A Description of Staff-resident Interactions in Assisted Living

Quality of life in assisted living facilities for seniors: A descriptive exploratory study

INTRODUCTION

Promoting individuals' health across different life spans has always been key to a holistic nursing practice. Seniors are a diverse population who go through many physical and mental changes as they age. During the last decade, assisted living facilities (ALFs) have dramatically increased in numbers to provide care and living services in a home-like environment.

AIM

The aim of this descriptive exploratory study was to explore the quality of life as perceived by seniors who reside in assisted living facilities (ALFs).

DESIGN

This study utilized a descriptive exploratory design to investigate the quality of life of seniors living in ALFs.

METHODS

Seventeen residents from two ALFs were interviewed to gather their perspectives on the quality of their lives while living in an ALF. The interviews were conducted by the researcher and were audio-recorded and transcribed verbatim. The data were analysed using thematic analysis.

RESULTS

Three major themes surfaced from residents' descriptions: 'physical environment', 'social environment' and 'home-like atmosphere'. The quality of life in ALFs was found to be predominantly an outcome of the exchange between the personal capability of residents to adapt to changes and the capacity of the facility to meet residents' diverse needs.

PATIENT OR PUBLIC CONTRIBUTION

Participants who discussed their quality of life in ALFs provided profound insights into this aspect of their lives. The findings from this study can potentially enlighten ALF stakeholders and enhance the quality of life for seniors residing in these facilities.

Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living

Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are primarily responsible for noncompliance, (2) unclear parameters place direct care workers in a role paradox, and (3) there is a persistent disconnect about when to seek qualified expertise before requesting psychotropic medications. AL/RC-specific mechanisms for medication prescription and administration are necessary to improve the structure and processes of care. Policymakers might consider how regulations unintentionally incentivize task-oriented versus person-centered care practices.

Model Testing of the Factors that are Associated with Care Interactions among Nursing Home Residents with Dementia

OBJECTIVE

The purpose of this study was to test a model of the resident and community factors that are associated with quality of care interactions among nursing home (NH) residents living with dementia and test for invariance between model fit when tested with the Black versus White residents and female versus male residents. It was hypothesized that resident age, gender, race, pain, comorbidities, quality of life, resistiveness to care, function, cognition, community profit status, overall community star rating, community size, and staffing star rating would be directly and/or indirectly associated with quality of care interactions. It was also hypothesized that the model fit would be invariant by resident race and gender.

DESIGN

This was a secondary data analysis using baseline, cross-sectional data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) intervention study.

SETTING AND PARTICIPANTS

The study included 528 residents from 55 NH facilities.

METHODS

Descriptive statistics and structural equation modeling was used to test the proposed model.

RESULTS

The results showed that the final model with significant paths only had a poor fit to the data (χ2/df = 10.79, comparative fit index = 0.57, Tucker-Lewis index = 0.15, normed fit index = 0.57, root mean square error of approximation = 0.13). However, the findings indicated that comorbidities, pain, profit status, and overall community star rating were significantly associated with quality of care interactions. There was no difference in model fit between Black residents versus White residents, and between male versus female residents.

CONCLUSIONS AND IMPLICATIONS

This study suggests factors that may influence quality of care interactions. Managing comorbidities, managing pain, and supporting higher quality of care in NH communities will likely help increase the frequency of positive care interactions. These findings can inform future interventions and training curricula for NH care staff to promote positive care interactions.

Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living

The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited from the memory care unit. Delivery, receipt, and enactment of the PPCI were assessed for feasibility. Change in staff outcomes and facility outcomes were examined for preliminary efficacy. The four steps of the PPCI were implemented as intended with 100% staff exposure to education and considerable staff engagement in weekly mentoring sessions. Although there was an improvement in AL environment and policy, no significant changes were observed in staff outcomes. Future testing of the PPCI should include a longer timeline and explore a hybrid model that includes online education and in-person mentoring and coaching of staff to improve care interactions. [Journal of Gerontological Nursing, 48(8), 17-25.].

"We Weathered the Storm": A Qualitative Phenomenological Study of the Lived Experience of Assisted Living Administrators During the COVID-19 Pandemic

The purpose of the current qualitative phenomenological study is to learn about the lived experiences of assisted living (AL) community administrators during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about how administrators coped with the ever-changing mandates (e.g., visitation, testing, communal activities, acceptance of COVID-positive residents). Semi-structured interviews with AL administrators were conducted, transcribed verbatim, and analyzed for meaning and essence using a modified Giorgi's approach. Data analysis showed that administrators experienced a multitude of feelings and actions related to the well-being of staff, residents, and residents' families. Findings also identified the complexity of the constant changes, including limited resources and policy changes, of the AL administrators' lived experiences during the pandemic. Results from this study can inform policies and strategies for providing care to this often-overlooked population of older adults. [Research in Gerontological Nursing, xx(x), xx-xx.].

Factors Influencing Long-Term Care Workers' Self-Efficacy for Encouraging Residents to Engage in Physical Activity

We aimed to assess work-related factors and their association with long-term care workers' self-efficacy for encouraging and engaging residents in physical activity. Baseline data from a worksite wellness study with 98 workers were used. We used a linear regression model, to assess if job satisfaction, work ability, and social support for staff health behaviors from coworkers and supervisors were associated with staffs' self-efficacy for Function-Focused Care (FFC) and Staffs' Outcome Expectations for FFC. Staffs' social support for healthy behaviors from coworkers was the only factor that was significantly associated with Staffs' Outcome Expectations for FFC and staffs' self-efficacy-FFC, respectively explaining 19% and 14% of the variance. Our findings show that staffs' social support from coworkers is associated with higher self-efficacy for encouraging and engaging residents in physical activity suggests future worksite wellness studies with long-term care workers may wish to consider assessing program impacts on residents' physical activity levels.

Promising best practices implemented in long-term care homes during COVID-19 pandemic to address social isolation and loneliness: a scoping review protocol

INTRODUCTION

Prior to the COVID-19 pandemic, social isolation and loneliness (SIL) affected at least one-third of the older people. The pandemic has prompted governments around the world to implement some extreme measures such as banning public gatherings, imposing social distancing, mobility restrictions and quarantine to control the spread and impact of the novel coronavirus. Though these unprecedented measures may be crucial from a public health perspective, they also have the potential to further exacerbate the problems of SIL among residents in long-term care homes (LTCHs). However, some LTCHs have developed promising best practices (PBPs) to respond to the current situation and prepare for future pandemics. Key aspects of such practices revolve around maintaining and strengthening social connections between residents and their families which helps to reduce SIL. This scoping review looks at existing PBPs that have been implemented to reduce SIL among LTCH residents during the most recent pandemics.

METHODS AND ANALYSIS

We will follow Arksey and O'Malley's framework of scoping review, further developed by Levac et al. In addition, we will also apply the Joanna Briggs Institute Reviewers' 'Methodology for Scoping Reviews'. Ten electronic databases and grey literature will be searched for articles published from January 2003 to March 2021 in either English or French. Two reviewers will independently screen titles and abstracts and then full texts for final inclusion. Data will be extracted using a standardised form from 'Evidence for Policy and Practice Information'. The results will be presented in a tabular form and will be summarised and interpreted using a narrative synthesis.

ETHICS AND DISSEMINATION

Formal ethical approval is not required as no primary data are collected. Findings will be used to develop a solid knowledge corpus to address the challenges of SIL in LTCHs. Our findings will help to identify cutting edge practices, including technological interventions that could support health services in addressing SIL in the context of LTCHs and our ageing society.