Supporting employees' work-family needs improves health care quality: Longitudinal evidence from long-term care

Understanding the experience of employees in assisted living facilities during the COVID-19 pandemic: A qualitative case study

The COVID-19 pandemic significantly impacted older adults, with assisted living facilities (ALFs) emerging as critical focal points for the spread and management of the virus in the United States. This study examines the challenges faced by workers in assisted living facilities during the pandemic and explores how the state policy impacted their professional and personal lives. The research team conducted semi-structured Zoom and in-person interviews with 29 employees at "Harmony House" in Oregon with the goal of understanding how they balanced federal and state guidelines for COVID-19 with the expectations of residents and their family members. An iterative thematic analysis based on grounded theory was adopted to analyze the transcripts of the 29 audio-recorded interviews. Nearly all participants reported facing a dilemma during the pandemic: they had to police the residents and their families and themselves during the pandemic to ensure the safety of the residents and to comply with the state policies, despite this approach conflicting with their professional training. This role conflict significantly increased their stress, impacting both their professional and personal lives. The findings highlight the complex role dynamics that ALF workers had to navigate, balancing their identity as compassionate caregivers with the unexpected and often distressing role of enforcer. By acknowledging and addressing these dual role demands, ALFs can improve not only the well-being of their staff but also the overall quality of care for their residents, ensuring better outcomes during and beyond public health crises.

Improving long-term care services: insights from high-reliability organizations

PURPOSE

Long-term care (LTC) organizations have struggled to protect their vulnerable clients from the ravages of the COVID-19 pandemic. Although various suggestions on containing outbreaks in LTC facilities have gained prominence, ensuring the safety of residents is not just a crisis issue. In that context, the authors must reasses the traditional management practices that were not sufficient for handling unexpected and demanding conditions. The purpose of this paper is to suggest rethinking the underlying attributes of LTC organizations and drawing insight from the parallels they have to high-reliability organizations (HROs).

DESIGN/METHODOLOGY/APPROACH

The authors analyzed qualitative data collected from a Canadian LTC facility to shed light on the current state of reliability practices and culture of the LTC industry and to identify the strengths and weaknesses of the traditional management approaches.

FINDINGS

To help the LTC industry develop the necessary crisis management capacity to tackle unexpected future challenges, there is an urgent need for adopting a more systemic top-down approach that cultivates mindfulness, learning and resilience.

ORIGINALITY/VALUE

This study contributes by applying the HRO theoretical lens in the LTC context. The study provides the LTC leaders with insights into creating a unified effort at the industry level to give rise to a high-reliability-oriented industry.

Validation of the Workplace Integrated Safety and Health (WISH) assessment in a sample of nursing homes using Item Response Theory (IRT) methods

OBJECTIVES

To validate and test the dimensionality of six constructs from the Workplace Integrated Safety and Health (WISH) assessment, an instrument that assesses the extent to which organisations implement integrated systems approaches for protecting and promoting worker health, safety and well-being, in a sample of nursing homes in the USA.

DESIGN

Validation of an assessment scale using data from a cross-sectional survey.

SETTING

Nursing homes certified by the Centers for Medicaid and Medicare services in three states of the USA: Ohio, California and Massachusetts.

PARTICIPANTS

569 directors of nursing from nursing homes serving adults and with more than 30 beds participated in the study.

RESULTS

Graded response Item Response Theory (IRT) models showed that five out of six constructs were unidimensional based on balanced interpretation of model fit statistics-M2 or C2 with p value >0.05, Comparative Fit Index >0.95, lower bound of the root mean squared error of approximation 90% CI <0.06 and standardised root mean square residual <0.08. Overall measure and construct reliability ranged from acceptable to good. Category boundary location parameters indicated that items were most informative for respondents in lower range of latent scores (ie, β1, β2, β3 typically below 0). A few items were recommended to be dropped from future administrations of the instrument based on empirical and substantive interpretation.

CONCLUSIONS

The WISH instrument has utility to understand to what extent organisations integrate protection and promotion of worker health, safety and well-being; however, it is most informative in organisations that present lower scores.

How to ask: Surveying nursing directors of nursing homes

BACKGROUND AND AIMS

Nursing home research may involve eliciting information from managers, yet response rates for Directors of Nursing have not been recently studied. As a part of a more extensive study, we surveyed all nursing homes in three states in 2018 and 2019, updating how to survey these leaders effectively. We focus on response rates as a measure of non-response error and comparison of nursing home's characteristics to their population values as a measure of representation error.

METHODS

We surveyed Directors of Nursing or their designees in nursing homes serving adult residents with at least 30 beds in California, Massachusetts, and Ohio (N = 2389). We collected contact information for respondents and then emailed survey invitations and links, followed by three email reminders and a paper version. Nursing home associations in two of the states contacted their members on our behalf. We compared the response rates across waves and states. We also compared the characteristics of nursing homes based on whether the response was via email or paper. In a multivariable logit regression, we used characteristics of the survey and the nursing homes to predict whether their DON responded to the survey using adjustments for multiple comparisons.

RESULTS

The response rate was higher for the first wave than for the second (30% vs 20.5%). The highest response rate was in Massachusetts (31.8%), followed by Ohio (25.8%) and California (19.5%). Nursing home characteristics did not vary by response mode. Additionally, we did not find any statistically significant predictors of whether a nursing home responded.

CONCLUSION

A single-mode survey may provide a reasonably representative sample at the cost of sample size. With that said, however, switching modes can increase sample size without potentially biasing the sample.