Residential Care Environment Research Articles

A model-based assessment of social isolation practices for COVID-19 outbreak response in residential care facilities

BackgroundResidential aged-care facilities (RACFs, also called long-term care facilities, aged care homes, or nursing homes) have elevated risks of respiratory infection outbreaks and associated disease burden. During the COVID-19 pandemic, social isolation policies were commonly used in these facilities to prevent and mitigate outbreaks. We refer specifically to general isolation policies that were intended to reduce contact between residents, without regard to confirmed infection status. Such policies are controversial because of their association with adverse mental and physical health indicators and there is a lack of modelling that assesses their effectiveness.MethodsIn consultation with the Australian Government Department of Health and Aged Care, we developed an agent-based model of COVID-19 transmission in a structured population, intended to represent the salient characteristics of a residential care environment. Using our model, we generated stochastic ensembles of simulated outbreaks and compared summary statistics of outbreaks simulated under different mitigation conditions. Our study focuses on the marginal impact of general isolation (reducing social contact between residents), regardless of confirmed infection. For a realistic assessment, our model included other generic interventions consistent with the Australian Government’s recommendations released during the COVID-19 pandemic: isolation of confirmed resident cases, furlough (mandatory paid leave) of staff members with confirmed infection, and deployment of personal protective equipment (PPE) after outbreak declaration.ResultsIn the absence of any asymptomatic screening, general isolation of residents to their rooms reduced median cumulative cases by approximately 27%. However, when conducted concurrently with asymptomatic screening and isolation of confirmed cases, general isolation reduced the median number of cumulative infections by only 12% in our simulations.ConclusionsUnder realistic sets of assumptions, our simulations showed that general isolation of residents did not provide substantial benefits beyond those achieved through screening, isolation of confirmed cases, and deployment of PPE. Our results also highlight the importance of effective case isolation, and indicate that asymptomatic screening of residents and staff may be warranted, especially if importation risk from the outside community is high. Our conclusions are sensitive to assumptions about the proportion of total contacts in a facility accounted for by casual interactions between residents.

Trauma–Sensitive Residential Care: Perspectives of Portuguese Professionals to Spark Change

ABSTRACT Despite global pressure for deinstitutionalization of children in care, and recent legislative changes, Portugal remains a country with very high prevalence of residential care amongst at-risk children. These children were exposed to multiple traumatic events that can disrupt development. Thus, the expansion toward a truly sensitive approach to trauma is valuable, as it aims to increase awareness of its effects and ensure the best empathic care, providing a safe and healthy environment, with consequences also for the wellbeing of residential care staff. The present study aims to characterize the quality of residential care environments in Portugal through the lens of trauma-sensitive care, and to map professionals understanding of main domains, priorities and obstacles to change in this area. The study adopts a mixed method design, reporting on the perceptions of 85 professionals. Main findings show that professionals demonstrate better perceptions regarding physical environment but consider training and supervision as fragile dimensions. Qualitative data bring detail to these views, reinforcing the call for training to all staff and for continuous support to demanding job roles. This exploratory study highlights major aspects that urge to ensure trauma-sensitive residential care – supportive of professionals, to meet the needs of children and youth. Practice Implications The need to invest in training as the cornerstone to gather staff consensus around the importance of trauma-sensitive care and leverage change. The value of supervision in order to strengthen all residential care community. The importance of a shared theoretical background, common to all staff, to ensure secure and restorative relations with children and youth in line with trauma-sensitive care. The added value of the Trauma-Sensitive Care Evaluation Questionnaire for Welfare System as a tool to guide and monitor organizational change and its multilevel impact.

POLICIES TO OUTCOMES: MULTILEVEL CONSIDERATIONS FOR THE ASSISTED LIVING WORKFORCE

Abstract Assisted living (AL) staff mix, levels, training requirements, regulatory enforcement, and career opportunities vary widely across license types, companies, and states. ALs represent the largest care providers for people living with dementia across the U.S. In most states, ALs must have enough qualified, trained staff to sufficiently meet the needs of their resident populations. While the use of interventions to address appropriate staffing levels and workforce retention is increasing, little is known about how the variation in the AL workforce relates to resident and staff experiences or manifests from policies governing these settings. This symposium uses a socioecological framework to examine AL-specific workforce variation. Presentations focus on national variation in staff training requirements, workforce recruitment and retention, trends in staffing levels, how staffing levels can relate to resident outcomes, and direct care staff experiences with stress and coping in long-term care communities. Findings emphasize similarities and differences in workforce composition and experience between states and across different types of facilities. From national comparison of state regulations to facility contexts to individual resident and staff experiences, this panel embraces multilevel contextual understanding of how policies, practices, and outcomes can intersect across AL and residential care environments. This is an Assisted Living Interest Group Sponsored Symposium.

Development and initial validation of the staff perception of residential care environments (SPORE) instrument.

The impact of the physical environment on healthcare staff well-being and work performance is well recognised, yet there is a lack of instruments assessing environmental features from the perspective of staff working in residential care facilities (RCFs) for older people. To develop and provide initial validation of the instrument Staff Perceptions Of Residential care facility Environments (SPORE). An instrument development and psychometric evaluation study. Based on material from a British project, items were translated and adapted for Swedish residential care facilities as SPORE. Care staff (N = 200), recruited from 20 Swedish RCFs, completed a questionnaire-based survey containing the SPORE instrument and two other instruments selected as suitable for use in the validation. In addition, an environmental assessment instrument was used for further validation. Analyses were performed at individual (staff) level and home (RCF) level. The SPORE subscales demonstrated good internal consistency reliability and were moderately to strongly correlated at the individual level with the subscales of measures of person-centred care, and strongly correlated with the same measures at the home level. The SPORE subscales were also highly correlated with the total score of the instrument used to assess the quality of the physical environment. The initial validation indicates that the SPORE instrument is promising for measuring care staff perceptions of environmental features in care facilities for older people. SPORE can be a valuable instrument for use in research and in practice to evaluate the environment as part of working towards high-quality care. The design of the physical environment within RCFs can affect the staff's health and work performance. The instrument is useful for evaluating the environment and informing decisions about design solutions that support staff in their important work.

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.

Adverse childhood experiences and residential care environment: The mediating role of trauma-related symptoms and psychological maladjustment in adolescents

BackgroundResearch has consistently found poorer outcomes in adolescents who have been exposed to early interpersonal adversities, especially those in out-of-home placements. The presence of mental health problems also contributes to the perception of a more negative group climate and peer interactions through cascading effects. ObjectiveTo analyze the sequential relationships between exposure to adverse childhood experiences (ACEs), trauma-related symptoms, psychological maladjustment, and the perception of group climate and peer interactions. In addition, the study analyzes the mediating role of trauma-related symptoms and psychological maladjustment. Participants and settingThe sample comprised 161 adolescents in out-of-home care (46.6 % males, 49.7 % females, 3.7 % non-binary), aged 12–18 (M = 15.22, SD = 1.59) from 24 residential facilities in Spain. MethodsThis study is part of the VRINEP project. Group care workers reported about ACEs and trauma-related symptoms through online questionnaires, whereas adolescents self-reported about psychological maladjustment, group climate, and peer interactions. ResultsDifferential associations between ACEs with trauma-related symptoms and internalizing problems were found. The relationship between certain ACEs and externalizing problems was fully mediated by trauma-related symptoms. Likewise, psychological maladjustment was related to a more negative perception of the group climate and peer interactions. Although trauma-related symptoms were not directly associated with the perception of the residential environment, they were indirectly associated with peer relational aggression through externalizing problems. ConclusionsMental health has a significant impact on the perception of the group climate and peer interactions among adolescents in residential care who have been exposed to ACEs.

Walking Bout Detection for People Living in Long Residential Care: A Computationally Efficient Algorithm for a 3-Axis Accelerometer on the Lower Back.

Accurate and reliable measurement of real-world walking activity is clinically relevant, particularly for people with mobility difficulties. Insights on walking can help understand mobility function, disease progression, and fall risks. People living in long-term residential care environments have heterogeneous and often pathological walking patterns, making it difficult for conventional algorithms paired with wearable sensors to detect their walking activity. We designed two walking bout detection algorithms for people living in long-term residential care. Both algorithms used thresholds on the magnitude of acceleration from a 3-axis accelerometer on the lower back to classify data as "walking" or "non-walking". One algorithm had generic thresholds, whereas the other used personalized thresholds. To validate and evaluate the algorithms, we compared the classifications of walking/non-walking from our algorithms to the real-time research assistant annotated labels and the classification output from an algorithm validated on a healthy population. Both the generic and personalized algorithms had acceptable accuracy (0.83 and 0.82, respectively). The personalized algorithm showed the highest specificity (0.84) of all tested algorithms, meaning it was the best suited to determine input data for gait characteristic extraction. The developed algorithms were almost 60% quicker than the previously developed algorithms, suggesting they are adaptable for real-time processing.

EPERCAS Study. Strategies for Preventing Medication Administration Errors in Nursing Homes.

Medication administration errors are one of the most frequent types of errors. There are different safety guides and recommendations to prevent medication errors (MEs) generally directed to the hospital environment. However, specific recommendations for the management process in the residential care environment are lacking. The main objective of this study was to develop a list of recommendations to aid in preventing the most important MEs that occur during the administration process in Nursing Homes (NH), such as not administering doses or administering medication to the wrong patient. The effectiveness and feasibility of the strategies proposed were evaluated by a panel of experts. The conventional Delphi method was applied. The first round in our study was a face-to-face questionnaire; the second round included an online questionnaire based on the results of the first round. Finally, eight strategies were included in the EPERCAS List: one professional in charge per shift; one professional commissioned by the residential unit; avoid interruptions; avoid medication outside of meal times; personalized medication drawer for each resident including oral medication from a bag and laxatives, inhalers, syrups, eye drops…; identification of the resident and their medication; visual check that everything has been administered; signature to verify medication administration. The great continual challenge for NH is to define safe and affordable procedures. Minimum safety recommendations for administering the medications, such as those included in this study, should be employed. Our next stage is to implement these strategies in one of our NH and subsequently, evaluate its effectiveness and consider expanding it to the rest of the NH.

Residential Social Care Experiences of LGBTQ+ Young People in England: A Qualitative Interview Study

Abstract Lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ+) young people are overrepresented in out-of-home social care and face significant physical health, mental health and well-being inequalities compared with their non-LGBTQ+ peers. Their residential care experiences have been missing from the knowledge base, with no prior in-depth published research in the UK. Theoretically informed by an intersectional minority stress framework and combining qualitative and co-production methodologies, this study produced a nuanced understanding of the residential care experiences of LGBTQ+ young people. We interviewed twenty young people (sixteen–twenty-four years old) in England with a broad range of LGBTQ+ and multiple intersecting minority identities. We analysed data using reflexive thematic analysis, producing four themes: widespread discrimination and marginalisation; unmet mental and sexual health needs; importance of affirming professional relationships and resilience and self-relying strategies. Findings suggest that multiple minority identities magnified young people’s challenges. Combining the findings with our systematic scoping review developed an explanatory model which provides a dynamic understanding of (un)supportive or (dis)affirming residential care environments. Implications for policy, practice and research include LGBTQ+ inclusive policies and services, mandatory competency-based training combined with ongoing reflexive supervisory practice and incorporating the voices of LGBTQ+ young people in service delivery.

Facets of Care in Youth: Attachment, Relationships with Care Workers and the Residential Care Environment

ABSTRACT According to the attachment theory, early experiences with primary caregivers are the foundation of the expectations and beliefs about the self, others, and the world. It becomes particularly relevant in youth living in Residential Care (RC) settings, due to their past adversities. In this context, care workers can provide emotional healing experiences by acting as secure base figures and fostering conditions for youth’s revision of their internal working models. The main aim of the present study was to explore the relationship between youth attachment dimensions and satisfaction with the residential caregiving environment, as well as, to analyze the potential mediator effect of the relationship quality with care workers in RC settings in the prior association. The sample was composed of youth, aged 12 to 18 (M = 15.54; SD = 1.66) living in RC settings in Porto district, Portugal (N = 248), that responded to three self-report measures. Results showed that attachment dimensions were associated with youth satisfaction with their caregiving environment, being this association mediated by the relationship quality with care workers. This study highlights the importance of investing in good relational experiences for youth satisfaction with the RC caregiving environment.

Residential Environments for Older Persons: A Comprehensive Literature Review (2005-2022).

Independent noninstitutional and institutional residential long-term care environments for older persons have been the subject of significant empirical and qualitative research in the 2005-2022 period. A comprehensive review of this literature is reported, summarizing recent advancements in this rapidly expanding body of knowledge. This comprehensive review conceptually structures the recent literature on environment and aging to provide conceptual clarity and identify current and future trends. Each source reviewed was classified as one of the five types-opinion piece/essay, cross-sectional empirical investigation, nonrandomized comparative investigation, randomized study, and policy review essay-within eight content categories: community-based aging in place; residentialism; nature, landscape, and biophilia; dementia special care units; voluntary/involuntary relocation; infection control/COVID-19, safety/environmental stress; ecological and cost-effective best practices; and recent design trends and prognostications. Among the findings embodied in the 204 literature sources reviewed, all-private room long-term care residential units are generally safer and provide greater privacy and personal autonomy to residents, the deleterious impacts of involuntary relocation continue, family engagement in policy making and daily routines has increased, multigenerational independent living alternatives are increasing, the therapeutic role of nature and landscape is increasingly well-documented, ecological sustainability has increased in priority, and infection control measures are of high priority in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review sets the stage for further research and design advancements on this subject in light of the rapid aging of societies around the globe.

Hearing from justice-involved, care experienced children: what are their experiences of residential care environments and regimes?

PurposeThe disproportionate representation in juvenile justice systems of children who are, or have been, in the care of the state is a major cause of concern internationally. However, the experiences of this particular group are largely absent from both policy debates and the international research base. This paper aims to correct that deficit by exploring the lived experiences of residential care, justice-involved children.Design/methodology/approachAn interpretivist investigation of care experienced children’s perceptions of their experiences, involving semi-structured interviews with a purposive sample of 19 children in England who were simultaneously in residential care and subject to youth justice supervision. Data were analysed using thematic content analysis.FindingsCare-experienced children described how their experiences of residential care environments and regimes have undermined their sense of how they see themselves, now and looking to the future. Against this background of disrupted identity, they also reported stigmatising interactions with staff that leave them feeling labelled both as a generic “looked-after child” and as a “bad kid”.Research limitations/implicationsThe findings are based on the perceptions of a group of children in the criminal justice system, which, although reflecting the experiences of those with negative outcomes, may not be representative of all children in residential care.Practical implicationsThe findings have implications for those responsible for the care and development of care-experienced children, as well policymakers concerned with reducing the numbers of care-experienced children in youth justice. Those responsible for the care and development of care-experienced children should consider steps to reduce how factors outlined here disrupt a child’s sense of self and introduce criminogenic labelling and stigma.Originality/valueDespite a number of studies seeking to understand why the number of care experienced children in the youth justice system is disproportionate, there is very little empirical work that seeks to understand the experiences and perceptions of children currently both in care and the criminal justice system. This paper seeks to correct this deficit, by detailing how children who are both in residential care and subject to youth justice supervision view their care experiences. The implications of this for policy, practice and further research are then explored.

Path towards home: Exploring pathways to the developmentof a sense of home in residential care settingsin China.

To understand different pathways leading to older adults' sense of home in residential care environments in China. This research adopted the qualitative comparative analysis method to analyse data from 29 interviews. Qualitative comparative analysis is an analytic strategy to systematically analyse potential causal pathways in small-to-medium-sized qualitative datasets. Findings uncovered four different pathways that older adults followed in their process of constructing a sense of home in residential care environments in China. This study adds to the body of literature by analysing how a sense of home in residential care environments can be achieved with pathways that contain a combination of sets of necessary, substitutive and absent conditions. It concludes that even though older adults may not live at home, they may achieve a sense of home by the joint effort at institutional, social and personal levels that facilitates older adults to find a sense of home.

Multi‐system factors impacting youth justice involvement of children in residential out‐of‐home care

AbstractChildren placed in residential care are significantly over‐represented in youth justice systems. Drawing on interviews and focus groups with service providers, this exploratory study examines practice factors that impact on the criminalization of this group of children across multiple services and systems, including in the residential care environment, police, lawyers, courts and youth justice systems, as well as multi‐systems practice with this group in one Australian state. Positive outcomes were observed for children in residential care where well‐functioning care teams existed, as well as for children in therapeutic residential care settings. However, clear limitations were identified across all phases of children's youth justice system involvement, including placement with offending peers, the criminalization of behaviours of concern, greater use of remand and detention, limited support to navigate legal and youth justice processes, challenges to service collaboration, and limited applicability of sentencing considerations. The findings indicate a pervasive level of systemic disadvantage for this group of children, and imply that a holistic strategy underpinned by affirmative action across several systems will be necessary to address the ongoing criminalization of children in residential care.

SCOPE: safer care for older persons (in residential) environments\u2014a pilot study to enhance care aide-led quality improvement in nursing homes

BackgroundNursing home residents require daily support. While care aides provide most of this support they are rarely empowered to lead quality improvement (QI) initiatives. Researchers have shown that care aide-led teams can successfully participate in a QI intervention called Safer Care for Older Persons in Residential Care Environments (SCOPE). In preparation for a large-scale study, we conducted a 1-year pilot to evaluate how well coaching strategies helped teams to enact this intervention. Secondarily, we measured if improvements in team cohesion and communication, and resident quality of care, occurred.MethodsThis study was conducted using a prospective single-arm study design, on 7 nursing homes in Winnipeg Manitoba belonging to the Translating Research in Elder Care research program. One QI team was selected per site, led by care aides who partnered with other front-line staff. Each team received facilitated coaching to enact SCOPE during three learning sessions, and additional support from quality advisors between these sessions. Researchers developed a rubric to evaluate how well teams enacted their interventions (i.e., created actionable aim statements, implemented interventions using plan-do-study-act cycles, and used measurement to guide decision-making). Team cohesion and communication were measured using surveys, and changes in unit-level quality indicators were measured using Resident Assessment Instrument-Minimum Data Set data.ResultsMost teams successfully enacted their interventions. Five of 7 teams created adequate-to-excellent aim statements. While 6 of 7 teams successfully implemented plan-do-study-act cycles, only 2 reported spreading their change ideas to other residents and staff on their unit. Three of 7 teams explicitly stated how measurement was used to guide intervention decisions. Teams scored high in cohesion and communication at baseline, and hence improved minimally. Indicators of resident quality care improved in 4 nursing home units; teams at 3 of these sites were scored as ‘excellent’ in two or more enactment areas, versus 1 of the 3 remaining teams.ConclusionsOur coaching strategies helped most care aide-led teams to enact SCOPE. Coaching modifications are needed to help teams more effectively use measurement. Refinements to our evaluation rubric are also recommended.

Biophilic Design Strategies in Long-Term Residential Care Environments for Persons with Dementia

The number of persons living with dementia and related cognitive disorders is predicted to increase dramatically in the coming years. As a consequence, the need is increasing for appropriately designed long-term care (LTC) environments and design guidelines for these settings. This investigation presents the findings of a broad literature review on biophilic design and its application to a set of LTC architectural case studies selected for the degree to which each variously expresses key attributes of a set of ten biophilic patterns particularly rooted in the day to day experience of the aged in these care settings: visual connections with nature, non-visual connection with nature, non-rhythmic sensory stimuli, thermal and airflow variability, presence of water, dynamic and diffused light, complexity and order, prospect, refuge, and mystery. The three methodological aims are to conduct an in-depth literature review, to distill the aforementioned subset of biophilic patterns with respect to how the aged experience their built surroundings, and third, to examine these in light of their various expression in recently built state-of-the art LTC settings for persons with dementia and related cognitive disorders. Residents’ engagement with and proximity to nature and landscape, and transactions with biophilia-inspired artifacts was the principal focus. The case studies are further examined in relation to the planning and design of LTC environments in the context of the COVID-19 pandemic. Future biophilic-inspired directions for evidence-based research and design for persons with dementia and related cognitive disorders are discussed.

Design stage evaluation tools for residential dementia care environments

PurposeThe independence and well-being of people with dementia can be significantly influenced by the design of the physical environments around them. Several assessment tools exist to evaluate the dementia design quality of existing residential aged care facilities but, to date, none have been formally identified as suitable for use during the design process. This paper aims to examine the feasibility of re-purposing existing post-occupancy tools for use during the design process, while mapping the influence of design stages on resulting dementia design quality.Design/methodology/approachLiterature searches identified audit tools for residential aged care settings. After reliability screening, three tools were analysed in-depth, mapping their suitability for use during the design process.FindingsThe study confirmed that existing tools can be re-purposed for design stage use and identified that early design stages have a larger influence on overall dementia design quality than previously thought.Research limitations/implicationsNon-English language publications were not reviewed. Searches may not have identified other existing audit tools for residential care environments.Practical implicationsThe ability to assess proposals at key stages of design may help improve the dementia design quality of future residential aged care environments – potentially enhancing the lives of ever-larger numbers of people with dementia.Originality/valueAccording to the authors’ knowledge, this is the first known paper to consider formal design-stage evaluation of dementia design quality and the first to identify the relative influence of key stages of design on the resulting dementia design quality.

106 - Environmental Influences on the Cognitive and Psychological Well Being of Older Adults with Dementia

This symposium will review the latest data on the influence of environmental design and its attributes on the cognitive and psychological wellbeing of older adults living with dementia. The presenters will cover the myriad ways in which the physical environment of care can adapt to the changing demands of older adults with sensory, motor and cognitive deficits and foster optimal functioning and quality of life. The role of emerging technologies will also be reviewed as they complement the contribution of the design of the physical environment to the wellbeing of older adults with cognitive impairment. Information will be offered through a review of the existing research literature as well as case studies that illustrate the impact of environmental modification on fostering wellbeing and minimizing the emergence of the behavioral and psychological symptoms of dementia. The presenters will represent and integrate sensibilities that have emerged from the fields of architecture, cognitive neuroscience and psychology.How the Principles of the Culture Change Movement Inform Environmental Design and the Application of Technology in the Care of Older Adults Living with DementiaWilliam E. ReichmanThe culture change movement informs a number of principles that have been applied to more contemporary design concepts for the congregate care of older adults living with dementia. This talk will review the core tenets of the Culture Change Movement as exemplified by the Greenhouse, Dementia Village and other innovative models of congregate long-term care. Specific reference will be made to how these tenets have been operationalized around the world into the design of programming and the creation of residential care environments that foster a better quality of life for older adults and an enhanced work environment for care providers. This talk will also include the emerging role of technologies that complement innovative design of the environment and which foster optimized social and recreational functioning of older adults living with dementia.A Better Life Through a Better Nursing Home DesignL. Bradford PerkinsOver the last 20 years there has been extensive experimentation related to the role of the environment in the housing, care and treatment of persons with Alzheimer’s and other age related dementias. Prior to that time the typical housing and care environment was a locked unit in a skilled nursing or other restrictive senior living facility. In 1991 the Presbyterian Association on Aging in Western Pennsylvania opened Woodside Place on its Oakmont campus. This small 36 bed facility was designed to incorporate the latest research and care experience with persons suffering from these issues. This one small project, as well as the long post occupancy research led by Carnegie Mellon University, clearly demonstrated that individuals with Alzheimer’s and related forms of dementia could lead a healthier, happier, higher quality of life in a more residential, less restrictive environment. Not everything in this pioneering project worked, and five generations of living and care models have followed that have refined the ideas first demonstrated by Woodside Place. Bradford Perkins, whose firm designed Woodside Place and over 100 other related projects, will discuss what was learned from Woodside Place as well as the five generations of projects (and post occupancy research) that followed.Innovative dementia care environments as alternatives for traditional nursing homes: evidence and experiences from the NetherlandsHilde VerbeekKey goals of the dementia care environment focus on increasing autonomy, supporting independence and trying to enable one’s own lifestyle for as long as possible. To meet these goals, innovative, small-scale and homelike care environments have been developed that have radically changed the physical, social and organizational aspects of long-term care in the Netherlands. This presentation discusses various Dutch models that have implemented small-scale and homelike care environments, including green care farms, dementia village and citizen initiatives. The models reflect a common care concept, focusing on residents’ remaining strengths, providing opportunity for choice and aiming to sustain a sense of self and control. A small number of residents (usually 6 to 8) live together in a homelike environment and nursing staff are part of the household. Residents are encouraged to participate in daily household activities, emphasizing normalization of daily life with person-centred care. The physical environment resembles an archetypal home. This talk presents the scientific evidence on the impact and effects of these small-scale, homelike models on residents, their family caregivers and staff. Furthermore, the presentation will highlight working approaches and how these initiatives have positively influenced routine care across the long-term care spectrum.

Low-impact (compliant) flooring and staff injuries

Introduction Low impact flooring (LIF) has shown potential for reducing fall-related injuries for older people in residential care or hospital environments. However, the increased rolling resistance when moving equipment on these floors has raised concerns that staff injuries may increase. Methods LIF was trialled on one Older Persons Health ward for 2.5 years. Reported staff injuries were monitored during and following the trial. Numbers of staff injured on the LIF ward were compared with three other similar and adjacent OPH wards without LIF for the duration of the trial (‘concurrent control’ evaluation). At the trial conclusion the LIF ward moved to a different hospital that had standard flooring. This enabled a further ‘during and after’ evaluation where numbers of staff injured from the LIF ward during the trial were compared with those reported afterwards by the same ward staff without LIF. Results There was no difference in the numbers of staff injured in the LIF ward compared with the concurrent control wards (28 LIF vs 30 control; p = 0.44). The number of staff with injuries in the LIF ward also did not significantly alter when those staff moved to a new ward without LIF (45 after vs 28 before; p = 0.11). Conclusion There was no change in the numbers of staff with injuries during the LIF trial in an Older Persons Health ward. This small study suggests LIF appears safe for both patients and staff. Implications for rehabilitation Falls in hospital are common with patient injuries occurring in approximately 20-30% of falls. Low impact (compliant) flooring may reduce fall-related injuries in hospitals and residential care. Low impact flooring has an increased rolling resistance, which has the potential to increase staff injuries when moving equipment. This study found no change in the number of staff injured during a low impact flooring trial providing some reassurance that these floors are safe for staff.

Factors Associated with Community Residence at the End of Life: A Population-Based Study (TH321B)

•State the prevalence of decedents by residential setting (community, community with supportive services, and nursing home) at the end of life in a national sample of Medicare beneficiaries.•Compare the clinical characteristics of decedents across residential setting (community, community with supportive services, and nursing home) at the end of life.•Explain how socioeconomic factors of decedents are associated with end of life residential setting (community, community with supportive services, and nursing home). Residence in the community in the last phase of life has increased substantially in the last two decades and encompasses a range of different types of residential care environments. Determine the associations between demographic, clinical, and socioeconomic characteristics and residential setting at the end of life. We used the Medicare Current Beneficiary Survey (2011-2013) linked to administrative data. We characterized residential setting as community, community plus supportive services (e.g., personal care, medication assistance, meal preparation, transportation), or nursing home. We used multinomial logistic regression to identify characteristics associated with residential setting at the end of life. Of 1,385 decedents, 53.8% resided in the community, 7.7% in the community with supportive services, and 38.5% in nursing homes. Those in the community with supportive services and those in nursing homes had similar clinical characteristics including high rates of dementia (36.4% and 43.2%) and ADL impairment (2.3 and 3.1) but different socioeconomic characteristics. Those in the community without supportive services had higher rates of cancer and were more likely to be younger, married, and non-white than those in other settings. Higher education was independently associated with residing in the community with supportive services versus nursing homes (OR=2.1, 95% CI 1.1, 4.2) and versus residing in the community without supportive services (OR=3.4, 95% CI 1.7, 6.8). Socioeconomic factors are associated with whether individuals remain in the community with supportive services or reside in nursing homes at the end of life independent of clinical and functional characteristics. A combination of clinical, functional, and socioeconomic factors are associated with residing in the community without supportive services at the end of life.