Institutional Issues

Voluntarily Stopping Eating and Drinking ◽

10.1093/med/9780190080730.003.0012 ◽

2021 ◽

pp. 229-240

Author(s):

David A. Gruenewald

Keyword(s):

Best Practice ◽

Long Term Care ◽

Shared Understanding ◽

Advanced Dementia ◽

Term Care ◽

Oral Nutrition ◽

Basic Care ◽

Institutional Issues ◽

Nutrition And Hydration

Increasingly, older adults wishing to avoid prolonged dying with dementia are completing advance directives to limit oral nutrition and hydration (ONH) in advanced dementia, but resistance to implementing these directives has arisen within the professional long-term care (LTC) community. Some “dementia directives” call for withholding or withdrawing assisted hand-feeding when specific thresholds are met during dementia’s progression. “Comfort feeding only” (CFO) has been suggested as a best practice in advanced dementia, but CFO may not be sufficient for those wishing to hasten death when advanced dementia develops. Of concern, some LTC facility residents desiring comfort-focused care may be harassed or coaxed to eat and drink by staff as part of “basic care.” It may be possible to identify areas of shared understanding between older people who fear living in advanced dementia and staff who find meaning in caring for demented people who appear to accept or even enjoy ONH.

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Issues Related to Late-Life Sexuality: Sex in Long-Term Care

Innovation in Aging ◽

10.1093/geroni/igaa057.2030 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 602-602

Author(s):

Rachael Spalding ◽

Peter Lichtenberg

Keyword(s):

Best Practice ◽

Long Term Care ◽

Social Stigma ◽

Late Life ◽

Assessment Tools ◽

Geographical Differences ◽

Term Care ◽

Practical Applications ◽

Ethical And Legal Issues

Abstract Despite surrounding social stigma and stereotypes of the “asexual older adult,” older adults, including those residing in long-term care facilities, indicate that expressing their sexuality continues to be important to them (Doll, 2013). This presentation will feature presentations regarding recent research and perspectives relevant to late-life sexuality with a focus on how issues of sexual expression may particularly emerge in long-term care settings. Dr. Maggie Syme will present findings from mixed-methods, consumer-based approaches that elucidate how current and future long-term care residents view late-life sexuality, with a focus on the practical applications of these findings to inform facility administration and policies. Ethical and legal issues surrounding sexuality in long-term care will be discussed by Dr. Pamela Teaster, who will present ethical models that can translate into potential best-practice recommendations and strategies. Rachael Spalding will discuss the paucity of psychometrically sound assessment tools for measuring attitudes towards late-life sexuality and discuss their development of such a measure. Finally, Dr. Lilanta Bradley and Dr. Pamela Payne-Foster will present a framework for sexual agency in late-life and identify relevant gaps in the literature regarding gender, ethnicity/race, and geographical differences. Ultimately, this presentation will offer a forum for lively discussion among attendees regarding these pertinent topics.

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Pharmacists’ perspectives on medication reviews for long-term care residents with advanced dementia: a qualitative study

International Journal of Clinical Pharmacy ◽

10.1007/s11096-019-00821-7 ◽

2019 ◽

Vol 41 (4) ◽

pp. 950-962 ◽

Cited By ~ 4

Author(s):

Domenica Disalvo ◽

Tim Luckett ◽

Alexandra Bennett ◽

Patricia Davidson ◽

Meera Agar

Keyword(s):

Qualitative Study ◽

Long Term Care ◽

Advanced Dementia ◽

Term Care ◽

Medication Reviews

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Calculating the True Costs of Food Service in Long-Term Care: Development of a Costing Methodology

Innovation in Aging ◽

10.1093/geroni/igaa057.291 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 88-88

Author(s):

Mikaela Wheeler ◽

Karen Abbey ◽

Sandra Capra

Keyword(s):

Long Term Care ◽

Systems Approach ◽

Food Service ◽

Term Care ◽

Oral Nutrition ◽

Total Cost ◽

Real Cost ◽

Future System ◽

Care Development

Abstract As population’s age and the need for long term care (LTC) increases, so too does the focus on the costs to provide that care. Providing food, oral nutrition supplements and meals, can be a considerable expense to a home. The objective of this research was to develop a valid foodservice costing tool (FCT), to calculate the real cost of providing foods and meals in LTC. Current costing methodologies are not specific to LTC and do not account for all costs of a foodservice, including staff, procurement and nutrition supplements. An initial tool was developed using the systems approach in conjunction with literature and professional knowledge. This was piloted in real world contexts, using volunteer LTC homes. Four iterations of the tool were completed to assess its feasibility in calculating costs and useability. Managers were interviewed after completing the tool to gather an understanding of how the tool was interpreted and to refine completion. Following feedback, the resulting tool consists of nine sections, measuring both costs incurred in meal production and service as well as analysis of staff workloads. Preliminary results show consistency between homes within Australia, indicating that the true cost is much higher than that reported in the literature to date. The development of a comprehensive, usable tool which captures the total cost of foodservice allows homes to accurately report and understand costs from a systems level. This information can be used to demonstrate cost effectiveness of a foodservice and the potential to justify and plan future system changes.

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Conflict Behaviours of Administrators in Long Term Care Facilities Influence Facility Ratings: SOS-Semantics of Self in Conflict™

Journal of Mediation & Applied Conflict Analysis ◽

10.33232/jmaca.5.1.9870 ◽

2018 ◽

Vol 5 (1) ◽

pp. 711-724

Keyword(s):

Best Practice ◽

Long Term Care ◽

Care Facility ◽

Harris County ◽

Nursing Facility ◽

Term Care ◽

Care Facilities ◽

Us Government ◽

Nursing Care Facility

Long term care (LTC) facilities, also called nursing homes, are often ripe for conflicts which cause stress for residents, their families and staff. This article presents the results of a survey showing how nursing facility administrators in Harris County, Texas, managed conflict within their facilities and how a more positive approach was consistently reflected in how their facilities were rated in US government quality consumer ratings. The concept at the centre of this study, SOS-Semantics of Self in Conflict™, recognises that the degradation of standards due to conflict is not just an event in a nursing care facility. It is a process that is heavily influenced, and in some cases exacerbated, by the way in which facility administrators react to conflict. These reactions have important broader implications for the facility’s best practice retrospectively.

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Falls

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0050 ◽

2017 ◽

pp. 373-382

Author(s):

Clemens Becker ◽

Jean Woo ◽

Chris Todd

Keyword(s):

Older People ◽

Best Practice ◽

Long Term Care ◽

Acute Hospital ◽

Screening Tools ◽

Term Care ◽

Risk Factors For Falls ◽

Use Of Health Services

Falls are very common among older people, with 30–40% of people aged 65 or over falling each year. Incidence increases with age, is particularly high in residential care settings, and has a considerable burden in terms of morbidity, mortality, use of health services, and reductions in quality of life. In the first section of this chapter we define falls, then review the epidemiology of falls in the community, and acute hospital, residential, and long-term care. We review and identify the major risk factors for falls and the assessment and screening tools used to detect risk and resources of best practice recommendations for clinical practice. In the second section, we provide overviews of best practice in prevention and clinical management, first for older people living independently in the community, then for acute hospital care, and thirdly for residential and long-term care.

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1236. Infection Control Risk Mitigation and Implementation of Best Practice Recommendations in Long-Term Care Facilities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1069 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S375-S376

Author(s):

Teresa Fitzgerald ◽

Regina Nailon ◽

Kate Tyner ◽

Sue Beach ◽

Margaret Drake ◽

...

Keyword(s):

Infection Control ◽

Best Practice ◽

Long Term Care ◽

Audit And Feedback ◽

Risk Assessments ◽

Term Care ◽

Practice Recommendations ◽

Care Facilities

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health and Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between November 2015 and July 2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined. Methods Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation. Results Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit and feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply and linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from three to 26 per LTCF (median = 15). The majority of the 270 recommendations (n = 162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs. Conclusion Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed toward mitigating identified IC gaps. Disclosures All authors: No reported disclosures.

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