Working at Green Care Farms and Other Innovative Small-Scale Long-Term Dementia Care Facilities Requires Different Competencies of Care Staff

Staff outcomes and the work environment in Green Care Farms and traditional nursing homes: A comparative study

INTRODUCTION

Green Care Farms are an alternative long-term care setting for people with dementia. Organizing daily life around a shared household and integrating nature and animals, they emphasize resident participation and activation. Such a radically different care environment not only affects residents, but also nursing staff who provide the care.

OBJECTIVE

To explore nursing staff outcomes and work environment characteristics of Green Care Farms and compare them with traditional nursing homes for people with dementia.

DESIGN

A comparative study based on a cross-sectional survey design1.

SETTING(S)

Green Care Farms for people with dementia, which provide care in an archetypical household, where nature and animals are an integrated part of daily life and where staff has integrated tasks (experimental group). Traditional psychogeriatric nursing homes for residents with dementia, where residents live in large wards, organizational routines determine daily life, and staff has differentiated tasks (comparison group).

PARTICIPANTS

All staff working direct resident care. The total sample included 262 staff members from 10 Green Care Farms and 380 staff members from 21 traditional nursing homes in the Netherlands.

METHODS

A questionnaire with eight measures was distributed online. Data were analyzed using regression analysis.

RESULTS

Both groups reported similar work demands and expected a similar sustainable work performance in the future. However, staff in Green Care Farms experienced better work satisfaction (mean = 4.28; 95 % CI = 4.14-4.43) than those working in traditional nursing homes (mean = 3.67; 95 % CI = 3.54-3.8). Furthermore, they reported more work resources, more vitality, better recovery after work, and a better team climate than staff in traditional nursing homes.

CONCLUSIONS

Knowing that work dissatisfaction, stress and burnout are predictors for staff turnover, the findings suggest that elements from the Green Care environment might provide a healthier work environment for staff compared to traditional nursing homes. More research is needed on these elements, to guide other nursing homes to improve their work environment.

Fostering an active daily life: An ethnographic study unravelling the mechanisms of Green Care Farms as innovative long-term care environment for people with dementia

OBJECTIVES

Green Care Farms (GCFs) are gaining attention as innovative dementia care environment. Compared with regular nursing homes, first studies suggested a more active daily life, more social interaction and a higher quality of life of GCF residents. Regular facilities aiming to redesign and implement GCF elements might be hindered to do so by a lack of space for meadows or regulations prohibiting animals. Therefore, this study explored the underlying mechanisms by which GCFs may generate the positive effects.

DESIGN

This study is an observational, explorative study using multiple methods.

SETTING

One GCF and one traditional nursing home aiming to implement GCF elements.

PARTICIPANTS

Residents, family members, staff, managers, and other involved individuals of the two nursing homes.

MEASUREMENTS

Ethnographic observations (n = 52 days), semi-structured interviews (n = 67) and a focus group with experts from various disciplines were conducted. Data was analyzed thematically and triangulated.

RESULTS

We identified six possible mechanisms of GCFs encouraging an active daily life. These are: 1) stimulating the senses, 2) promoting engagement in purposeful activities tailored to the individual, 3) creating a community, 4) promoting freedom and autonomy in a responsible way, 5) integrating the vision in all actions, and 6) continuously transforming to carry out the vision in practice.

CONCLUSIONS

Our results provide first insights into environmental working mechanisms, which are relatively generic and have the potential to be transferred to other settings. Hence, this study provides other care organizations with guidance on implementing the care vision of GCFs in their local context.

WHAT IS ALREADY KNOWN

WHAT THIS PAPER ADDS.

Utilizing the physical green care environment to support activities of daily living for nursing home residents: a focused ethnographic case study

BACKGROUND

The nursing home residents' ability to carry out Activities of Daily Living (ADLs) is influenced by the physical care environment. One emerging area of interest in scientific research is the green care environment within nursing home care, where agricultural activities such as gardening and animal care are integrated alongside daily care. Previous research has neglected to explore how these environments can be employed to enhance ADL performance. This study, therefore, explores how a green care environment, specifically one with an animal shelter, can be used to support nursing home residents in their ADLs.

METHODS

A focused ethnographic case study was conducted in one nursing home. Data was collected employing participatory observations, informal conversations, and semi-structured interviews, which we analyzed by employing a thematic analysis.

RESULTS

Overall, 25 residents were observed for a total time of 89h, and interviews were conducted with 10 staff members. The nursing home integrates activities in the green care environment into daily care for a broad scope of residents. The analysis revealed four themes: (1) The (in)visibility of ADL, (2) Reciprocal care dynamics: Fostering ADL performance through connection and teamwork, (3) Seized and missed opportunities for meaningful integration of ADL in the physical green care environment, and Theme (4) Professional fulfillment and ADL task obligation: Views from staff and management.

CONCLUSIONS

This physical green care environment carries the potential to enhance the residents' daily activities and foster better staff-resident relationships. Yet, there are varying views among staff and management regarding its integration into the residents' lives and care.

The perspectives of older people living with dementia regarding a possible move to a nursing home

BACKGROUND/OBJECTIVES

Moving into a nursing home is often an unavoidable life event for older people living with dementia. It is associated with negative emotions and outcomes. Research capturing their perspectives is scarce. This study aims to identify how older people living with dementia perceive a potential life in a nursing home and to understand their (future) care wishes.

MATERIALS AND METHODS

This study is part of the European TRANS-SENIOR research network. The study followed a qualitative phenomenological methodology. Semi-structured interviews with 18 community-dwelling older people living with dementia were conducted between August 2018 and October 2019 (METCZ20180085). A stepwise interpretive phenomenological analysis was performed.

RESULTS

The majority of community-dwelling older people feared the idea of potentially moving to a nursing home. The participants associated a possible move with negative perceptions and emotions. Additionally, this study emphasized the importance of knowledge of current and past experiences with care when identifying the participant's wishes. They wanted to remain (a) individuals, who are (b) autonomous and have (c) social contacts if they would move to a nursing home.

DISCUSSION/IMPLICATIONS

This study showed how past and current care experiences can educate/inform healthcare professionals on the future care wishes of older people living with dementia. The results indicated that listening to the wishes, and life stories of people living with dementia could be a way of identifying 'a suitable time' to suggest a move to a nursing home. This could improve the transitional care process and adjustment to living in a nursing home.

An overview of innovative living arrangements within long-term care and their characteristics: a scoping review

BACKGROUND

Within long-term care, a culture change (e.g. focus on increasing autonomy in everyday life) is leading to the development of innovative living arrangements for older adults. Insight into characteristics of innovative living arrangements, which are described as an alternative to regular nursing homes, is lacking. This review aims to provide an overview of innovative living arrangements and to describe their defining characteristics.

METHODS

A scoping review was performed following the framework of Arksey and O'Malley. The preferred reporting items for systematic reviews and meta-analyses with extension, for scoping reviews (PRISMA-ScR) was also followed. The databases PubMed, PsycInfo, CINAHL, and Web of Science were searched. Articles, published between 2012 and 2023 were included when they presented an innovative living arrangement as an alternative to regular nursing homes. A thematic analysis was performed, describing the physical, social, and organizational environment of the innovative living arrangements.

RESULTS

Fifty-six articles were identified describing seven types of distinct innovative living arrangements: small-scale living, the green house model, shared housing arrangements, green care farms, dementia villages, group homes, intergenerational living, and an 'other' category. The themes included supporting autonomy and creating a small-scale and/or homelike environment, which were emphasized in most innovative living arrangements. Other themes, such as involvement of the community, focus on nature, integration of work tasks, and involvement of family members, were emphasized in a subsection of the described living arrangements. Twenty-eight articles reported on the effects of the innovative living environment on residents, family members, or staff members. Most articles (N = 22) studied resident-related outcomes, focusing mainly on quality of life and aspects of daily life.

CONCLUSION

More insight into the mechanisms of the social and organizational environments is needed, which may lead to greater transparency and homogeneity regarding the description of living arrangements. This review shows that more knowledge is needed about the potential key elements of innovative living arrangements, especially related to their social and organizational environment. This may provide a better guide for developers within long-term care.

End-of-life care for people with dementia on a green care farm during the COVID-19 pandemic: a qualitative study

OBJECTIVE

Green care farms combine agriculture production with health-related, social and educational services. In the Netherlands, they form an alternative to traditional nursing homes for people with dementia. Green care farms that offer 24-hour care, also offers end-of-life care. To date, little is known about end-of-life care for people with dementia on green care farms. This study aimed to explore the experiences of healthcare workers and family caregivers with end-of-life care for people with dementia who died on a green care farm.

DESIGN

An explorative, descriptive qualitative design with a phenomenological approach.

SETTING AND PARTICIPANTS

A purposive sample of 15 participants - seven healthcare workers and eight family caregivers - from three green care farms in the Netherlands.

METHODS

Semi-structured, in-depth interviews were conducted to explore participants' experiences with end-of-life care, including topics such as advance care planning, the influence of COVID-19, and bereavement support. Transcripts were thematically analysed using Braun and Clarke's approach.

RESULTS

Four main themes were extracted: 1) tailored care and attention for the individual resident, 2) reciprocal care relationships between healthcare workers and family caregivers, 3) compassionate care and support in the dying phase, and 4) the influence of COVID-19 on end-of-life care.

CONCLUSION AND IMPLICATIONS

The overall experience of the healthcare workers and family caregivers was that end-of-life care offered on green care farms is person-centred and compassionate and is tailored to the person with dementia and their family caregivers. Despite the COVID-19 pandemic, healthcare workers and family caregivers were satisfied with end-of-life care on the green care farms. Green care farms may offer a valuable alternative care setting for people with dementia in their last phase of life. More research is needed to investigate green care farms'benefits compared to other, more traditional settings.