Impact of a public policy restricting staff mobility between long-term care homes in Ontario, Canada during the COVID-19 pandemic

AbstractObjectivesTo assess changes in the mobility of staff between long-term care homes in Ontario, Canada before and after enactment of public policy restricting staff from working at multiple homes.DesignPre-post observational study.Setting and Participants623 long-term cares homes in Ontario, Canada between March 2020 and June 2020.MethodsWe used anonymized mobile device location data to approximate connectivity between all 623 long-term care homes in Ontario during the 7 weeks before (March 1 – April 21) and after (April 22 – June 13) the policy restricting staff movement was implemented. We visualized connectivity between long-term care homes in Ontario using an undirected network and calculated the number of homes that had a connection with another long-term care home and the average number of connections per home in each period. We calculated the relative difference in these mobility metrics between the two time periods and compared within-home changes using McNemar’s test and the Wilcoxon rank-sum test.ResultsIn the period preceding restrictions, 266 (42.7%) long-term care homes had a connection with at least one other home, compared to 79 (12.7%) homes during the period after restrictions, a drop of 70.3% (p <0.001). The average number of connections in the before period was 3.90 compared to 0.77 in after period, a drop of 80.3% (p < 0.001). In both periods, mobility between long-term care homes was higher in homes located in larger communities, those with higher bed counts, and those part of a large chain.Conclusions and ImplicationsMobility between long-term care homes in Ontario fell sharply after an emergency order by the Ontario government limiting long-term care staff to a single home, though some mobility persisted. Reducing this residual mobility should be a focus of efforts to reduce risk within the long-term care sector during the COVID-19 pandemic.

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A systematic review and meta-analysis of the prevalence and associations of stress and burnout among staff in long-term care facilities for people with dementia

International Psychogeriatrics ◽

10.1017/s1041610218001606 ◽

2018 ◽

Vol 31 (08) ◽

pp. 1203-1216 ◽

Cited By ~ 16

Author(s):

Harry Costello ◽

Sebastian Walsh ◽

Claudia Cooper ◽

Gill Livingston

Keyword(s):

Long Term Care ◽

Meta Analysis ◽

Care Home ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Care Staff ◽

High Turnover ◽

Term Care ◽

People With Dementia

ABSTRACTBackground:Care home staff stress and burnout may be related to high turnover and associated with poorer quality care. We systematically reviewed and meta-analyzed studies reporting stress and burnout and associated factors in staff for people living with dementia in long-term care.Methods:We searched MEDLINE, PsycINFO, Web of Science databases, and CINAHL database from January 2009 to August 2017. Two raters independently rated study validity using standardized criteria. We meta-analyzed burnout scores across comparable studies using a random effects model.Results:17/2854 identified studies met inclusion criteria. Eight of the nine studies reporting mean Maslach Burnout Inventory (MBI) scores found low or moderate burnout levels. Meta-analysis of four studies using the 22-item MBI (n = 598) found moderate emotional exhaustion levels (mean 18.34, 95% Confidence Intervals 14.59–22.10), low depersonalization (6.29, 2.39–10.19), and moderate personal accomplishment (33.29, 20.13–46.46). All three studies examining mental health-related quality of life reported lower levels in carer age and sex matched populations. Staff factors associated with higher burnout and stress included: lower job satisfaction, lower perceived adequacy of staffing levels, poor care home environment, feeling unsupported, rating home leadership as poor and caring for residents exhibiting agitated behavior. There was preliminary evidence that speaking English as a first language and working shifts were associated with lower burnout levels.Conclusions:Most care staff for long-term care residents with dementia experience low or moderate burnout levels. Prospective studies of care staff burnout and stress are required to clarify its relationship to staff turnover and potentially modifiable risk factors.

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Challenges in Caring for Unbefriended Residents in Long-term Care Homes: A Qualitative Study

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa079 ◽

2020 ◽

Vol 75 (9) ◽

pp. 2050-2061

Author(s):

Stephanie A Chamberlain ◽

Wendy Duggleby ◽

Pamela B Teaster ◽

Janet Fast ◽

Carole A Estabrooks

Keyword(s):

Complex Adaptive Systems ◽

Adaptive Systems ◽

Long Term Care ◽

Care Staff ◽

Care Homes ◽

Term Care ◽

Complex Adaptive ◽

Care Aides

Abstract Objectives This study examined challenges experienced by long-term care staff in caring for unbefriended residents who are incapacitated and alone. These residents often are estranged from or have no living family or live geographically distant from them and require a public guardian as their surrogate decision-maker. To date, research on unbefriended older adults has focused on those living in acute care and community settings. Little is known about those living in long-term care homes. Method We conducted semi-structured interviews with 39 long-term care staff (e.g., registered nurses, care aides, social workers) and 3 public guardians. Staff were sampled from seven long-term care homes in Alberta, Canada. We analyzed interview transcripts using content analysis and then using the theoretical framework of complex adaptive systems. Results Long-term care staff experience challenges unique to unbefriended residents. Guardians’ responsibilities did not fulfill unbefriended residents’ needs, such as shopping for personal items or accompanying residents to appointments. Consequently, the guardians rely on long-term care staff, particularly care aides, to provide increased levels of care and support. These additional responsibilities, and organizational messages dissuading staff from providing preferential care, diminish quality of work life for staff. Discussion Long-term care homes are complex adaptive systems. Within these systems, we found organizational barriers for long-term care staff providing care to unbefriended residents. These barriers may be modifiable and could improve the quality of care for unbefriended residents and quality of life of staff. Implications for practice include adjusting public guardian scope of work, improving team communication, and compensating staff for additional care.

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Implementation of eHealth to support assessment and decision-making for residents with dementia in long-term care: systematic review (Preprint)

10.2196/preprints.29837 ◽

2021 ◽

Author(s):

Juliet Gillam ◽

Nathan Davies ◽

Jesutofunmi Aworinde ◽

Emel Yorganci ◽

Janet E Anderson ◽

...

Keyword(s):

Decision Making ◽

Long Term Care ◽

Care Home ◽

End Users ◽

Care Homes ◽

Successful Implementation ◽

Key Factors ◽

Term Care ◽

Care Assessment

BACKGROUND As dementia progresses, symptoms and concerns increase causing considerable distress for the person and caregivers. Integration of care between care homes and healthcare services is vital to meet increasing care needs and maintain quality of life. However, access to high-quality healthcare is inequitable. eHealth offers a potential solution, by supporting remote specialist input on care processes like clinical assessment and decision-making, and streamlining care on site. How best to implement eHealth in the care home setting is unclear. OBJECTIVE This review aimed to identify key factors that influence implementation of eHealth for people living with dementia in long-term care. METHODS A systematic search of EMBASE, PsychInfo, MEDLINE and CINHAL was conducted to identify studies published between 2000-2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analysed and deductively mapped onto the six constructs of the adapted Consolidated Framework for Implementation Research (CFIR). Results are presented as a narrative synthesis. RESULTS 29 studies were included, focusing on a variety of eHealth interventions including remote video-consultations and clinical decision support tools. Key factors which influenced eHealth implementation were identified across all six constructs of the CFIR. Most concerned the Inner Setting construct about requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership and sufficient training and resources. Four novel subconstructs were identified to inform implementation requirements to meet resident needs and engage end-users. CONCLUSIONS Implementing eHealth in care homes for people with dementia is multi-factorial and complex, involving interaction between the resident, staff and organisation. Application of the CFIR for care homes requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed, and translated into 18 practical recommendations on implementation of eHealth in long-term care to guide implementers or innovators in care homes. The policy imperative for integrated health and social care demands successful implementation of eHealth, to maximise uptake and drive improvements.

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Dexamethasone and oxygen therapy in care home residents with diabetes: a management guide and algorithm for treatment: a rapid response action statement from the European Diabetes Working Party for Older People (EDWPOP) and European Geriatric Medicine Society (EuGMS)

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01822-1 ◽

2021 ◽

Vol 33 (4) ◽

pp. 895-900

Author(s):

Alan James Sinclair ◽

Stefania Maggi ◽

Ahmed Hassan Abdelhafiz ◽

Nicola Veronese ◽

Leocadio Rodriguez-Manas ◽

...

Keyword(s):

Older People ◽

Oxygen Therapy ◽

Long Term Care ◽

Care Home ◽

Geriatric Medicine ◽

Working Party ◽

Care Staff ◽

Term Care ◽

Practical Guidance

AbstractThis statement addresses the need to provide clinically relevant and practical guidance for long-term care staff working in care homes and other stakeholders engaged in the care of residents who require consideration for dexamethasone and oxygen therapy. It had been provided following a series of consensus discussions between the EDWPOP and the EuGMS in January and February 2021. Its main aim is to minimise morbidity and mortality from serious acute illnesses including COVID-19 requiring these treatments within the long-term care sector.

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Environment Still Matters: Examining Person-Place-Relationships in the Old and the New Normal Across Settings

Innovation in Aging ◽

10.1093/geroni/igab046.2033 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 531-531

Author(s):

Frank Oswald ◽

Habib Chaudhury ◽

Amanda Grenier

Keyword(s):

Long Term Care ◽

Care Home ◽

Risk Groups ◽

Care Homes ◽

Term Care ◽

Environmental Interventions ◽

Research Issues ◽

New Normal ◽

Environmental Gerontology

Abstract In environmental gerontology, the home and the neighborhood have always been of particular interest for empirical research. Issues such as orientation and safety, place attachment and biographical bonding, have proven to be important for community dwellings older adults and for those living in care homes. However, with Covid-19, the seemingly stable person-place-relationships have been challenged. This symposium provides a set of applied research contributions that demonstrate the persistent salience of the environment by examining person-place-relationships in the old and the new normal in private homes and care homes. Contributions draw from ideas of “precarious ageing” (Grenier & Phillipson) and “pandemic precarity”, for instance to understand housing insecurity, while concepts from environmental gerontology are used to explain processes of environmental agency and belonging. The first contribution by Mahmood and colleagues introduces an environmental audit tool for people at risk of homelessness to assess built environmental features of housing and neighborhood that support housing stability in the face of insecurity. Second, Wanka provides data from people framed as ‘risk-groups’ through the Covid-19 pandemic and how they dealt with contact restrictions, showing the role of intergenerational neighborhood relations to mediate risks of pandemic precariousness. Third, Elkes examined mobility and wayfinding challenges for residents in a long-term care home and subsequent environmental interventions to improve orientation. Forth, Leontowitsch and colleagues present findings from long-term care home residents during the pandemic to gain understanding of their experiences of social isolation and a biographical sense of resilience. Finally, Amanda Grenier will serve as the session’s discussant.

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Improving the Nutritional Status of Elderly Residents of Long-Term Care Homes

Journal of Health Services Research & Policy ◽

10.1258/jhsrp.2007.007017 ◽

2008 ◽

Vol 13 (1_suppl) ◽

pp. 25-29 ◽

Cited By ~ 12

Author(s):

Noella Leydon ◽

Wendy Dahl

Keyword(s):

Long Term Care ◽

Service Providers ◽

Care Staff ◽

Care Homes ◽

Clear Understanding ◽

Food Services ◽

Term Care ◽

Service Staff ◽

Food And Nutrition

Introduction High rates of malnutrition exist in long-term care residents in Canada. Residents may be admitted in a malnourished state or may become malnourished while in care. Nutritional decline of residents may be due to medical conditions but may also result from the failure to provide for the unique nutritional needs of this population, through an inadequate menu, inadequate swallowing and functional assessments, and lack of assistance with dining. Assessment of problem A project for the implementation of regional food services policies and practices was deployed with the ultimate goals to reduce nutritional risk and enhance the quality of life of the individuals residing in the 29 long-term care homes in the Saskatoon Health Region. The objectives were: to ensure that food and nutrition staff were competent; to provide adequate nutrition to residents; and to ensure nutrition screening, assessment and appropriate intervention, as approved by the resident or their relatives, was provided. Implementation consisted of: extensive communication of the problem; the development of draft Saskatchewan Food Services policies; planning regional goals, tasks, accountabilities and indicators; delivering meal assistance training to staff; and establishing a Regional Menu Advisory Committee. Results Outcomes have been clearly articulated and methods to collect data clearly defined. Interventions in progress include:the development of key relationships among the health region's long-term care staff, managers and directors; communicating a clear understanding of resident-directed care; determining the baseline knowledge of food service staff; and assembling a project tool kit for implementing food and nutrition policies at each home. Strategies for quality improvement Although the expectation was that food services policy implementation would be presented to all homes simultaneously, a more intensive pilot schedule has focussed on early-adopter sites. The three-year implementation plan is designed for sustainability. Lessons and messages Malnutrition is multifactorial and a concerted effort of all caregivers and service providers is important to address root causes.

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Critical Contextual Elements in Facilitating and Achieving Success with a Person-Centred Care Intervention to Support Antipsychotic Deprescribing for Older People in Long-Term Care

BioMed Research International ◽

10.1155/2018/7148515 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 8

Author(s):

Lynn Chenoweth ◽

Tiffany Jessop ◽

Fleur Harrison ◽

Monica Cations ◽

Janet Cook ◽

...

Keyword(s):

Older People ◽

Long Term Care ◽

Direct Care ◽

Care Staff ◽

Care Homes ◽

Term Care ◽

Train The Trainer ◽

People With Dementia ◽

Contextual Elements

Antipsychotic and other tranquilising medicines are prescribed to help care staff manages behaviour in one-quarter of older people living in Australian long-term care homes. While these medicines pose significant health risks, particularly for people with dementia, reliance on their use occurs when staff are not educated to respond to resident behaviour using nonpharmacological approaches. The Halting Antipsychotic use in Long-Term care (HALT) single-arm study was undertaken to address this issue with 139 people 60 years and over with behaviours of concern for staff living in 24 care homes. A train-the-trainer approach delivered person-centred care education and support for 22 HALT (nurse) champions and 135 direct care staff, dementia management education for visiting general practitioners (GP) and pharmacists, use of an individualised deprescribing protocol for residents, and awareness-raising for the resident’s family. The HALT champions completed open-ended questionnaires and semistructured interviews to identify the contextual elements they considered most critical to facilitating, educating care staff, and achieving success with the study intervention. They reported that person-centred approaches helped care staff to respond proactively to resident behaviours in the absence of antipsychotic medicines; the champions considered that this required strong managerial support, champion empowerment to lead change, reeducation of care staff, and the cooperation of families and GPs.

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Derivation and validation of a decision support algorithm for urgent admissions to long-term care homes in Ontario

10.31219/osf.io/34tvb ◽

2019 ◽

Author(s):

Aaron Jones ◽

Chi-Ling Joanna Sinn

Keyword(s):

Decision Support ◽

Long Term Care ◽

Care Home ◽

Decision Support Tool ◽

Fundamental Principle ◽

Care Homes ◽

Risk Level ◽

Term Care ◽

Support Tool

Equitable access to care is a fundamental principle of Canada’s healthcare system. In Ontario, the absence of a provincial standard to support consistent decision making around urgent admissions to long-term care homes has led to variation in practice across the province. A working group was established in 2014 to develop an evidence-informed decision support tool to promote consistency in care planning regarding urgent admissions to long-term care homes. The resulting CRISIS algorithm demonstrates good prognostic ability, with the proportion of patients urgently admitted to a long-term care home within 90 days ranging from 2.4% in the lowest risk level to 39.9% in the highest risk level. The implementation of the algorithm will improve equity in access to long-term care homes in Ontario.

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Evaluation of factors associated with urinary incontinence in elderly people in long-term care homes

Acta Scientiarum Health Sciences ◽

10.4025/actascihealthsci.v38i2.29237 ◽

2016 ◽

Vol 38 (2) ◽

pp. 137

Author(s):

Tábada Samantha Marques Rosa ◽

Melissa Medeiros Braz ◽

Valdete Alves Valentins dos Santos Filha ◽

Anaelena Bragança de Moraes

Keyword(s):

Urinary Incontinence ◽

Elderly People ◽

Long Term Care ◽

Demographic Data ◽

Care Home ◽

Care Homes ◽

Term Care ◽

Significance Level ◽

Factors Associated

The aim of this study was to assesses the factors associated with the occurrence of urinary incontinence (UI) in elderly people living in long-term care homes. Reports on Urinary Incontinence coupled to clinical-functional and socio-demographic data were retrieved from the medical records of elderly people. In addition, the application of the protocols: Mini-Mental State Examination, Katz Index, Short Physical Performance Battery. It was considered a significance level of 5%. It was noted that the UI occurred in 80.6% of elderly people, with average age 76.5 years (± 8.3) and average time at the care home reaching 5.2 years (± 6.4). Significant UI association was reported with gender, education and disease. A discrete increase in scores occurred in protocols for elderly people without UI occurrence. It is concluded that sample was characterized by elderly females with less than five years living in homes. The elderly with UI were similar to elderly people in general with regard to protocols.

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It takes time: Building relationships and understanding through an intergenerational ballet programme

Dementia ◽

10.1177/1471301218772895 ◽

2018 ◽

Vol 19 (2) ◽

pp. 270-284

Author(s):

Shelley E Canning ◽

Michael Gaetz ◽

Darren Blakeborough

Keyword(s):

Older Adults ◽

Residential Care ◽

Long Term Care ◽

Care Home ◽

Care Homes ◽

Term Care ◽

Negative Stereotypes ◽

Building Relationships ◽

Meaningful Relationships

Individuals living in long-term residential care homes are often viewed through a negative lens. These residents have increasingly complex care needs, and their functional, communication and cognitive challenges can support conceptualizations of difference and disability perpetuating negative stereotypes of age and dementia. However, engaging in meaningful activities and relationships with older adults, including those with dementia, has been shown to promote positive attitudes. Specifically, intergenerational programming that provides opportunities for meaningful engagement between children and older adults has been shown to support positive emotional experiences through socializing and building relationships. This qualitative study explored the development of relationships between school-aged children and older adults with dementia living in a long-term residential care home. Residents in long-term care homes and children typically have limited opportunities to interact with each other; in this study, participating in an intergenerational dance programme provided an opportunity for meaningful relationships to develop. This paper focuses on the development of the children’s attitudes and understandings of their much older dance partners. Seven girls between the ages of seven and nine participated in ballet classes with residents in a long-term care home for one hour each week over a six-month period. All of the residents had a diagnosis of moderate to advanced dementia. Further, all of the residents also had other chronic health issues such as cardiac, respiratory and/or neurological diseases. The children were interviewed at the baseline, three- and six-month intervals. Prior to beginning the dance programme, the children anticipated their dance partners to be unwell and unable. However, by the end of six months, the children described the residents much more positively highlighting their abilities and strengths. Over time, through participating in a structured intergenerational programme, the children’s views of disability and difference disappeared as they formed dance partnerships and developed meaningful relationships.

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