Suchergebnisse

Purpose
The purpose of this paper is to explore the concept of homelikeness from the perspective of family members and friends of nursing home residents across different models of nursing homes.


Design/methodology/approach
This mixed-methods study examined survey data collected from 397 family members and friends of residents living in 23 nursing homes representing three models of care (traditional, new augmented, and full scope). Participants completed a homelikeness scale and a measure of the importance of nursing home spaces to family members and friends. This study also involved conducting three focus groups with 20 family members and friends to provide further insights into the findings.


Findings
Analysis of survey data indicated quite high levels of homelikeness overall. Significant differences did emerge between traditional model nursing homes compared to new full-scope and new augmented models for all items in the homelikeness scale and for many items about nursing home spaces. Qualitative results provided insights into how homelikeness can be fostered through public and private spaces and through care and relationships.


Research limitations/implications
As this study was conducted in one Canadian province, the results may not be applicable to other geographic areas. In addition, there are limitations in survey response rate.


Practical implications
Homelikeness can be supported across models of care by fostering relationships between residents and staff, ensuring that that family and friends feel welcome, and creating public and private physical spaces that are conducive to new and ongoing relationships.


Originality/value
The results provide evidence to nursing home decision makers about how to foster a homelike environment in various models of nursing homes.

The objective of this study was to assess the prevalence of residents who are incapacitated and have no surrogate decision maker, known as the "unbefriended" in Alberta long-term care (LTC) homes. Using cross-sectional online survey methods, data were collected from 123 staff (i.e., directors of care/nursing, administrators) from Alberta LTC homes. Information was collected on survey respondents' demographic characteristics, number of unbefriended residents, and on organizational characteristics. The overall prevalence of unbefriended residents in LTC homes was 4.14% in Alberta ( SD = 6.28%, range: 0%-34.6%). Homes with the highest prevalence (nearly 15%) of unbefriended residents had >135 beds and were public not-for-profit and located in large urban centers. Fifty-three percent of unbefriended residents were male. The highest prevalence of unbefriended residents lived in homes located in large urban centers and public not-for-profit operators. Population level and LTC home level prevalence data are needed to assess the scope of unmet needs.

AbstractNursing home (NH) residents are often considered passive recipients of care with a limited role in shaping their experience. This perspective is often reproduced in NH research, which restricts resident participation, thereby upholding ageist views that cause discrimination of older adults living in NH settings. In this article, we propose using Contextual Action Theory (CAT) as a conceptual framework for exploring NH experiences in a way that incorporates the active role of residents. CAT supports the active role of NH residents by emphasizing the capabilities of human beings to form preferences and act on those preferences, without assumptions of rationality. The emphasis on human action allows researchers to consider NH experiences as co-constructed between residents, care providers, and family members, which means placing an emphasis on the actions and goals of NH residents, no matter their cognitive or physical impairments. CAT also supports personhood and social citizenship concerns in NH research, by acknowledging the differing preferences and thereby differing experiences of NH care by individual residents. We argue that CAT should be considered a useful framework for putting residents in the center of NH research.

AbstractObjectivesThis 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.MethodWe 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.ResultsLong-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.DiscussionLong-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.

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014–2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work–life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.

Family or friend caregivers' concerns about assisted living (AL) residents' mental health are reflective of poor resident and caregiver mental health. COVID-19-related visiting restrictions increased caregiver concerns, but research on these issues in AL is limited. Using web-based surveys with 673 caregivers of AL residents in Western Canada, we assessed the prevalence and correlates of moderate to severe caregiver concerns about residents' depressed mood, loneliness, and anxiety in the 3 months before and after the start of the COVID-19 pandemic. Caregiver concerns doubled after the start of the pandemic (resident depressed mood: 23%–50%, loneliness: 29%–62%, anxiety: 24%–47%). Generalized linear mixed models identified various modifiable risk factors for caregiver concerns (e.g., caregivers' perception that residents lacked access to counseling services or not feeling well informed about and involved in resident care). These modifiable factors can be targeted in efforts to prevent or mitigate caregiver concerns and resident mental health issues.