Residential Care Facilities Research Articles

Adaptation to Residential Care: Voices from New Zealand

This article explores the adaptation process of older adults in residential care facilities in New Zealand. Through a phenomenological approach, this study provides clarity on how older adults adjust in residential care despite losses and challenges. Qualitative data on 24 older adults, 6 residential care facilities, and 10 staff were collected. Utilising qualitative software the following were identified: loss, support, acceptance and meaningful support. Initially, the unfamiliar environment and faces, structured routines, lack of interaction, absence of familiar activities, and limited visits from family and friends increased residents’ feelings of loneliness with institutionalisation. In time, they adapted to the routines and came to accept the facilities as, if not “home,” then “like home.” Participation in activities and support from staff and family contributed to this process. Activities can facilitate adjustment by promoting social contact, providing meaning and helping residents to establish new identities. The participants’ stories revealed that, despite the challenges of relocation, they adapted well to the residential environment.

FC47: To use or not to use? Multiple perspectives on residents’ alcohol and tobacco use in residential care facilities

Objectives:Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities. RCFs aim to provide person-centred care (PCC) to enhance the quality of life (QoL) of residents. Residents are dependent on their environment to fulfil their needs and wishes, such as drinking alcohol or smoking tobacco. Although alcohol and tobacco use can be experienced as a part of QoL in the final phase of life and the motivation to quit these substances is low, it can cause severe health problems in older adults. In RCFs this may cause a dilemma between the QoL of individual residents and the health and safety problems of all residents. This study aims to explore multiple perspectives on alcohol and tobacco use within the RCF.Methods:A qualitative research design was chosen, and semi-structured interviews were conducted. A various sample was purposively selected in two organizations on two types of units (psychogeriatric units and units providing care for residents with mainly physical disabilities): residents who use alcohol and/or tobacco and those who do not. Subsequently, four of these 16 residents were invited to participate in an in-depth case study. To explore the dynamics of the social environment, both formal and informal caregivers were invited to participate.Results:Residents are satisfied with their current use and value their autonomy regarding alcohol and tobacco use. Residents acknowledge that their use could cause a nuisance to others. Multiple caregivers are involved in their use and residents experience dependency on these caregivers to smoke tobacco or drink alcohol. There was limited interaction between the residents and their (in)formal caregivers and amongst the caregivers on this topic. Moreover, caregivers tended to act from their own perspectives, based on their professional expertise, knowledge, and attitudes towards residents’ alcohol and tobacco use.Conclusion:A dilemma arises between protecting residents from the adverse (health) outcomes of alcohol and tobacco use and sustaining their QoL by optimizing their autonomy. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health, and safety risks for all.

Hospitality in volunteer engagement: navigating complexities in residential care facilities for children

ABSTRACT This study investigates the multifaceted realm of volunteer engagement in orphanages and residential care facilities for children, as places of hospitality towards volunteers, in low- and middle-income countries. While the positive outcomes of such engagements, including assistance, economic contributions and personal growth, are acknowledged, the study critically examines the potential ethical challenges inherent in these settings. Drawing from a theoretical framework developed by Duursma and colleagues on motives for volunteering, the research focuses on 25 volunteer applications submitted to a residential care facility in Bali, Indonesia. The qualitative analysis, guided by thematic analysis, explores motives, exchanges, individual behaviour, place and space considerations, time-based dimensions and outcomes and impacts. Ethical considerations, including data anonymisation, were rigorously implemented to ensure the privacy and confidentiality of potential volunteers and child-related data. The findings reveal diverse motives among potential volunteers, encompassing moral imperatives, leisure needs, personal interests and a genuine desire to care for others. The emphasis on non-monetary exchanges and a commitment to the community echoes Duursma and colleagues’ framework, aligning with concepts of voluntary exchange, individual behaviour and place/space considerations. The study underscores the transcendence of empathy and compassion in motivating volunteers to engage with orphanages and residential care facilities for children, reflecting a dedication to making a lasting impact, and fostering substantive connections within the community. The discussion integrates the empirical findings with the theoretical framework, providing a nuanced understanding of the complexities surrounding hospitality volunteering in orphanages and residential care facilities. The study acknowledges ethical concerns and calls for continued scrutiny, ethical considerations and collaboration to ensure that volunteerism remains a force for positive change and authentic care.

P209: Psychological therapies for depression in older adults residing in long-term care settings: Are they effective?

Objectives:This systematic review and meta-analysis aimed to (1) assess the effectiveness of psychological therapies for depression in older people living in long-term care (LTC) settings, and (2) investigate differences in effectiveness between types of psychological treatments.Methods:We included randomised controlled trials (RCTs) with participants aged 65 years and older. Participants were required to present with (a) major depressive disorder (MDD) or (b) symptoms of depression based on a score over a cut-point on a validated depression measure. The study setting was LTC facilities, including nursing homes, assisted-living facilities, and residential aged care facilities, where some level of day-to-day care was provided by staff employed in the facility. Treatments were grouped and classified as cognitive-behavioural therapy, behaviour therapy, or reminiscence therapy.Results:The literature review identified 19 studies for the qualitative synthesis: 18 were included in a meta-analysis. Results indicated a benefit for psychological treatments on depressive symptoms at end-of-intervention (standardized mean difference (SMD) -1.04, 95% CI -1.49 to -0.58; 18 trials, 644 participants), and at a medium-term follow-up (SMD -0.43, 95% CI -0.81 to -0.06; 8 RCTs, 355 participants), but not in the longer-term (SMD -0.16, 95% CI -0.58 to 0.27; 2 RCTs, 92 participants). There was no difference in outcomes between therapy types.Conclusion:This systematic review demonstrated positive impacts of psychological therapies on symptoms of depression in older people living in LTC, both immediately after therapy and in the medium term, but longer-term impacts were not demonstrated.

P182: Effects of Physical Environment on Quality of Life of Residents in Dementia Facilities in Canada & South Korea: A Longitudinal Observational Study

Approximately 44% of new residents of care facilities in Korea were diagnosed with dementia (Song, Park & Kim, 2013), and in Canada, about one-third of older adults younger than 80 who have been diagnosed with dementia live in long-term care facilities (Canadian Institute for Health Information, 2018). Due to the rapid increase of these figures in the future, continuing to provide assistance services and appropriate environment for residents with dementia could be challenging for both countries.This longitudinal observational study aims to examine whether residents with dementia in long-term care facilities with variability in physical environment attributions in Vancouver (N=11), Canada and Seoul (N=9), South Korea had a distinction in their quality of life (QoL). Physical environmental assessment was conducted using the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) (Sloane et al., 2002). QoL was assessed three times over one year using Dementia Care Mapping tool (DCM) (University of Bradford, 2010). The results of the study demonstrated that the residents with dementia living in an institutional large-scale setting showed statistically more withdrawn behavior and spent more time to be negative mood or affect compared to the ones in a small-scale setting. This study also found that the number of potential positive behaviors of residents in a small-scale setting was three times higher than that of residents in an institutional large-scale setting. When looking at the distinction between two countries in the behavior category with a large average time difference, the residents with dementia in Korea had shorter meal/dessert times compared to those in Canada. The study supports that the small-scale homelike environment is intensely associated with a therapeutic environment for older adults with dementia.

Predictive Ability of Physical Performance Measures in Identifying Falls in Older Adults with Dementia: A Systematic Review and Meta‐Analysis

AbstractBackgroundFalls are very common in older adults with dementia and pose a serious threat to their physical and psychological health, functional independence, and life expectancy. Reduced physical performance (i.e., gait, balance, muscle strength, and mobility impairments) has been shown to be a risk factor for falls in older adults with dementia. Identifying measures of physical performance that can predict falls in this population is crucial for clinicians and researchers to select appropriate assessment tools to evaluate their fall risk and design effective fall prevention strategies.The objective of this systematic review and meta‐analysis is to determine whether physical performance measures commonly used in clinical settings can predict falls in older adults with dementia.MethodMEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, Cochrane Library, and PEDro databases were searched from inception until 27 January 2023 (Prospero Registration: CRD42022303670). Longitudinal cohort and cross‐sectional studies that evaluated the associations between physical performance measures and falls in individuals aged ≥ 65 with dementia were included. The standardized mean difference (SMD) in each physical performance measure between fallers and non‐fallers was calculated.ResultTwenty‐five studies were included in this systematic review and meta‐analysis (Figure 1). Five‐time chair stands (SMD: 0.23; 95% CI: 0.01, 0.45), postural sway on floor with eyes open (SMD: 0.25; 95% CI: 0.07, 0.43), postural sway on foam with eyes open (SMD: 0.45; 95% CI: 0.25, 0.66), Berg Balance Scale (SMD: ‐0.52; 95% CI: ‐0.87, ‐0.17), and Timed Up and Go test (SMD: 0.34; 95% CI: 0.03, 0.64) predicted falls in older adults with dementia (Figure 2). Sensitivity analyses showed that gait speed could predict falls in those who were staying in residential care facilities or hospitals (SMD: ‐0.21; 95% CI: ‐0.38, ‐0.05). Concerns about the risk of bias in the included studies were noted, and the quality of evidence was generally very low to low.ConclusionChair stands, postural sway on floor and foam, Berg Balance Scale, and Timed Up and Go test can predict falls in older adults with dementia. Gait speed can only predict falls among those who are staying in residential care or hospital units.

The person first: reflections about reminiscence, decision and person-centered attention to reduce the psychological impact of losses in Residential Care Facilities (RCF ́s)

Background:Although the losses associated with aging activate additional psychological resilience resources, dependency settings, which often require admission to Residential Care Facilities (RCF's), need adequate care so that the person can maintain his/her dignity and quality of life. The activation of mechanisms for regulating losses and the preservation of the identity and autonomy of the person respecting his/her decision-making capacity are central for the preservation of the well-being of people with dependence. Portuguese RCF's are mainly based on care models that are opposed to the models of attention centered on the person, which value the person's potential and decision-making capacity. The COVID-19 pandemic has tested RCF's, highlighting their weaknesses and limitations.Objective:This study aimed to identify ways to improve the provision of care in RCF's during the pandemic.Method:This is a qualitative study, with data collection through an online questionnaire. Participants were invited to indicate strategies to improve the provision of care to elderly residents in RCF's. The study included 198 RCF ́s workers during the COVID-19 pandemic. Content analysis of the collected data was performed.Preliminary results on the ongoing study: The results indicate that the strategies that RCF´s workers consider most necessary are at the level of human resources, also highlighting the need for greater proximity, affection and attention to residents, the personalization of care and the valorization of the resident person and his/her opinions. These are considered by the participants as central strategies for the quality of care and satisfaction of RCF ́s workers.Conclusion:The needs identified are in line with the guiding principles of Person-Centered Care. The use of reminiscence as a strategy for valuing the person and his/her identity, as well as the promotion of self-determination, evaluating and allowing the person to make decisions may be central to meeting the needs identified at the level of care. The necessary transition from RCF's in Portugal to paradigms of centered care is thus reinforced by the results of this study.

FC26: What have staff got to do with it? Untangling complex relationships between residential aged care staff, the quality of care they provide, and the quality of life of people with dementia

Background:Despite the integral role long term residential care staff play in the lives of residents with dementia, the mechanisms for supporting staff to bring about good quality of care (QOC) and quality of life (QOL) are poorly understood. This study focused on establishing the key mechanisms to improve QOC and in turn QOL of residents with dementia.Method:Over a 10-month period we followed: 247 older adults with dementia from 12 not-for-profit residential care facilities, their families/care partners (n=225), managers (n=12) and staff (n=232). Facilities ranged in size from 10 to 137 beds, located across remote, rural and metropolitan areas of south eastern Australia. Measures included: staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. Multilevel Modelling or Generalised Estimating Equations analyses were conducted for each of the 12 QOC variables, with 22 staff and control variables as the predictors, and for each of the 11 QOL variables, with 20 QOC and control variables as predictors.Results:Analyses established significant associations between a large number of staff and QOC variables and between QOC and QOL variables.Conclusions:The quality of the care provided to residents has strong, widespread influences on the QOL of residents. The most promising areas for intervening with staff were: increasing the relevance and applicability of staff training and qualifications, upskilling staff in empathic care provision, communication, and restraint reduction, using a mixture of permanent and rotating shifts, prioritising recreational activity provision by all staff and increasing assistance with meals. patients with cognitive impairment in rural hospitals.

Comparison of resource utilization by physical function, cognitive function, and behavioral symptoms of residents in long-term care facilities: A cross-sectional study

Purpose: This study aimed to provide basic data for improving the classification system by comparing the service time and the total resource utilization by the residents' physical function, cognitive function, and behavioral symptoms in long-term care (LTC) facilities. Methods: The service time provided by direct service providers was measured in 3,295 residents in 32 LTC facilities, from September 3 to November 16 in 2018. The LTC resources utilization was analyzed by the residents' physical function, cognitive function, and behavioral symptoms, adjusted by facilities’ characteristics. Results: The highest daily total resource utilization per resident was 110.0 minutes in the group with a physical function score 32 or above, cognitive function score under 3, and no behavioral symptom. Total resource utilization increased along with the score of physical function. When the score of physical function is within the same range, total resource utilization increased along with the score of cognitive function. But, in the group with physical function score of 32 or above, there was a inverse relationship of total resource utilization to cognitive function. Conclusion: This study confirmed that the residents' resource utilization correlates with their physical and cognitive functions. It is necessary to ensure ways to provide appropriate LTC services in accordance with their functions.

Comparing approaches to determining poor oral health among older adults in a national survey.

To compare the clinical validity of the three approaches in residential care facility residents. In NZ residential care facilities, the interRAI assessment tool is used by trained registered nurses for assessing oral status when new residents are admitted, but its validity has been questioned. Although Locker's global oral health item has been used to measure oral health in surveys and health services research, it is not routinely used in care facilities, yet its clinical validity has been demonstrated in population-based samples. Self-perceived oral health need may also be useful. Using a secondary analysis of clinical and self-reported data from a national survey of nursing home residents (the 2012 New Zealand Older People's Oral Health Survey, or OPOHS), we compared the validity of Locker's item, the interRAI tool and self-reported treatment need for identifying three key clinical indicators of poor oral health among dentate older adults; those were coronal caries (3+ teeth affected), root caries (1+ teeth affected) and xerostomia. Analyses were conducted using STATA, and survey weighting was used to obtain estimates for a source population of 25-843 individuals. The prevalence of 3+ teeth with coronal caries was 28.7% (23.9, 34.0), the prevalence of 1+ teeth with root caries was 33.7% (28.7, 39.0), the prevalence of xerostomia was 23.1% (18.4, 28.3). Marked gradients in prevalence risk ratio were seen across different categories of Locker's global oral health item and the interRAI assessment tooth for coronal caries and xerostomia. Locker's global oral health item gave a better fitting model and was more discriminative in detecting coronal caries than the interRAI assessment tool (Lockers AIC = 0.76, interRAI AIC = 0.81). None of the approaches was particularly discriminative for root surface caries experience. Self-reported approaches are discriminative for poor oral health. Standardised assessment tools used in residential care facilities should consider including a self-assessment component such as Locker's global oral health item.

The Association of Organizational, Environmental, and Staffing Characteristics of Residential Care Facilities and the Risk Rating of Statutory Notifications: A Cross-Sectional Study in Ireland.

Safety incidents (SIs) are an indicator of quality in health and social care services. Safety incident research has largely focused on acute health care settings. We aimed to examine the association of organizational, environmental, and staffing characteristics of residential care facilities (RCFs) and severity of regulatory SI notifications. This was a retrospective analysis of SI notifications to the regulator for social care in Ireland received in 2018 and 2019. The mean risk rating of SI notifications for each RCF was used as the outcome. Regression analysis was conducted for the association of RCF characteristics (beds, staff to bed ratio, staff full-time equivalent (FTE), nurse to bed ratio, nurse FTE, number of RCF operated by the service provider, non-statutory or statutory provider) and the outcome, separately for nursing homes and residential disability services. A total of 53,268 SI notifications were received. One thousand nine hundred RCFs were operational during the period: 594 (31.3%) for RCF-Nursing home and 1304 (68.7%) for RCF-Disability. For nursing homes, in the most adjusted model, the number of RCF operated by a provider ( β coefficient [95% confidence interval] = 0.508 [0.223-0.793]) was positively associated with mean risk rating of SI. For disability services, the following characteristics were positively associated in the most adjusted model: beds (0.081; 0.060-0.101), staff to bed ratio (0.068; 0.017-0.120), nurse to bed ratio (0.356; 0.044-0.667), staff FTE (0.029; 0.015-0.042), and number of RCF operated by a provider (0.067; 0.050-0.084). Various modifiable organizational, environmental, and staffing characteristics and severity of SI notifications were associated in this study, most of which were related to RCF-Disability. Policymakers and providers of social care services should be cognizant of the relationship of these characteristics and severity of SI, when designing and planning residential care.

Development and Factor Structure of the Mueller Assessment of Transition (MAT): A Tool for Measuring Older Adults’ Wellbeing during Transitions into Assisted Living Facilities

This paper details the development and factor structure of the Mueller Assessment of Transition (MAT), a novel assessment to measure older adults’ wellbeing when transitioning into assisted living facilities (ALF). Older adult participants (n = 69) in nine ALFs in the United States completed the MAT. Exploratory factor analysis identified a 2-factor, 12-item solution of influences on older adults’ wellbeing. Further results found significant differences in older adults’ wellbeing when transitioning into ALFs before and during the COVID-19 pandemic. Implications for healthcare practitioners and future research recommendations are discussed.

Description of the mealtime of older adults with dementia in a long-term care facility: A video analysis

This study analyzed the mealtime structure of older adults with dementia in long-term care facilities. The study conducted video observations at 2 long-term care facilities with 10 residents and 24 staff members, resulting in 41 dyads. The average mealtime duration was 12.21 ± 5.16 minutes; the average time of a single intake was 0.21 ± 0.21 minutes; and the median of the eating interval was 0.17 minutes. The average verbal assistance time was 1.41 ± 1.31 minutes; the average verbal assistance frequency was short (23.92 ± 15.50 times). During mealtime, residents had an average of 5.00 ± 4.07 instances of failing to eat properly. The video analysis emphasized the necessity of implementing a mealtime assistance program that incorporates patient-centered education for the staff and ensures sufficient staffing to provide high-quality meals for residents in long-term care facilities.

Characteristics and consequences of participatory research approaches in long-term care facilities for older adults: a meta-ethnography of qualitative studies

BackgroundParticipatory research approaches can potentially empower older adults and improve their quality of life and care. These include research designs, methods, and conceptual frameworks in collaboration with people directly involved and invested in the research and research outcomes. However, participatory research approaches have rarely been explored in long-term care facilities for older adults, such as nursing homes or residential care facilities. We aimed to provide increased understanding and recommendations about how participatory research approaches can be conceptualised and used in long-term care facilities for older adults. MethodsInspired by Noblit and Hare (1988) and the seven phases of the eMERGe guidelines (2019), we performed a meta-ethnography (synthesis of qualitative research). We searched MEDLINE, CINAHL, ERIC, Sociological Abstracts, and Web of science in July 2021 and June 2022 for studies published between Jan 1, 2001, and June 27, 2022 (see appendix for search terms). We included peer-reviewed qualitative publications on participatory research approaches with older adults or staff in long-term care facilities, written in English. To promote rigour, a protocol was used with two authors independently screening the articles, reaching consensus through critical discussions with a third author, and using the Critical Appraisal Skills Programme (CASP) checklist. We extracted data regarding types of participatory research approaches and themes. This study is registered with PROSPERO, CRD42021275187. FindingsTen of 1445 articles screened were included in the analysis. Using seven types of participatory research approaches, the included studies investigated experiences of approximately 153 residents and 99 staff from seven countries (Australia, Belgium, England, Guyana, Ireland, Sweden, and the Netherlands). We identified five themes, expressed as a conceptual model with recommendations: (1) participatory backdrop; (2) collaborative places; (3) seeking common ground and solidarity; (4) temporal considerations; and (5) empowerment, growth, and cultural change. We recommend researchers allow flexible time for the slow-paced progression and potentially unintended consequences of this emergent approach. InterpretationThis meta-ethnography provides an international and systematic synthesis of a diverse group of small-scale qualitative studies, which are, however, limited by insufficient reporting of participants’ age, gender, or ethnicity. FundingThe Strategic Research Area in Health Care Science (SFO-V) at Karolinska Institutet and the Swedish Research Council for Health, Working Life and Welfare (FORTE).

The Impact of MRSA Colonization on Healthcare-Associated Infections in Long-Term Care Facility Residents: A Whole-Genome Sequencing-Based Study.

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been considered a risk factor for the development of infection, however, there are no studies that have compared the colonizing and infecting strains using whole-genome sequencing (WGS). The aim of this study is to determine the prevalence of and risk factors for MRSA colonization among long-term care facilities (LTCF) residents of Tenerife (Spain), and to analyze the epidemiological relationship between the colonizing and infecting strains using WGS. A point-prevalence study was carried out at 14 LTCFs in Tenerife from October 2020 to May 2021. Nasal swabs were cultured for MRSA. Colonized residents were followed up for two years. A phylogenetic comparison between colonization and infection strains was performed using WGS. A total of 764 residents were included. The prevalence of colonization by MRSA was 28.1% (n = 215), of which 12 (5.6%) subsequently developed infection. A close genetic relationship between colonization and infection isolates was found in three of the four (75%) residents studied. Our study confirms that colonized residents can develop serious MRSA infections from the same nasal colonization strain. Given the high prevalence of MRSA colonization in these centers, it is necessary to implement strategies with preventive measures to avoid the development of infection and the transmission of MRSA.

Detection of SARS-CoV-2 in aerosols in long term care facilities and other indoor spaces with known COVID-19 outbreaks

Coronavirus outbreaks are likely to occur in crowded and congregate indoor spaces, and their effects are most severe in vulnerable long term care facilities (LTCFs) residents. Public health officers benefit from tools that allow them to control COVID-19 outbreaks in vulnerable settings such as LTCFs, but which could be translated in the future to control other known and future virus outbreaks. This study aims to develop and test a methodology based on detection of SARS-CoV-2 in aerosol samples collected with personal pumps that could be easily implemented by public health officers. The proposed methodology was used to investigate the levels of SARS-CoV-2 in aerosol in indoor settings, mainly focusing on LTCFs, suffering COVID-19 outbreaks, or in the presence of known COVID-19 cases, and targeting the initial days after diagnosis.Aerosol samples (N = 18) were collected between November 2020 and March 2022 in Castelló (Spain) from LTCFs, merchant ships and a private home with recently infected COVID-19 cases. Sampling was performed for 24-h, onto 47 mm polytetrafluoroethylene (PTFE) and quartz filters, connected to personal pumps at 2 and 4 L/min respectively. RNA from filters was extracted and SARS-CoV-2 was determined by detection of regions N1 and N2 of the nucleocapsid gene alongside the E gene using RT-PCR technique.SARS-CoV-2 genetic material was detected in 87.5% samples. Concentrations ranged ND-19,525 gc/m3 (gene E). No genetic traces were detected in rooms from contacts that were isolated as a preventative measure. Very high levels were also measured at locations with poor ventilation. Aerosol measurement conducted with the proposed methodology provided useful information to public health officers and contributed to manage and control 12 different COVID-19 outbreaks.SARS-CoV-2 was detected in aerosol samples collected during outbreaks in congregate spaces. Indoor aerosol sampling is a useful tool in the early detection and management of COVID-19 outbreaks and supports epidemiological investigations.

Initial validation of the powered mobility device autonomy residential screen (PoMoDARS)

Background The Powered Mobility Device Autonomy Residential Screen (PoMoDARS) is a new tool to enable clinicians to screen resident capacity and performance skills for powered mobility device (PMD) use in residential aged care settings. The PoMoDARS is context specific, time efficient and promotes resident autonomy and safety. Aims To (i) undertake initial face and content validation of the PoMoDARS, and (ii) use the research findings to make any modifications. Methods A mixed-methods study design, underpinned by Classical Test Theory. Eight clinicians completed 20 PoMoDARS screens and provided both quantitative and qualitative feedback on item importance and ease of use within a formal interview. Results Initial face and content validity of the PoMoDARS were supported, with small modifications made to item descriptors and instructions. Conclusions The PoMoDARS has been developed for use in residential aged care settings to screen resident PMD use. While initial validation has been undertaken, further studies to determine the reliability of the tool and continue the validation process are required. Significance Older adults in residential aged care facilities benefit greatly from the autonomy gained through PMD use. The PoMoDARS promotes collaboration between occupational therapists, nurses, and the wider team to support residents and safe PMD use.

Antibody responses after BNT162b2 vaccination in Japanese geriatric intermediate care facilities

BackgroundTo evaluate antibody responses against the primary series of vaccination of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2] vaccines in the staff and residents of Japanese geriatric intermediate care facilities. MethodsAll subjects (159 staff and 96 residents) received two doses of the BNT162b2 mRNA vaccine 3 weeks apart. Baseline data of subject were collected using a structured form. Serum samples were collected three times: before vaccination, 3 weeks after the first dose, and 4 weeks after the second dose, and anti-receptor binding domain of the spike protein of SARS-CoV-2 [anti-RBD] IgG was measured using two immunoassays. ResultsAfter the second dose, geometric mean titers [GMT] of anti-RBD with both the Abbott and Roche assay were significantly lower in residents than staff (2282 AU/mL vs. 8505 AU/mL, and 258 U/mL vs. 948 U/mL, respectively). Multivariate analysis of characteristics affecting antibody responses (≥1280 AU/mL for Abbott and > 210 U/mL for Roche) showed lower odds ratios [ORs] for older age (adjusted OR per 10 year increase [aOR] = 0.62, 95 % confidence interval [95 %CI]; 0.38–1.02), steroid usage (aOR = 0.09, 95 %CI; 0.01–0.60) and regular nonsteroidal anti-inflammatory drugs [NSAIDs] usage (aOR = 0.16, 95 %CI; 0.03–0.88). ConclusionsElderly people and steroid and NSAID users had lower antibody responses following the second vaccine dose.

Factors Impacting Retention of Aged Care Workers: A Systematic Review.

Retention of care support workers in residential aged care facilities and home-based, domiciliary aged care is a global challenge, with rapid turnover, low job satisfaction, and poorly defined career pathways. A mixed-methods systematic review of the workforce literature was conducted to understand the factors that attract and retain care staff across the aged care workforce. The search yielded 49 studies. Three studies tested education and training interventions with the aim of boosting workforce retention and the remaining 46 studies explored opinions and experiences of care workers in 20 quantitative, four mixed-methods and 22 qualitative studies. A range of factors impacted retention of aged care staff. Two broad themes emerged from the analysis: individual and organisational factors facilitating retention. Individual factors related to personal satisfaction with the role, positive relationships with other staff, families, and residents, and a cooperative workplace culture. Organisational factors included opportunities for on-the-job training and career development, appropriate wages, policies to prevent workplace injuries, and job stability. Understaffing was often cited as a factor associated with turnover, together with heavy workloads, stress, and low job satisfaction. With global concerns about the safety and quality of aged care services, this study presents the data associated with best practice for retaining aged care workers.

It's not special treatment… That's part of the Treaty of Waitangi! Organisational barriers to enhancing the Aged Residential Care environment for older Māori and Whānau in New Zealand.

New Zealand's older Indigenous Māori people experience poorer health and reduced access to healthcare than their older non-Māori counterparts. Organisational factors (such as leadership or workforce) may influence the attitudes and perceptions of older Māori and their family (whānau) to use aged residential care services. Currently, there is a paucity of research surrounding the organisational barriers that impact the experiences of older Māori people who seek care in aged residential care (ARC) services. This study used a Kaupapa Māori qualitative research approach that legitimises Māori knowledge and critiques structures that subjugate Māori autonomy and control over their wellbeing. Interviews regarding their experiences of care were carried out with older Māori (n=30) and whānau (family) members (n=18) who had used, or declined to use an aged residential care facility. Narrative data were analysed inductively for themes that illustrated organisational barriers. The key organisational theme was 'Culturally safe care', within which there were three barriers: 'Acceptability and Adequacy of Facility', 'Interface Between Aged Residential Care and Whānau Models of Care', and 'Workforce'. Collectively, these barriers emphasise the importance of an organisational approach to improving the quality of care delivered to older Māori and whānau in ARC. Fostering a collective culture of equity within ARC provider services and equipping healthcare leaders and staff with the skills and knowledge to deliver culturally safe care is critical to addressing organisational barriers to ARC.