Residential Care Research Articles

Few studies have empirically tested if trait and behavioral impulsivity hinder treatment engagement (TE), which is unfortunate since TE is crucial for treatment success. Therefore, this study collected data from 16- to 17-year-old males (n = 322) and females (n = 110) residing in Flemish youth detention centers or residential (secured) care institutions. Dimensions of TE (i.e., readiness to change, bond with staff, collaboration on goals and tasks, and therapeutic engagement) and trait impulsivity (i.e., positive and negative urgency, sensation seeking, lack of premeditation, and lack of perseverance) were measured through self-report questionnaires, while behavioral impulsivity (i.e., response inhibition, choice impulsivity, and risk-taking) was assessed via computerized tasks. A series of multiple linear regressions was performed, including all facets of trait impulsivity and all indices of behavioral impulsivity as independent variables, and TE dimensions as dependent variables. Self-reported callous-unemotional traits showed a significant negative zero-order correlation with TE and were therefore included as a control variable. Findings showed that various facets of trait impulsivity and indices of behavioral impulsivity were significantly associated with different dimensions of TE in both males and females. Moreover, sex differences were observed in the associations between trait and behavioral impulsivity and TE. The results underscore the need to examine both trait and behavioral impulsivity in future research to clarify how they relate to TE and other treatment outcomes across sex and to inform targeted interventions, thereby potentially enhancing TE and improving treatment success.

BackgroundOpioid use is associated with increased health care service utilization but home care recipients and patients with dementia have been mostly ignored in earlier studies, although changes in their health status can have dramatic cost consequences. This study examined social and health care utilization and costs among older home care recipients before and after opioid initiation, with persons with dementia as a subgroup of interest.MethodsThis retrospective nationwide register-linkage study included Finnish regular home care recipients aged ≥ 65 years with opioid initiation between 1st March 2015 and 31st December 2016. Recipients with health care contacts due to cancer and palliative care were excluded.Incidence rate ratios of social and health care service use during the observation period starting one year before and ending one year after opioid initiation were calculated using nationwide register data. The utilization costs of various social and health care service categories were compared before and after the opioid initiation. Recipients with and without dementia were analysed separately.ResultsHome care recipients had 1.76 (95% CI 1.75 − 1.78) times more inpatient days, 1.31 (1.26 − 1.36) times more emergency care admissions, and recipients without dementia had more outpatient service use (secondary care 1.10 [1.06 − 1.13], primary care 1.06 [1.04 − 1.07]) after opioid initiation compared to the preceding year. Home care service use decreased (0.85 [0.85 − 0.85]) in recipients with dementia but increased in those without (1.08 [1.08 − 1.08]). Of the recipients, 20.8% were admitted to long-term residential care during the follow-up year. The mean annual total costs per recipient were 21% higher during the year following opioid initiation compared to the preceding year. A peak in the costs, consisting largely of inpatient costs, was observed about a month before opioid initiation, after which costs showed a declining trend but remained above the baseline level.ConclusionsRecipients’ monthly health care resource use started to increase already before opioid initiation, after which monthly expenditures declined steadily, which may reflect mostly recipients’ worsened health status before opioid initiation. Most of the expenditures arose from housing services. The relationship between opioid use and utilization of residential care and home care services should be further examined.Trial registrationNot applicable (a retrospective register-based study).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06550-z.

ABSTRACT Objectives This study addressed the high prevalence of mental health issues among older adults in residential aged care facilities and the undertreatment of these concerns. Focusing on the innovative use of telehealth, the research aimed to investigate the feasibility, acceptability, and potential efficacy of a telehealth counselling service for older adults in aged care. Methods Data collected between May 2020 and May 2023 from an Australian telehealth counselling service for residential aged care formed the basis of this study. Participants were predominantly female (69%), with 35% of referrals from rural areas. Using a single-arm, pre-post service evaluation design, the investigation assessed outcomes related to depressive symptoms, anxiety, and loneliness in Australian aged care residents before and after telehealth counselling. Results Three-hundred and ninety-four aged care residents participated in 3,445 counselling sessions, averaging 8.8 sessions each lasting approximately 54 min. Supportive counselling emerged as the most frequently used therapeutic intervention. The study reports high satisfaction levels among both residents and referrers, a low attrition rate, and a high uptake rate. Statistically significant reductions in depressive and anxiety symptoms, as well as loneliness, were observed post-telehealth counselling. Conclusion Telehealth counselling within residential aged care is feasible and acceptable by aged care residents and referrers and shows promising preliminary efficacy in reducing depressive and anxiety symptoms and loneliness. The positive outcomes underscore the need for a larger randomised control trial to further validate the potential of telehealth counselling in this setting.

An evaluation of therapeutic Life Story Work in residential out of home care

Racial disparities in child welfare: A propensity score matched analysis of Black and White children in Canada.

Impact of maltreatment, shame and self-criticism on psychological difficulties: A variable- and a person-centred approach with adolescents from community and residential youth care.

Implementing research findings into nursing homes: A mixed-methods study.

Territorial inequality in access to residential care for the aged in Spain

Background: Older adults are a vulnerable population wherein their advancing age leads to limitations in physical and mental functionality that can compromise quality of life. Objective: The objective of this study was to analyze the relationship between mental health factors and quality of life in older adult users of long-term care services in Mexico. Methods: The present cross-sectional study was conducted with a convenience sample of 131 older adult users of long-term care services (three residential care homes and a day center) in Morelia, Michoacán, Mexico. A questionnaire including the World Health Organization Quality of Life Older Adults Scale (WHO-QoL-Old), Geriatric Depression Scale (GDS), Hamilton Anxiety Rating Scale (HARS), Cognitive Reserve Questionnaire (CRQ), and sociodemographic variables was administered. The analysis of the relationship between variables was performed using bivariate analysis (comparisons between groups and Pearson correlations). Due to the type of sampling, the representativeness of the sample obtained was not evaluated. Results: Depression and anxiety were found to inversely influence overall quality of life and its dimensions, while cognitive reserve is a factor that favors quality of life. Also, as related to cognitive reserve, level of education was found to be a factor that favors quality of life. Conclusions: Older adult users of long-term care services are a vulnerable group, given the negative impact on their quality of life that some mental health conditions could have, such as depression, anxiety, and low cognitive reserve.

ABSTRACT Objectives This study examined the impact of befriending on depression, anxiety, perceived social support and loneliness in older people living in residential aged care homes. Methods A pragmatic randomized controlled trial compared depressive symptoms (Geriatric Depression Scale-15), anxiety symptoms (Geriatric Anxiety Inventory), loneliness (UCLA loneliness scale), and perceived social support (Lubben Social Network Scale) measured at baseline, 8 weeks and 16 weeks post baseline for people randomized to receive either befriending or usual care. Trial registration ANZCTR N12619000676112. Results Among N = 345 participants, a significant reduction in depressive symptoms for people receiving befriending compared to the control group: 0.76 points lower on GDS at 8 weeks and 0.95 lower at 16 weeks (Cohen’s d = -0.458). Loneliness (UCLA) was 2.39 units lower than the control group at 8 weeks and 2.71 units lower at 16 weeks (Cohen’s d −0.481). There was no significant difference for anxiety symptoms or perceived social support. Conclusions Befriending led to a small improvement in depressive symptoms and loneliness in older people living in residential aged care. Clinical Implications The improvement in depressive symptoms and loneliness indicates that befriending may be a useful supplement to psychological services for those living in residential aged care

Factors associated with CPR quality in out-of-hospital cardiac arrest.

ABSTRACT Children worldwide have the legitimate right to a birth certificate, which fulfils their right to identity. This article examines the challenges faced in obtaining identity documents for children in residential care facilities in Harare, Zimbabwe. Using a qualitative approach, data were gathered from seven residential care facilities through eleven semi-structured interviews with seven directors and four residential social workers. Thematic analysis revealed three main barriers to birth registration: uncooperative parents or relatives who hinder the registration process, the non-renewal of court orders by the Department of Social Development (DSD), and the absence of resident social workers in some facilities. This study highlights the implications for improving birth registration in residential care facilities in Zimbabwe. It emphasises the need for effective mechanisms to address uncooperative parents or relatives in birth registration processes. The study calls for the timely renewal of court orders by the DSD. It further recommends the formation of an external committee to monitor the birth registration process. Recognising the critical role of social workers, the study further urges the DSD to ensure that each children’s home has at least one qualified social worker to support the birth registration process.

Providing quality care for older people continues to be a significant challenge globally and in Australia. The Quality-of-Care Experience - Aged Care Consumers (QCE-ACC) has been adopted as a key quality indicator in the national aged care quality indicator program in Australia for public reporting of care quality variation across residential aged care facilities. This study aims to provide further evidence of the construct validity of QCE-ACC among older people living in residential aged care facilities. Older people (aged > 65years) receiving residential aged care services participated via face-to-face interview. Participants completed a range of validated instruments, including the QCE-ACC and five additional measures. Feasibility was assessed by examining missing data and floor/ ceiling effects. Construct validity was assessed through two approaches: convergent validity (correlations with other instruments) and known group validity (distinguishing self-rated health and quality of life levels). Internal consistency reliability was measured using Cronbach's alpha (α). Of the 200 respondents (mean age, 85 ± 7.7years), more than half (n = 113, 56.5%) were over the age of 85year and 60% (n = 120) were female. The QCE-ACC showed adequate feasibility and demonstrated moderate correlations with the QOL-ACC (ρ = 0.57) and ASCOT (ρ = 0.60). It was also able to differentiate between varying levels of self-reported health and quality of life. The QCE-ACC and its dimensions showed good internal consistency reliability (α = 0.77-0.81). The QCE-ACC demonstrated adequate feasibility, validity and internal consistency to monitor quality of care provided in residential aged care settings.

Improved dental services have increased the retention of natural teeth and prostheses, creating complex oral care needs among older adults. Care managers are key in overseeing residents' oral health; their perceptions can inform strategies to improve geriatric oral health in residential aged care facilities (RACFs). To explore care managers' perceptions of the oral healthcare experiences and needs of older adults in RACFs. A descriptive qualitative study, grounded in a constructivist paradigm, was conducted using the Socio-Ecological Model to guide data collection and analysis at individual, interpersonal, organisational, community and policy levels. Ten care managers were purposively sampled and interviewed online using a semi-structured guide. Data were analysed using reflexive thematic analysis following Braun and Clarke's framework. Participants (n = 10; age 28-59 years; mean age 41.7; 5 males, 5 females) were from urban and semi-urban areas of western India. Five themes were identified: (1) A Moral Duty to Care-Personal Beliefs and Emotional Drivers of Oral Health Practice; (2) Navigating Relational Complexities-Care Amidst Resistance, Trust and Support; (3) Systemic Gaps and Adaptive Practices in Resource-Limited Settings; (4) Disconnected Services and the Social Devaluation of Residents' Oral Health; and (5) Calls for Oral Health Care Delivery/Systemic Reforms-Embedding Oral Health in Aged Care Policy. Care managers perceived residents' oral health as often being deprioritized in RACFs due to competing general health demands. An interdisciplinary care team, including a dentist, stronger policy support, and targeted training for care managers and staff, was strongly recommended to improve older adults' oral health outcomes in residential settings.

Multicompartment compliance aids (MCAs) are widely used to assist patient medication adherence. However, there is limited evidence on the challenges associated with use. The aim of this review was to determine the barriers to the use of MCAs and propose how they can be overcome. A methodical search strategy was conducted across Medline, Emcare, CINAHL, and Scopus (inception to June 2024), with articles screened against inclusion and exclusion criteria. Data analysis was guided by a multilevel, socio-institutional lens of mega-, macro-, meso-, and micro-perspectives. Eleven studies were included in the review reporting on use in clinical and experimental settings, including in residential aged care, community pharmacy, independent at home use, and laboratory settings. At the mega-level, barriers have emerged including lack of guidelines and government funding, while at the macro-level miscommunication between prescribers and the pharmacy were identified. The lack of patient involvement in the decision to commence use and the perceived loss of autonomy, which increases a lack of adherence has been confirmed at the meso-level. The actual device which is neither designed to adequately protect the medicines from the environment nor fully consider the physical and cognitive impediments associated with advancing age and technological complexity has emerged as a barrier at the micro-level. This review has identified that there are barriers to the use of MCAs. Current recommendations call for revision of multicompartment compliance aids service guidelines and remuneration to enhance their use through optimising multi-disciplinary communication, alongside device remodelling to improve medication stability and user uptake.

BackgroundDementia caregiver intervention research often lacks focus on mechanisms of benefit. This study addresses this gap through a process evaluation of the Residential Care Transition Module (RCTM), a telehealth intervention designed to assist family caregivers of persons with dementia post-institutionalization, consisting of six sessions with flexible ad hoc support over a 12-month period. This process evaluation describes the RCTM’s content and delivery, examines treatment fidelity, identifies implementation factors that influenced the primary outcomes (caregiver subjective stress and depressive symptoms), and clarifies mechanisms of intervention benefit.MethodsThe RCTM enrolled 240 primary caregivers randomly assigned to the intervention or attention control group (n = 120 each). Process/implementation data were collected through study logs documenting session duration, modality, and content, and treatment review checklists completed at four, eight, and 12 months, capturing caregiver ratings of intervention content, utility, and acceptability. Additionally, 30 purposively selected caregivers completed semi-structured interviews probing their perceptions of the intervention. This process evaluation employed a parallel convergent mixed-methods design, integrating quantitative data from longitudinal surveys with qualitative thematic analysis of interviews.ResultsMost caregivers (107; 89%) completed all six intervention sessions; of these, the majority (80; 75%) completed the intervention in four months. Caregivers found the intervention beneficial across multiple domains, expressing strong support for its utility and acceptability. Interviews revealed nine intervention components that facilitated treatment enactment and highlighted mechanisms of benefit. Longitudinal models showed participation in ad hoc intervention sessions was associated with greater benefit over the 12-month period, with higher frequency and longer duration of ad hoc sessions significantly associated with larger reductions in depressive symptoms and care-related stress, respectively.ConclusionsThe RCTM was delivered with high fidelity, demonstrating strong caregiver participation and positive feedback. Qualitative and quantitative data highlight the RCTM’s value in providing emotional support and informational counseling to help caregivers build mastery for managing residential care-related issues. In particular, results demonstrated the potential importance of flexible ad hoc sessions in complementing the core intervention. These insights can inform future adaptation/implementation of the RCTM to support dementia caregivers within residential long-term care settings.Trial RegistrationClinicalTrials.gov: NCT02915939; 09-26-2016Supplementary informationThe online version contains supplementary material available at 10.1186/s12913-025-13547-2.

Regulatory expansion in children’s residential care has emerged as a response to identified malpractices and aims to strengthen children’s rights. This article investigates how care workers experience and respond to regulatory challenges in implementing legislation designed to address these issues in Finland. The findings highlight tensions between ‘law on the books’ and ‘law in action’, revealing a perceived disconnect between legislative ideals and everyday realities. Contributing to broader discussions on rights-based care, the article emphasises the relational, interpretive and context-sensitive nature of applying legal frameworks in practice.

Long-term care policies across the globe have moved to ‘ageing in place’ with support from community and family care. For some countries, this is a reorientation away from residential or institutional care; for others, it reframes existing practice as policy. Taking a multi-scalar approach, this article questions: what global governance care outcomes are countries signed up to; what care is being envisaged; and whether ground realities and institutional practices facilitate such care or are disabling and depleting. Understanding the interplay between polices, institutional practices and ground realities is central to effective long-term care policies and planning for an ageing population. At first glance, ageing in place and family and community care resonate with international and regional policies on the rights of older persons. Yet they cannot do so without review and mitigation of the ground realities and institutional practices. Without mitigation, ageing in place policies can be disabling and depleting for older persons and their family caregivers. Using South Africa as a test case for ageing in place policies in resource-poor contexts, we found that family care is taking place in ground realities that are out of step with the social imaginaries underpinning later life care policies and institutional arrangements. This lack of fit creates a social policy environment that is itself disabling and depleting; it constrains access to health services, erodes domestic budgets and depletes the well-being and health of older persons and their family caregivers.

ABSTRACT The quality of relationships between staff and children in residential childcare is crucial for fostering healthy psychological and emotional development in vulnerable populations. This study explores the links between staff burnout, emotional intelligence (EI) and the quality of interactions in childcare facilities providing residential care and full-time education in the UK. More specifically, the aim of the study was to assess the role of EI in mitigating burnout’s adverse effects on staff-child relationships. Using cross-sectional survey data from 78 participants (70.5% residential childcare workers; 29.5% residential teachers), the results indicated a significant negative association between burnout and relationship quality, with EI showing a positive correlation with better relationship outcomes. However, contrary to expectations, EI did not moderate the link between burnout and relationship quality, suggesting that even individuals with high EI are not fully protected from the impacts of burnout. Further analysis revealed that client-related burnout had a particularly detrimental effect on staff-child relationships, highlighting the need for targeted interventions.

Staff at residential youth care institutions often encounter conflictual and sometimes dangerous situations while enforcing rules and providing care for adolescents. Although research has explored staff victimization risk factors in this occupational setting, little attention has been paid to the interaction-level factors that may influence this risk. This paper addresses this gap by examining the face-to-face dynamics of staff-adolescent conflicts. We analyzed 135 incidents and retrospectively reported by 50 employees from seven facilities, ranging from open to secure units. Using a case-crossover study design, we first coded staff and adolescent actions in both staff victimization and non-victimization events. We then estimated how staff conflict management actions correlated with staff’s subsequent exposure to violence and threats in the situation. Contrary to our hypothesis, we found no significant influence of staff actions on their risk of victimization. However, further exploratory analysis indicated that when staff attempt to control an object in the adolescent’s possession this leads to escalation and staff victimization. Our null findings may suggest a need to adjust expectations regarding the effectiveness of conflict management strategies in some contexts, although it is important to note that the current results do not preclude the potential for larger-sampled studies to identify preventive benefits of management actions.