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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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Reckrey JM, McKendrick K, Morrison RS, Osakwe ZT, Ornstein KA, Aldridge M. Variation in Hospice Aide Care by Residential Setting. J Palliat Med 2024. [PMID: 38647702 DOI: 10.1089/jpm.2023.0585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Background: Hospice care frequently includes hands-on care from hospice aides, but the need for hospice aide care may vary in residential settings (e.g., assisted livings and nursing homes). Objectives: The objective of this study is to compare hospice aide use and factors associated with use across residential settings. Design: This longitudinal cohort study used data from Medicare beneficiaries in the United States enrolled in the Medicare Current Beneficiary Survey (MCBS) who died between 2010 and 2019 and had hospice claims and available residential setting data in MCBS (n = 1,915). Analysis: Decedent hospice aide use was compared by residential settings; multivariable models controlling for sociodemographic, clinical/functional, and hospice characteristics examined factors associated with hospice aide care in different residential settings. Results: Hospice aide visits were least common in the community setting (64.4% vs. 76.6% vs. 72.6% with any hospice aide visits in community, assisted living, and nursing home, respectively, p = 0.001). In adjusted models, factors associated with hospice aide visits did not significantly differ by residential settings. Conclusions: Despite staff providing hands-on support in assisted livings and nursing homes, hospice aide visits were more common in residential as opposed to community settings, and factors associated with hospice aide visits were similar among settings. To maximize the potentially positive impact of hospice aides on overall care, additional work is needed to understand when hospice aides are used and how hospice aides collaborate with families and care teams. This will help to ensure that hospice care is appropriately tailored to individual care needs in all residential settings.
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Affiliation(s)
| | - Karen McKendrick
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R Sean Morrison
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zainab Toteh Osakwe
- Adelphi University College of Nursing and Public Health, New York, New York, USA
| | | | - Melissa Aldridge
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Plys E, Ahmad N, Wei A, Thompson RA, Chang ES, Locke J, Bell JG, Vranceanu AM, Palan Lopez R. Psychosocial Distress Among Certified Nursing Assistants in Long-Term Care During the COVID-19 Pandemic: A Social Ecological Model Informed Scoping Review. Clin Gerontol 2024:1-18. [PMID: 38622883 DOI: 10.1080/07317115.2024.2337137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVES This scoping review maps the literature on psychosocial distress and coping among nursing assistants (CNAs) in long-term care facilities (LTC) during the COVID-19 pandemic onto the Social Ecological Model (SEM) of Occupational Stress. METHODS Searches yielded 862 unique studies. Inclusion criteria were sample CNAs or equivalent in LTC; includes psychosocial variable; and collect data from February 2020-. A multi-phasic, meta-synthesis was used to synthesize qualitative data. RESULTS We identified 20 studies (13 quantitative, 7 qualitative) conducted between March 2020 and December 2021 from 14 countries. Prevalence rates were reported for perceived stress (31-33%; n = 1 study), post-traumatic stress (42%; n = 1), anxiety (53%; n = 1), depression (15-59%; n = 2), suicidal thoughts (11-15%; n = 1), and everyday emotional burnout (28%; n = 1). Qualitative studies identified factors contributing to psychosocial distress and coping at each SEM level (i.e. individual, microsystem, organization, and peri-/extra-organizational). Quantitative studies primarily measured factors relating to psychosocial distress and coping at the individual and organizational levels. CONCLUSIONS & CLINICAL IMPLICATIONS This review identifies specific targets for intervention for psychosocial distress among CNAs in LTC at multiple levels, including job clarity; workload; facility culture; community relations; and policy. These intervention targets remain relevant to the LTC industry beyond the context of the COVID-19 pandemic.
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Affiliation(s)
- Evan Plys
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina Ahmad
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea Wei
- MGH Institute of Health Professions, School of Nursing, Boston, Massachusetts, USA
| | - Roy A Thompson
- School of Nursing, University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jenna Locke
- MGH Institute of Health Professions, School of Nursing, Boston, Massachusetts, USA
| | - Jessica G Bell
- MGH Institute of Health Professions, Bellack Library, Boston, Massachusetts, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Ruth Palan Lopez
- MGH Institute of Health Professions, School of Nursing, Boston, Massachusetts, USA
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Benham S, Milstrey B, Stemple J, Davis J, Scatena D, Bush J, Kolakowsky-Hayner S, Amy K. Mobile device accessibility with 3D printed devices for individuals with physical disabilities. Disabil Rehabil Assist Technol 2023:1-6. [PMID: 37982729 DOI: 10.1080/17483107.2023.2280244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Disparities may disproportionately exist for those with disabilities when using mobile devices, which are critical for independence in activities such as socialization and leisure. Prior 3D printing studies in rehabilitation have not focused on mobile device access to everyday preferred activities. METHODS This study examined user satisfaction, self-rated performance and satisfaction with daily activities while using the mobile device, and the feasibility of customized 3D printed assistive devices. The design was a one-group, quantitative pre-test to post-test study of individuals (n = 10) residing in long-term care with a physical disability due to a neurological condition. RESULTS Satisfaction with the 3D printed device, as compared to the previously used assistive device, was significantly higher (p = 0.005), as well as improvements in self-rated daily activity performance (p = 0.016) and satisfaction (p = 0.037), with acceptability and satisfaction of the intervention. CONCLUSIONS Findings suggest that 3D printing is feasible with a potential increase in user satisfaction through a customization process that is client centred.
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Affiliation(s)
- Sara Benham
- Rehabilitation Sciences, Moravian University, Bethlehem, PA, USA
| | - Brianna Milstrey
- Rehabilitation Sciences, Moravian University, Bethlehem, PA, USA
| | - Jordan Stemple
- Rehabilitation Sciences, Moravian University, Bethlehem, PA, USA
| | - Jennifer Davis
- Rehabilitation Sciences, Moravian University, Bethlehem, PA, USA
| | - Derek Scatena
- Rehabilitation Sciences, Moravian University, Bethlehem, PA, USA
| | - Jeffrey Bush
- Mathematics & Computer Science, Moravian University, Bethlehem, PA, USA
| | | | - Katelyn Amy
- Good Shepherd Creates, Good Shepherd Rehabilitation, Allentown
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Fong MC, Russell D, Gao O, Franzosa E. Contextual Forces Shaping Home-Based Health Care Services Between 2010 and 2020: Insights From the Social-Ecological Model and Organizational Theory. THE GERONTOLOGIST 2023; 63:1117-1128. [PMID: 35921664 PMCID: PMC9384634 DOI: 10.1093/geront/gnac113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Demands for home-based care have surged alongside population aging, preferences for aging in place, policy-driven reforms incentivizing lower hospital utilization, and public concerns around coronavirus disease 2019 transmissions in institutional care settings. However, at both macro and micro levels, sociopolitical, and infrastructural contexts are not aligned with the operational needs of home health care organizations, presenting obstacles to home health care equity. We integrate the social-ecological model and organizational theory to highlight contextual forces shaping the delivery of home-based care services between 2010 and 2020. Placing home-based health care organizations at the center of observation, we discuss patterns and trends of service delivery as systematic organizational behaviors reflecting the organizations' adaptations and responses to their surrounding forces. In this light, we consider the implications of provision and access to home care services for health equity, discuss topics that are understudied, and provide recommendations for home-based health care organizations to advance home health care equity. The article represents a synthesis of recent literature and our research and industry experiences.
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Affiliation(s)
- Mei-Chia Fong
- Business Intelligence and Analytics, VNS Health, New York, New York, USA
| | - David Russell
- Center for Home Care Policy & Research, VNS Health, New York, USA
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
| | - Oude Gao
- Business Intelligence and Analytics, VNS Health, New York, New York, USA
| | - Emily Franzosa
- Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Brouillette NM, Markkanen PK, Quinn MM, Galligan CJ, Sama SR, Lindberg JE, Karlsson ND. Aide and Client Safety "Should Go Hand-In-Hand": Qualitative Findings From Home Care Aides, Clients, and Agency Leaders. J Appl Gerontol 2023; 42:571-580. [PMID: 36565062 PMCID: PMC9996781 DOI: 10.1177/07334648221146769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides (n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.
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Affiliation(s)
- Natalie M Brouillette
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole D Karlsson
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
- Environmental Public Health Tracking Program, Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH, USA
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Schwartz LB, Lieblich C, Laxton CE, Kaes L, Barnett DP, Port C, Pace DD. COVID-19 in Assisted Living: Protecting a Critical Long-Term Care Resource. J Am Med Dir Assoc 2023; 24:134-139. [PMID: 36592942 PMCID: PMC9801232 DOI: 10.1016/j.jamda.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/17/2022] [Accepted: 12/10/2022] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic had a big impact on assisted living (AL), a vital setting in long-term care (LTC). Understanding the strengths and opportunities for improvement through practice, policy, and research are essential for AL to be prepared for the next pandemic and other challenges. AL communities experienced the pandemic in unique ways, because of varying regulatory environments, differences in familiarity with using and procuring personal protective equipment not typically used in AL (such as N95 masks), loss of family involvement, the homelike environment, and lower levels of licensed clinical staff. Being state rather than federally regulated, much less national data are available about the COVID-19 experience in AL. This article reviews what is known about cases and deaths, infection control, and the impact on residents and staff. For each, we suggest actions that could be taken and link them to the Assisted Living Workgroup Report (ALW) recommendations. Using the Center for Excellence in Assisted Living (CEAL) 15-year ALW report, we also review which of these recommendations have and have not been implemented by states in the preceding decade and half, and how their presence or absence may have affected AL pandemic preparedness. Finally, we provide suggestions for policy, practice, and research moving forward, including improving state-level reporting, staff vaccine requirements, staff training and work-life, levels of research-provider partnerships, dissemination of research, and uptake of a holistic model of care for AL.
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Affiliation(s)
- Lindsay B Schwartz
- Center for Excellence in Assisted Living (CEAL), Workforce & Quality Innovations, LLC, Bear Creek, NC, USA.
| | - Cathy Lieblich
- Center for Excellence in Assisted Living (CEAL), Pioneer Network, Orlando, FL, USA
| | - Christopher E Laxton
- Center for Excellence in Assisted Living (CEAL), AMDA, The Society for Post-Acute and Long-Term Care Medicine, Columbia, MD, USA
| | - Loretta Kaes
- Center for Excellence in Assisted Living (CEAL), American Assisted Living Nurses Association (AALNA), NAPA, CA, USA
| | - D Pearl Barnett
- Center for Excellence in Assisted Living (CEAL), ADvancing States, Arlington, VA, USA
| | | | - Douglas D Pace
- Center for Excellence in Assisted Living (CEAL), Alzheimer's Association, Washington, DC, USA
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Lai VSK, Yau SY, Lee LYK, Li BSY, Law SSP, Huang S. Caring for Older People during and beyond the COVID-19 Pandemic: Experiences of Residential Health Care Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15287. [PMID: 36430006 PMCID: PMC9692584 DOI: 10.3390/ijerph192215287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Older people and health care workers in residential care homes are particularly vulnerable to the adverse impacts of the COVID-19 pandemic. As COVID-19 has been spreading around the world for more than two years, the nature of care delivery has been substantially transformed. This study aims at understanding the long-term and ongoing impacts of COVID-19 on the delivery of care in residential care homes. It investigates how the delivery of care has been transformed by the COVID-19 pandemic and how health care workers adapted to these changes from the perspectives of frontline health care workers. Semi-structured interviews were conducted from February to December 2021 with a purposive sample of 30 health care workers from six residential care homes in Hong Kong. Thematic analysis identified three themes, including (1) enhancing infection prevention and control measures; (2) maintaining the psychosocial wellbeing of residents; and (3) developing resilience. Discussions and implications were drawn from these findings.
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Affiliation(s)
- Veronica Sze-Ki Lai
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Sui-Yu Yau
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Linda Yin-King Lee
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Becky Siu-Yin Li
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Susan Sin-Ping Law
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Shixin Huang
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, China
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Let's Rename Nursing Assistants What They Are: Professional Caregivers. J Am Med Dir Assoc 2022; 23:1755-1756. [DOI: 10.1016/j.jamda.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
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Zimmerman S, Cesari M, Gaugler JE, Gleckman H, Grabowski DC, Katz PR, Konetzka RT, McGilton KS, Mor V, Saliba D, Shippee TP, Sloane PD, Stone RI, Werner RM. The Inevitability of Reimagining Long-Term Care. J Am Med Dir Assoc 2022; 23:187-189. [DOI: 10.1016/j.jamda.2021.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
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Vellani S, Zuniga F, Spilsbury K, Backman A, Kusmaul N, Scales K, Chu CH, Mateos JT, Wang J, Fagertun A, McGilton KS. Who's in the House? Staffing in Long-Term Care Homes Before and During COVID-19 Pandemic. Gerontol Geriatr Med 2022; 8:23337214221090803. [PMID: 35529694 PMCID: PMC9073116 DOI: 10.1177/23337214221090803] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Critical gaps exist in our knowledge on how best to provide quality person-centered care to long-term care (LTC) home residents which is closely tied to not knowing what the ideal staff is complement in the home. A survey was created on staffing in LTC homes before and during the COVID-19 pandemic to determine how the staff complement changed. Perspectives were garnered from researchers, clinicians, and policy experts in eight countries and the data provides a first approximation of staffing before and during the pandemic. Five broad categories of staff working in LTC homes were as follows: (1) those responsible for personal and support care, (2) nursing care, (3) medical care, (4) rehabilitation and recreational care, and (5) others. There is limited availability of data related to measuring staff complement in the home and those with similar roles had different titles making it difficult to compare between countries. Nevertheless, the survey results highlight that some categories of staff were either absent or deemed non-essential during the pandemic. We require standardized high-quality workforce data to design better decision-making tools for staffing and planning, which are in line with the complex care needs of the residents and prevent precarious work conditions for staff.
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Affiliation(s)
- Shirin Vellani
- Faculty of Health Sciences, School of Nursing, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - Franziska Zuniga
- Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Karen Spilsbury
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, UK
| | | | - Nancy Kusmaul
- School of Social Work, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Kezia Scales
- Paraprofessional Healthcare Institute, Bronx, NY, USA
| | - Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - José Tomás Mateos
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Jing Wang
- Fudan University School of Nursing, Shanghai, China
| | - Anette Fagertun
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway
| | - Katherine S McGilton
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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Berridge C, Grigorovich A. Algorithmic harms and digital ageism in the use of surveillance technologies in nursing homes. FRONTIERS IN SOCIOLOGY 2022; 7:957246. [PMID: 36189442 PMCID: PMC9525107 DOI: 10.3389/fsoc.2022.957246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/26/2022] [Indexed: 05/10/2023]
Abstract
Ageism has not been centered in scholarship on AI or algorithmic harms despite the ways in which older adults are both digitally marginalized and positioned as targets for surveillance technology and risk mitigation. In this translation paper, we put gerontology into conversation with scholarship on information and data technologies within critical disability, race, and feminist studies and explore algorithmic harms of surveillance technologies on older adults and care workers within nursing homes in the United States and Canada. We start by identifying the limitations of emerging scholarship and public discourse on "digital ageism" that is occupied with the inclusion and representation of older adults in AI or machine learning at the expense of more pressing questions. Focusing on the investment in these technologies in the context of COVID-19 in nursing homes, we draw from critical scholarship on information and data technologies to deeply understand how ageism is implicated in the systemic harms experienced by residents and workers when surveillance technologies are positioned as solutions. We then suggest generative pathways and point to various possible research agendas that could illuminate emergent algorithmic harms and their animating force within nursing homes. In the tradition of critical gerontology, ours is a project of bringing insights from gerontology and age studies to bear on broader work on automation and algorithmic decision-making systems for marginalized groups, and to bring that work to bear on gerontology. This paper illustrates specific ways in which important insights from critical race, disability and feminist studies helps us draw out the power of ageism as a rhetorical and analytical tool. We demonstrate why such engagement is necessary to realize gerontology's capacity to contribute to timely discourse on algorithmic harms and to elevate the issue of ageism for serious engagement across fields concerned with social and economic justice. We begin with nursing homes because they are an understudied, yet socially significant and timely setting in which to understand algorithmic harms. We hope this will contribute to broader efforts to understand and redress harms across sectors and marginalized collectives.
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Affiliation(s)
- Clara Berridge
- School of Social Work, University of Washington, Seattle, WA, United States
- *Correspondence: Clara Berridge
| | - Alisa Grigorovich
- Recreation and Leisure Studies, Brock University, St. Catharines, ON, Canada
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