Long-term Care Staff Research Articles

Mealtime Support by Long-Term Care Staff and Impact on Meal Intake and Behaviors Among Adults with Dementia: A Systematic Review

Mealtime Support by Long-Term Care Staff and Impact on Meal Intake and Behaviors Among Adults with Dementia: A Systematic Review

Evaluation of a Workshop on Therapeutic Lying and Dementia Care for Long-Term Care Staff Supporting Persons With Dementia.

Therapeutic lying is an intervention used by health care professionals (HCPs) when a person with dementia is disoriented and distressed and when all other interventions have not succeeded in deescalating the symptoms of dementia. The goal of this study was to evaluate a workshop on therapeutic lying and dementia care for HCPs specializing in the care of persons living with dementia with symptoms of dementia. Seventeen HPCs, including nurses and personal support workers (PSWs), participated in the workshop and evaluation survey. The workshop did not affect the attitudes of HCPs toward therapeutic lying and dementia, their sense of competence in providing care to patients with dementia, or their rate of admitting to using therapeutic lying in dementia care settings. All of the PSWs and 50.0% of the nurses admitted to using therapeutic lying as an intervention. Conclusion: Current nursing ethics standards and training practices may cause reluctance among nurses to include therapeutic lying in care plans as a last resort and as a person- and family-centered intervention to deescalate the symptoms of dementia. [J Contin Educ Nurs. 2021;52(9):438-444.].

COVID-19 Incidence and Mortality Among Long-Term Care Facility Residents and Staff in South Carolina

ObjectivesThis study explored differences in COVID-19 incidence, mortality, and timing among long-term care facility (LTCF) residents and staff with those living in the community in South Carolina (SC). DesignLongitudinal secondary data analysis. Setting and ParticipantsAdults age ≥18 in SC with confirmed COVID-19 diagnosis from 3/15/2020 and 1/2/2021 (n = 307,891). MethodsCOVID-19 data came from the SC Department of Health and Environmental Control (SCDHEC). We included all COVID-19 cases, hospitalizations, and deaths among adult residents. Residence and employment in LTCF were confirmed by SCDHEC. Descriptive statistics and trends for cases, hospitalizations, and deaths were calculated. We used Cox proportional hazards to compare COVID-19 mortality in LTCF residents and staff to community dwelling older adults and adults not employed in LTCF, respectively, controlling for age, gender, race, and pre-existing chronic health conditions. ResultsLTC residents experienced greater incidence of cases throughout the study period until the week ending on 1/2/21. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR: 1.74, 95% CI: 1.59-1.90), after adjusting. LTC staff experienced greater incidence of cases compared to adults not employed in LTCF until the week ending on 12/26/2020, while experiencing similar incidence of death compared to the similar community members. After adjusting, LTC staff had 0.58 (HR = 0.58; CI: 0.39-0.88) times lower hazard of death compared to community members that did not work in a LTCF. Conclusions and ImplicationsNarrowing of the gap between LTCF and community-wide infection and mortality rates over the study period suggests that early detection of COVID-19 in LTCFs could serve as a first indicator of disease spread in the greater community. Results also indicate that policies and regulations addressing staff testing and protection may help to slow or prevent spread within facilities.

Effect of Dementia Training on Knowledge and Attitude Among Long-Term Care Staff in Yogyakarta, Indonesia

BACKGROUND: The number of patients with dementia has increased globally. Caring for these patients is very challenging and demanding. There are many patients with dementia in long-term care facilities in Yogyakarta, Indonesia. However, most staff members do not have proper training regarding how to care for patients with dementia. AIM: This research aimed to investigate the effect of dementia care skills training on knowledge and attitudes about dementia among long-term care staff in Yogyakarta, Indonesia. METHODS: A pre-experimental study was conducted using a one-group pre-test and post-test method. There were 30 staff members in a long-term care facility in Yogyakarta, Indonesia, who participated in this study in July 2019. Training given was the Dementia Care Skills 18 h version for care workers provided by Alzheimer’s Indonesia by two certified trainers. Outcomes measured were knowledge and attitudes of the participants, which were measured using the Dementia Knowledge Assessment Scale and Dementia Attitude Scale. Data were analyzed using paired and independent t-tests as well as Pearson correlation tests. RESULTS: The results showed that staff knowledge of dementia (t = 4.78, p = 0.000) and attitudes toward persons with dementia (t = 3.27, p = 0.003) were improved significantly after the dementia training provided by the Alzheimer’s Indonesia trainers. CONCLUSIONS: Training in dementia care can improve knowledge and attitude of long-term care staff. This study recommends that dementia care skills training be provided for staff and nurses in long-term care to improve their knowledge and attitudes regarding patients with dementia and their care.

Evaluation of the Abbott PanbioTM COVID-19 Ag rapid antigen test for the detection of SARS-CoV-2 in asymptomatic Canadians

Several rapid testing methodologies have been approved for testing of symptomatic individuals but have not been validated for asymptomatic screening. We evaluated performance of the Abbott PanbioTM COVID-19 rapid antigen assay in the asymptomatic setting. We conducted a prospective study in an urban assessment center and in the context of long-term care staff screening. A total of 3014 individuals submitted paired nasopharyngeal samples, which were tested in parallel with the rapid antigen and laboratory-based, RT-PCR assays SARS-CoV-2 detection. There was 54.5% concordance in positive results between the rapid antigen assay and RT-PCR. All positive rapid antigen assay results were confirmed by RT-PCR. The negative predictive value of the rapid antigen assay minimally improved on the negative pre-test probability of SARS-CoV-2 infection. The Abbott PanbioTM COVID-19 rapid antigen test allowed for faster identification of infected individuals but cannot be used to rule-out SARS-CoV-2 infection.

Evaluation of Screening Tests in Bavarian Healthcare Facilities during the Second Wave of the SARS-CoV-2 Pandemic.

Due to the lack of data on asymptomatic SARS-CoV-2-positive persons in healthcare institutions, they represent an inestimable risk. Therefore, the aim of the current study was to evaluate the first 1,000,000 reported screening tests of asymptomatic staff, patients, residents, and visitors in hospitals and long-term care (LTC) facilities in the State of Bavaria over a period of seven months. Data were used from the online database BayCoRei (Bavarian Corona Screening Tests), established in July 2020. Descriptive analyses were performed, describing the temporal pattern of persons that tested positive for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) or antigen tests, stratified by facility. Until 15 March 2021, this database had collected 1,038,146 test results of asymptomatic subjects in healthcare facilities (382,240 by RT-PCR, and 655,906 by antigen tests). Of the RT-PCR tests, 2.2% (n = 8380) were positive: 3.0% in LTC facilities, 2.2% in hospitals, and 1.2% in rehabilitation institutions. Of the antigen tests, 0.4% (n = 2327) were positive: 0.5% in LTC facilities, and 0.3% in both hospitals and rehabilitation institutions, respectively. In LTC facilities and hospitals, infection surveillance using RT-PCR tests, or the less expensive but less sensitive, faster antigen tests, could facilitate the long-term management of the healthcare workforce, patients, and residents.

Mandatory COVID-19 vaccination for frontline care home staff soon to become law

British Journal of Healthcare AssistantsVol. 15, No. 6 Health MattersMandatory COVID-19 vaccination for frontline care home staff soon to become lawAlan GlasperAlan GlasperEmeritus Professor of Nursing, University of SouthamptonSearch for more papers by this authorAlan GlasperPublished Online:11 Jul 2021https://doi.org/10.12968/bjha.2021.15.6.296AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Albert A. Care homes fear mandatory vaccination will lead to exodus of workers. 26 April 2021. https://www.carehome.co.uk/news/article.cfm/id/1647914/Fears-grow-mandatory-staff-vaccination-could-make-care-home-workers-unemployable (accessed 23 June 2021) Google ScholarAllegretti A. Ministers urged not to ‘threaten’ NHS staff over mandatory COVID jab. 30 May 2021. https://www.theguardian.com/politics/2021/may/30/ministers-urged-not-to-threaten-nhs-staff-over-mandatory-covid-jab (accessed 23 June 2021) Google ScholarAllegretti A. UK rights watchdog endorses compulsory COVID jabs for care home staff https://www.theguardian.com/society/2021/jun/02/uk-rights-watchdog-endorses-compulsory-covid-jabs-for-care-home-staff (accessed 23 June 2021) Google ScholarAragbonfoh Abumere F. Utilitarianism. 2019. https://press.rebus.community/intro-to-phil-ethics/chapter/utilitarianism/ (accessed 23 June 2021) Google ScholarBerger D. Up the line to death: COVID-19 has revealed a mortal betrayal of the world’s healthcare workers. 29 January 2021. https://blogs.bmj.com/bmj/2021/01/29/up-the-line-to-death-covid-19-has-revealed-a-mortal-betrayal-of-the-worlds-healthcare-workers/ (accessed 23 June 2021) Google ScholarBooth R, Rawlinson K. A third of care home staff in some London areas have not had COVID jab. 16 June 2021. https://www.theguardian.com/society/2021/jun/16/all-care-home-staff-in-england-should-have-covid-vaccine-says-minister (accessed 23 June 2021) Google ScholarBrowne Salas J, Comas-Herrera A, Drou Roget G et al. National discussions on mandatory vaccination for long-term care staff in 24 countries. LTCcovid international overviews of long-term care policies and practices in relation to Covid-19 (No. 1, May 2021). 2021. https://ltccovid.org/2021/05/25/national-discussions-on-mandatory-vaccination-among-long-term-care-staff-in-23-countries-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19-no-1-may/() Google ScholarDepartment of Health and Social Care. Consultation launched on staff COVID-19 vaccines in care homes with older adult residents. 2021a. https://www.gov.uk/government/news/consultation-launched-on-staff-covid-19-vaccines-in-care-homes-with-older-adult-residents (accessed 23 June 2021) Google ScholarDepartment of Health and Social Care. Making vaccination a condition of deployment in older adult care homes. 2021b. https://www.gov.uk/government/consultations/making-vaccination-a-condition-of-deployment-in-older-adult-care-homes (accessed 23 June 2021) Google ScholarField RI. Mandatory vaccination of health care workers: whose rights should come first? PT. 2009;34(11):615–618 Google ScholarGoldstein A. Should health-care workers be required to get coronavirus shots? Companies grapple with mandates. 5 April 2021. https://www.washingtonpost.com/health/should-health-care-workers-be-required-to-get-coronavirus-shots-companies-grapple-with-mandates/2021/04/04/2369048e-92f2-11eb-a74e-1f4cf89fd948_story.html (accessed 23 June 2021) Google ScholarHassan C. Employees protest against Houston hospital’s policy that all staff must be vaccinated against COVID-1. 9 June 2021. https://edition.cnn.com/2021/06/08/us/houston-hospital-staff-protest-vaccine-mandate/index.html (accessed 23 June 2021) Google ScholarHoltug N. The harm principle. Ethical Theory Moral Pract. 2002;5(4):357–389 Crossref, Google ScholarKhinkulova K. Alarming COVID surge cools Russia’s football fever. 19 June 2021. https://www.bbc.co.uk/news/world-europe-5751135 (accessed 23 June 2021) Google ScholarLocke T. UK COVID-19 update: cases ‘rising exponentially’, mandatory NHS jabs divide opinion in Medscape UK poll. 2021. https://www.medscape.com/viewarticle/953270 (accessed 23 June 2021) Google ScholarNightingale F. Notes on nursing: what it is, and what it is not. London: Harrison; 1860 Google ScholarPaterlini M. COVID-19: Italy makes vaccination mandatory for healthcare workers. BMJ 2021; 373: n905 doi: https://doi.org/10.1136/bmj.n905 Google ScholarRoberts L. Nurse who spread Covid conspiracy theories that vaccines will ‘kill you’ struck off. 3 June 2021. https://www.telegraph.co.uk/news/2021/06/03/nurse-spread-covid-conspiracy-theories-vaccines-will-kill-struck/ (accessed 23 June 2021) Google ScholarRoyal College of Nursing. RCN position on mandating vaccination for health and social care staff. 2021. https://www.rcn.org.uk/about-us/our-influencing-work/position-statements/rcn-position-on-mandating-vaccination-for-health-and-social-care-staff() Google ScholarWalker P, Campbell D, Booth R. Plan to oblige care staff to have Covid jab and England easing delay confirmed. 16 Jun 2021. https://www.theguardian.com/politics/2021/jun/16/matt-hancock-confirms-plan-to-require-care-staff-to-have-covid-vaccine (accessed 23 June 2021) Google Scholar FiguresReferencesRelatedDetails 2 July 2021Volume 15Issue 6ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 11 July 2021 Published in print 2 July 2021 Information© MA Healthcare LimitedPDF download

Moral Injury.

Moral Injury.

Intimacy for older adults in long-term care: a need, a right, a privilege—or a kind of care?

BackgroundTo investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as...

Hearing and vision health for people with dementia in residential long term care: Knowledge, attitudes and practice in England, South Korea, India, Greece, Indonesia and Australia.

ObjectivesUp to 90% of people with dementia in long term care (LTC) have hearing and/or vision impairment. Hearing/vision difficulties are frequently under‐recognised or incompletely managed. The impacts of hearing/vision impairment include more rapid cognitive decline, behavioural disturbances, reduced quality of life, and greater care burden. This research investigated LTC staff knowledge, attitudes and practice regarding hearing/vision care needs for residents with dementia.MethodsA survey of staff in LTC facilities in England, South Korea, India, Greece, Indonesia and Australia. Respondents used a five‐point scale to indicate agreement or YES/NO response to questions regarding sensory‐cognitive care knowledge (what is known); attitudes (what is thought); practice (what is done).ResultsRespondents reported high awareness of hearing/vision care needs, although awareness of how to identify hearing/vison difficulties or refer for assessment was low. Most felt that residents were not able to use hearing/vision devices effectively due to poor fit, being poorly tolerated or lost or broken devices. A substantial minority of respondents reported low confidence in supporting use of assistive hearing/vision devices, with lack of training the main reason. Most staff did not undertake routine checking of hearing/vision devices, and it was rare for facilities to have designated staff responsible for sensory needs. Variation among countries was not significant after accounting for staff experience and having received dementia training.ConclusionsThere is a need to improve sensory support for people with dementia in LTC facilities internationally. Practice guidelines and training to enhance sensory‐cognitive knowledge, attitudes and practice in professional care teams is called for.

Effect of a multimethod quality improvement intervention on antipsychotic medication use among residents of long-term care

BackgroundAntipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted...

A systematic review of the association between nursing staff and nursing-sensitive outcomes in long-term institutional care.

To examine the association between type of nursing staff and nursing-sensitive outcomes in long-term institutional care. This systematic review included studies published in English, German, and Dutch between January 1997 and January 2020. The databases Medline (PubMed), CINAHL, PsycINFO, Embase, and the Cochrane Library were searched. Original quantitative studies were included. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to critically appraise the reporting of the studies. Fifteen articles were included. Of 33 quality of care outcomes, 21 were identified as nursing-sensitive outcomes of which 13 showed a significant association with nursing staff, specifically: Activities of daily living, aggressive behavior, bladder/bowel incontinence, contractures, expressive language skills, falls, infection (including vaccination), range of motion, pain, pressure ulcers, and weight loss. However, studies reported inconsistent results regarding the association among RNs, LPNs, CNAs, and HCAs and these nursing-sensitive outcomes, evidence shows that more RNs have a positive impact on nursing-sensitive outcomes. As to the evidence regarding the other type of nursing staff, especially HCA, findings regularly showed a negative association. Future research should be expanded with structure and process variables of which the mediating and moderating effect on nursing-sensitive outcomes is known. These may explain variances in quality of care and guide quality improvement initiatives. Researchers should consider fully applying Donabedian's structure-process-outcomes framework as it is a coherent entirety for quality assessment. This review provides an overview of quality of care outcomes that are responsive to nursing interventions in long-term institutional care. As the effects can be monitored and documented, quality assessment should focus on these nursing-sensitive outcomes. The inconclusive results make it difficult to provide recommendations on who should best perform which care.

Effectiveness of the Pfizer-BioNTech COVID-19 Vaccine Among Residents of Two Skilled Nursing Facilities Experiencing COVID-19 Outbreaks - Connecticut, December 2020-February 2021.

Residents of long-term care facilities (LTCFs), particularly those in skilled nursing facilities (SNFs), have experienced disproportionately high levels of COVID-19-associated morbidity and mortality and were prioritized for early COVID-19 vaccination (1,2). However, this group was not included in COVID-19 vaccine clinical trials, and limited postauthorization vaccine effectiveness (VE) data are available for this critical population (3). It is not known how well COVID-19 vaccines protect SNF residents, who typically are more medically frail, are older, and have more underlying medical conditions than the general population (1). In addition, immunogenicity of the Pfizer-BioNTech vaccine was found to be lower in adults aged 65-85 years than in younger adults (4). Through the CDC Pharmacy Partnership for Long-Term Care Program, SNF residents and staff members in Connecticut began receiving the Pfizer-BioNTech COVID-19 vaccine on December 18, 2020 (5). Administration of the vaccine was conducted during several on-site pharmacy clinics. In late January 2021, the Connecticut Department of Public Health (CT DPH) identified two SNFs experiencing COVID-19 outbreaks among residents and staff members that occurred after each facility's first vaccination clinic. CT DPH, in partnership with CDC, performed electronic chart review in these facilities to obtain information on resident vaccination status and infection with SARS-CoV-2, the virus that causes COVID-19. Partial vaccination, defined as the period from >14 days after the first dose through 7 days after the second dose, had an estimated effectiveness of 63% (95% confidence interval [CI]=33%-79%) against SARS-CoV-2 infection (regardless of symptoms) among residents within these SNFs. This is similar to estimated effectiveness for a single dose of the Pfizer-BioNTech COVID-19 vaccine in adults across a range of age groups in noncongregate settings (6) and suggests that to optimize vaccine impact among this population, high coverage with the complete 2-dose series should be recommended for SNF residents and staff members.

Nurse Practitioners Rising to the Challenge During the Coronavirus Disease 2019 Pandemic in Long-Term Care Homes.

Background and ObjectivesThere is an urgency to respond to the longstanding deficiencies in health human resources in the long-term care (LTC) home sector, which have been laid bare by the coronavirus disease 2019 (COVID-19) pandemic. Nurse practitioners (NPs) represent an efficient solution to human resource challenges. During the current pandemic, many Medical Directors in LTC homes worked virtually to reduce the risk of transmission. In contrast, NPs were present for in-person care. This study aims to understand the NPs’ roles in optimizing resident care and supporting LTC staff during the pandemic.Research Design and MethodsThis exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes in Ontario, Canada, was recruited. Data were generated using semistructured interviews and examined using thematic analysis.ResultsFour categories relating to the NPs’ practices and experiences during the pandemic were identified: (a) containing the spread of COVID-19, (b) stepping in where needed, (c) supporting staff and families, and (d) establishing links between fragmented systems of care by acting as a liaison.Discussion and ImplicationsThe findings suggest that innovative models of care that include NPs in LTC homes are required moving forward. NPs embraced a multitude of roles in LTC homes, but the need to mitigate the spread of COVID-19 was central to how they prioritized their days. The pandemic clearly accentuated that NPs have a unique scope of practice, which positions them well to act as leaders and build capacity in LTC homes.

Medical and Mental Health Services in US Assisted Living Settings During COVID-19: Challenges and Opportunities

The COVID-19 pandemic has disproportionately affected long-term care settings, staff, residents, and residents’ families across the US; related reports and recommendations highlight the confusion around where assisted living (AL) belongs within the context of “long-term care.” Although much attention has been paid to skilled nursing facilities in the context of COVID-19, AL and other residential care settings have rarely been singled out in media and empirical discourse. This study describes perceptions of medical and mental health care provisions within US AL communities in the COVID-19 context.

Field Testing of Ro-Tri, a Robot-Mediated Triadic Interaction for Older Adults.

Older adults residing in long term care (LTC) settings commonly experience apathy, a neuropsychiatric condition with adverse consequences of increased morbidity and mortality. Activities that combine social, physical and cognitive stimuli are most effective in engaging older adults with apathy but are time consuming and require significant staff resources. We present the results from an initial pilot field study of our socially assistive robotic (SAR) system, Ro-Tri, capable of multi-modal interventions to foster social interaction between pairs of older adults. Seven paired participants attended two sessions a week for three weeks. Sessions consisted of robot-mediated triadic interactions with three types of activities repeated once over the 3 weeks. Ro-Tri gathered quantitative interaction data, head pose, vocal sound, and physiological signals to automatically evaluate older adults’ activity and social engagement. Ro-Tri functioned smoothly without any technical issues. Older adults had > 90% attendance and 100% completion rate and remained engaged with the system throughout the study duration. Participants’ visual attention toward the SAR system and their partners increased 7.2% and 4.7%, respectively, with their interaction effort showing an increase of 2.9%. Older adults and LTC staff had positive perceptions with the system. These initial results demonstrate Ro-Tri’s ability to engage older adults, encourage social human-to-human interaction, and assess the changes using quantitative metrics. Future studies will determine SAR’s impact on apathy in LTC older adults.

Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic

ObjectivesTo assess changes in the mobility of staff between nursing homes in Ontario, Canada, before and after enactment of public policy restricting staff from working at multiple homes. DesignPre-post observational study. Setting and Participants623 nursing homes in Ontario, Canada, between March 2020 and June 2020. MethodsWe used GPS location data from mobile devices to approximate connectivity between all 623 nursing homes in Ontario during the 7 weeks before (March 1–April 21) and after (April 22–June 13) the policy restricting staff movement was implemented. We constructed a network diagram visualizing connectivity between nursing homes in Ontario and calculated the number of homes that had a connection with another nursing home and the average number of connections per home in each period. We calculated the relative difference in these mobility metrics between the 2 time periods and compared within-home changes using McNemar test and the Wilcoxon rank-sum test. ResultsIn the period preceding restrictions, 266 (42.7%) nursing homes had a connection with at least 1 other home, compared with 79 (12.7%) homes during the period after restrictions, a drop of 70.3% (P < .001). Including all homes, the average number of connections in the before period was 3.90 compared to 0.77 in the after period, a drop of 80.3% (P < .001). In both periods, mobility between nursing homes was higher in homes located in larger communities, those with higher bed counts, and those part of a large chain. Conclusions and ImplicationsMobility between nursing homes in Ontario fell sharply after an emergency order by the Ontario government limiting long-term care staff to a single home, though some mobility persisted. Reducing this residual mobility should be a focus of efforts to reduce risk within the long-term care sector during the COVID-19 pandemic.

Caring Relations at the Margins of Neurological Care Home Life: The Role of ‘Hotel Service’ Staff in Brain Injury Rehabilitation

Context: Domestic staff in hospitals and aged long-term care have been shown to perform a range of caring roles alongside their cleaning work. Objective: This paper explores the roles these people and other ‘hotel service staff’ (catering, domestic, maintenance, finance and administrative) play in the rehabilitation of people with brain injuries residing in long-term care settings. Methods: This research draws on in-depth ethnographic data collected in 2014–15 over five months at two neurological long-term care settings in the UK; including interviews and observations of day-to-day happenings in the lives of around 60 brain injured residents and the work of 16 hotel service staff. The data was subject to a situational analysis – underpinned by grounded theory and discourse analysis. Findings: Hotel service staff contribute to and compliment the rehabilitation of patients’ cognitive skills, communication and physical functioning, and provide opportunities for occupation and interaction. The therapeutic accomplishments achieved by involving patients in mundane tasks of everyday life (e.g., gardening, managing money, sharing food), fit with the aims of more ‘formalized’ rehabilitation – to restore patients’ abilities to carry out ‘activities of daily living’. Limitations: This study has been unable to fully explicate how hotel service staff have, or gain, the skills to interact so positively with brain injured residents. The study was confined to two sites and may not be reflective of practice elsewhere. Implications: The study findings highlight how the work and interactions of hotel service staff contribute not only to care but to the rehabilitation of people with severe brain injuries. This has implications for service design as well as health and social care education.

Willingness of Long-Term Care Staff to Receive a COVID-19 Vaccine: A Single State Survey.

To plan for coronavirus infectious disease 2019 (COVID-19) vaccine distribution, the Indiana Department of Health surveyed nursing home and assisted living facility staff. Cross-sectional analysis of an anonymous survey sent via text message link to personal cell phones and emails. Nursing home and assisted living facility staff in Indiana. Staff characteristics including age, gender, race, ethnicity, role in the facility, experience in long-term care, and geographic location of facility were self-reported along with prior infection and willingness to receive an approved vaccine as soon as it is available. Responses were weighted to represent staff statewide. Weighted frequencies and logit regression estimated characteristics associated with vaccine willingness. There were 8,243 responses to the survey. For nursing home staff (survey delivered via 23,232 working phone numbers), there was a 33% response rate). There were 2,372 (29%) in nurse aide or similar roles and 1,602 nurses providing direct clinical care (19%). Overall, 45% of respondents indicated they would receive an approved COVID-19 vaccine as soon as available. Of those unwilling to take the vaccine when first available, 44% would consider in the future. Concerns about side effects was the primary reason for vaccine hesitancy (70%). Characteristics associated with increased willingness were age over 60, male, and white race (P < .0001). No statistically significant differences were observed among staff self-reporting prior SARS-CoV-2 infection. The willingness to receive the COVID-19 vaccine immediately or in the future may be as high as 69%, but varies among subgroups of nursing home staff which has implications for distribution. Educating staff on the vaccine may be critical for increasing uptake. Widespread vaccination holds the promise of protection against serious illness and death and a return of visitors and activities that support improved quality of life. This promise will not be realized without strong uptake of the vaccines.

Long-Term Residential Care Policy Guidance for Staff to Support Resident Quality of Life.

Background and ObjectivesAmidst a complex policy landscape, long-term residential care (LTRC) staff must navigate directives to provide safe care while also considering resident-preferred quality of life (QoL) supports, which are sometimes at odds with policy expectations. These tensions are often examined using a deficit-based approach to policy analysis, which highlights policy gaps or demonstrates how what is written creates problems in practice.Research Design and MethodsThis study used an asset-based approach by scanning existing LTRC regulations in 4 Canadian jurisdictions for promising staff-related policy guidance for enhancing resident QoL. A modified objective hermeneutics method was used to determine how 63 existing policy documents might be interpreted to support Kane’s 11 QoL domains.ResultsAnalysis revealed regulations that covered all 11 resident QoL domains, albeit with an overemphasis on safety, security, and order. Texts that mentioned other QoL domains often outlined passive or vague roles for staff. However, policy texts were found in all 4 jurisdictions that provided clear language to support staff discretion and flexibility to navigate regulatory tensions and enhance resident QoL.Discussion and ImplicationsThe existing policy landscape includes promising staff-related LTRC regulation in every jurisdiction under investigation. Newer policies tend to reflect more interpretive approaches to staff flexibility and broader QoL concepts. If interpreted through a resident QoL lens and with the right structural supports, these promising texts offer important counters to the rigidity of LTRC policy landscape and can be leveraged to broaden and enhance QoL effectively for residents in LTRC.