Multidisciplinary residential home intervention to improve outcomes for frail residents

Background Residential homes provide accommodation and assistance with personal care only and are not required to have registered nurses on site. However, their residents often have a combination of comorbidity, polypharmacy, frailty and mental-health conditions with poor access to healthcare to meet these needs. Integrated healthcare for older people is a key NHS priority in the Long-Term Plan and the Five-Year Forward View. We describe development and implementation of multi-disciplinary intervention to integrate healthcare and promote interprofessional education. Methods A multi-disciplinary residential home quality improvement project in two cycles by a team comprising senior and trainee general practitioners, trainees in geriatrics, psychiatry, pharmacist and residential home senior staff. The intervention was underpinned by the framework for enhanced health in care homes including Comprehensive Geriatric Assessment (CGA) and mental-health review. Each intervention session included an educational presentation by a team member consideration of each resident in a pre-evaluation multi-disciplinary discussion followed by a structured clinical assessment and discussion of proposed management. Results Three residential homes participated with a total 34 residents receiving intervention. In one residential home, there was a 75% reduction in admissions for those reviewed and a reduction in overall admission costs. Polypharmacy was reduced by an average of 2 medications per resident across the three sites. There was a 63% increase in cardio-pulmonary resuscitation decisions and 76% increase in advance care planning discussions. Conclusion This was an effective model for multi-disciplinary trainees working with a perceived impact on physical and mental health, and valuable opportunities for sharing learning.

OBSERVATION OF FEMALE DORM PRIVACY IN ISLAMIC BOARDING SCHOOLS IN WEST JAVA, INDONESIA

In learning activity processes in Islamic boarding schools, students must study and live in a dormitory. It functions to replace a residential home where the privacy aspect should be taken into consideration. This study aims to observe the privacy aspects closely related to the female students' bedrooms, covering six elements examined in five case studies, including the sex-segregated dormitories, the main function of staying, visual privacy on the dimensions height of the windows, acoustic privacy, and olfactory privacy in terms of the connection between dormitory rooms. It was found that the privacy aspect in the dormitory room still lacked attention due to the addition of space functions and bathroom facilities in it. Meanwhile, adding personal facilities, such as storage and study areas, could enhance the students' privacy. Especially for the type of student bedroom, it is necessary to provide a place for drying clothes by utilizing the balcony area. Besides that, it is required to pay attention to the type, dimensions direction of window openings so that the level of privacy of female students will be more optimal.

Employees’ Post-service Plans and Options in Nigeria

One of the greatest challenges that faced typical employees throughout their working life is life after retirement. Despite government roles at providing social security, retirement epoch has been a tension provoking and overwhelming phenomenon in Nigeria and other emerging economies of Africa, Asia and Latin America. A close observation of many retirees in Nigeria society and the problems they are facing draw the attention of all and sundry. These problems seem to range from sudden death, dwindling status, lack of occupation, loss of the usual monthly salary, decreased strength and deteriorated health condition, physical disabilities, aging and anxiety about a residential home. In Nigeria, the regular non-payment of pensions and gratuities benefits has brought untold hardship and sudden death to many retirees, thereby making retirement something that is dreaded by workers. This problem is further compounded to lack of planning and management of post-service epoch and conditions. It is against this backdrop that this paper seeks to identify and discusses strategies available for managing post-service condition in Nigeria. The paper calls on Nigerian workers to embrace one of the options to remain moderately productive and healthy after retirement. The paper suggests, among others, that both employers and government should undertake regular pre-retirement training for their workers in order to save the country the embarrassment of seeing their retirees going to early graves or turning into destitute on the streets.

Advancing Craft: A translation to modern tectonics

<p>Well-made joinery can be pricey, no matter if it is hand-crafted or prefabricated. This thesis attempts to understand all available tectonics used to fabricate joints and find a potential alternative to generate well-made joints in a more accessible manner. Specifically looking at traditional Japanese carpentry, Japanese joinery is a crucial precedent for examining due to its prestigious nature for withstanding the test of time and earthquakes. Here following the crafting of traditional joints is necessary to understand the hand-tool tectonic, allowing for an understanding to then iterate joints in the other tectonics with machine-tools and information-tools. Retrofitting provides for the opportunity for owners to add additional components to their existing properties. The standard residential home is commonly retrofitted by the owners to follow the ‘trend’ and ‘personalise’ their home. The want for retrofitting is usually due to the basic nature of cookie-cutter homes that are common to the New Zealand suburbs. By studying ways to construct joints, methods of fabricating joinery can assist the DIY culture in New Zealand, whether through prefabrication on the CNC router that is sold as kitsets or machine jigs that can be made onsite.</p>

Advancing Craft: A translation to modern tectonics

<p>Well-made joinery can be pricey, no matter if it is hand-crafted or prefabricated. This thesis attempts to understand all available tectonics used to fabricate joints and find a potential alternative to generate well-made joints in a more accessible manner. Specifically looking at traditional Japanese carpentry, Japanese joinery is a crucial precedent for examining due to its prestigious nature for withstanding the test of time and earthquakes. Here following the crafting of traditional joints is necessary to understand the hand-tool tectonic, allowing for an understanding to then iterate joints in the other tectonics with machine-tools and information-tools. Retrofitting provides for the opportunity for owners to add additional components to their existing properties. The standard residential home is commonly retrofitted by the owners to follow the ‘trend’ and ‘personalise’ their home. The want for retrofitting is usually due to the basic nature of cookie-cutter homes that are common to the New Zealand suburbs. By studying ways to construct joints, methods of fabricating joinery can assist the DIY culture in New Zealand, whether through prefabrication on the CNC router that is sold as kitsets or machine jigs that can be made onsite.</p>

Infection Control in Small Residential Care Settings: Insights From a National Survey and Washington State Data

Infection control is a vital issue in long-term care, and the increasing popularity of small residential care facilities (SRCF) raises questions about the effectiveness of this model for preventing facility-acquired infections. In SRCF, care is provided in a residential home to a small number of residents. The setting lacks common terminology, and states license SRCF under various titles including Adult Family Homes, Adult Foster Homes and Family Care Homes. To better inform infection control efforts in this unique setting type, DOH staff conducted a comprehensive search to locate states that license SRCF. A total of 24 states were identified and approached to participate in a qualitative research study; 21 responded, three declined and nine were unable to participate due to staff time constraints. Between March 12th and April 15th, 2021, ten public health and regulatory staff from nine states completed semi-structured telephonic interviews on infection control in SRCF. Infection control licensing requirements and public health oversight for SRCF varied significantly across participating states. Data from these interviews was analyzed and compared with two Washington State Adult Family Home (AFH) sources: 1) online survey of AFH providers 2) Infection Control Assessment and Response evaluations conducted by public health staff. Four themes were identified in all three data sets: access to personal protective equipment, environmental safety, staffing issues and knowledge deficits. SRCF are valued by states that license them. Despite the challenges of implementing infection control in the home-like environment, extraordinary opportunities exist for improving care and preventing infections in this setting.

Verdant Home: Growing Elements of Architecture

<p>‘Verdant Home’ explores how the design of residential architecture can evoke the senses through the integration of the garden with the house. This research challenges the use of New Zealand native and exotic plant species as merely an addition to architecture; instead creating stimulating and efficacious verdant elements (components) as part of the architecture. Two concerns provoked investigations into this subject. Firstly, a concern for the gradually occurring loss of vegetation amongst city residences, and secondly a concern for the way in which green elements are often added to buildings, without consideration of how they could sensually transform and improve the aesthetics of space and context. The final refined solution addresses these concerns by incorporating verdant components in an advantageous way, creating a new typology of residential home for New Zealand. Modern architectural technologies allow conventionally separate garden spaces to be integrated with building forms, removing the need for separate garden spaces. These technologies provide humans with the positive environmental benefits of plants within interior spaces. This thesis builds on these benefits, providing ideas for enhancing spatial experiences within the home by merging programmatic use with the pleasurable qualities of gardens. Presented at the outset of the thesis is evidence supporting the physical and mental benefits of everyday human contact with nature. The pursuit for a way in which architecture can encompass verdant elements as integral components of the home is explored through a review of garden history and theory. This review provides specific inspiration for the creation of splendid spaces, spaces which manipulate dimension and materials, sensually practical spaces and statement spaces in the design of a residential home. Following this, buildings from various time periods and locations which innovatively incorporate vegetation are evaluated. An analysis of the New Zealand architectural context and its relationship to gardens is then completed, leading to designs which incorporate all of this research. This thesis challenges the current use of verdant elements such as: living walls, roofs and facades. Whilst these are beneficial technologies, there is potential for them to have an increased atmospheric effect on the spaces they are part of. New aesthetic possibilities are focused on through the designs, which utilise principles of historical garden design typologies to sensually integrate verdant technologies. This results in the creation of aesthetically engaging verdant home solutions.</p>

Enhancing Quality of Life through Singing: A Music Therapy Study into Huntington’s Disease

<p>This mixed methods study investigated whether the process of singing in music therapy can enhance the quality of life of patients with Huntington’s Disease. It took place in New Zealand, over a two-month period, in a residential home dedicated to the rare condition. The research involved five participants: two residents diagnosed with Huntington’s Disease who participated in individual music therapy sessions, two caregivers at the facility, and the music therapy student (MTS). The study endeavoured to answer the research question by triangulating three data sources. Data sources included; the MTS’s clinical notes of the sessions, semi-structured interviews with the staff members and a short questionnaire developed by the researcher which involved gathering the personal self-rated scores from the resident participants. A thematic analysis was undertaken with the two text-based data sources (clinical notes and interview transcripts) and the questionnaire scores were collated for each case. However the questionnaire results were deemed predominantly invalid. The triangulation of findings found that participants observed the process of singing had contributed to areas of quality of life for both of the residents, by providing them with: 1) a stimulus for socialisation; 2) emotional and psychological support; and 3) support for their remaining cognitive and physical ability. The outcome of the study found that the process of singing stimulated the resident participants in two contrasting ways and their motivation to participate was not only the singing itself but also the music in the session, instrumental play and the relationship between the residents and the MTS. From the perspectives of the participants consulted in this study it was concluded that the results from this research added some rich detail to the current literature available. Findings also concluded that residents, caregivers and the MTS herself valued the process of singing in music therapy and regarded it as an important intervention when seeking to preserve the quality of life of Huntington’s patients.</p>