Older People In Residential Homes Research Articles

1985 Understanding the Perceptions of Caregivers of Older People in Residential Homes in Cairo

Abstract Introduction Institutional care for older people is a relatively new social phenomenon in Egypt that is associated with societal stigma. Traditionally dependent older people are looked after by family members at home. There are currently 145 care homes in Egypt, mostly based in Cairo serving 2% of the older population. The aim of this study was to understand the perspectives of paid caregivers on the strengths, weaknesses, opportunities, and threats (SWOT) associated with their professional roles. This knowledge is crucial to deliver a culturally sensitive training program for caregivers, and enhance their job satisfaction, ultimately leading to person-centred high-quality care. Method Two focus group meetings, 90 minutes each, were conducted with 39 caregivers in a private care home in Cairo. Each group was further divided into four working sub-groups using a SWOT approach to guide the discussion. Generic themes were identified, analysed, and agreed on by the group participants. Results Thirty-nine caregivers (31 % males), age range 18-50 years, were interviewed including undergraduate and qualified nurses and social workers. Five themes were identified: administration, team values, training, place and equipment, and residents and families. SWOT findings related to each theme are summarised below: Theme Strength Weakness Opportunities Threats Administration Support and flexibility Poor incentives Access to healthcare services Lack of rest facilities Team values Peer support Mixed qualities in different leaders Outdoor recreational activities Lone working Training Mentoring programme Unfulfilled training needs Regular updates on CGA No medical cover Place & Equipment Resident accommodation Not always fit for purpose Health and safety compliance Cost of accommodation Residents and families Sharing knowledge Discriminatory attitudes toward staff Documentation of resident’s priorities Unfounded complaints Conclusion Reflecting on the views of paid caregivers provided valuable insight that could enhance the quality of institutional care for older people in Cairo.

Dirt, decency and the symbolic boundaries of caregiving in residential homes for older people

This article draws upon an ethnography of two differently-priced UK residential care homes for older people. Informed by recent scholarship on the materialities of care, together with separate theoretical contributions by Mary Douglas and Émile Durkheim, I examine the spatial and material organisation of care work. I sketch out care workers’ attitudes and practices concerning hygiene and bodily waste, and how these are established and reaffirmed through the marking out of boundaries between materials, spaces and persons. Central to understanding care workers’ erecting of, or inattention to, these boundaries is an awareness of the material, temporal and cultural conditions of work. Variances in the availability of resources, the formal organisation of work and the layout of residential homes affect the care provided to residents. In examining these variances, I identify how care workers’ use of space functions to maintain or undercut not only hygiene and infection control standards but, also, more interpersonal virtues, such as dignity and respect for older people receiving care. I conclude by highlighting how the (mis)treatment of older people is a story of both a deeply inequitable market for care provision and a broader context of oppression, devaluation and dehumanisation.

The costs of care: An ethnography of care work in residential homes for older people.

The cost of social care, the work conditions experienced by care workers and the quality of care provided by residential homes for older people are all linked, yet we know very little about how this relationship works in practice. Drawing upon an ethnography of two differently priced residential care homes for older people in Southern England, I examine the implications of different financial regimes for care-giving practices. I show how the scheduling and allocation of resources-conveyed, for example, in formal routines and staffing levels-structure the care workers' time, tasks and activities in each setting. This acts to symbolically demarcate what, or who, is valued. I argue that the availability of resources facilitates and impedes the symbolic culture of care work, shapes care workers' ability to afford dignity to the individuals in their care and affects how care workers experience, and relate to, their labour. I conclude by discussing how current practices of funding and pricing social care have effects seeping beyond the practical and measurable, and into the realm of the symbolic.

The problems of social care in English nursing and residential homes for older people and the role of state regulation

ABSTRACT The problems facing English care homes for older people have largely been defined in terms of funding. This paper starts from the position that it is vitally important also to address the big issue of the social care system, especially the changing nature of private provision since the introduction of a quasi-market almost three decades ago, such that large corporations have become increasingly dominant. The paper focuses on the implications of a fragmented, for-profit system of provision for financial sustainability and care quality, particularly in terms of workforce issues. It argues that heavy reliance on regulation via the market and operating through competition and choice is misplaced and that state regulation can play a crucial part in securing improvement in these fields. It concludes that the Government’s recent (2021) proposals, which are mainly confined to funding and designed to prop up the current system, are unlikely to provide the ‘long-term fix’ that social care needs.

Relationships and material culture in a residential home for older people

AbstractResidents of older people's homes furnish their rooms with belongings that are associated with meaningful relationships. Previous research shows how material culture symbolises residents’ past and existing relationships, helping residents to remain embedded within familial and social networks. Less attention has been paid to how relationships are actively (re)constituted through socio-material interactions, and to the potential for objects to facilitate new relationships. This article presents findings from an ethnographic study into the everyday experiences of residents of an older people's home in northern England. Using observations of daily life and in-depth interviews with residents, it demonstrates how residents used material culture in gift-giving, divestment practices and in mundane social interactions. In this way, residents used objects to not only maintain relationships with family members outside the home, but form new relationships inside the home with other residents and members of staff. Combining theories of materiality, relationality and social practice, I argue that residents’ interactions with material culture helped to facilitate new social interaction and meaningful relationships. This is important in a social context where loneliness has been identified as a significant threat to residents’ mental and physical health. Residential homes for older people can develop guidance on practical activities and strategies that can use material culture to increase social interaction and enhance quality of life for residents.

Structure and agency attributes of residents' use of dining space during mealtimes in care homes for older people.

Research stresses that mealtimes in care homes for older people are vital social events in residents' lives. Mealtimes have great importance for residents as they provide a sense of normality, reinforce individuals' identities and orientate their routines. This ethnographic study aimed to understand residents' use of dining spaces during mealtimes, specifically examining residents' table assignment processes. Data were collected in summer 2015 in three care homes located in England. The research settings looked after residents aged 65+, each having a distinct profile: a nursing home, a residential home for older people and a residential home for those with advanced dementia. Analyses revealed a two-stage table assignment process: 1. Allocation - where staff exert control by determining residents' seating. Allocation is inherently part of the care provided by the homes and reflects the structural element of living in an institution. This study identified three strategies for allocation adopted by the staff: (a) personal compatibilities; (b) according to gender and (c) 'continual allocation'. 2. Appropriation - it consists of residents routinely and willingly occupying the same space in the dining room. Appropriation helps residents to create and maintain their daily routines and it is an expression of their agency. The findings demonstrate the mechanisms of residents' table assignment and its importance for their routines, contributing towards a potentially more self-fulfilling life. These findings have implications for policy and care practices in residential and nursing homes.

Inequality in access to hearing care for older adults in residential homes.

The population of older people in residential homes is projected to rise. There are unrecognized hearing difficulties among residents and prevalence of hearing loss in this population is underreported. This can result in an overestimation of levels of cognitive impairment. Untreated hearing loss is associated with social isolation, depression, disruptive behaviour and cognitive decline. This study aimed to explore the provision of hearing care (hearing assessment, rehabilitation and staff training) in Scottish care homes for older people. A survey comprising 18 questions was distributed to the managers (or designated staff members) of 659 care homes across Scotland. Responses were obtained from 154 care homes. The results support existing evidence that hearing is not assessed in the majority of homes, resulting in under detection of hearing loss. Staff lack training in supporting residents' hearing needs. Access to hearing care in residential homes differs across health board areas. There is an urgent requirement for hearing assessment of older adults on admission to residential care. Care providers require this information to construct effective care plans and mitigate the effects of hearing loss. Those responsible for providing hearing rehabilitation services require information about service users to address any unmet need.

Managing complaints in multilingual care encounters

AbstractTroubles-telling and complaints are common in contexts of care for older people and need to be managed by care staff in a respectful manner. This paper examines the handling of an older person’s complaints in multilingual care encounters that involve participants who do not share a common language. The data consist of video-recordings and ethnographic fieldwork in a residential home for older people in Sweden that is characterised by a variety of languages and backgrounds. The findings are based on analyses of multi-party interactions involving an Arabic-speaking resident and caregivers with different levels of knowledge in different languages. We focus on complaint sequences when the resident expresses a negative stance (displeasure, anger, etc.) towards some difficult circumstance. Using the methodology of conversation analysis, we analyse the affect-regulating work through which the caregivers attempt to turn a pressing situation into a moment of cheerfulness and intimacy. The analyses bring to light the multilingual practices that the caregivers draw upon in pursuing this work, such as translating and giving voice to the resident’s complaining.

Family Health Conversations have Positive Outcomes on Families - A Mixed Method Research Study.

Background:Having a family member living in a residential home affects the entire family and can be hard to handle. Family members require encouraging and open communication support from nurses during and after relocation to a residential home. A Family Systems Nursing intervention, “Family Health Conversations” (FamHC) was conducted in order to strengthen the health of families having relatives at residential home for older people.Objectives:The aims of this study were to evaluate the responses to the Family Health Conversations in families with a member living at a residential home for older people and to integrate the empirical results with a theoretical assumption upon which the intervention was based.Methods:A mixed methods research design was used. The Swedish Health-Related Quality of Life Survey and the Family Hardiness Index were administered before and 6 months after the intervention. Qualitative data was collected by semi-structured interviews with each family 6 months post-intervention. The sample included 10 families comprising 22 family members.Result:Main finding was that FamHCs helped family members process their feelings about having a member living at a residential home and made it easier for them to deal with their own situations. FamHCs helped to ease their consciences, improve their emotional well-being, and change their beliefs about their own insufficiency and guilt. Seeing problems from a different perspective facilitated the families’ thinking in a new way.Conclusion:These findings showed that FamHC could be an important type of intervention to improve family functioning and enhance the emotional well-being.

Experiences With Family Health Conversations at Residential Homes for Older People.

The aim of this study was to highlight family members' experiences of participating in Family Health Conversation (FamHC), based on families in which a family member was living in a residential home for older people. A total of 10 families and 22 family members participated in evaluating family interviews 1 month after participating in FamHC. The interviews were analyzed by qualitative content analysis. The main finding was being a part of FamHC increased family members' insights, understanding, and communication within the family. Getting confirmation from nurses was essential to cope with the new life situation, which also meant that they felt comfortable to partly hand over the responsibility for the older person who moved to the residential home. By being open and expressing their feelings, a bad conscience could be relieved. These findings showed that FamHC could be helpful for family members in adapting to this novel situation.

Question Marc.

I work in a residential home for older people. Can I verify or certify that someone has died during the night instead of calling out a general practitioner?

Becoming visible – Experiences from families participating in Family Health Conversations at residential homes for older people

Having a sick family member living at a residential home for older people can be difficult for families, who as a result often suffer from feelings of forsakenness and powerlessness. In response, the purpose of this study was to illuminate family members' experiences with participating in Family Health Conversations at residential homes for older persons 6 months after concluding the conversation series. Twenty-two family members who participated in the conversations later took part in group interviews, the texts of which were analyzed according to qualitative content analysis. Findings showed that participating in Family Health Conversations mediated consolation, since within such a liberating communicative interaction, family members for the first time felt visible as persons with individual significance. Family members reported a positive experience involving both being open to each other and speaking and listening to each other in a new, structured way. As a result, families were able to discover their family members' problems and suffering, as well as to identify their family's resources and strengths.

Interprofessional Approaches to Non-Complex Wound Care in a Welsh Residential Home for Older People

Care services in Wales are facing the dual challenges of increasing demand and decreasing resources so in 2014, the Welsh Government set aside a national Intermediate Care Fund. Llys y Bryn residential home for older people in south west Wales was identified as a pilot site to develop interprofessional management of non-complex wound care between care home staff providing direct care to the elderly residents and district nurses in the community. There were two distinct elements to the rapid evaluation, essentially focussing on non-financial and financial benefits of the project. These were collected via a semi-structured interview and cost saving analysis respectively. The project was well received by all stakeholders and it sought to improve the quality of life for the residents in the home. The financial elements proved challenging to estimate with certainty but even by conservative estimates, there may be a financial return on investment after six months at the care home. More research is needed so as to build up an evidence-base to support possible expansion of the project and to underpin national policy on service integration between health and social care.

Anxiety and depression in care homes in Malta and Australia: part 2

This cross-sectional comparative study, conducted in two phases, assessed the levels of and factors contributing to anxiety and depression in older people in residential homes in Malta and Australia. Part 1 presented the methodology of this cross-sectional study and presented the quantitative findings; this constituted phase 1. Part 2 presents the qualitative findings on the contributing factors to anxiety and depression and discusses the overall findings. Maltese residents were recruited from four church homes in Malta and Australia and two state residences in Malta; there was a high response rate in phase 2 of 89.4% (n=42, mean age 71.9 years). The residents were all mobile Roman Catholics who had lived in the homes for a minimum of 6 months. Data was collected using audiotaped focus groups. The qualitative data generated three contributing factors: physical functional abilities, adaptation to institutionalisation, and personal outlook towards the future. Mobility was found to foster an active life, which appeared to help residents to control their anxiety and depression. Rehabilitation programmes and facilitation of strategies were recommended to strengthen relationships with family members, room mates, health professionals and pets to help residents live meaningfully. Further cross-cultural longitudinal research would identify the role of other influencing variables such as culture, spirituality and caring relationships.

Anxiety and depression in care homes in Malta and Australia: part 1

This cross-sectional comparative study, conducted in two phases, assessed the levels of and factors contributing towards anxiety and depression in older people in residential homes in Malta and Australia. A mixed-method approach was adopted and the cognitive theory of stress and coping (Lazarus and Folkman, 1984) guided the study. Maltese residents were recruited from four church-run homes in Malta and Australia and two state residences in Malta. Response rates were high, with phase 1 at 94.48% (n = 137; mean age = 72.8 years) and phase 2 at 89.4%, (n = 42, mean age = 71.9 years). All the residents were mobile, were Roman Catholics and had lived in the homes for at least 6 months. In phase 1, quantitative data was collected using a demographic questionnaire and the hospital anxiety and depression scale. Normal ranges of anxiety and depression were found (anxiety: mean = 3.53-4.35; depression: mean = 2.67-4.72). No significant differences were found in anxiety and depression between countries, demographic characteristics and some other variables. The only significant difference lay in depression by mobility (F = 5.263; P = 0.006; df = 2), with wheelchair users scoring the highest mean (mean = 6.77; SD = 5.847; P = 0.007). Mobility was linked to functional abilities, which appeared to control anxiety and depression. Recommendations are made for rehabilitation and cross-cultural longitudinal research to investigate other influencing variables such as spirituality and caring relationships.

Using Participatory Approaches with Older People in a Residential Home in Guyana: Challenges and Tensions

Participatory approaches are a popular and entrenched strategy in community development, yet a number of unresolved issues and tensions persist regarding the definition, rationales, outcomes and ethics of participation. Despite its popularity there are relatively few examples of participatory projects with older people or in institutional settings so their potential with this group is poorly understood. This case study presents some of the practical and ethical challenges that arose over the course of a participatory project that aimed to analyse and improve quality of life in a residential home for older people in Guyana. Through a qualitative process evaluation it examines the degree of participation achieved, the determinants of the participatory process, the benefits the approach brought and the ethical dilemmas encountered. Although the degree of participation achieved was limited, beneficial outcomes were observed, notably the selection of appropriate and desirable interventions and the effect on the residents themselves, who valued their part in the project. The participatory process was unpredictable and complex, however, and key determinants of it included the organizational dynamics of the home and the skills, actions and attitudes of the researcher. Adopting a participatory approach brought valuable benefits in a residential home, but others adopting the approach should ensure they critically consider at the outset the ethical and practical dilemmas the setting and approach may produce and have realistic expectations of participation.

The restaurant within the home: experiences of a restaurant‐style dining provision in residential homes for older people

PurposeThis study aims to explore the experiences of residents and staff with new restaurant‐style meal provision in four residential care homes in Norfolk, England.Design/methodology/approachMeal and drink provision were observed over a full day in each home and unstructured individual interviews with 16 residents and 32 staff recorded and transcribed. Content analysis was used to discover and explore main themes.FindingsAlthough older care home residents enjoyed the restaurant experience, they valued stable table companions more highly than flexibility. Residents appreciated attractive surroundings, good food and their ability to make choices, but in some circumstances and for frailer residents, choice was more limited with care staff making some decisions. While the central restaurant was valued for the main meal some residents indicated they preferred smaller “family‐type” dining for other meals. Care staff sometimes found the negotiation of their waitressing and caring roles difficult. Available space and the dining‐room's location also contributed to the comparative success of the restaurant‐style provision.Research limitations/implicationsResidents valued the restaurant experience with attractive food, surroundings and the ethos of being served at lunch time, but other residents or the same residents at other meals, valued cosier stable family‐type dining more highly. Staff were also torn between service roles implied by restaurant settings and supporting residents to remain independent in the domestic model.Practical implicationsWhen planning new eating facilities thought needs to be given to ensuring both restaurant and family‐type food provision are available, and staff roles in these settings discussed and negotiated.Originality/valueThe research provides insights into the experiences of residents and staff of new dining facilities.

“Everyone is Romeo and Juliet!” Staging dementia in Wellkåmm to Verona by Suzanne Osten

This paper examines the intertextual dialog between Shakespeare's play Romeo and Juliet (1595) and the Swedish film Wellkåmm to Verona (2006) by Suzanne Osten. In the film adaptation, Verona no longer refers to an ancient town in Northern Italy that tries to control its passionate youth. Instead, it is the name of a residential home for older people where the dementia-afflicted Walter, former director of the Swedish Royal Theatre, stages Romeo and Juliet with his co-residents. The article explores the question what the film can do to its viewers in terms of overcoming the stigma attached to dementia. It focuses on the formal strategies that the film adaptation makes use of to imagine people with dementia other than lost selves during the staging of the canonical love story, ultimately entwining Eros and Thanatos.

Oral health status of older people in residential homes in Saudi Arabia

The aim of the study was to de-termine the oral health status and treatment needs of elderly residents of residential homes in Riyadh, Saudi Arabia. Methods: Among 129 elderly residents, 83 (51 males, and 32 females) of them were interviewed and clini-cally examined according to WHO criteria by two calibrated dentists. Results: The mean age of the subjects was 72 ± 8.5. Male subjects had a higher smoking rate than females. Among elderly subjects below 74 years old, 20.8% had a functional dentition (> or = 20), while only 6.7% for those aged greater or equal to 75 years (p = 0.0004). Mean number of the sound teeth in all subjects was 6.7 ± 8.5. The mean number of DMFT was 18.6 ± 12.6. The missing component was the highest (16 ± 13) for both genders. The mean number of decayed roots was 2.75 ± 3.95 in males and 0.63 ± 1.96 in females. Overall, males had more sound and decayed teeth and less filled and missed teeth than females. There was no significant difference between males and females in periodontal problems except the calculus scores. The majority of subjects in need for tooth extraction were male subjects. With no gender difference 63% were in need for restorations, 40% needed upper and lower full dentures. Need for partial dentures was 38% upper and 48% lower. Conclusion: The oral health of the institutionalized elderly population in Saudi Arabia is generally poor and their treatment needs are high.

People, pets and care homes: a story of ambivalence

Purpose – The purpose of this paper is to examine the history of pet ownership and its relationship to wellbeing in later life. In particular, the paper addresses the issue of pet ownership in communal residential settings for older people both now and in the past, comparing attitudes, policies, and practices in regard to pets in the late 1950s with the early years of the twenty‐first century.Design/methodology/approach – Following a review of the research literature on older people and companion animals, the paper draws on new data derived from recent research conducted by the authors. It compares archived material on the residential homes for older people that Peter Townsend visited in the late 1950s as part of his classic study, The Last Refuge (1962), with findings from revisiting a sample of these homes 50 years later. The authors employed the same methods as Townsend (observation together with interviews with managers and residents).Findings – The historical dimension of the research reveals ambival...