Residential Care Organisation Research Articles

LONG-TERM PAID CARE WORKFORCE: SHORTAGE, BURNOUT, TRAINING, TURNOVER, WHAT’S NEXT?

Abstract Although the long-term care workforce has struggled historically with staff satisfaction, safety, and retention, the pandemic triggered increased turnover and higher levels of staff burnout. As a result, many residential care organizations are using agency staff at unprecedented levels. Given that continuity of care is central to high-quality person-centered care, and the workforce should have access to a physically and psychologically safe environment, it is imperative that the gerontological research and practical community understand the changing conditions experienced by this workforce in crisis and offers solutions at the workplace, industry, and policy levels. In this symposium, authors explore different facets of paid long-term care workforce to stimulate thought and discussion. One paper contrasts the well-being of the workforce to that of the residents during COVID-19. A second paper presents workforce management capabilities and strategies and posits essential questions for the capacity of management and leadership needs of the workforce. Two papers highlight the struggles that are presented as paid long-term care relies increasingly on contract, short-term workers. Paper three discusses how the use of the contract workforce does not support the provision of person-centered care for conditions like dementia. Paper four uses payroll-based journal data to delve into short and long-term use of contract workforce and discusses the nature of contract staffing, and considers how contract staffing may be disruptive to both the direct care worker and the nursing home environment. The discussant will draw out the policy and practice implications arising from the papers. This is a collaborative symposium between the Aging Workforce and Paid Caregiving Interest Groups.

Placement Matching of Children and Young People within Out-of-Home Residential Care: A Qualitative Analysis

Residential care for children and young people is typically regarded as the least preferred option in out-of-home care by child welfare and protection practitioners. Increasingly, residential care is only used to place young people after multiple unsuccessful placements in kinship or foster care. Consequently, these young people often come into residential care with complex needs and entrenched emotional and behavioural difficulties. Coplacement of these young people in residential care has raised significant and persistent concern of peer victimisation while in residential care. Improved matching of peers within residential care may enhance safety and stability, a proposal for which young people themselves have expressed support. However, the matching of young people in residential care has received little attention in research. This article reports the qualitative findings of a multiinformant study, drawing on the first-hand experiences of 34 participants comprising eight young people and 26 practitioners in residential care, to identify the considerations they perceived as important when matching young people in residential care. Framework analysis of young people's and practitioners’ perspectives identified three matching strategies that may more effectively address the concern of peer victimisation in residential care including (1) balancing risks and strengths; (2) steering into collective duty of care; and (3) involving young people in planning and transition. Implications of the findings directly point to the need to prioritise young people’s rights to protection and participation, and to provide independent oversight to assist residential care organisations and the broader child welfare system to navigate the complexity in the practice of matching young people in residential care.

A Preliminary Exploration of the Impact of Aged Care Reforms on the Governance of Two Australian Residential Care Facilities.

Objectives: Australia's ongoing aged care reforms have re-focused service provisions from a provider-driven policy approach to a consumer-directed care focus and redirected residential care subsidies. This study aimed (i) to identify the experiences and perceptions of people involved in the governance of residential care facilities about their management of changes due to new accreditation requirements and funding mechanisms, and (ii) to describe their strategic responses to aged care reform changes. Methods: A qualitative description design used interviews exploring perspectives of Board Chairs, Board Directors, and Chief Executive Officers of two NSW-based residential care organizations. Thematic analysis was conducted of interview transcripts. Results: Four key themes emerged from the data: (1) Business strategies and challenges under reform conditions including the need for business diversification and new approaches, (2) costs incurred by the reforms such as compliance with accreditation requirements, (3) workforce demands: for example maintaining staffing levels and training needs, and (4) expectations about maintaining quality of care. Discussion: Changes were necessary in business models for facilities to remain sustainable, meet staffing needs, and continue to provide services in a complex, changing fiscal environment. These included generating revenue streams other than government subsidies, better clarity about government support and establishing partnerships.

Vicarious trauma and compassion fatigue in residential care workers of traumatized children

This research comprised of 13 face-to-face semi-structured interviews with residential care workers (seven males and six females), all based within the same UK residential care organisation, offering care for adolescents aged 11 to 17 years. Interviews focussed on the psychological impact of traumatic events on staff functioning. Findings noted that participants had been exposed to varied distressing and traumatic experiences, occurring within and outside their employment. Experiences included witnessing or being a victim of physical and sexual aggression, witnessing self-injury or suicidal behaviour, and reading about neglect, abuse, self-injury, suicidal behaviour, and physical and sexual aggression from residents’ histories. When considering the psychological impact on staff, qualitative analyses identified themes of emotional distress and interpersonal discord. Furthermore, increased exposure to a young person’s traumatic experience led to endurance being prioritised over emotional wellbeing, ineffective coping, and poor sleep hygiene. A reduction in the impact of exposure to a young person’s traumatic experiences related to emotional and proactive support from others, use of effective coping, and increased knowledge and preparation into distressing events. The findings are discussed in relation to the overall impact of trauma exposure on staff, protective factors, and suggestions for staff intervention to reduce and/or remove potential impact.

Therapeutic content in Swedish residential care for children and youth – managers choices and the reasoning behind

ABSTRACT The field of residential care for children and youth in Sweden is fragmented; there is a diversity both in terms of ownership and in terms of therapeutic content. This article analyses how decisions regarding therapeutic content are made in residential care settings. The data consists of interviews with representatives of different types of residential care organisations. The results indicate that the field is impacted by different logics as well as multiple actors and environmental elements shaping the prerequisites for decisions about therapeutic content. Local managers have substantial discretion in deciding which models and treatments that should be used in their settings and they can in that capacity be viewed as key actors in the field. The decisions of managers are influenced by a mix of professional and market logics, but there are also some traces of a family logic. Signs of a professional logic can be discerned in claims about models and treatments viewed as evidence-based and/or locally evaluated, but such claims are also perceived as competitive on the market. A gap between descriptions of models and treatments and actual practice is acknowledged by managers and believed to be fuelled by procurement processes and market considerations.

Practitioners’ experience of implementing therapeutic residential care: A multi-perspective study

Repeated inquiries into residential care for children and young people in out-of-home care have documented persistent service inadequacies. Calls for reforming residential care into therapeutic care have received growing attention in recent years. However, limited research exists to inform how therapeutic care can be optimally implemented in residential care settings. This research draws on the first-hand experience of residential care practitioners to examine the barriers they experienced when implementing therapeutic care. Twenty-six practitioners across five different service strata (senior managers, therapeutic specialists, caseworkers, team leaders and direct care workers) from three Australian residential care organizations participated in semi-structured interviews. Framework analysis of the interview data indicated, whilst there was a strong consensus that therapeutic residential care should be underpinned by trauma-informed knowledge, its implementation was constrained by six barriers: (1) inconsistent understandings of how therapeutic care should be operationalized; (2) crisis-driven referrals and assessments; (3) problematic placement configuration and client mix; (4) inadequate workforce development; (5) the emotional cost of care; and (6) atrophied clinical support. These barriers call into question the extent to which therapeutic residential care is implemented as intended. Findings indicate that, to actualize the full potential of therapeutic residential care, substantial work is needed to provide a more translatable practice framework, strengthen referral and assessment processes, revitalize the workforce and elevate implementation efforts to a systemic level, bringing closer alignment between different service systems to jointly avert re-traumatization and enhance consistency in service delivery.

Negotiating Social Diversity in Residential Care for Older Persons

Studies have long noted challenges of diversity in the workplace. Growing evidence suggests that both the aging population and the workforce needed for health and social care will be more diverse than in previous decades. The confluence of older person and care worker diversity can result in suboptimal care. Drawing on 44 interviews, observations of 62 meetings, and a five-year immersion, this organizational ethnography examines the impact of social diversity at a large, urban, multi-level, residential care organization for older persons. The impact of diversity is delineated on three levels such as among care workers, between care workers and residents, and in terms of personal and organizational responsibility for diversity work. Strengths of diversity are mainly with regard to connectivity between care workers and residents. Diversity challenges include implications for care processes, care workers’ identities, and organizational health.

Moving Towards Family Solutions: An Introduction to an Immersive Simulation Workshop

Residential care organisations, such as children’s homes, are well-positioned to reshape their programmes to support family-based models of care. However, new models bring unknown factors, making organisations hesitant to transition programmes. To alleviate concerns and support transition, researchers developed an experiential workshop mirroring the conditions of an organisation transitioning to family care. Workshop participants are guided through a series of activities and discussions detailing the transition of a fictional programme to a family-based model of care. The workshop focuses on six key components: engagement, case management, families, asset transitions, measurement and fundraising. The workshop also gives participants the opportunity to create a personalised plan for their programme. The goal of the current article is to present this workshop framework and share the free Facilitator’s Toolkit ( https://cafo.org/ovc/sim-lab/ ).

Integrating Technology Into Clinical Practice for the Assessment of Balance and Mobility: Perspectives of Exercise Professionals Practicing in Retirement and Long-term Care

ObjectiveTo explore exercise professionals’ perspectives on technology integration for balance and mobility assessment practices in retirement and long-term care. SettingA private residential care organization in Ontario, Canada, with 18 sites providing accommodation and services for older adults. DesignA qualitative descriptive approach was used including semistructured focus group interviews. Open-ended questions explored perceptions of technology integration along with factors influencing its adoption. Analysis involved preliminary coding based on research questions, review and discussion of emerging themes, and final, resultant coding for each category. ParticipantsExercise professionals (kinesiologists and exercise therapists) (N=18). InterventionsNot applicable. Main Outcome MeasuresNot applicable. ResultsAll participants felt that technology could enhance their practice by supporting programming, communication, and/or information management. Potential barriers to technology integration related primarily to the need to accommodate the broad range of complex health conditions present among clients, which would impact (1) their ability to engage with the technology and (2) relevance of technology-derived outcomes. Specific concerns related to individuals with significant cognitive and/or functional impairment. Solutions to these barriers emphasized the need for flexible technology and appropriate normative data to maximize the potential for uptake. ConclusionsThe participating exercise professionals working in a retirement and long-term care setting saw technology as a potentially effective addition to current clinical practice. To increase the likelihood for clinical uptake, technology must be maximize flexibility in order to accommodate a wide range of physical and cognitive abilities and meet specific needs related to setting and job responsibilities. The findings emphasize the need for continuous dialogue between technology producers and end users for successful development and implementation.

Reliability and Feasibility of Systematic Registration of Coercive Measures in Care for People With Intellectual Disabilities

AbstractPolicies limit the use of coercive measures as a measure of last resort to protect people from danger. Success of policies can only be determined by registering the use of coercive measures. The reliability of 57 standardized coercive measures was tested. In addition, implementation was investigated of improved registration in a residential care setting. This mixed methods study within a residential care organization for people with intellectual disabilities in the Netherlands included 55 living units and 269 residents. Reliability of 57 standardized coercive measures was tested against other informants (colleague staff, trained outside observer) and results were validated by a panel of stakeholders. Second, the implementation of a mandatory routine registration system was investigated by comparing registration of coercive measures to personal files of 30 residents. Registration of coercive measures yielded reliable data for at least 25 out of 57 types of coercive measures. The second part of the study showed widely varying explanations of unreliable data by stakeholders, including knowledge and awareness of coercive measures of support staff and the influence of contextual factors on the encoding of coercive measures. After implementation, 46% of the coercive measures were registered in the registration system. Comprehensive registration of coercive measures by staff neither appeared feasible nor yielded reliable data. Clearly, multidisciplinary discussion among support staff and professionals is needed to decide whether care practices are restrictive or not. Further research should focus on how these considerations can lead to a reliable and meaningful registration.

Mental and emotional health needs of orphaned and separated youth in New Delhi, india during transition into adulthood

The transition process into adulthood from adolescence is a difficult period for many young adults. It is especially taxing for orphaned and separated children (OSC) populations, who tend to have traumatic past histories and inconsistent psychosocial support systems. Due to such adverse factors, OSCs may be more vulnerable to mental health risks during transition and beyond. However, there is currently limited research on the difficulties OSCs face during this period and how they influence their mental and emotional well-being. This study describes the mental health outcomes and transition experiences of a group of young adults who are currently transitioning (aftercare) or have already transitioned (alumni) out of a residential care organisation for OSCs in New Delhi, India. A sample of aftercare and alumni (n=50) were administered questionnaires on anxiety, depression, and life satisfaction, as well as qualitative semi-structured interviews. Findings indicate the diverse mental health trajectories prevalent in this population, showing both risks and areas of resilience. While a majority of the sample is experiencing some level of anxiety and clinically significant levels of depression, only a small percentage reported being dissatisfied with life. From the overall sample, two sub-groups were identified with having either high or low mental health risks. More individuals from the high risk group reported that the transition process was very hard and that they had less social support than did individuals from the low risk group. However, the complexity of patterns and differences in needs across the sample highlight the importance of addressing complex mental health issues on an individualised basis. Overall, these results emphasise the necessity of addressing the challenges of transition age youth. Specifically, analysis focuses on how qualitative information can be used to supplement quantitative measures to understand how best to support the emotional and mental health needs of vulnerable populations.

“You Shouldn’t Look at Us Strangely”: An Exploratory Study on Personal Perspectives on Quality of Life of Adolescents with Emotional and Behavioral Disorders in Residential Youth Care

Adolescents with Emotional and Behavioral Disorders (EBD) have complex needs and experience challenges in various developmental areas and life domains. The majority of current studies regarding Quality of Life (QOL) among adolescents often adopt a quantitative design to assess health-related aspects of QOL. While considerable progress has been made in acknowledging the rights of children and adolescents to express their views on life and well-being, there remains a lack of research regarding adolescents with EBD and their personal perspectives on QOL. This qualitative study aims to address this gap. Focus groups (N = 6) were conducted with 25 adolescents aged 13 to 17 years living in a large-scale residential care organization. An expert panel, comprising six experts, was convened to classify the results from the focus groups (i.e., indicators) according to the QOL framework by Schalock and Verdugo (2002). An in-depth overview of the wide variety of aspects adolescents value with regard to their QOL was presented. The findings highlighted the importance of adopting a broad and holistic approach, instead of a traditional health-related and deficit-oriented one, when aiming to enhance the QOL of adolescents with EBD. Furthermore, several benefits for research and clinical practice relating to adolescents’ personal perspectives on QOL were discussed.

Medication review using a Systematic Tool to Reduce Inappropriate Prescribing (STRIP) in adults with an intellectual disability: A pilot study

A Systematic Tool to Reduce Inappropriate Prescribing (STRIP), which includes the Screening Tool to Alert doctors to Right Treatment (START) and the Screening Tool of Older Peoples’ Prescriptions (STOPP), has recently been developed in the Netherlands for older patients with polypharmacy in the general population. Active involvement of the patient is part of this systematic multidisciplinary medication review. Although annual review of pharmacotherapy is recommended for people with an intellectual disability (ID), a specific tool for this population is not yet available. Besides, active involvement can be compromised by ID. Therefore, the objective of this observational pilot study was to evaluate the process of medication review using STRIP in adults with an ID living in a centralized or dependent setting and the identification of drug-related problems using this tool. The study was performed in three residential care organizations for ID. In each organization nine clients with polypharmacy were selected by an investigator (a physician in training to become a specialized physician for individuals with an ID) for a review using STRIP. Clients as well as their legal representatives (usually a family member) and professional caregivers were invited to participate. Reviews were performed by an investigator together with a pharmacist. First, to evaluate the process time-investments of the investigator and the pharmacist were described. Besides, the proportion of reviews in which a client and/or his legal representative participated was calculated as well as the proportion of professional caregivers that participated. Second, to evaluate the identification of drug-related problems using STRIP, the proportion of clients with at least one drug-related problem was calculated. Mean time investment was 130minutes for the investigator and 90minutes for the pharmacist. The client and/or a legal representatives were present during 25 of 27 reviews (93%). All 27 professional caregivers (100%) were involved. For every client included at least one drug-related problem was identified. In total 127 drug-related problems were detected, mainly potentially inappropriate or unnecessary drugs. After six months, 15.7% of the interventions were actually implemented.Medication review using STRIP seems feasible in adults with an ID and identifies drug-related problems. However, in this pilot study the implementation rate of suggested interventions was low. To improve the implementation rate, the treating physician should be involved in the review process. Besides, specific adaptations to STRIP to address drug-related problems specific for this population are required.

Two-Year Assessment of Mental and Physical Health of OVCs in a Residential Care Organisation: Duke SRTP India Report

Orphaned and separated children (OSC) tend to have worse mental health outcomes compared to non-OSC peers. The purpose of this longitudinal study is to help better understand mental health outcomes within a population of OSC children of a residential care programme in New Delhi, India. Children were randomly selected across 11 group homes in 2014 (N = 89) and 2015 (N = 82) and interviewed for measures of self-concept, peer and guardian attachment, self-concept, depression, ego-resiliency and trauma symptoms. To understand the impact of a residential care programme on OSC children after coming of age, aftercare/alumni members (N = 32) were also interviewed in 2015. Descriptive mental health patterns are discussed as well as recommended for service application and further study.

Two-year assessment of mental and physical health of OVCs in a residential care organisation: duke srtp India report

Two-year assessment of mental and physical health of OVCs in a residential care organisation: duke srtp India report

Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning

To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning.A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential.It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered.

‘The Taste Buddies’: participation and empowerment in a residential home for older people

ABSTRACTThe active participation and autonomy of older people living in residential homes is considered to be problematic. However, in our action research project conducted in a Dutch residential care organisation we found ways to enhance residents' direct participation. This form of participation is grounded in deliberative and participatory approaches to democracy. In this article we describe how a group of seven residents (all female), calling themselves ‘The Taste Buddies’, developed a joint vision on how meals could be improved. The facilitation of this process enhanced this group's empowerment, building interpersonal trust, social identity and joint purpose. We will take the reader through this process and discuss the developments of these older women against the background of relational empowerment. We argue that resident participation as partnership with employees and managers starts with relational empowerment among residents themselves (enclave deliberation). This process is non-linear and requires time and constructive facilitation.