Residential Care Environment Research Articles

IMPACT OF RESIDENTIAL CARE CULTURE ON QUALITY OF LIFE OF CARE LEAVERS

The quality of life of young adult residential care leavers is influenced by several factors. The impact of the residential care environment can be conceptualised as organisational culture. In our empirical study we explored how organisational culture affects the quality of life of care leavers. The research was conducted using a combination of qualitative and quantitative methods in 8 selected residential care facilities in Slovakia, and among 39 young care leavers. Data from semi-structured interviews were analysed using methods associated with grounded theory, and data obtained via questionnaires were analysed using statistical methods. The results show that adequate material conditions, adherence to facility rules, the space to act independently, responsive care, support in planning for the future, mutual assistance, and social support from peers and others are all likely to contribute to a higher quality of life for care leavers.

Exploiting WiFi Channel State Information for Residential Healthcare Informatics

Detection and interpretation of human activities have emerged as a challenging healthcare problem in areas such as assisted living and remote monitoring. Besides traditional approaches that rely on wearable devices and camera systems, WiFi based technologies are evolving as a promising solution for indoor monitoring and activity recognition. This is, in part, due to the pervasive nature of WiFi in residential settings such as homes and care facilities, and unobtrusive nature of WiFi based sensing. Advanced signal processing techniques can accurately extract WiFi channel status information (CSI) using commercial off-the-shelf (COTS) devices or bespoke hardware. This includes phase variations, frequency shifts and signal levels. In this paper, we describe the healthcare application of Doppler shifts in the WiFi CSI, caused by human activities which take place in the signal coverage area. The technique is shown to recognize different types of human activities and behaviour and be very suitable for applications in healthcare. Three experimental case studies are presented to illustrate the capabilities of WiFi CSI Doppler sensing in assisted living and residential care environments. We also discuss the potential opportunities and practical challenges for real-world scenarios.

The Public's Perceptions of a Cafe within the Social and Physical Context of a Residential Aged Care Facility

Background: The publics’ perceptions of aged care residential facilities (ACRF’s) are generally derogatory in nature; with terms such as the ‘end of the road’ or ‘the last resort’ being used to describe them. The institutional design and nature of the traditional ‘nursing home’ has contributed to such a perception. However, more contemporary models of residential aged care facilities are encompassing design features which aim to enhance the physical and social environment and therefore the lives of the older people residing within them. Purpose: This research reports on the inclusion of a café in the foyer of an aged care residential which is open to the public. Members of the public who use the café were interviewed. Methods: This research project utilised qualitative inquiry of a descriptive nature. Data was gathered through semi-structured interviews; seven participants were interviewed. Data analysis to establish themes utilised coding. Findings: The perceptions of members of the public who use the café is presented according to three major themes; place and purpose, people and relationships and community exposure and perceptions. The café is perceived, by the participants of this research project, as a place to go in the local community which was appreciated for its familiarity, pleasant surroundings and the quality of its service. Interactions between staff and residents were observed as caring and participants reflected that the staff were personally invested in their work. Visiting this café has challenged the notion that ACRF’s are closed off institutional places and the environment was described as open and inviting. The interaction between the community and the ACRF was discussed the benefits for the residents and for themselves were identified. Participants described a developing affiliation and connection between the facility and themselves and this prompted reflection about their own future residential needs. Conclusion: This café has opened a door between the ACRF and the local community. Members of the public who visit the café are able to observe, interact and make connections within the residential care environment. Perceptions about the nature of aged care facilities have been challenged and reflection about future residential care needs has occurred.

A Case Study Approach to Reducing the Risks of Child Sexual Exploitation (CSE)

ABSTRACTThe risk of child sexual exploitation is a growing concern, both within community and child care settings. Within community services working with vulnerable young people, the risks of exploitation are pervasive and present a constant management problem for professionals. This makes the need for focused educational interventions within such settings all the more vital. This case study aims to describe the assessment, formulation, intervention, and outcomes of a young female considered to be at risk of sexual exploitation. It was hypothesised that, after completion of a psychoeducational group designed to enhance knowledge and skills around child sexual exploitation, positive outcomes would be seen in psychometric assessment, risk-taking behavior, and risk awareness. Results demonstrated no clinically significant change for measures of impulsivity, resourcefulness, or self-reported difficulties. A significant increase was seen for self-reported self-esteem, and all outcomes revealed a positive direction of change. Observational accounts of behavioral and attitudinal change produced more positive results, revealing an increase in prosocial behaviors and a reduction in risk-taking behaviors. Outcomes are discussed in relation to the individual’s history and the residential care environment. Implications for future research and practice are outlined, and the study limitations are considered.

Validation of an instrument to measure moral distress within the Australian residential and community care environments.

The aim of this study was to gain insight into the experience of moral distress within the aged care workforce. The objective of this study was to use and validate an existing instrument to measure moral distress within the aged care setting. Moral distress, a phenomenon associated with worker satisfaction and retention, is common within nursing. Instruments to measure moral distress exist; however, there are no validated instruments to measure moral distress within an aged care setting. An existing instrument, the Moral Distress Scale (Revised) was identified and amended. Amendments were subject to expert review for face and content validity. Data were collected from aged care nurses working in residential and community aged care, in Australia. Reliability was assessed using Cronbach's alpha with exploratory factor analysis undertaken for construct validity. 106 participants completed the survey, 93 (87.7%) identified as female and 13 (12.3%) male. Participants ranged in age from 21 to 73years, with a mean time working in nursing of 20.6years. The frequency component of the instrument demonstrated an alpha of 0.89, the intensity component 0.95 and the instrument as a whole 0.94. Three factors were identified and labelled as: Quality of Care, Capacity of Team and Professional Practice. Mean scores indicate a low occurrence of moral distress, but this distress, when experienced, was felt with a moderate level of intensity. Primary causes of moral distress were insufficient staff competency levels, poor quality care because of poor communication and delays in implementing palliation. The instrument demonstrates validity and reliability within the Australian aged care setting. Further analysis with larger populations is required to support these findings. Australian aged care workers do experience moral distress. They suffer adverse consequences of this distress and quality of care is negatively impacted. This newly validated instrument can be used to quantify the occurrence of moral distress and to inform targeted interventions to reduce the occurrence and intensity of the experience.

Care assistant experiences of dementia care in long-term nursing and residential care environments

Care assistants have a unique insight into the lives of service users and those factors which may impede or enhance the delivery of high quality dementia oriented care. To address the paucity of research in this area, the present study examined care assistant experiences of dementia care in British long-term residential and nursing environments. Semi-structured interviews were conducted with eight care assistants and transcripts were analysed using interpretive phenomenological analysis. Super-ordinate themes emerging from the data were psychological wellbeing of the care assistant, barriers to effective dementia care, the dementia reality and organisational issues within the care environment. The study revealed important deficiencies in understanding and varying levels of dementia training. Whilst person centred strategies were being implemented, task orientated care remained dominant. Furthermore, care assistants reported taking the perspectives of those with dementia into account, and actively using these to develop relationship centred care.

The carnival is not over: Cultural resistance in dementia care

Within the still-dominant medical discourse on dementia, disorders of language feature prominently among diagnostic criteria. In this view, changes in ability to produce or understand coherent speech are considered to be an inevitable result of neuropathology. Alternative psychosocial accounts of communicative challenges in dementia exists, but to date, little emphasis has been placed on people with dementia as social actors who create meaning and context from their social interactions. In this article we draw on Bakhtin’s concepts of the carnivalesque, heteroglossia, polyphony and dialogism to analyse a series of interactions involving people with dementia in day and residential care environments. We argue that many of the communicative challenges faced by people with dementia arise from the social environments in which they find themselves, and that the utterances of people with dementia in the face of these social challenges show many of the hallmarks of cultural resistance identified by Bakhtin.

The carnival is not over

Within the still-dominant medical discourse on dementia, disorders of language feature prominently among diagnostic criteria. In this view, changes in ability to produce or understand coherent speech are considered to be an inevitable result of neuropathology. Alternative psychosocial accounts of communicative challenges in dementia exists, but to date, little emphasis has been placed on people with dementia as social actors who create meaning and context from their social interactions. In this article we draw on Bakhtin’s concepts of the carnivalesque, heteroglossia, polyphony and dialogism to analyse a series of interactions involving people with dementia in day and residential care environments. We argue that many of the communicative challenges faced by people with dementia arise from the social environments in which they find themselves, and that the utterances of people with dementia in the face of these social challenges show many of the hallmarks of cultural resistance identified by Bakhtin.

Demystifying aged care for medical students.

Residential aged care environments can provide valuable learning opportunities for health professional education. An aged care community-university partnership developed the Beyond the Teaching Nursing Home: Community Partnership of Learning and Care (BTTNH:CPLC) programme, where older adults volunteer in learning activities with health professional students. This article describes medical students' experience of participating in a clinical learning activity as part of the broader programme. Fourth-year medical students (enrolled in a 6-year medical degree) on geriatric medicine rotation participated in a half-day clinical visit as part of the BTTNH:CPLC programme. Medical students participated in an interview activity with an older adult from the aged care facility. A survey was administered to evaluate medical students' experience of the structured clinical visit to a residential aged care facility. Residential aged care environments can provide valuable learning opportunities for health professional education RESULTS: Medical students valued the learning experience of interacting with older adults, observation of the residential aged care environment and learning about the needs of older adults living in residential aged care. Providing meaningful learning opportunities for medical students in residential aged care environments may contribute to a better understanding of residents, aged care environments, development of communication skills, professional role and clinical decision-making skills that are relevant for the care of older adults not only in aged care but also in other care settings.

Bullying in Adolescent Residential Care: The Influence of the Physical and Social Residential Care Environment

Background To date, no study examined possible contributions of environmental factors to bullying and victimization in adolescent residential care facilities.

Evidence for Using Farm Care Practices to Improve Attachment Outcomes in Foster Children: A Systematic Review.

Anecdotal evidence suggests that care farming practices have the potential to provide positive outcomes for young people in foster-care and residential care environments. A systematic review (searching; CINAHL, Web of Knowledge, PsychInfo) was conducted to explore how participation in care farming initiatives impacts attachment in children in foster-care and what aspects of care farming initiatives provides positive attachment outcomes. The systematic review did not identify any research publication in care farming and foster-care. Therefore, it is imperative that practitioners realise that the evidence is lacking when using these types of interventions and keep a close account of the benefit and harms that may be encountered during the interaction processes.

Variations Among Medicare Beneficiaries Living in Different Settings: Demographics, Health Status, and Service Use.

Older people with complex health issues and needs for functional support are increasingly living in different types of residential care environments as alternatives to nursing homes. This study aims to compare the demographics and health-care expenditures of Medicare beneficiaries by the setting in which they live: nursing homes, residential care settings, and at home using data from the 2002 to 2010 Medicare Current Beneficiary Study (MCBS), a nationally representative survey of the Medicare population. All Medicare beneficiaries aged 65 years or older who participated in the fall MCBS interview (years 2002-2010) and were alive for the full year (N = 83,507) were included in the sample. We found that there is a gradient in health status, physical and cognitive functioning, and health-care use and spending across settings. Minority elderly are overrepresented in facilities and underrepresented in alternative living settings.

The Development of the strain in dementia care scale (SDCS)

Though many staff gain satisfaction from working with people with dementia in residential facilities, they also experience significant stress. This is a serious issue because this in turn can affect the quality of care. There is, however, a lack of instruments to measure staff strain in the dementia-specific residential care environment, and the aim of this study, accordingly, was to develop the "Strain in Dementia Care Scale." The instrument was developed in three steps. In the first step, items were derived from six focus group discussions with 35 nurses in the United Kingdom, Australia, and Sweden concerning their experience of strain. In the second step, a preliminary 64-item scale was distributed to 927 dementia care staff in Australia and Sweden, which, based on exploratory factor analysis, resulted in a 29-item scale. In the final step, the 29-item scale was distributed to a new sample of 346 staff in Sweden, and the results were subjected to confirmatory factor analysis. The final scale comprised the following 27 items producing a five-factor solution: Frustrated empathy; difficulties understanding and interpreting; balancing competing needs; balancing emotional involvement; and lack of recognition. The scale can be used (a) as an outcome measurement in residential care intervention studies; (b) to help residential facilities identify interventions needed to improve staff well-being, and, by extension, those they care for; and

Making sense of varying standards of care: the experiences of staff working in residential care environments for adults with learning disabilities

Accessible summary To find out why standards of care might vary in residential homes for adults with learning disabilities, this study describes the experiences of six care workers currently working in residential homes. Each care worker took part in an interview where they were asked to talk about their jobs in detail. Three things were found to be important aspects of care workers experiences: the quality of their relationships with others; their levels of motivation for their work; and their feelings about the environments they worked in. The study discusses how each of those things can lead to variations in care standards. SummaryResearch evidence reveals that adults with learning disabilities who live in residential care facilities are being exposed to considerable variation in the standards of care they receive. High profile cases of substandard care have also raised concerns regarding the appropriateness of existing care provisions and practices. While attempts have been made to understand variations in care standards, there remains a need for more research in this area. Additionally, little attention has been paid to understanding support staff experiences of working in residential services and to developing a more theoretical understanding of the role they fulfil. Using interpretive phenomenological analysis (IPA), this study aimed to examine front‐line staff members' experiences of working in residential care for people with learning disabilities. Six experienced front‐line care workers (four female, two male) took part in semi‐structured interviews. Data were analysed according to the principles of IPA, and three superordinate themes were identified as being central to participants' experiences of their work roles: Degree of Positive Relationship Reciprocity; Value Congruence and Intrinsic Motivation; and Experiences of Environmental and Organisational Constraints. Results are discussed in relation to the existing literature on care standards and the factors associated with abusive or neglectful practices, and in terms of their contribution to theory and applied practice.

Swimming upstream: the provision of inclusive care to older lesbian, gay and bisexual (LGB) adults in residential and nursing environments in Wales

ABSTRACTThis paper examines the ways in which older people's residential and nursing homes can constitute heteronormative environments – social spaces in which the same-sex attractions and desires of residents are disregarded in the provision of everyday care. The aim of this discussion is to examine the synergies and differences between older lesbian, gay and bisexual (LGB) adults' expectations for future care home provision and the expectations of care staff and managers in providing residential services to older people with diverse sexual backgrounds. We present qualitative evidence from research into the provision of care environments in Wales. In this paper, we present findings from two cohorts: first, from five focus groups with care and nursing staff and managers; and second, from 29 semi-structured interviews with older LGB adults (50–76 years) residing in urban and rural locations across Wales. We argue that residential care environments can constitute heterosexualised spaces in which LGB identities are neglected in comparison to the needs and preferences of other residents. To this extent, we discuss how care staff and managers can be more attentive and responsive to the sexual biographies of all residents and argue against the separation of care and sexual orientation in practice.

Perceptions Of Clinical Leadership In An Aged Care Residential Facility In Perth, Western Australia

Objective: To investigate the perceptions and approaches to leadership and leadership development of senior nurses and care home managers in an aged care residential facility. Method: A descriptive phenomenological research approach was employed to support purposive sampling. A questionnaire (n=10) was used, followed by interviews (n=8). Analysis employed an SPSS and NVivo 0.6 computer programs, with manual data configuration as required. Results: Participants saw a distinction between their role as leaders and managers and that their more clinically focused responsibilities favoured a greater affinity with clinical leadership. In addition, the attributes and characteristics of clinical leaders identified by participants were approachability, clinical skills, clinical knowledge, honesty, integrity, support for others and visibility in the clinical area. Conclusion: The development and deployment of clinical leadership attributes are vital so that senior nurses and care home managers can play a more effective part in care provision and service improvement in the residential care environment.

Dignity and respect: facilitating meaningful occupation for SeSotho elders

Aim: Frail and vulnerable adults are divested of meaningful encounters when modernization and urbanization force them to embrace an unconventional residential care environment as a home. The aim of this article is to report on a study of SeSotho elders living in residential care to illustrate how more meaningful and culturally relevant experiences could be facilitated for them. Methods. A content analysis was done of the individual opinions of 15 collaborators as a secondary scrutiny of information obtained during a nominal group process. Major findings. Findings revealed that elders were prone to experience loneliness, helplessness, and boredom due to situations dominated by occupational injustice. Co-occupations, training of staff, and environmental adaptations that allow a sense of interdependence could contribute in facilitating occupational justice for elders from a traditional South African indigenous background living in residential care. Principal conclusion. Human dignity and respect are upheld within residential care when elders have access to purposeful and meaningful activities of their choice that are culturally appropriate. Occupational therapists should advocate for doing, belonging, and becoming by facilitating meaningful occupational participation that is culturally relevant for their clients.

An Exploration of Adjustment Needs and Efforts of Persons with Dementia After Relocation to a Residential Care Facility

This study examined the adjustment needs and efforts of individuals with dementia after relocation to a residential care facility. This was a qualitative prospective study that involved in-depth face-to-face interviews with 16 individuals with dementia and their family caregivers at 2 and 6 months post-relocation. In their efforts to recreate a sense of home, individuals with dementia had to meet three major highly interrelated and overlapping categories of needs to settle in, fit in, and find meaning in this transition. The satisfactory fulfillment of these adjustment needs resulted in a sense of comfort, connection, and continuity associated with feeling at home. Participants’ efforts to place themselves in their new living environments created a simultaneous need to integrate relocation into their overall sense of self. The results support earlier research indicating that place making is a critical process in the overall psychosocial adjustment to old age. The findings inform supportive interventions to assist individuals with dementia to reconstruct home in a residential care environment.

Home in Later Life

ABSTRACTWith the growing number of people moving into old age, architects face the challenge of designing appropriate residential environments for current and future generations of older people. Too often they live in houses that are not adapted to their needs and desires, with few spatial and social qualities of a real home. Among architects and professional care givers awareness is growing of the importance of “feeling at home” in residential care environments, rather than just having basic needs like food, shelter, and medical care met. This article builds on this tendency. Based on literature from different disciplines, we first identify a set of concepts that form a framework to understand: (1) what is important in order to create a feeling of homeliness, particularly for older people, and (2) how the physical house and its environment can contribute to that. We then articulate how these concepts can be reflected in the architecture of the home by drawing on empirical material from case studies in the homes of older people living in different contexts. The feeling of homeliness is based on a dynamic balance between autonomy and security. This balance is an ongoing process, called appropriation; it is the process by which a person makes a house into a home. For five spatial aspects we describe and document how they may contribute to enhancing the autonomy/security balance.

Affordances of the Care Environment for People with Dementia—An Assessment Study

Evidence on the importance of the physical environment for the well-being of people with dementia has been growing steadily. This article aims to (1) introduce an assessment tool for evaluating the physical care environment for people with dementia; (2) describe the method's initial results and the subsequent feedback provided to the 10 care units; and (3) describe the follow-up results 1 year later. The goal has been to provide care workers and managers with information that affects the well-being of people with dementia and to provide this information on the care environment in the context of their own work environment. The assessment was part of a randomized controlled intervention using nonpharmaceutical methods to decrease behavioral and psychological symptoms of people with dementia. During the half-day visits, photographs and field notes were taken, and a final assessment was carried out via the Residential Care Environment Assessment (RCEA) tool developed at the beginning of the study and based on affordance theory. Follow-up data were gathered after 12 months. There were several possibilities for improvements in the provision of residential care in a person-centered environment. Improvements were needed mostly in comfort and in providing opportunities for engagement, activity, and expression of identity. However, in practice, it was difficult to achieve the improvements even with an intensive intervention study. The authors conclude that the physical care environment involves a complex set of issues and stakeholders in which the impetus to fulfill responsibilities to carry out improvements can easily fall away.