Long-term Care Settings Research Articles

Environmental audit scoring evaluation: evolution of an evidence-based environmental assessment tool to support person-centered care.

Long-term care settings are at the center of strongly debated approaches to policies that shape the delivery of care and operational practices. There is advocacy for transformational change within these settings to support a person-centered approach to care delivery, but it is difficult and multifaceted involving everything from changing the level of staffing and care models to developing appropriate metrics to assess an individual's quality of life. The physical environment is a key component for accomplishing the organizational and operational goals related to person-centered care, but providers and their design teams need the appropriate tools to guide evidence-based decision-making. The Environmental Audit Scoring Evaluation (EASE) is a tool that helps lend structure to the process of developing the environment for our senior population-especially those living with dementia. This perspective article will discuss how EASE aims to align the design process to more fully support the myriad environmental elements that have a demonstrable impact on the individual, and the associated quality of life they experience. The article will also explore how EASE differs from previous planning strategies that did not prioritize residents' psychological wellbeing in conforming to current person-centered philosophies.

Long-Term Residential Care and the Built Environment: Improving Quality of Life and Resilience Through a Universal Design Approach.

This paper draws on a series of transdisciplinary research projects examining the role of the built environment in supporting quality of life in long-term residential care settings (LTRC) in Ireland. Acknowledging the impact of COVID-19, these projects include airborne infection control as a key theme. Moreover, considering the wide spectrum of needs, impairment, and health conditions experienced by people living in these settings, along with the diversity of residents, staff, and visitors who occupy LTRC buildings, the research is underpinned by a Universal Design (UD) approach. Finally, climate change is examined as emerging challenge, particularly for older people living in LTRC. Starting with these major concerns, this exploratory paper examines how UD can act as a bridging concept to bring together inclusion, quality of life, health and wellbeing, and climate resilience in the context of long-term residential care in Ireland and beyond.

Infectious Disease as a Modifiable Risk Factor for Dementia: A Narrative Review.

This narrative review examines infectious diseases as modifiable risk factors for dementia, particularly in the context of an aging global population. As the prevalence of Alzheimer's disease and related dementias is expected to rise, prevention has become increasingly important due to the limited efficacy of current treatments. Emerging evidence links specific infectious diseases to increased dementia risk, possibly through mechanisms like neuroinflammation and disruption to normal cell function. Here, we review findings on how viral and bacterial infections contribute to dementia and explore potentially preventive measures, including vaccinations and antiviral treatments. Studies indicate that vaccinations against influenza, herpes zoster, and hepatitis, as well as antiviral treatments targeting human herpesvirus, could reduce the incidence of dementia. Additionally, non-pharmaceutical interventions during pandemics and in long-term care settings are highlighted as effective strategies for reducing the spread of infectious diseases, potentially lowering dementia risk. Putative mechanisms underlying the protective effects of these interventions suggest that reducing systemic inflammation may be important to their efficacy. While the currently available evidence suggests at best an association between some infectious diseases and dementia, this narrative review emphasizes the need to incorporate infectious disease prevention into broader public health strategies to potentially mitigate the growing burden of dementia. Further research is required to explore these preventive measures across diverse populations and to deepen our understanding of the biological mechanisms involved.

Strategies to Improve Environmental Comfort of Institutionalized Older Adults: A Scoping Review

The demographic trends of an aging global population present significant challenges and opportunities for healthcare, particularly in providing optimal care environments for older adults living in long-term care facilities, with it being imperative to ensure these environments provide basic care and promote overall well-being through enhanced environmental comfort. This scoping review intends to show evidence-based practices enhancing the environmental comfort of institutionalized older people. Following the Joanna Briggs Institute’s methodology, this scoping review’s inclusion criteria included studies in English, Portuguese, or Spanish between 2013 and 2023, focused on institutionalized people over the age of 65 years residing in long-term care settings where nurses implemented strategies or interventions designed to enhance environmental comfort in which older residents themselves directly evaluated, indexed in Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Psychology and Behavioral Sciences Collection, DART-Europe, or Repositório Científico de Acesso Aberto de Portugal (RCAAP). Out of 497 initially retrieved studies, none of them met the established criteria, leading this study to be an empty review. The absence of studies meeting the inclusion criteria indicates a significant gap in the existing literature, highlighting the need for specialized training programs that equip nurses with the skills and knowledge to implement effective comfort-enhancing interventions, ensuring that the unique and challenging needs of older people are covered.

Shared decision-making in long-term care: A systematic review of assessment instruments

This systematic review explored the instruments used to measure Shared Decision Making (SDM) within long-term care (LTC) settings. Relevant publications from the period between January 2000 and October 2022 were searched across five databases. Thirty-six SDM assessment instruments were identified, which encompassed those measuring SDM for LTC recipients/family caregivers and/or healthcare providers. These instruments were either specifically tailored for LTC settings or more broadly applicable across healthcare contexts, including LTC. In terms of psychometric properties of the instruments, internal consistency reliability, content validity, structural validity, and hypothesis testing were commonly tested. The findings of this research can aid health researchers, managers, and scholars in choosing suitable instruments for assessing SDM in specific LTC scenarios, considering factors such as measurement scope, assessment methods, and instrument reliability. Additionally, these findings offer valuable insights for the future development of high-quality SDM assessment instruments in LTC field.

Effective Strategies for Managing Substance Use Disorders in Older Adults in Nursing Homes

Substance use disorder is very prevalent in nursing home (NH) residents due to aging, the number of prescription drugs that are being used to manage their physical and psychological pain, and several discharges with the diagnosis of substance use disorder from hospitals to NH for aftercare support. However, many nursing homes are not equipped to provide adequate care for residents with a diagnosis of substance use. The staff is not well-trained to care for this type of population, which is becoming a challenge for the staff to manage residents in-house, leading to overdose, recurrent hospitalization, and unsuccessful discharges to communities due to relapses and an increase in the number of frequent flyers. Substance use disorder has become a significant public health concern in the United States, especially in the older population from the past couple of decades, which tends to increase. Discharging older adults with substance use disorders into nursing homes without ensuring established resources in the long-term care setting raises safety and quality concerns, emphasizing a pressing need for innovative preventive and management approaches for substance use disorders to meet unique needs of older adults in nursing homes. Purpose: The purpose of the study is to explore and identify the interventions, treatments and care models to effectively manage substance use disorders in older residents who are living in nursing homes. The study further focuses on the unique challenges that are faced by older adults and staff in nursing homes to understand the need for integrating addiction treatments in Long-term care settings to assess the need to enhance care strategies to improve resident outcomes, which includes handling overdose emergencies, prevention, rehabilitation and relapse management of substance use disorders (SUDs). Scope: Provides valuable insights for future researchers and points out the need for collaborative models among the rehabilitation, addiction centers, and LTC and the need for virtual health platforms to improve access to care, interdisciplinary approaches, and policy innovation on resident retention and optimum resource allocation to reduce the health care cost of frequent flyers or unnecessary hospitalizations, therefore, improve patient outcomes.

HCA PIECESTM Care Coach Program: Peer to peer approach to promote person-centred care in long-term care

In Long-Term Care (LTC) settings, the potentially inappropriate use of antipsychotics for behavioural and psychological symptoms of dementia is a persistent issue, with high rates despite limited benefit and serious risk. Best practice is a non-pharmacological, person-centred approach to care, though this can be challenging in LTC settings. To help address this gap, we developed the PIECESTM HCA Care Coach Program and described its implementation and outcomes observed at 13 LTC homes. This program empowers Health Care aides with training, tools, and processes to practice the principles of person-centred care and provide peer mentorship to the care team. After 1 year, we found declining antipsychotics use (by 4.4%) and positive indicators of improved staff experience and improved resident quality of life. The Care Coach Program can be adapted and spread to a variety of LTC settings to help reduce potentially inappropriate antipsychotic use and better support people living with dementia.

Long-term care facilities: what do we know about multidrug-resistant organisms in this setting?

Abstract Background People with intellectual disabilities (ID) are an often overlooked high-risk group for health-related issues. In the Netherlands, people with ID may reside at home, in small communities, or within long-term care facilities. This diverse living arrangement challenges the healthcare system, with responsibilities spread among multiple formal and informal caregivers. During an outbreak with multidrug-resistant organisms (MDROs), coordinated efforts should be made to prevent further spread throughout all healthcare settings. Therefore, adequate infection prevention and control (IPC) practices, are required to improve or maintain individual health outcomes. To understand the complexity of MDROs in long-term care for people with ID, it is important to gain insight into knowledge, attitudes and perceptions of involved healthcare professionals and, investigate innovative strategies that could play a role in surveillance or monitoring an outbreak within this setting. Methods We conduct several studies in long-term care for people with ID, using a wide scale of methodologies including a cross-sectional survey study and innovative quantitative methods, such as wastewater surveillance. Results We have identified several challenges in long-term care for people with ID related to IPC and MDROs. First, while IPC and MDRO guidelines exist, they lack specific context and applicability to the long-term care setting. Second, proper use of hand gloves among healthcare professionals demands increased attention as knowledge about this preventive measure seems to be insufficient. Finally, given the challenges in sample collection for MDRO screening, non-invasive strategies are needed to offer insight during outbreaks, serving surveillance or outbreak management purposes. Conclusions Insights from these studies could inform future strategies to prevent or respond early in case of an MDRO outbreak within long-term care for people with ID.

Epidemiology and Antibiotic Resistance Patterns of Klebsiella pneumoniae Infections Among Male Patients in a Long-Term Care Hospital in Riyadh, Saudi Arabia: A Retrospective Study.

Klebsiella pneumoniae is an opportunistic pathogen commonly found in the normal flora of the gastrointestinal tract. While it typically remains benign, it can lead to severe healthcare-associated infections, particularly among immunocompromised individuals and those in long-term care settings. This study aimed to investigate the epidemiology and antibiotic resistance patterns of K. pneumoniae infections among male patients in a long-term care hospital. A retrospective cross-sectional study was conducted, analyzing microbial culture data from 29 male patients admitted to the male ward of a long-term care hospital in Riyadh, Saudi Arabia. The study included patients with confirmed positive cultures for K. pneumoniae. Data were collected regarding demographic information, culture sites, and antibiotic susceptibility test results. Statistical analysis was performed to identify significant associations between patient characteristics and resistance patterns, with a particular focus on the prevalence of carbapenem-resistant Enterobacterales (CRE) and the production of extended-spectrum beta-lactamases (ESBL). Around 51.7% of the K. pneumoniae isolates were found to be resistant to carbapenems, while 24.1% were classified as producers ofESBL. Patients suffering from bedsores had a significantly higher prevalence of CRE infectionsat 37.9% compared to only 13.8% in patients without bedsores (p=0.034). The analysis also indicated that older patients (aged over 50 years) exhibited a higher prevalence of CRE infections (34.5%) compared to their younger counterparts (17.2%, p=0.069). Notably, resistance levels against antibiotics were high, with 75.9% of isolates resistant to cotrimoxazole, 65.5% to ciprofloxacin, and 62.1% to gentamicin. In contrast, imipenem and meropenem showed relatively higher susceptibility, with each antibiotic having a susceptibility rate of 34.5%. There is a significant prevalence of multidrug-resistant K. pneumoniae infections in long-term care environments, particularly affecting older male patients and those with bedsores. These findings underscore the need for targeted infection control measures and enhanced antibiotic stewardship programs. Future research should include both genders to investigate epidemiological differences and broader resistance trends.

Affective Experiences of Older Adults Enrolled in a Multi-Component Health Promotion Program: A Focu-Group Study

The purpose of this qualitative study using focus groups was to explore the affective experiences of older adults enrolled in Bingocize®, a health promotion program that combines bingo and exercise after program facili-tators received a supplemental training developed by a recreational therapist titled, FUNctional Movement. The training emphasized participant enjoyment and autono-my support utilizing The Self-Determination Enjoyment Enhancement Service Delivery Model. Focus groups, comprised of 17 participants across three sessions, re-vealed that while the supplemental training may have improved engagement, many were unaware of the fall prevention components of Bingocize®. Focus group themes included autonomy sup-port, enjoyment, future desired activities, and barriers to physical activity. This may highlight a need to explicitly incorporate fall prevention and functional movement into Bingocize® training for facilitators. Additionally, integrating health education topics like sexual health and incontinence into Bingocize® could address participant needs and enhance program offerings. These findings may provide insights for refining Bin-gocize® training, aligning it more closely with participant expectations through a rec-reational therapy approach to physical activity in long-term care settings. The authors provide practice recommendations.

The Experience of Burnout of Rehabilitation Therapists in Long-Term Care Settings: A Qualitative Exploration

The Experience of Burnout of Rehabilitation Therapists in Long-Term Care Settings: A Qualitative Exploration

Barriers and facilitators to providing rehabilitation for long-term care residents with dementia: a qualitative study

BackgroundRehabilitation can help long-term care (LTC) residents with dementia maintain their independence. However, many residents do not receive rehabilitation. This study aimed to identify the barriers and facilitators to providing rehabilitation for LTC residents with dementia and propose practical interventions for overcoming them.MethodsUsing a phenomenological research design, we conducted a qualitative study involving 17 privately owned LTC homes in Nova Scotia, Canada. Data were collected through individual interviews and a focus group with residents with dementia (n = 3), family members (n = 4), rehabilitation providers (n = 6), and other staff (n = 3). We analyzed the data using inductive thematic content analysis and mapped the results onto the socioecological framework and the Behaviour Change Wheel (BCW) to classify and analyze barriers and facilitators to rehabilitation. The APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) in the BCW were used to identify feasible interventions and policies linked to the identified barriers and facilitators.ResultsBarriers at the intrapersonal level included communication difficulties, comorbidities, and lack of motivation among residents. Interpersonal factors encompassed the availability of family support and lack of interdisciplinary practice. Policy/environmental factors involved limited resources, complex admission processes, low staff ratios, and restrictive restraint policies. Enhancing communication, reducing the use of restraints, promoting interdisciplinary practice, and increasing accessibility to activity spaces and equipment will improve the provision of rehabilitation for the residents.ConclusionEnhancing the capabilities, opportunities, and motivations of all actors in LTC homes can potentially minimize these barriers. Interventions such as staff training on effective communication and dementia care, promoting person-centred and meaningful activities, and improving interdisciplinary collaboration are crucial. Policy measures to improve hospital-to-LTC transitions, increase volunteer involvement, educate families and communities, and recruit more staff are recommended. Addressing these barriers through targeted interventions and policy changes can significantly improve rehabilitation provision for residents with dementia in LTC settings.

Clinical Practice Guideline for Diabetes Management in the Post-Acute and Long-Term Care Setting

The newly revised Clinical Practice Guideline (CPG) for Diabetes Management in the Post-Acute and Long-Term Care (PALTC) Setting is an extremely useful resource that incorporates new evidence and perspectives related to overall goals in diabetes care. The CPG provides detailed information in usable Tables for how to use and manage the increasing number of medication alternatives for PALTC patients with diabetes. In addition, the CPG addresses the critical roles of all members of the interprofessional team for the optimal management of older adults living with diabetes.The primary goal of care as described in the CPG is to make diabetes management individualized and consistent with the patient's/resident's goals of care, and to optimize quality of life and the ability to live in the least restrictive setting possible. To achieve this, the CPG emphasizes the importance of understanding the patients’ overall health status, what their preferences and values are, their life expectancy, the clinical benefit of tight versus more liberal control of glucose, risk of hypoglycemia, and impact of treatment on quality of life and ability to live in a certain setting of care (e.g., if injectable therapy is possible). As with other PALTmed CPGs, this new CPG takes the team through the process of recognition, assessment, treatment and monitoring. Implementation of the Diabetes Management in PALTC Settings CPG can help those working in these settings ensure that their patients and residents are getting the most appropriate and current evidence-based treatment for this challenging clinical problem.

Dysphagia Screening in Residential Long-Term Care Settings in the Republic of Ireland: A Cross-Sectional Survey.

Dysphagia affects up to 70% of older adults living in residential long-term care settings (RLTCS) and may lead to serious complications if not identified and adequately managed. However, there is a dearth of clinical guidelines tailored to older adults at risk of dysphagia in RLTCS. An online survey consisting of 40 questions was conducted to identify dysphagia screening practices, referral patterns and interventions implemented by nurses in cases of suspected dysphagia, to quantify the number of residents with dysphagia, episodes of aspiration pneumonia in the previous year, and use of modified texture diets and fluids and explore differences between groups of RLTCS. The survey was developed using Qualtrics XM Platform and circulated via email, with one response per RLTCS sought. Data were analysed using RStudio. Of the 429 RLTCS contacted, 45 completed and returned the survey, a 10.5% response rate. Dysphagia screening practices, referral patterns, and dysphagia management interventions varied across participating RLTCS. All participants reported that they observe for signs and symptoms of dysphagia at mealtimes to identify residents at-risk of dysphagia. Ninety six percent of RLTCS reported referring residents with suspected dysphagia to speech and language therapy dysphagia services. A diagnosis of dysphagia was reported in 35.3% of residents. All participating RLTCS reported providing modified texture diets and fluids if residents had suspected dysphagia. The implementation of standardised and validated dysphagia screening protocols in RLTCS in the Republic of Ireland may be useful in supporting the identification of at-risk residents.

Paucity of Published Data and Protocols for Hypoglycemia Management in Long-term Care.

Background: Older people with diabetes are at high risk for hypoglycemia. Implementing a hypoglycemia treatment protocol in long-term care (LTC) settings may positively affect patient-related outcomes and health care resource utilization and costs. Anecdotal experience indicates little has been studied and published regarding this clinical practice. Objective: To identify hypoglycemia treatment protocols established for LTC settings and assess their effects on patient-related outcomes and health care resource use. Data Sources: The authors performed a systematic literature search of English-language articles and abstracts published between January 1, 2003 (PubMed), or 2018 (Google Scholar) and May 10, 2023. Search terms were "hypoglycemia," "diabetes mellitus," "longterm care," "nursing facilities," "assisted living facilities," "geriatrics," "elderly," "aged," "disabled," "disease management," "evidence-based medicine," "clinical protocols," "guideline," "glucagon," and/or "blood glucose." Included were publications with hypoglycemia treatment and management protocols or hypoglycemia-specific recommendations for LTC settings. DATA SYNTHESIS: The authors identified 405 articles and abstracts, removed 36 duplicates, screened 369 titles/ abstracts, and analyzed the full text for 93. Five met the inclusion criteria. Two originated from the American Diabetes Association: 2016 position statement regarding the management of diabetes in LTC and skilled nursing facilities, and 2023 standard-of-care guideline for managing older people with diabetes. One included the results after implementing an overall diabetes clinical care management algorithm in LTC facilities. A 2020 abstract and 2019 article were the only 2 publications involving specific hypoglycemia treatment protocols in LTC settings. Conclusion: This systematic literature search identified lack of published hypoglycemia treatment protocols in LTC settings and their effects on patient outcomes.

Are quality of care instruments inclusive of older people living with dementia? A scoping review in long-term care settings.

More than half of older people in long-term care facilities have dementia. Little is currently known about the methods and instruments which can be used to capture the perspectives of older people, including those with dementia, regarding the quality of care provided in such facilities. The main aims of this scoping review were two-fold. Firstly, to identify quality of care instruments that have been applied in long-term care settings. Secondly, to evaluate how these instruments have been developed and validated, particularly in terms of their applicability among older people with dementia. Seven databases (Medline, Web of Science, Scopus, ProQuest, Ageline, CINHAL and google scholar) were searched for relevant literature without any date limit. We used quality criteria adapted from COSMIN (Consensus-based Standards for the selection of health status Measurement Instruments) guidelines to assess the psychometric properties of the instruments. The search identified 16 quality of care instruments which had been used in long-term care settings. Of which, two (12.5%) were specifically designed for older people with dementia, and three instruments (18.7%) were modified for use with older people with mild to moderate dementia. A variety of methods were used to develop the identified instruments including literature reviews, qualitative interviews, expert panel reviews, pre-testing and piloting with older people. None of the identified instruments had been subjected to comprehensive psychometric assessment. Most instruments for assessing quality of care in long term care settings lack alternative communication techniques tailored to people with dementia. This review highlights the need for more rigorous psychometric testing of existing instruments for assessing quality of care in long-term care settings. Several existing measures show promise and may be taken forward for further testing and development for widespread application with older people, including those living with dementia, in long term care settings.

Core outcome set for studies evaluating interventions to prevent or treat delirium in long-term care older residents: international key stakeholder informed consensus study.

Trials of interventions to prevent or treat delirium in older adults resident in long-term care settings (LTC) report heterogenous outcomes, hampering the identification of effective management strategies for this important condition. Our objective was to develop international consensus among key stakeholders for a core outcome set (COS) for future trials of interventions to prevent and/or treat delirium in this population. We used a rigorous COS development process including qualitative interviews with family members and staff with experience of delirium in LTC; a modified two-round Delphi survey; and virtual consensus meetings using nominal group technique. The study was registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative (https://www.comet-initiative.org/studies/details/796). Item generation identified 22 delirium-specific outcomes and 32 other outcomes from 18 qualitative interviews. When combined with outcomes identified in our earlier systematic review, and following an item reduction step, this gave 43 outcomes that advanced to the formal consensus processes. These involved 169 participants from 12 countries, and included healthcare professionals (121, 72%), researchers (24, 14%), and family members/people with experience of delirium (24, 14%). Six outcomes were identified as essential to include in all trials of interventions for delirium in LTC, and were therefore included in the COS. These are: 'delirium occurrence'; 'delirium related distress'; 'delirium severity'; 'cognition including memory', 'admission to hospital' and 'mortality'. This COS, endorsed by the American Delirium Society and the European and Australasian Delirium Associations, is recommended for use in future clinical trials evaluating delirium prevention or treatment interventions for older adults residing in LTC.

Identifying Spasticity Treatment Gaps in Long-term Care and Community Settings from Ontario Real-world Evidence

Identifying Spasticity Treatment Gaps in Long-term Care and Community Settings from Ontario Real-world Evidence

A Novel Primary Care-Based, Practice Nurse-Led Bone Health Service for People in Long Term Care

Abstract Background 11% of all Irish hip fractures originate in the long-term care (LTC) setting and LTC residents are at the highest risk of reduced bone density. Risk is poorly managed as no primary care framework exists. A novel practice nurse-prescriber-led service is described in which risk estimation directs stratification, investigation, and treatment of fragility fracture risk. Methods Baseline assessment uses FRAX (fracture risk assessment tool) to risk-stratify using NOGG (National Osteoporosis Guideline Group) risk charts and inform the need for bone mineral density (BMD) measurement. A bone health drug optimisation process ensured patients were offered treatment at appropriate intensity. Results 107 residents of mean age 86.2 were newly admitted to long-term care in 2023. 92 were included and 15 were excluded due to poor prognosis. 10 of the 92 residents included died in 2023. 91 patients were risk-stratified into NOGG categories as follows: Low 22%, n=20; intermediate, below intervention threshold 23%, n=21; intermediate, above intervention threshold 16%, n=15; high 19%, n=17; very high 20% n=18. 84% (n=77) of those in risk categories indicating anti-resorptive treatment were not prescribed a bisphosphonate at baseline and none were prescribed Denosumab. 84% (n=42) were prescribed Vitamin D either with or without supplemental calcium and 16% were prescribed nothing to improve bone health. Post-intervention, 100% (n=43) of patients at a risk level of NOGG ‘intervention threshold’ or above were prescribed either Vitamin D with or without supplemental calcium and 58% (n=25) were prescribed anti-resorptive therapy (denosumab =47%, n=20 or bisphosphonate = 9%, n=5). Discussion of treatment with the primary care and LTC team is periodic. At the time of data capture, 88% of residents were discussed and 12% were planned for discussion. Conclusion A practice nurse-prescriber led service targeting LTC residents is effective in optimising screening and prescribing. Future work could include replication in the national LTC community.

“I would have to walk around to find the best Wi-Fi connection…”: qualitatively exploring challenges associated with rapid rollout of telehealth in Canadian long-term care homes

BackgroundEarly in the COVID-19 pandemic, long-term care (LTC) homes in British Columbia, Canada, restricted visitation to ensure the safety of their residents against transmission of the novel coronavirus. As such, these LTC homes had to quickly implement a rapid rollout of telehealth services to maintain physician care for residents while avoiding the infection risk of in-person visits amidst lockdown measures. The abrupt transition from traditional in-person physician care to telehealth presented significant challenges. Investigating these challenges is pivotal to the development of strategies for sustained telehealth use for physician services in LTC homes. This analysis is part of a broader qualitative, utilization-focused evaluation study of telehealth services rapidly implemented for physician care in LTC homes within the Fraser Health Authority region of British Columbia. The evaluation has aimed to consider integral factors such as telehealth challenges, facilitators, preferences, and continued use. Semi-structured interviews and focus groups were conducted with 70 physicians, staff, residents, and family caregivers across 27 different LTC homes in the region. All interviews and focus groups were transcribed verbatim and were analyzed using a thematic approach to identify common barriers surrounding the rapid rollout of telehealth in LTC across relevant groups.ResultsFrom the data, four challenges were identified: connectivity challenges (e.g., inconsistent or no Wi-Fi or cellular connectivity), device challenges (e.g., lack of accessible devices and software issues), privacy challenges (e.g., lack of private space to support telehealth use), and informational challenges (e.g., lack of electronic medical record access). All challenges posed barriers to telehealth access for both care provider and recipient groups in LTC settings.ConclusionsThe challenges identified in this analysis are supported by existing literature, which is significant given the different contexts within which such research has been undertaken. Collectively, this knowledge base can support evidence-informed improvements to telehealth for physician care in LTC settings. Future research should capture the perspectives of diverse cultural groups, LTC residents with cognitive impairments, and those who provide and receive care in rural settings.