scholarly journals Navigating Conflicting Rights Among Residents, Visitors, and Families in Long-Term Care Facilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 20-20
Author(s):  
Angela Perone
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Direct Care ◽  
Front Line ◽  
Term Care ◽  
Street Level ◽  
Front Line Workers ◽  
Bureaucracy Theory ◽  
Street Level Bureaucracy

Abstract Background: An abundance of long-term care regulations creates a bevy of rights for nursing facility residents, staff, and families. Front-line workers and managers have significant discretion and responsibilities for interpreting these rights. Building on street-level-bureaucracy theory (Lipsky, 2010), which focuses on how front-line workers implement policy, this study examines how staff at various levels (direct care, mid-level professional, top management) resolve conflicting rights. Methods: This study employs a novel advanced multi-method qualitative design with semi-structured staff interviews (n=90), content analysis of long-term care facility policies (n=75), and participant observation of two facilities for a multi-layered comparative case study. Findings: Data analysis revealed variations in staff responses to conflicting rights regarding autonomy and safety (e.g. fall prevention, dementia, coronavirus) and discrimination (i.e. sexual/racial harassment). While harassment was rampant, direct care workers responded more deferentially to residents and often justified harassment as part of a customer service job in one’s home. Staff at all levels relied on teams to develop creative problem-solving approaches, but team composition and discretion varied significantly between facilities and staff levels. While staff included few social workers, staff heavily relied on them to adjudicate conflicting rights. Implications: Conflicting rights impact resident care and relationships among residents, staff, and families. This research provides policymakers and practitioners with new data about how staff resolve conflicting rights, which can facilitate stronger policies to support an overburdened and underpaid long-term care workforce. This research also expands street-level-bureaucracy theory to include managers and reveals how various team approaches can produce diverse solutions.

scholarly journals Navigating Religious and Moral Exemptions in Serving LGBTQ Residents in Long-Term Care Facilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 675-675
Author(s):  
Angela Perone
Keyword(s):  
Long Term Care ◽  
Direct Care ◽  
Term Care ◽  
Group Interest ◽  
Street Level ◽  
Care Workers ◽  
Lgbtq Rights ◽  
Court Mandated ◽  
Street Level Bureaucracy

Abstract Almost immediately after the U.S. Supreme Court mandated marriage equality, a surge in policies carved out exceptions to LGBTQ rights for religious or moral reasons. This study examines how long-term care workers, managers, and administrators respond when staff, visitors, or residents challenge LGBTQ rights based on these exemptions. Building on street-level bureaucracy theory, this study employs an advanced multi-method qualitative design with semi-structured staff interviews (n=85), content analysis of facility policies (n=110), and observation of two facilities. Data analysis revealed three key themes: visibility, bodily autonomy/respect, and safety. While nearly all workers expressed universal concern for LGBTQ rights, direct care workers and managers wavered when religious or moral exemptions arose in serving transgender residents. Workers invoked facility policies regarding gender and bodily care to justify differential treatment. This research provides new knowledge and guidance for workers, facilities, and policymakers and theoretical contributions to street-level bureaucracy. Part of a symposium sponsored by Rainbow Research Group Interest Group.

scholarly journals Adaptations for TAP in a Long-Term Care Setting

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 631-631
Author(s):  
Katherine Marx ◽  
Lauren Parker ◽  
Laura Gitlin
Keyword(s):  
Behavioral Interventions ◽  
Long Term Care ◽  
Clinical Symptoms ◽  
Functional Decline ◽  
Care Facility ◽  
Direct Care ◽  
Care Staff ◽  
Term Care ◽  
Long Term Care Facility

Abstract One of the most difficult aspects of caring for people living with dementia is managing neuropsychologic symptoms and functional decline. Although there are hundreds of efficacious non-pharmacologic interventions tested in homes, few are adapted for and tested in long-term care. The purpose of this pilot study was to identify the adaptations needed for the Tailored Activity Program (TAP) to make it feasible and acceptable in a long-term care facility. TAP provides tailored activities matched to interests and abilities to address dementia-related clinical symptoms. Two sites, under the umbrella of one company, participated. A total of five persons living with dementia, their family caregivers, two direct care staff and an interventionist participated, and occupational therapist who contracts with the site on a regular basis. Adaptations included shorter sessions and changes to forms to fit with workflows and documentation. Additional considerations challenging implementation of TAP included staff turn-over and training. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.

Maintaining a Long-Term Care Workforce: Ideas from Front Line Workers

2003 ◽  
Vol 25 (2) ◽  
pp. 27-30
Author(s):  
P. Branch ◽  
Amanda Shearer
Keyword(s):  
Rural Areas ◽  
Long Term Care ◽  
Front Line ◽  
Care Needs ◽  
High Turnover ◽  
Community Based ◽  
Term Care ◽  
Care Services ◽  
Front Line Workers

Throughout Alaska older people say that they would rather remain in their own homes and communities for the duration of their lives. A growing array of home and community based long-term care services are available to assist elders and their families as care needs increase. These include services such as personal care, respite care, delivered meals, and chore services. However, high turnover and the inability to recruit staff limit the availability of these services in many of our rural areas.

scholarly journals ‘Bare-bones’ to ‘silver linings’: lessons on integrating a palliative approach to care in long-term care in Western Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Denise Cloutier ◽  
Kelli I. Stajduhar ◽  
Della Roberts ◽  
Carren Dujela ◽  
Kaitlyn Roland
Keyword(s):  
Quality Of Life ◽  
Long Term Care ◽  
Western Canada ◽  
Front Line ◽  
Term Care ◽  
Team Members ◽  
Care Workers ◽  
Front Line Workers

Abstract Background ‘Whole-person’ palliative approaches to care (PAC) are important for enhancing the quality of life of residents with life-limiting conditions in long-term care (LTC). This research is part of a larger, four province study, the ‘SALTY (Seniors Adding Life to Years)’ project to address quality of care in later life. A Quality Improvement (QI) project to integrate a PAC (PAC-QI) in LTC was implemented in Western Canada in four diverse facilities that varied in terms of ownership, leadership models, bed size and geography. Two palliative ‘link nurses’ were hired for 1 day a week at each site over a two-year time frame to facilitate a PAC and support education and training. This paper evaluates the challenges with embedding the PAC-QI into LTC, from the perspectives of the direct care, or front-line team members. Sixteen focus groups were undertaken with 80 front-line workers who were predominantly RNs/LPNs (n = 25), or Health Care Aides (HCAs; n = 32). A total of 23 other individuals from the ranks of dieticians, social workers, recreation and rehabilitation therapists and activity coordinators also participated. Each focus group was taped and transcribed and thematically analyzed by research team members to develop and consolidate the findings related to challenges with embedding the PAC. Results Thematic analyses revealed that front-line workers are deeply committed to providing high quality PAC, but face challenges related to longstanding conditions in LTC notably, staff shortages, and perceived lack of time for providing compassionate care. The environment is also characterized by diverse views on what a PAC is, and when it should be applied. Our research suggests that integrated, holistic and sustainable PAC depends upon access to adequate resources for education, training for front-line care workers, and supportive leadership. Conclusions The urgent need for integrated PAC models in LTC has been accentuated by the current COVID-19 pandemic. Consequently, it is more imperative than ever before to move forwards with such models in order to promote quality of care and quality of life for residents and families, and to support job satisfaction for essential care workers.

scholarly journals Risk factors for COVID-19 diagnosis, hospitalization, and subsequent all-cause mortality in Sweden: a nationwide study

2021 ◽  
Vol 36 (3) ◽  
pp. 287-298
Author(s):  
Jonathan Bergman ◽  
Marcel Ballin ◽  
Anna Nordström ◽  
Peter Nordström
Keyword(s):  
Risk Factors ◽  
Down Syndrome ◽  
Long Term Care ◽  
Care Facility ◽  
Prescription Medication ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
All Cause Mortality

AbstractWe conducted a nationwide, registry-based study to investigate the importance of 34 potential risk factors for coronavirus disease 2019 (COVID-19) diagnosis, hospitalization (with or without intensive care unit [ICU] admission), and subsequent all-cause mortality. The study population comprised all COVID-19 cases confirmed in Sweden by mid-September 2020 (68,575 non-hospitalized, 2494 ICU hospitalized, and 13,589 non-ICU hospitalized) and 434,081 randomly sampled general-population controls. Older age was the strongest risk factor for hospitalization, although the odds of ICU hospitalization decreased after 60–69 years and, after controlling for other risk factors, the odds of non-ICU hospitalization showed no trend after 40–49 years. Residence in a long-term care facility was associated with non-ICU hospitalization. Male sex and the presence of at least one investigated comorbidity or prescription medication were associated with both ICU and non-ICU hospitalization. Three comorbidities associated with both ICU and non-ICU hospitalization were asthma, hypertension, and Down syndrome. History of cancer was not associated with COVID-19 hospitalization, but cancer in the past year was associated with non-ICU hospitalization, after controlling for other risk factors. Cardiovascular disease was weakly associated with non-ICU hospitalization for COVID-19, but not with ICU hospitalization, after adjustment for other risk factors. Excess mortality was observed in both hospitalized and non-hospitalized COVID-19 cases. These results confirm that severe COVID-19 is related to age, sex, and comorbidity in general. The study provides new evidence that hypertension, asthma, Down syndrome, and residence in a long-term care facility are associated with severe COVID-19.

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