Community Residential Care Research Articles

Aged Care Energy Use and Peak Demand Change in the COVID-19 Year: Empirical Evidence from Australia

Aged care communities have been under the spotlight since the beginning of 2020. Energy is essential to ensure reliable operation and quality care provision in residential aged care communities (RAC). The aim of this study is to determine how RAC’s yearly energy use and peak demand changed in Australia and what this might mean for RAC design, operation and energy asset investment and ultimately in the healthcare plan for elderly residents. Five years of electricity demand data from four case study RACs in the same climate zone are analyzed. Statistical tools are used to analyze the data, and a clustering algorithm is used to identify typical demand profiles. A number of energy key performance indicators (KPIs) are evaluated, highlighting their respective benefits and limitations. The results show an average 8% reduction for yearly energy use and 7% reduction for yearly peak demands in the COVID-19 year compared with the average of the previous four years. Typical demand profiles for the four communities were mostly lower in the pandemic year. Despite these results, the KPI analysis shows that, for these four communities, outdoor ambient temperature remains a very significant correlation factor for energy use.

How Will COVID-19 Alter the Politics of Long-Term Care? A Comparative Policy Analysis of Popular Reform Options.

This policy analysis reviews three popular proposals with significant political endorsement to enhance long-term care (LTC), here defined broadly to include residential care facilities, home care, and community care, in the wake of the coronavirus disease (COVID-19) crisis: national standards, provincial autonomy, and de-privatization. The proposals are summarized succinctly followed by a neo-institutionalist analysis of the obstacles to enact them based upon a series of interviews conducted prior to COVID-19 with senior civil servants in Canadian provinces for a newly published book (Marier, 2021) and political considerations. While the federal government has pursued the avenue of instituting national standards, the provinces have clearly expressed a desire to secure higher federal health transfers and pursue LTC reforms on their own. Considering the diversity of LTC arrangements across the provinces, which impact the politics of LTC within each jurisdiction, and the presence of many Conservative governments in provincial capitals, Ottawa faces an uphill battle to transform profoundly the LTC landscape.

National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff

ABSTRACT Objectives This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders’ opinions about the impact of COVID-19 on the mental health of aged care residents and staff. Methods A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed an online survey between 10th September and 31st October 2020. Results On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios. Conclusions Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities. Clinical Implications This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.

QuickStats: Percentage* of Residential Care Communities† Engaged in Selected End-of-Life and Bereavement Care Practices§ - National Study of Long-Term Care Providers, United States, 2018.

QuickStats: Percentage* of Residential Care Communities† Engaged in Selected End-of-Life and Bereavement Care Practices§ - National Study of Long-Term Care Providers, United States, 2018.

Changes in Older Adults' Social Contact During the COVID-19 Pandemic.

ObjectivesTo understand changes during the coronavirus disease 2019 (COVID-19) pandemic in weekly contact with nonresident family and friends for U.S. adults aged 70 and older in residential care and community settings.MethodsParticipants in the National Health and Aging Trends Study COVID-19 mail supplement (N = 3,098) reported frequency of phone, electronic, video, and in-person contact with nonresident family and friends in a typical week before and during the pandemic. We examined less than weekly contact by mode for those in residential care settings and community residents with and without limitations. We estimated multinomial logit models to examine predictors of change to less than weekly contact (vs. maintaining weekly or more contact) by mode, overall, and stratified by setting.ResultsWeekly in-person contact fell substantially (from 61% to 39%) and more so in residential care (from 56% to 22%), where nearly 4 in 10 transitioned to less than weekly in-person contact (doubling to 8 out of 10). Weekly or more contact was largely stable for electronic and telephone modes across settings. Weekly or more video contact increased mainly for community residents without limitations. Compared to community residents without limitations, those in assisted living or nursing homes had more than 5 times the odds (adjusted odds ratio [AOR] = 5.3; p = .01) of changing to less than weekly in-person contact; those in independent living also had higher odds of changing to less than weekly in-person (AOR = 2.6; p = .01) and video (AOR = 3.4; p = .01) contact.DiscussionThe pandemic revealed the importance of ensuring that communication technologies to maintain social ties are available to and usable by older adults, particularly for those living in residential care settings.

COVID-19 Vaccine Uptake Among Residents and Staff Members of Assisted Living and Residential Care Communities—Pharmacy Partnership for Long-Term Care Program, December 2020–April 2021

ObjectivesIn December 2020, CDC launched the Pharmacy Partnership for Long-Term Care Program to facilitate COVID-19 vaccination of residents and staff in long-term care facilities (LTCFs), including assisted living (AL) and other residential care (RC) communities. We aimed to assess vaccine uptake in these communities and identify characteristics that might impact uptake. DesignCross-sectional study. Setting and ParticipantsAL/RC communities in the Pharmacy Partnership for Long-Term Care Program that had ≥1 on-site vaccination clinic during December 18, 2020–April 21, 2021. MethodsWe estimated uptake using the cumulative number of doses of COVID-19 vaccine administered and normalizing by the number of AL/RC community beds. We estimated the percentage of residents vaccinated in 3 states using AL census counts. We linked community vaccine administration data with county-level social vulnerability index (SVI) measures to calculate median vaccine uptake by SVI tertile. ResultsIn AL communities, a median of 67 residents [interquartile range (IQR): 48-90] and 32 staff members (IQR: 15-60) per 100 beds received a first dose of COVID-19 vaccine at the first on-site clinic; in RC, a median of 8 residents (IQR: 5-10) and 5 staff members (IQR: 2-12) per 10 beds received a first dose. Among 3 states with available AL resident census data, median resident first-dose uptake at the first clinic was 93% (IQR: 85-108) in Connecticut, 85% in Georgia (IQR: 70-102), and 78% (IQR: 56-91) in Tennessee. Among both residents and staff, cumulative first-dose vaccine uptake increased with increasing social vulnerability related to housing type and transportation. Conclusions and ImplicationsCOVID-19 vaccination of residents and staff in LTCFs is a public health priority. On-site clinics may help to increase vaccine uptake, particularly when transportation may be a barrier. Ensuring steady access to COVID-19 vaccine in LTCFs following the conclusion of the Pharmacy Partnership is critical to maintaining high vaccination coverage among residents and staff.

Dying in Place: Factors Associated with Hospice Use in Assisted Living and Residential Care Communities in Oregon

Hospice use among assisted living residents may support aging in place. A cross-sectional survey was used to characterize variation in the health and personal care needs of Oregon assisted living and residential care (AL/RC) residents who did and did not receive hospice services. All AL communities licensed in Oregon as of fall 2019 were asked to answer questions about three randomly selected residents. A final sample of 998 residents was included in the analysis. Multiple variable logistic regression was used to examine associations between resident- and community-level characteristics and hospice use. While hospice services provide supplemental support for AL residents’ end-of-life process, our findings show that residents often receive continued assistance from AL staff as their condition deteriorates.

Treatment Bed Utilization Following Placement in a Foster Care Program for Veterans with Serious Mental Illness

Hospital and residential treatment bed utilization rates were measured before and after foster home placement in individuals with serious mental illness. Medical records of all Veterans consecutively enrolled in a Department of Veterans Affairs Community Residential Care (CRC) program during a 6year period (N = 140) were reviewed retrospectively. Treatment bed days were tabulated by bed type (psychiatric hospital, inpatient detoxification, medical hospital, physical rehabilitation, and psychosocial residential treatment) for each patient during symmetric pre- and post-placement time intervals. Pre- and post-placement bed days were compared using the paired-sample t test in a naturalistic one-group pretest-posttest analytic design. Psychiatric hospital and residential treatment bed days were significantly reduced post-placement (-77.5% and -99.8%, respectively). Most patients (89.0%) had fewer psychiatric hospital bed days post-placement, and all patients with pre-placement residential treatment program bed days had fewer of those days post-placement. Longer CRC placements were associated with greater reductions in bed utilization.

Multiple Chronic Conditions and Provision of Services in Residential Care Communities

This study describes the relationships between the number of selected chronic conditions among residents and the number and provision methods of services provided by residential care communities (RCCs). Estimates are from the 2016 wave of the National Study of Long-Term Care Providers conducted by the National Center for Health Statistics. Chronic conditions were measured by whether the RCC reported having at least one resident with any of the most common chronic conditions: dementia, diabetes, depression, or heart disease. Services included were mental health, social work, therapeutic, dietary, and skilled nursing. Each service type was categorized by provision method (provided by employees, arrangement or referral only, or not provided). Among RCCs, 63% had all four conditions among residents, 23% had three, 12% had one to two, and 1% had none. About 66% of RCCs provided all five services, 16% provided four, 15% provided 1-3, and 3% provided none. Of the 63% of RCCs that had all four conditions among residents, 69% provided all five services, 29% provided 1-4, and 2% provided none. In these RCCs, a greater percentage provided dietary (69%) and skilled nursing services (33%) with employees compared to the other methods; a greater percentage provided therapeutic (85%) and mental health services (83%) solely through arrangement or referral compared to the other methods. This study found that, in 2016, RCCs with multiple selected conditions among their residents tended to provide a greater number of services for managing chronic conditions. How these RCCs provide services varied based on service type.

Quality in Assisted Living: Does It Lie in the Eyes of the Beholder?

Quality is defined in multiple ways and by different stakeholders (e.g., residents, regulators, informed observers). Using a two-stage stratified sampling strategy, we collected data from N=241 residents living in 31 assisted living and residential care communities (AL/RC) in Oregon. Residents rated their overall satisfaction and satisfaction with the AL/RC as a place to live and to receive care. Each interviewer completed a facility profile summarizing their observations about the setting, including quality of staff-resident interactions and physical environment. Residents and interviewers were also asked whether they would recommend the community to others. Finally, we used deficiency citations given during regular inspections by the licensing agency to proxy regulatory perspective. Results show that perceived quality varied by stakeholder (e.g., residents’ assessments differed from deficiency citations). Given this variation, findings suggest that efforts to make quality indicators publicly available should include multiple measures and perspectives, especially residents.

Frequency and severity of dental caries in foster care children of Turin, Italy: a retrospective cohort study.

Aim of this retrospective cohort study was to assess the frequency and severity of dental caries (DC) among foster care children in the city of Turin, in North West Italy, and to compare these data with those of a general paediatric population. From May 2016 to September 2018, 75 paediatric subjects between the age of 4 and 12, located in 11 residential child care communities were recruited. Instructions were provided concerning oral health, caries and correlation with dietary habits. Oral and dental examination were carried out to establish frequency and severity of caries (not-penetrating, nPC, corresponding to the International Caries Detection and Assessment System (ICDAS) codes: 1-4, vs. penetrating, PC, corresponding to ICDAS codes: 5-6). Decayed, missed, filled teeth (DMFT) index was used. Data for comparison were acquired from the WHO Collaboration Center For Epidemiology and Community Dentistry of Milan (WHO-CCOMS), belonging to a nationwide sample of 2,141 Italian children. Only 13 subjects (17%) were caries-free; 187 caries were identified: 133 were PC, whereas 54 were nPC. Overall, 76% of the caries were found in deciduous teeth. Mean DMFT was 3.43 (D = 2.97; M = 0.24; F = 0.22). When the study data were compared to those from WHO-CCOMS, a significantly higher DMFT (3.43 vs 0.96; p <0.00001) and D (2.97 vs 0.62; p <0.00001) was detected. A significant higher frequency of caries in foster care children in Turin, Italy compared to the general population was detected.

Rehabilitation of persons living with dementia: Using technology to improve participation

AbstractBackgroundRehabilitation following an illness or injury can improve functioning for persons living with dementia (PLWD) and help them remain as independent in daily life as possible. Gains, however, may be limited, because PLWD are often not able to engage fully in treatment. This study examined how a technology system, “It’s Never 2 Late” (iN2L), may help augment traditional rehabilitation approaches for PLWD by improving engagement in therapy sessions and achieving better functional outcomes.MethodThe study used a two group quasi‐experimental design. Older adults living with dementia (N= 96) were recruited from two rehabilitation departments housed within residential care communities operated by the same organization. Participants received daily occupational and physical therapy sessions using treatment as usual (TAU) at one site (n = 49) or treatment augmented with iN2L (n = 47) at the other site. A goal attainment approach was used to assess functional outcomes. As part of standard procedures at each site, initial and final functioning was assessed across 23 measures of functioning, mobility, and activities of daily living. Therapists selected goals from these items and specified levels of function that would indicate goal attainment. Goal attainment was scored comparing functioning at completion of treatment against initial goals. Engagement was rated from observations of treatment sessions by research assistants using the Pittsburgh Rehabilitation Participation Scale. It was hypothesized that patients at the iN2L site will show greater attainment of therapy goals and greater engagement during therapy sessions than patients receiving TAU and that improvement in engagement will mediate the association of treatment type (iN2L or TAU) with greater goal attainment.ResultParticipants in the iN2L treatment had significantly higher goal attainment than TAU, significantly higher levels of engagement at baseline, and significantly steeper increases in engagement over the course of therapy. A multilevel regression model in MPLUS was used to estimate total and indirect (i.e. mediation) effects. Results showed that the effects of treatment on goal attainment was significantly mediated by increases in engagement.ConclusionFindings suggest that iN2L technology has the potential to increase treatment engagement and enhance rehabilitation outcomes among older adults living with dementia.

Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande).

Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world. We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples. All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases. We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.

Exploring a volunteer community residential care facility for new mothers

Background:All women deserve a “dwelling space” during their postnatal period after the birth of their infant. This “space” provides her an opportunity to be cared for, to be replenished, to rest and to reflect on herself being a new mother before returning home. We explored a volunteer community residential service set up to help new mothers to document their experiences and determine if the outcomes matched their expectations. Methods: Semi-structured interviews were offered to all women who had utilised this service since its inception. The questionnaire explored their motivations to seek such as service and to learn of their experiences. The interviews were audio recorded, transcribed and a thematic analysis employed. Results: Over the last 8 years, 12 women, 4 twice, availed themselves of this service, two being first-time mothers. Reasons given by mothers for utilising this service included recovery from the trauma of childbirth both past and present, physical and emotional, and delaying assuming responsibilities at home. All the women had welcomed the “dwelling space”, being mothered, feeling replenished and having time to meaningfully relate to their newborn infant.The ambience of the accommodation and the care they received were above their expectations. All would recommend other new mothers to avail themselves of this service

Differences in the prescribing of potentially inappropriate medicines in older Australians: comparison of community dwelling and residential aged care residents

Potentially inappropriate medications (PIMs) can contribute to morbidity through exacerbations or progression of existing conditions among older people. In order to characterize the prevalence of PIMs according to the Beers Criteria in older Australians, three hundred and eleven participants were recruited from three residential aged care facilities (RACFs) and two hundred and twenty participants from three community pharmacies in South Australia for a retrospective audit of medication administration charts and community pharmacy dispensing histories. Although a similar number of participants were prescribed at least one PIM (P = 0.09), the average number of PIMs was significantly greater in the RACF cohort (1.96 vs 1.26, P < 0.05). Additionally, PIMs prescribed as pro re nata (PRN) in the RACF cohort had a significantly low administration rate compared to prescription rate (19.7% vs 40.7%). The mean number of PIMs within each cohort was statistically significant (RACF = 1.93 vs CDOA = 1.26, P < 0.05). RACF residents were at a slightly greater risk of being prescribed more than one PIM compared to those within the community. Routine medication reviews by pharmacists embedded in RACFs and within the community could be utilised to detect PIMs before such harm occurs.

Rehabilitation of persons with dementia: using technology to improve participation

Objectives The current study examined how a technology system, “It’s Never 2 Late” (iN2L), may help augment traditional rehabilitation strategies for older adults with dementia by improving engagement in therapy sessions and achieving better functional outcomes. Method The study used a two group quasi-experimental design. Older adults with dementia (N = 96) were recruited from two rehabilitation departments housed within residential care communities. Participants received daily occupational and physical therapy sessions using treatment as usual (TAU) at one site (n = 49) or treatment with iN2L (n = 47) at the other site. A goal attainment approach was used to assess functional outcomes. It was hypothesized that patients whose therapists used iN2L in treatment will show greater attainment of therapy goals and greater engagement during OT and PT sessions than patients receiving TAU. It was also hypothesized that levels and improvement in engagement will mediate the association of treatment type (iN2L or TAU) with greater goal attainment. Results Participants in the iN2L treatment had significantly higher goal attainment than TAU, significantly higher levels of engagement at baseline, and significantly steeper increases in engagement over the course of therapy. The effects of treatment on goal attainment was significantly mediated by increases in engagement. Conclusion Findings suggest that iN2L technology has the potential to increase treatment engagement and enhance rehabilitation outcomes among older adults with dementia.

SERVICE PROVISION IN RESIDENTIAL CARE COMMUNITIES FOR RESIDENTS WITH DEMENTIA AND DEPRESSION

Assisted living and similar residential care communities (RCCs) are an important source of care for older adults, many of whom have dementia or depression. In 2016, 42% of residents in RCCs were diagnosed with dementia and 31% were diagnosed with depression. About two-thirds of RCCs (63%) provided social work and mental health services and 37% provided neither service. Using the 2016 National Study of Long-Term Care Providers, this study includes bivariate and ANOVA modeling to (1.) examine the variation in dementia and depression between RCCs that provide social work and mental health services and those that do not, and (2.) assess if there is an interaction between provision of services and RCC bed size in their association with dementia and depression. Bivariate results show that the prevalence of dementia does not vary by service provision, but the prevalence of depression does. The percent of residents with depression varied from 34% in RCCs that provided both social work and mental health services to 31% in RCCs that provided only one service to 28% in RCCs that provided neither service. The prevalence of dementia was around 4 in 10 residents, regardless of service provision. Fitting a two-way ANOVA model for dementia indicated that the effect was 4 percentage points higher for RCCs that provided services than those that did not, but only among small RCCs. Findings from this study can inform strategies to care for the needs of residents with dementia and depression across the various sizes of RCCs.

FACTORS ASSOCIATED WITH RESIDENTIAL CARE COMMUNITIES THAT HAVE RESIDENTS VISITING EMERGENCY DEPARTMENTS

Emergency department (ED) visits are an important part of healthcare utilization. However, ED visits can be costly, lead to hospitalizations, and are sometimes unnecessary. Studies characterizing ED visits among long-term care settings have been largely focused on nursing homes where the unit of analysis is typically the resident. Facility- or community-level analyses describing residential care communities (RCCs) with ED visits are limited. Using RCCs as the unit of analysis, this study examines community-level factors associated with RCCs that have residents with ED visits. Community-level factors include ownership and chain affiliation, Medicaid participation, electronic health records use, service provision, nurse staffing, U.S. census region and metropolitan status. The study uses data from the 2016 National Study of Long-Term Care Providers conducted by the National Center for Health Statistics. In 2016, about 81% of RCCs had at least one resident visiting the ED in the past 90 days and around 19% of RCCs had no residents with ED visits in the past 90 days. Bivariate analyses indicated that ED visits varied by chain affiliation, ownership status, electronic health records use, and Medicaid participation. Logistic regression modeling to examine factors associated with whether or not RCCs had any residents with ED visits in the past 90 days will also be presented. Results may benefit efforts focused on implementing practices to reduce ED visits in RCCs.

EVALUATING ENHANCEMENTS TO ADDRESS SAMPLE DIVERSITY, RESPONDENT BURDEN, AND DIFFICULTY REACHING RESPONDENTS

Every two years since 2012, the National Study of Long-Term Care Providers includes provider surveys with residential care communities (RCCs) and adult day services centers (ADSCs), via a multi-mode approach using Web, hard-copy questionnaires, and computer-assisted telephone interviewing. In each wave, we struggled to achieve target response rates. First, diversity among providers surveyed—e.g. RCC size, type of ADSC—presents unique challenges. For RCCs, small communities have lower response compared to larger ones. For ADSCs, how they define themselves (medically vs socially oriented) influenced their decision to participate. Second, respondents’ perceived burden, particularly the time required to complete the survey, is a recurring concern especially for directors of multiple RCCs and ADSCs. Finally, reaching target respondents—directors, administrators or operators—is problematic. These challenges affect data quality. In this presentation, we share results of our efforts to enhance contacting and interviewing protocols intended to address low participation associated with these challenges.

Preventing Opsteoporosis in residential and aged care communities: a toolkit for aged care staff

Preventing Opsteoporosis in residential and aged care communities: a toolkit for aged care staff