The Need to Consider Relocations WITHIN Long-Term Care

The Impact of Relocations Within Nursing Home Care on Long-Term Care Residents According to Stakeholders: A Qualitative Study

INTRODUCTION

Nursing home residents can be faced with relocations within nursing home care for various reasons, whether individual or per group. We aimed to collect a broad stakeholder overview of observed and experienced impacts on residents and aspects that influence the impact.

METHODS

We conducted a qualitative study using semistructured interviews followed by one focus group. We recruited participants from various stakeholder perspectives based on differences in roles while having an interest or involvement in relocations, and experience with relocations. The interviews and focus group were audiorecorded, transcribed verbatim and analysed using responsive and thematic analysis.

RESULTS

In 17 interviews including one duo interview, participants described the impact on residents varying from very positive to very negative. In addition, stakeholders addressed differences in impact related to the relocation phase (before, during, after). Aspects influencing the impact of relocations were (1) mental resilience of residents, (2) organisation of relocations, (3) social connections of residents, and (4) the new (care) environment. The focus group with six participants added further insights in the subtheme 'organisation of relocations', emphasising the importance of clear and timely communication with residents and relatives and recognizability of (personal) items and professional caregivers from the former nursing home.

CONCLUSION

Stakeholders described the impact of relocations within nursing homes to vary between and within nursing home residents. Aspects they identified to influence this impact provide incentives to reduce the negative impact on residents and foster positive impact. Further research needs to zoom-in on the perceived impact of relocations within nursing homes of residents themselves.

Experiences and needs of residents with dementia in relocating to an innovative living arrangement within long-term care: A qualitative study

During the last decade, an increasing number of care organizations have chosen to rebuild or build a new care facility to provide better person-environments for residents with dementia. This has inevitably led to an increase in relocations. This study investigated how residents with dementia experienced a relocation from a regular nursing home to an innovative living arrangement. A qualitative study was performed, using semi-structured interviews and observations. Two nursing homes offering 24 h care to residents with psychogeriatric symptoms that planned a relocation to an innovative living arrangement were selected. Sixteen residents were included. Five themes from the data described what was of importance to residents when moving, including (1) the physical environment of the new location, (2) the belongings of residents, (3) feeling at home, (4) the importance of social contact when relocating, and (5) the need to be engaged in daily life. This study found that the residents were not actively involved in the relocation process, despite the clear desire they expressed to be involved and of importance. As the residents with dementia were able to express what was important to them in this study, relocation processes should focus more on involving such residents and incorporating them within relocation processes.

The frequency and types of resident relocations in Dutch nursing homes: a nationwide cohort study of electronic health record data

PURPOSE

One third of Dutch nursing home residents relocated at least once during length of stay. Roughly 75 percent were individual relocations and the other 25 percent concerned group relocations. The average yearly number of individual relocations was about 3 times as high in the first 4 months after admission compared with later periods.

METHODS

We performed an historical cohort study of pseudonymized registration data from a Dutch electronic health record. We selected data from nursing home residents aged 65 years and older who stayed on a ward for physical impairment or dementia and passed away between 2015 and 2019. Our study sample consisted of 26,060 long-stay nursing home residents from 67 nursing homes in the Netherlands. We examined the number of relocations, trends over time, individual versus group relocations and relocation destinations.

RESULTS

We found that approximately one-third of long-stay nursing home residents relocated at least once with an average of 36 relocations per 100 residents per year. Roughly, 75 percent of relocations were individual relocations and 25 percent concerned group relocations. In the first 4 months after admission, the average number of individual relocations per 100 resident per year was about 3 times as often compared to later periods after admission. Most individual relocations were within the same type of care.

CONCLUSION

A considerable proportion of Dutch long-stay nursing home residents experienced one or more relocations. Relocations for individual reasons occurred mostly in the first months after admission. Further investigation is warranted to explore which factors lead to relocations.

An exploration of relocation initiatives deployed within and between nursing homes: a qualitative study

BACKGROUND

Relocations within and between nursing homes often induce stress, anxiety, and depression in residents and cause additional workload for and burnout in staff. To prevent this, many nursing homes deploy pre-transition initiatives, bridging initiatives, and post-transition initiatives to support residents and staff during the relocation process. As little is known about these initiatives, this study aims to explore the pre-relocation, bridging and post-relocation initiatives used for relocations within and between nursing homes.

METHODS

In seven Dutch nursing homes, eight focus groups were conducted with two to six participants (N = 37) who were actively involved in relocation processes in different roles (i.e., managers, healthcare professionals, support staff, client council members, residents and family). The focus groups were conducted based on a predefined topic list and lasted approximately 60 min. The transcripts were recorded, transcribed verbatim and analysed using thematic coding.

RESULTS

Nursing homes had to be inventive in developing relocation initiatives as neither shared guidelines nor knowledge exchange on this topic were available. A total of thirty-seven relocation initiatives were identified in these seven nursing homes. Nineteen pre-relocation initiatives were identified, of which eight emphasized information and engagement, three highlighted training and practice and eight stressed orientation and visualization. Seven bridging initiatives were identified, of which four emphasized coordination and continuity and three highlighted entertainment and celebration. Eleven post-relocation initiatives were identified, of which seven emphasized evaluation and troubleshooting and four highlighted change and adjustment.

CONCLUSION

The identified relocation initiatives were developed unassisted by nursing homes, due to a lack of shared guidelines, knowledge exchange and mutual learning on this topic. Therefore, it may be expedient and more effective to develop general guidelines for relocations within and between nursing homes in collaboration with nursing homes.

Residential Environments for Older Persons: A Comprehensive Literature Review (2005-2022)

BACKGROUND

Independent noninstitutional and institutional residential long-term care environments for older persons have been the subject of significant empirical and qualitative research in the 2005-2022 period. A comprehensive review of this literature is reported, summarizing recent advancements in this rapidly expanding body of knowledge.

PURPOSE AND AIM

This comprehensive review conceptually structures the recent literature on environment and aging to provide conceptual clarity and identify current and future trends.

METHOD AND RESULT

Each source reviewed was classified as one of the five types-opinion piece/essay, cross-sectional empirical investigation, nonrandomized comparative investigation, randomized study, and policy review essay-within eight content categories: community-based aging in place; residentialism; nature, landscape, and biophilia; dementia special care units; voluntary/involuntary relocation; infection control/COVID-19, safety/environmental stress; ecological and cost-effective best practices; and recent design trends and prognostications.

CONCLUSIONS

Among the findings embodied in the 204 literature sources reviewed, all-private room long-term care residential units are generally safer and provide greater privacy and personal autonomy to residents, the deleterious impacts of involuntary relocation continue, family engagement in policy making and daily routines has increased, multigenerational independent living alternatives are increasing, the therapeutic role of nature and landscape is increasingly well-documented, ecological sustainability has increased in priority, and infection control measures are of high priority in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review sets the stage for further research and design advancements on this subject in light of the rapid aging of societies around the globe.

Types, Aspects, and Impact of Relocation Initiatives Deployed within and between Long-Term Care Facilities: A Scoping Review

Relocation of residents within or between long-term care facilities occurs regularly. To mitigate potential negative consequences, supportive relocation initiatives have been developed. This scoping review addresses types, aspects, and impact of relocation initiatives developed to relocate residents between or within long-term care facilities. A total of 704 articles were identified in a systematic literature search of 11 databases between April and July 2021. Using predefined eligibility criteria, two researchers independently screened titles and abstracts, resulting in 36 articles for full-text screening. Finally, six articles were included. Analysis was performed using thematic coding. Three types of relocation initiatives were identified, namely, interventions (n = 3), guidelines (n = 2), and a plan (n = 1). These initiatives described specific aspects of relocation, namely, spatial orientation (n = 3), practical assistance (n = 3), psychological support (n = 3), staff preparation (n = 2), and client engagement (n = 2). Only three intervention studies reported the impact of relocation initiatives on residents, namely, improved mental health (n = 3), spatial orientation (n = 2), self-reliance (n = 2), and social behavior (n = 1). The scope of the found relocation initiatives was often limited as they focused on specific designs, aspects, and residents. Therefore, the complexity of relocation processes is often overlooked, and more comprehensive relocation initiatives should be developed.