Use and alternatives to coercive measures in inpatient residential care facilities for adults with disabilities: study protocol of a mixed-methods study

BackgroundIn Germany, the use of coercive measures such as physical or chemical restraints in certain settings has been the focus of high court decisions, political debates, and scientific research in areas like psychiatric care. Such encroachments on fundamental rights could easily be overlooked in the case of residents in inpatient residential care facilities for adults with disabilities. However, little data are available on this issue. This study aims to investigate the types, frequencies, and characteristics of the use of coercive measures as well as the reasons and justifications of their use. Possible alternatives to these measures and contextual conditions will also be identified.MethodsThe study is based on an explorative, multi-phase, cross-sectional design, which consists of a mixed-methods approach including several forms of data collection and analysis bringing together forensic, sociological, pedagogical and medical perspectives and expertise. First, the entirety of the approximately n = 880 residential care facilities for adults with disabilities in the study area will be surveyed by an online questionnaire. Participating passive observations will be carried out in n = 5 selected residential care facilities (24 hours per facility), with an approximate total of n = 150 residents. In these facilities, organizational documents such as house rules and residential documents such as medication plans will also be collected and analysed. Focus groups will be conducted in each of the five facilities including residents, staff, and legal guardians of the residents.DiscussionThis study will address important gaps in the current research by providing different forms of empirical data on the use or avoidance, causes, contexts, and alternatives to coercive measures in inpatient residential care facilities for adults with disabilities. This study is the first in Germany to combine a general overview (survey) and detailed insight (observations, document analysis, focus groups) approach to this issue. These findings will provide a basis for further research in the field as well as for the management of coercive measures in practical settings.

The Impact of Nursing Staffs’ Working Conditions on the Quality of Care Received by Older Adults in Long-Term Residential Care Facilities: A Systematic Review of Interventional and Observational Studies

Background: Little documentation exists on relationships between long-term residential care facilities (LTRCFs), staff working conditions and residents’ quality of care (QoC). Supporting evidence is weak because most studies examining this employ cross-sectional designs. Methods: Systematic searches of twelve bibliographic databases sought experimental and longitudinal studies, published up to May 2021, focusing on LTRCF nursing staff’s working conditions and the QoC they provided to older adults. Results: Of the 3577 articles identified, 159 were read entirely, and 11 were retained for inclusion. Higher nursing staff hours worked per resident per day (HPRD) were associated with significant reductions in pressure sores and urinary tract infections. Overall staff qualification levels and numbers of RNs had significant positive influences on QoC. Conclusions: To the best of our knowledge, this systematic review is the first to combine cohort studies with a quasi-experimental study to explore associations between LTRCF nursing staff’s working conditions and older adult residents’ QoC. Human factors (including HPRD, staff turnover, skill mix, staff ratios) and the specific working contribution of RNs had overwhelmingly significant influences on QoC. It seems essential that LTRCF supervisory and decision-making bodies should promote optimal working conditions for nursing staff because these have such a direct impact on residents’ QoC.

Factors Associated with Older Peoples′ Perceptions of Dignity and Well-being at Residential Care Facilities

Dignity and well-being should be promoted in care of older people living at residential care facilities (RCFs). In addition, care should be person-centred. Dignity and well-being can be interpreted as person-centred outcomes. Older people living at RCFs experience a lack of dignity and well-being. To promote this, it is important to understand the associated factors to target. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to attitudes of staff, the care environment and individual issues (age, gender, self-rated health and dementia) among older people living at RCFs. A national cross-sectional study was conducted retrospectively. All older people 65 years and older (n=71,696) living at RCFs in 2018 were invited to respond to the survey. The survey included the areas: self-rated health, indoor-outdoor-mealtime environment, performance of care, treatment from staff, safety, social activities, availability of staff and care in its entirety. Age, gender and diagnosed dementia were collected from two national databases. Data was analysed using ordinal logistic regression models. The result indicated that respondents who had experienced disrespectful treatment, who did not thrive in the indoor-outdoor-mealtime environment, who rated their health as poor and respondents with dementia had higher odds of being dissatisfied with dignity and well-being. There is a need to improve the prerequisites of staff regarding respectful attitudes and to improve the care environment. The Person-centred Practice framework, targeting the prerequisites of staff and the care environment, can be used as a theoretical framework for designing future improvements.

Aging and Masculinity in Bibliotherapy and Poetry Groups for Men in Late Life

The transition to residential care facility may symbolize the joining into the 'community of older people'. This may influence the ways men in late life construct their identities and the intersection of aging and masculinity. Due to some barriers, this experience may be difficult to express explicitly. Bibliotherapy aims to bridge this gap by using literature to address diverse issues in the form of reading and writing activities. In this presentation we will present "The Literary Parliament" project, in which bibliotherapy and poetry groups of men in late life were conducted in residential care facilities in Israel. We will present findings of a qualitative research which explored poems written by group participants, and the way these helped participants to express their perceptions and feelings of ageing and masculinity in the context of residential care. The use of bibliotherapy to encourage psychological discourse among men in late life will be discussed.

Influences of Prejudice and Stereotyping in the Direct Care Workforce

Direct Care Workers (DCW; nursing assistants, personal care aides, home health aides) have the most one on one care with sexual and gender minority (SGM) older adults who reside in residential care facilities or use home health services. DCWs make up a vast majority of the healthcare workforce, holding almost five million jobs in 2019, with approximately 70% of the positions held being in residential care facilities. In a qualitative design study, 11 DCWs were interviewed using an open-ended, semi-structured format to describe their perceptions of care provided to SGM older adults in residential care facilities and the home health setting. These results were part of a larger qualitative study which found there were cues of stereotyping and prejudice in DCW narratives toward SGM older adults. The category DCWs’ care and social system referred to characteristics of the DCWs’ work environment and the perspectives, attitudes, and reported care toward SGM older adults and diverse populations. It was determined that there are synergies among SGM older adults’ care and DCW along with DCW workforce issues (short staffed, low wages, lack of health benefits) that may prevent the DCW from being accepting of implicit bias training or culture change within these facilities/agencies. Implications for practice, policy, and future research are discussed.

Coping With COVID-19: Challenges and Resilience

COVID-19 has introduced unprecedented challenges for older adults. At the same time, older adults have adapted to meet the challenges of the pandemic. In this symposium, we explore a number of difficulties brought about by COVID-19, while also investigating the ways in which individual, social, and community resources and strengths have bolstered older adults' resilience through the pandemic. Paper 1 investigates family caregivers of older adults with dementia living in long-term residential care facilities, a group that has been especially heavily affected by the pandemic. Using longitudinal data spanning Fall 2017-Spring 2021, the authors estimate caregivers' trajectories of well-being pre-and-post pandemic. With an exceptionally large qualitative data sample, Paper 2 examines the influence of COVID-19 on older adults' neighborhood engagement. Thematic analysis has revealed diverse patterns of response to the pandemic, as well as community and personal characteristics that have facilitated older adults' coping and resilience. Papers 3 and 4 examine how older adults' personality traits may influence their responses and adjustment to the pandemic, each using assessments of personality taken before the pandemic. Specifically, Paper 3 investigates the relationship between Big Five personality traits and older adults' concerns, precautions, and preparatory behaviors. Paper 4 explores how optimism predicts older adults' emotional responses, including worry, loneliness, and benefit-finding. Using a variety of methods and populations, these studies illustrate the challenges that older adults and their families have faced over the past year, as well key factors at the level of individuals, relationships, and communities that have contributed to their resilience.

Older People’s Perceptions of what is Needed to Experience Dignity and Well-being at Residential Care Facilities

Dignity and well-being are central values in care of older people living in residential care facilities. In addition, care of older people living in residential care facilities should be person-centred. Dignity and well-being can according to the person-centred practice framework be interpreted as person-centred outcomes. Despite this older people living in residential care facilities have described that they not fully experience dignity and well-being and improvements are needed. To improve care it is important to know what to target. The aim of this qualitative study was therefore to describe residents’ perceptions and experiences of what is needed to live with dignity and a sense of well-being. Interviews were carried out with older people living at residential care facilities (n=20). Inductive content analysis was used to analyse data and one overarching theme and three categories emerged. The result revealed the importance of, and that staff and the care environment supported, to manage daily life by oneself, to be shown respect and to belong to a social context. For older people to experience the person-centred outcomes dignity and well-being managers at residential care facilities need to develop and support the staff prerequisites related to knowledge, skills and attitudes and to improve the care environment. According to the person-centred practice framework, the staff prerequisites and the care environment must be taken into account to achieve the person-centred outcomes dignity and well-being.