct and concurrent validity and reliability of the incident-reporting attitude scale used for staff in long-term care facilities (IRA-LTC) by the two-phase cross-validation method. Lack of accurate measurement on incident-reporting attitude might hinder improvements of safety practice in long-term care facilities. A two-phase cross-sectional questionnaire survey was conducted in Taiwan. A fixed proportion of long-term care facilities were randomly selected that included 20 and 15 long-term care facilities at phases one and two separately. Nursing and administrative staffs in these facilities were recruited at the first phase (N=207) for testing the validity and reliability of the newly developed scale and for cross-validation of the scale at the second phase (N=251). The scale of IRA-LTC was a self-developed structured questionnaire consisting of 31 items. The data were analysed using spss for Windows 20.0 and AMOS 24.0. Descriptive statistics, correlation analysis, Cronbach's α, exploratory and confirmatory factory analysis were carried to examine the homogeneity of items, reliability, construct and concurrent validity. The STROBE checklist was adhered (See Appendix S1). The IRA-LTC scale comprised two dimensions: "cognition and intention to report" and "barriers to report." The two-factor structure explained 60.20%-61.89% of the total variance at two phases. Validation of the initial factorial model gained at the first phase was satisfactorily supported at the second phase. Concurrent validity of the IRA-LTC scale was satisfied. Cronbach's α for the scale and subscales was 0.94-0.97. This IRA-LTC scale is valid and reliable and can be recommended to evaluate the incident-reporting attitude among all kinds of staff in long-term care facilities. Positive incident-reporting attitude can lead to positive incident-reporting behaviour. Using the IRA-LTC scale for assessing staff's incident-reporting attitude is recommended as the first step to enhance staff's safety performance in long-term care facilities.

Foreign Domestic Workers and Eldercare in Singapore: Who Hires Them?

ABSTRACTIn Singapore, policy makers expect families to remain actively involved in the care of their frail older relatives, as manifestly expressed in its Many Helping Hands approach to long-term care. To enable families to fulfill this expectation, the government has enacted policies that encourage the hiring of foreign domestic workers (FDWs) to complement or supplement informal caregiving efforts. Using the Andersen Behavioral Model, we were interested in identifying caregiver and care receiver characteristics that might predict the hiring of FDWs. With data from a convenience sample of 488 informal caregivers, we ran logistic regression regressing the hiring of an FDW on various predisposing, enabling, and need factors. Of interest, enabling factors such as household income, housing type, and educational level were predictive of hiring an FDW in the home. Only one need factor, time spent in caregiving, was predictive of the increased likelihood to hire an FDW. Policies that encourage the marketization of care are likely to favor those with financial means and inadvertently ignore the caregiving burdens of lower income families. In addition, we suggest research and policies to ensure the well-being and protection of FDWs who have become a key component of the long-term care policy and practice in Singapore.

Keeping the Elderly Alive: Global Entanglements and Embodied Practices in Long-Term Care in Southeast Italy

This article explores the success of the “migrant in the family” model of care for the elderly in southeast Italy and the mechanisms that bond the caregivers and their patients in a mutual dependency. I describe this model as a meeting place between endurance and vulnerability, and between the fragility of the elderly and the fragility of most of the women who work as migrant care workers. I argue that migrant live-in care work for the elderly is a combination of attentive practice and detachment in completion to the current description of care work as ritual and as tinkering and adaptation. In a broader perspective, the article shows that the economic needs in poorer regions of the world manifest in the commitment and determination to keep the elderly alive in Italy. This article reports findings from long-term ethnographic research among 34 migrant domestic care workers and 24 Italian employers in a medium-sized town in Italy. The article illustrates the findings by means of three case studies and engages with the existing literature on person-centered care in patients with dementia, biopolitics, and the global political economy of migration for work in the field of care. Migrant work for the elderly is crucial for a general understanding of social reproduction in Italy and in many other global contexts.

Intergenerational Housing: The Case of Humanitas Netherlands

We analyze a case study of an innovative intergenerational housing arrangement in the Netherlands as an example of how a local long-term elderly care practice evolved in response to contemporary challenges. Identified elements of the established local practice relate to the characteristics and strategies of an institutional entrepreneur and elements of the new practice that comes into being, in which reciprocity and mutual learning have a central place. These elements might benefit future elderly housing initiatives as well.

Assumptions of good practices in home care for the elderly: a systematic review.

To synthesize the knowledge produced on best nursing practices in long-term care for elderly at home, in order to promote healthy aging. A systematic review, based on the Joanna Briggs Institute's proposal: without restriction of dates; in the English, Portuguese and Spanish languages; conducted in PubMed, CINAHL, LILACS, Embase and Scopus databases. Among 453 articles identified, 16 were included in the review: seven qualitative and nine quantitative, published between 1996 and 2015. The synthesis of the data identified as best practices identifies a premise of care centered on the elderly and the inclusion of the elderly, family and nurses as agents of this care. According to evidence, good practices in gerontological and nursing home care fundamentally depend on constant planning and reorganization, so that they are indeed comprehensive and contextualized. Thus, providing care will be reasoned by and driven to the elderly, based on their specific and global needs, favoring a process of healthy and active aging.

Commonly Heard, Commonly Said: Catchphrases That Hurt Long-Term Care Practice and How to Address the Issues They Imply

Commonly Heard, Commonly Said: Catchphrases That Hurt Long-Term Care Practice and How to Address the Issues They Imply

Quality of life and paracetamol in advanced dementia (Q-PID): protocol of a randomised double-blind placebo-controlled crossover trial

BackgroundNo proven effective interventions on quality of life (QoL) are available for persons with dementia in a long-term care facility (LTCF). However, several interventions are effective in diminishing mediators of QoL (i.e. challenging behaviour, depressed mood, sleeping disorders), including pain treatment. Un(der)diagnosed and un(der)treated pain is a serious and frequent problem in persons with dementia. Also, although pain is difficult to assess in this group, the impact on QoL is probably considerable. There is evidence that pain has a negative impact on behaviour, mood, functioning and social participation, and benefit may be derived from use of paracetamol. Therefore, in LTCF residents with advanced dementia, this study aims to evaluate the effect of scheduled pain treatment with paracetamol on QoL, neuropsychiatric symptoms, ADL function, pain, care dependency, and (change in) use of psychotropic and pain medication.MethodsThis randomised, double-blind, placebo-controlled crossover trial will include 95 patients with: 1) age ≥ 65 years, 2) advanced dementia (Reisberg Global Deterioration Scale 5–7), and 3) QUALIDEM score ≤ 70. Exclusion criteria are the regular use of pain treatment, allergies to the study drugs, severe liver insufficiency or disease, use of > 4 units of alcohol/day, weight < 50 kg, and/or concomitant use of flucloxacillin. The two treatment periods of six weeks each (paracetamol and corresponding placebo) will be separated by a washout period of seven days. Primary outcome is effect on QoL (QUALIDEM and DS-DAT) and secondary outcome is effect on neuropsychiatric symptoms, ADL function, pain, care dependency, and (change in) use of psychotropic and pain medication (all compared to baseline).DiscussionIf regular treatment with paracetamol proves to be beneficial for QoL, this could have major implications for daily practice in long-term care. Information from this study may help professionals in their decision making regarding the prescription of pain medication to improve the QoL of persons with dementia and a low QoL.Trial registrationThe trial was registered on the Netherlands Trial Register (NTR6766); Trial registration date: 20th October, 2017.

Advancing Research on Care Needs and Supportive Approaches for Persons With Dementia: Recommendations and Rationale

The first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers was held on October 16-17, 2017, at the National Institutes of Health. In this paper, participants from the Summit Session on Research on Care Needs and Supportive Approaches for Persons with Dementia summarize the state of the science, identify gaps in knowledge, and offer recommendations to improve science and practice in long-term care. Recommendations cover 4 areas focused on persons living with dementia: (1) symptoms (behavioral and psychological symptoms of dementia, function, cognition, and sleep); (2) dementia care settings (physical and social environments, home, and residential care); (3) living with dementia (living well with dementia, living alone with dementia, and living with dementia and intellectual and developmental disabilities); and (4) technology as a cross-cutting theme. The participants identify 10 of the most pressing research issues based on the findings from their collective papers. Final Summit recommendations included those presented by session participants and will be used to advise federal agencies and other organizations that fund research.

Interprofessional and collaborative care planning activities for students and staff within an academic nursing home

Abstract With an aging population, there is an increasing need for health professionals interested and trained in collaborative geriatric care and long term care (LTC). The development of academic nursing homes is an innovative solution that exposes health professional students to the LTC practice setting and is uniquely suited to interprofessional education (IPE) opportunities. This report describes Interprofessional Team Experiences in an academic nursing home, and discusses the IPE curriculum and student outcomes. The academic nursing home is a partnership between a LTC provider and an academic institution in Atlantic Canada. Key features of the planning and implementation involved the creation of a steering committee and the development of interprofessional team experiences for students and collaborative team meetings for staff. Student learning was assessed using post-placement evaluations and pre- and post-test surveys using the Interprofessional Collaborative Competencies Attainment Survey. Students' self-reports demonstrated increased interest in LTC practice and increased interprofessional competencies. Consultations with staff, physicians, family and residents were the basis of the evaluation of the academic partnership. Positive impacts were identified for residents, students, and staff, demonstrating that the site was a valuable setting for IPE for students and staff alike. The components of the collaborative partnership and learning activities described can be modified and applied in similar settings to foster student and staff collaboration. The implementation and systematic evaluation of similar collaborative learning initiatives in LTC settings is encouraged to further enhance services to an aging population.

The potential for leisure to be a key contributor to long-term care culture change

ABSTRACT Long-term care (LTC) culture change describes efforts to transform LTC homes into caring communities where quality of life is paramount. Since leisure is recognized as one of the strongest contributors to quality of life for individuals living in LTC homes, it has a vital role to play in the culture change process. In this paper we present findings from a study that examined ways leisure programs and practices in LTC homes align with culture change principles. These findings highlight ways leisure is providing opportunities for residents, team members, and family to be in relationships where there is deeper knowing of individuals and celebrations of their lives, a sharing of power, and opportunities to work together to enhance meaningful experiences. We argue that in order for leisure to fulfill its potential as a key contributor to culture change, there need to be more flexible and freely chosen experiences that bring people together and help to create nurturing communities within LTC homes.

A constructivist grounded theory research project studying music therapy as an anti-oppressive practice in long-term and psychiatric residential care

Analytical emancipatory social justice and anti-oppressive practice concepts have begun to be integrated into music therapy to inform and expand the theoretical basis of practice (Sajnani et al., 2017). Anti-oppressive practices (AOP) in music therapy have been developed to expose and undo both obvious and unknown oppression to increase social justice within music therapy systems, practice, and research (Baines, 2013). Music therapy as an Anti-Oppressive Practice (Baines, 2013) was examined in two sites, 1. a long-term care facility, and 2. a secure mental health centre The study used Constructivist Grounded Theory method guided by the question: What are the experiences of residents and staff in music therapy as an anti-oppressive practice? The research revealed dilemmas, opportunities, and outcomes of music therapy research and practice processes that engage anti-oppressive analysis. Further consideration of the data revealed that an anti-oppressive practice framework for music therapy research and practice broadened client agency through integration of client preferred music experiences in all aspects of programming and increased cultural humility and competence in staff offering heightened ethical standards across both sites.

Prophylaxis of Venous Thromboembolism in Geriatric Settings: A Cluster-Randomized Multicomponent Interventional Trial

ObjectivesTo evaluate the efficacy of an intervention on the practice of venous thromboembolism prevention. DesignA multicenter, prospective, controlled, cluster-randomized, multifaceted intervention trial consisting of educational lectures, posters, and pocket cards reminding physicians of the guidelines for thromboprophylaxis use. SettingsTwelve geriatric departments with 1861 beds total, of which 202, 803, and 856 in acute care, post-acute care, and long-term care wards, respectively. ParticipantsPatients hospitalized between January 1 and May 31, 2015, in participating departments. MeasurementsThe primary endpoint was the overall adequacy of thromboprophylaxis prescription at the patient level, defined as a composite endpoint consisting of indication, regimen, and duration of treatment. Geriatric departments were divided into an intervention group (6 departments) and control group (6 departments). The preintervention period was 1 month to provide baseline practice levels, the intervention period 2 months, and the postintervention period 1 month in acute care and post-acute care wards or 2 months in long-term care wards. Multivariable regression was used to analyze factors associated with the composite outcome. ResultsWe included 2962 patients (1426 preintervention and 1536 postintervention), with median age 85 [79;90] years. For the overall 18.9% rate of inadequate thromboprophylaxis, 11.1% was attributable to underuse and 7.9% overuse. Intervention effects were more apparent in post-acute and long-term care wards although not significantly [odds ratio 1.44 (95% confidence interval 0.78;2.66), P = .241; and 1.44 (0.68, 3.06), P = .345]. Adequacy rates significantly improved in the postintervention period for the intervention group overall (from 78.9% to 83.4%; P = .027) and in post-acute care (from 75.4% to 86.3%; P = .004) and long-term care (from 87.0% to 91.7%; P = .050) wards, with no significant trend observed in the control group. Conclusions/ImplicationsThis study failed to demonstrate improvement in prophylaxis adequacy with our intervention. However, the intervention seemed to improve practices in post-acute and long-term care but not acute care wards.

Applying a trauma-informed perspective to loss and change in the lives of older adults

ABSTRACTTraumatic events are widely acknowledged to have long-term impacts on individuals, yet only recently have health-care professionals begun to assess for and gain an understanding of trauma in the lives of older adults. For many older adults, trauma is often disenfranchised and overlooked as being either a distant past event (e.g., child abuse) or a normal part of aging (e.g., widowhood). Trauma-informed care, on the other hand, calls for health-care professionals to acknowledge that past and recent events may have been traumatic for older adults and to assess and care plan to reduce or prevent re-traumatization. In this article, we explore the impacts of trauma in later life through a case study of a patient admitted to a long-term care facility. Analysis of this case study suggests several important implications for social work practice in long-term care and the use of person-centered care practices in the care of older adults in general.

Session 318 - How to Make It Work? Different Models of Geriatric Mental Health Practice in Long Term Care

Session 318 - How to Make It Work? Different Models of Geriatric Mental Health Practice in Long Term Care

Antidepressant switching patterns in the elderly.

A cohort study of medication supply data from 6011 aged care residents in 60 long-term care facilities was conducted. Incident antidepressant users were followed for 12 months and their patterns of antidepressant use determined. The type of switching from and to different antidepressant classes was determined according to National and International recommendations for antidepressant switching. In total, 11% (n = 44) of the residents were initiated on an antidepressant medication (n = 402) switched to a different antidepressant agent within 12 months. Residents commenced on a SNRI or TCA were most likely to switch antidepressants (17% in each group). Almost half of the switches (n = 21, 48% of all switches) were not implemented according to guideline recommendations. Direct switch and taper followed by wash out and switch, accounted for all of the inappropriate switching (29% and 71%, respectfully), with half occurring to mirtazapine (N = 7) or from mirtazapine (N = 3). Over one in 10 long-term aged care residents who commence an antidepressant will switch to a different antidepressant within 12 months. Current antidepressant switching practices in long-term residential aged care may be increasing the risk of harm associated with antidepressant switching, with around half of all switches not following current guideline recommendations.

Nurses’ and Care Workers’ Perception of Care Quality in Japanese Long-Term Care Wards: A Qualitative Descriptive Study

Despite the growing importance of long-term care for older adults, there has been limited attention to its quality assurance issues in Japan. To start planning the initiation of continuous quality improvement in long-term care hospitals, we explored how nurses and care workers themselves perceived current approaches to quality assurance and improvement on their ward. We interviewed 16 licensed nurses and nine care workers, transcribed and analyzed data using qualitative content analysis techniques, and derived six categories: keeping clients alive is barely possible, the absence of a long-term care practice model, the lack of quality indicators, long-term care hospitals as places for castaways, client quality of life as a source of satisfaction, and conflict between staff and client well-being. To develop continuous quality improvement in Japanese long-term care hospitals, it may be first necessary to introduce a practice model of long-term care and mechanisms to evaluate quality.