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D'Ascanio AM, Hewlett D, Davda K, Montecalvo MA. Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022. J Public Health Manag Pract 2024; 30:346-353. [PMID: 38603743 DOI: 10.1097/phh.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
CONTEXT Assisted living facility (ALF) residents are especially vulnerable to SARS-CoV-2 infection due to the age and comorbidities of the resident population and the social nature of these facilities. OBJECTIVE To collate all New York State Department of Health guidance and regulations to control transmission of SARS-CoV-2 infection within ALFs from March 2020 through December 2022 and to include US Food and Drug Administration COVID-19 testing and vaccine authorizations. DESIGN A narrative chronological review of all New York State Department of Health guidance. RESULTS Documents and associated guidance and regulations are divided into 4 sections: (1) lockdown until COVID-19 vaccine emergency use authorization; (2) COVID-19 vaccine authorization until phased reopening; (3) phased reopening, vaccination requirements, and booster vaccination; (4) the period of the bivalent booster. CONCLUSION Controlling the spread of SARS-CoV-2 within ALFs required a multifactorial approach that included stringent infection control measures, testing, and vaccination and careful attention to the social structure and support systems within ALFs. The SARS-CoV-2 pandemic highlighted the complexity of controlling spread of an easily transmissible respiratory pathogen in assisted living communities and the need to structure infection control programs within the diverse ALFs that provide care for our aging population.
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Affiliation(s)
- Antonella M D'Ascanio
- Author Affiliations: New York Medical College, Valhalla, New York (Ms D'Ascanio and Dr Montecalvo); Westchester County Department of Health, White Plains, New York (Drs Hewlett and Montecalvo); and Bureau of Communicable Disease Control, New York State Department of Health, Albany, New York (Ms Davda)
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Levenson S, Resnick B, Katz P. Recommendations for Next Steps in Our Understanding of Use of Antipsychotics Among Older People in the Post-Acute Long-Term Care Environments: Article 3 of 3. Sr Care Pharm 2024; 39:169-172. [PMID: 38685619 DOI: 10.4140/tcp.n.2024.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article is the third installment of a multi-part series on the history and usage of antipsychotics in older people living in nursing and assisted living facilities. This article presents next steps and recommendations for appropriate usage of antipsychotics in the older population based on the lead author's early drafts, submitted to the editors prior to his untimely death, of this series and on his consultations with the coauthors. Dr Levenson emphasized in his focus on next steps related to antipsychotic use: that all providers should review the history of antipsychotic use and recognize clinically legitimate alternative explanations for the findings. His conclusions were that "off label" usage should not be a reason to exclude the appropriate use of antipsychotics. His overall recommendations to clinicians are to assess and diagnose the underlying cause of the problem, understand the treatment options and select the best one to address the clinical problem and/or the symptom if the problem cannot be fully resolved, and to focus on all medications, not just antipsychotics, in a patient's regimen to aid in a comprehensive understanding of the assessment and inform therapeutic recommendations.
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Affiliation(s)
- Steven Levenson
- 1 Deceased, former post-acute long-term care physician and medical director
| | | | - Paul Katz
- 3 College of Medicine, Florida State University, Tallahassee, Florida
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Smith L, Carder P, Hua C, Zimmerman S, Sloane PD, Zhang W, Wretman CJ, Cornell P, Thomas KS. A National Typology of Health Service Regulation in Assisted Living. Gerontologist 2024; 64:gnad109. [PMID: 37549891 PMCID: PMC11020221 DOI: 10.1093/geront/gnad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES State-regulating agencies use 350 different licenses and certifications to govern assisted living (AL), resulting in significant variation in regulations governing health services, the scope of practice, and capacity. This lack of standardization makes it difficult to compare and contrast AL operations and residents' outcomes across similarly regulated communities. RESEARCH DESIGN AND METHODS We used qualitative and quantitative methods to empirically develop and describe a typology of state AL regulations that captures inter- and intrastate variation. Based on the rules governing health services, we created regulatory specificity scores for 5 thematic dimensions: medication administration, third-party care, skilled nursing, medication review, and licensed nurse staffing. With these scores, we conducted a K-means cluster analysis to identify groups of AL license types. To differentiate the regulatory types, we calculated standardized mean differences across structure, process, outcome, and resident characteristics of the AL communities licensed under each type. RESULTS We identified 6 types of AL differentiated by the regulatory provisions governing health services: Housing, Holistic, Hybrid, Hospitality, Healthcare, and Health Support. The types align with previous work and reflect tangible differences in resident characteristics, health service structures, processes, and outcomes. DISCUSSION AND IMPLICATIONS This typology effectively captures differences across regulated dimensions and can inform and support quality of care. Researchers, policy-makers, and consumers may benefit from using this typology and acknowledging these differences in AL licensure when designing research studies, developing policies, and selecting an AL community.
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Affiliation(s)
- Lindsey Smith
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Institute on Aging, Portland State University, Portland, Oregon, USA
| | - Paula Carder
- Institute on Aging, Portland State University, Portland, Oregon, USA
- Oregon Health & Science University, Portland State University School of Public Health, Portland, Oregon, USA
| | - Cassandra Hua
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Social Work and the Center for Excellence in Assisted Living, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Philip D Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wenhan Zhang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Portia Cornell
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Kali S Thomas
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
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Zimmerman S, Stone R, Carder P, Thomas K. Does Assisted Living Provide Assistance And Promote Living? Health Aff (Millwood) 2024; 43:674-681. [PMID: 38709966 DOI: 10.1377/hlthaff.2023.00972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Assisted living has promised assistance and quality of living to older adults for more than eighty years. It is the largest residential provider of long-term care in the United States, serving more than 918,000 older adults as of 2018. As assisted living has evolved, the needs of residents have become more challenging; staffing shortages have worsened; regulations have become complex; the need for consumer support, education, and advocacy has grown; and financing and accessibility have become insufficient. Together, these factors have limited the extent to which today's assisted living adequately provides assistance and promotes living, with negative consequences for aging in place and well-being. This Commentary provides recommendations in four areas to help assisted living meet its promise: workforce; regulations and government; consumer needs and roles; and financing and accessibility. Policies that may be helpful include those that would increase staffing and boost wages and training; establish staffing standards with appropriate skill mix; promulgate state regulations that enable greater use of third-party services; encourage uniform data reporting; provide funds supporting family involvement; make community disclosure statements more accessible; and offer owners and operators incentives to facilitate access for consumers with fewer resources. Attention to these and other recommendations may help assisted living live up to its name.
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Affiliation(s)
- Sheryl Zimmerman
- Sheryl Zimmerman , University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Paula Carder
- Paula Carder, Portland State University, Portland, Oregon
| | - Kali Thomas
- Kali Thomas, Johns Hopkins University, Baltimore, Maryland
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Temkin-Greener H, Guo W, McGarry B, Cai S. Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement. J Am Med Dir Assoc 2024; 25:917-922. [PMID: 38575115 PMCID: PMC11065589 DOI: 10.1016/j.jamda.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Assess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. DESIGN 2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for up to 2 years to track their NH placement. We used data from the Medicare Enrollment Database, the Medicare Beneficiary Summary File, Minimum Data Set, and a national directory of state-licensed AL communities. AL residents were identified using a validated, previously reported 9-digit zip code methodology. SETTING AND PARTICIPANTS A cross-sectional study sample included 289,350 Medicare beneficiaries in 17,265 AL communities across 50 states and in the District of Columbia. METHODS The outcome was permanent NH placement: a continuous stay for more than 90 days. Key independent variable was presence of SMI-schizophrenia, bipolar disorder, and major depression. Other covariates included sociodemographic factors and presence of other chronic conditions, including ADRD. A linear probability model with robust SEs, and AL-level random effects, was used to test the association between SMI diagnoses, ADRD, and their interactions on NH placement. RESULTS More than half (55.65%) of AL residents had a diagnosis of SMI, among them 93.2% had major depression, 28.5% schizophrenia, and 22.2% bipolar disorder. Individuals with schizophrenia and bipolar disorder had a significantly lower probability of NH placement, a 32% and a 15% decrease relative to the cohort mean, respectively. Placement risk was significantly greater for residents with ADRD compared to those without, increasing for those who also had schizophrenia or bipolar disorder, 12.9% and 1.5% relative to the sample mean, respectively. CONCLUSION AND IMPLICATIONS Presence of schizophrenia and bipolar disorder, in conjunction with ADRD, significantly increases the risk of long-term NH placement, suggesting that ALs may not be well prepared to care for these residents.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
| | - Wenhan Guo
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Brian McGarry
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
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Sturge J, Janus S, Zuidema S, Frederiks B, Schweda M, Landeweer E. The Moral and Gender Implications of Measures Used to Modulate the Mobility of People With Dementia Living in Residential Care Environments: A Scoping Review. Gerontologist 2024; 64:gnad071. [PMID: 37330640 PMCID: PMC10943503 DOI: 10.1093/geront/gnad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can violate human rights and affect the quality of life. This review aims to summarize the literature on what is known about measures used to modulate the life-space mobility of residents with dementia living in a residential care environment. Furthermore, moral and sex and gender considerations were explored. RESEARCH DESIGN AND METHODS A scoping review framework was referenced to summarize the literature. A total of 5 databases were searched: PubMed, Embase, CINAHL, SCOPUS, and Web of Science. The studies for eligibility using the Rayyan screening tool. RESULTS A total of 30 articles met the inclusion criteria. A narrative description of the findings of the articles is presented across 3 themes: (1) measures and strategies used to modulate the life-space mobility; (2) moral aspects; and (3) sex and gender considerations. DISCUSSION AND IMPLICATIONS Various measures are used to modulate the life-space mobility of people with dementia living in residential care facilities. Research exploring the sex and gender differences of people with dementia is lacking. With a focus on human rights and quality of life, measures used to restrict or support mobility must support the diverse needs, capacity, and dignity of people with dementia. Noting the capacity and diversity of people with dementia will require society and public space to adopt strategies that promote safety and mobility to support the quality of life of people with dementia.
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Affiliation(s)
- Jodi Sturge
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda Frederiks
- Department of Ethics, Law and Humanities, University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Mark Schweda
- Division of Ethics in Medicine, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Elleke Landeweer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Dancis A. Do-Not-Hospitalize Orders in Assisted Living Facilities: Direct Care Workers' Perspectives. J Gerontol Nurs 2024; 50:11-15. [PMID: 38569104 DOI: 10.3928/00989134-20240311-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE To gather sufficient qualitative data to create an intervention that would prevent direct care workers (DCWs) from sending residents with do-not-hospitalize (DNH) orders to the hospital. METHOD This was a qualitative study with eight participants that included a descriptive survey followed by semi-structured interviews. RESULTS DCWs were unfamiliar with DNH orders and their thinking on end-of-life care was binary (hospice or hospital) and protocol driven. However, supportive leaders were able to help DCWs problem-solve these complicated scenarios. Results were mixed on whether having a RN on site was helpful. CONCLUSION DCWs may benefit from having access to a nurse with palliative care experience when making decisions about residents with DNH orders. [Journal of Gerontological Nursing, 50(4), 11-15.].
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Experiences of health care personnel in promoting a sense of home in older adults living in residential care facilities. Nurs Health Sci 2024; 26:e13088. [PMID: 38369303 DOI: 10.1111/nhs.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
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Bleck C, Höppner G. [The relationship between participation and space in residential care facilities for older people]. Z Gerontol Geriatr 2024; 57:140-145. [PMID: 37084090 PMCID: PMC10914890 DOI: 10.1007/s00391-023-02176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/03/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Participation has been a key issue in gerontology, geriatric care policy and practice for several years now. The relationship between participation and space plays a role in the discussion about community orientation. So far, little attention has been paid to the relationship between participation and space within residential care facilities for older people. MATERIAL AND METHODS Qualitative data from two studies on residential care facilities for older people were secondarily analyzed by a "supra-analysis" and using qualitative content analysis with respect to participation in relation to space and space in relation to participation. RESULTS Almost all levels of the participation ladder considered can be found with respect to the co-design of spaces, although residents with dementia are granted fewer opportunities for participation. In addition, spaces can create conditions for participation through their arrangement. Reciprocal relationships are condensed in processes of space appropriation, design and planning. If there is no access to these processes, self-determined everyday life is limited. CONCLUSION The results contribute to a spatially related development of participation concepts because they show in which spatial contexts participation is produced in institutional settings through the interaction of different actors and how it is distributed spatially. In order to promote participation in institutions, it is important to reflect on existing possibilities for spatial appropriation, design and planning against the background of institutional framework conditions.
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Affiliation(s)
- Christian Bleck
- Fachbereich Sozial- und Kulturwissenschaften, Hochschule Düsseldorf, Münsterstraße 156, 40476, Düsseldorf, Deutschland
| | - Grit Höppner
- Fachbereich Sozialwesen, Katholische Hochschule Nordrhein-Westfalen, Piusallee 89, 48147, Münster, Deutschland.
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Alomari E, Steinke C. Quality of life in assisted living facilities for seniors: A descriptive exploratory study. Nurs Open 2024; 11:e2084. [PMID: 38429879 PMCID: PMC10907605 DOI: 10.1002/nop2.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 03/03/2024] Open
Abstract
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.
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Affiliation(s)
- Elham Alomari
- Nursing Faculty, Faculty of NursingUniversity of Calgary in QatarDohaQatar
| | - Claudia Steinke
- Faculty of Health SciencesUniversity of LethbridgeLethbridgeAlbertaCanada
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Loomer L. Worse quality at for-profit assisted living facilities in non-urban Minnesota. J Am Geriatr Soc 2024; 72:624-626. [PMID: 37909323 DOI: 10.1111/jgs.18657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/01/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Lacey Loomer
- Department of Economics and Health Care Management, Labovitz School of Business and Economics, University of Minnesota Duluth, Duluth, Minnesota, USA
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Johs-Artisensi JL. An Examination of Assisted Living Facility Administrator Qualifications Across States. J Aging Soc Policy 2024; 36:69-86. [PMID: 36328373 DOI: 10.1080/08959420.2022.2139124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Abstract
Resident acuity, Medicaid's increased role in funding assisted living, and the COVID-19 pandemic have brought increased attention to the regulatory environment of assisted living facilities (ALFs) and the responsibilities of ALF administrators (ALFAs) are growing increasingly complex. This study explores, describes, and compares the education (degree and assisted living-specific training), experience, exam (competency), and continuing education requirements for ALFAs across all states, and how states' requirements compare to national assisted living associations' suggested standards for entry-level and ongoing practice. Wide variation in ALFA qualifications are identified, with some states found to have extremely low qualification requirements.
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Affiliation(s)
- Jennifer L Johs-Artisensi
- Professor and Program Director, Health Care Administration Program, Department of Management and Marketing, University of Wisconsin - Eau Claire, Eau Claire, Wisconsin, USA
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Khirallah Abd El Fatah N, Abdelwahab Khedr M, Alshammari M, Mabrouk Abdelaziz Elgarhy S. Effect of Immersive Virtual Reality Reminiscence versus Traditional Reminiscence Therapy on Cognitive Function and Psychological Well-being among Older Adults in Assisted Living Facilities: A randomized controlled trial. Geriatr Nurs 2024; 55:191-203. [PMID: 38007908 DOI: 10.1016/j.gerinurse.2023.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Virtual reality (VR) reminiscence is an innovative strategy that integrates technology into the care of older adults. Limited research was conducted to compare the role of VR reminiscence and traditional RT in improving older adults' cognitive and psychological well-being. AIM Investigate the effect of virtual reality reminiscence versus traditional reminiscence therapy on cognitive function and psychological well-being among older adults in assisted living facilities. METHODS A randomized controlled trial research design was followed. Sixty older adults were recruited and randomly assigned to three equal groups (20 older adults for each group). RESULTS Post interventions, a significant increase in the mean scores of cognitive function and psychological well-being was evident among the VR and RT groups with statistically significant differences (P <0.05) compared with pre-intervention and the control group. CONCLUSION Application of VR reminiscence or traditional RT is efficacious in improving cognitive function and psychological well-being among institutionalized older adults.
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Affiliation(s)
| | - Mahmoud Abdelwahab Khedr
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt; Department of Nursing, College of Applied Medical Sciences, Hafr Albatin University, Hafr Albatin, Saudi Arabia.
| | - Mukhlid Alshammari
- Department of Nursing, College of Applied Medical Sciences, Hafr Albatin University, Hafr Albatin, Saudi Arabia.
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Coleman A, McLaughlin E, Floren M. Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account. Am J Occup Ther 2024; 78:7801205090. [PMID: 38224353 DOI: 10.5014/ajot.2024.050341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
IMPORTANCE Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care. OBJECTIVE To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures. DESIGN Cross-sectional online survey with descriptive data. PARTICIPANTS Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media. RESULTS Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not. CONCLUSIONS AND RELEVANCE Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.
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Affiliation(s)
- Ashley Coleman
- Ashley Coleman, OTD, OTR/L, is Occupational Therapist, Virginia Beach, VA;
| | - Ellen McLaughlin
- Ellen McLaughlin, EdD, OTR/L, FAOTA, is Professor, Occupational Therapy Department, Misericordia University, Dallas, PA
| | - Michael Floren
- Michael Floren, PhD, is Assistant Professor, Data Analytics, University of North Alabama, Florence
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Bahr KO, Bhavsar GP, Zhao D. "We are still tired": staff and administrators' experiences during the COVID-19 pandemic within California residential care facilities for older adults. BMC Geriatr 2023; 23:868. [PMID: 38110888 PMCID: PMC10726520 DOI: 10.1186/s12877-023-04537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Extensive research has been conducted on the impacts of the COVID-19 pandemic on long-term care workers in specialized care facilities. However, little is known about the impacts faced by facilities that provide generalized long-term support and care, such as residential care facilities for older adults (RCFs). This study describes the challenges experienced by staff and administrators of RCFs during the COVID-19 pandemic. METHODS An electronic questionnaire collecting data using both closed- and open-ended questions on staff experiences was sent to 5,721 unique RCF administrator emails within the state of California between June-December 2021. Email addresses were obtained from the public database of RCFs available through the California Health and Human Services Open Data Portal. Descriptive statistics were calculated on quantitative data regarding staff preparedness training, access to resources, and administrators' confidence in meeting recommended guidelines during the pandemic. Inductive thematic analysis was conducted on qualitative data regarding the confidence levels in meeting pandemic guidelines and challenges faced related to staff stress and morale. RESULTS A total of 150 RCF administrators across California (response rate of 2.6%) completed the survey. Over three-fourths of respondents indicated their facilities had a designated staff member to train other staff members on emergency preparedness plans and the most frequently used resources during the COVID-19 pandemic were the Department of Social Services Community Care Licensing Division (88.7%), the county health department (86.7%), and the Centers for Disease Control and Prevention (80.7%). Administrators felt least confident in their facilities' ability to maintain adequate staffing (52.0%), communication with nearby hospitals (62.1%) and communication with state and local public health officials (69.8%) during the pandemic. Three central themes emerged from the thematic analysis on staff stress and morale: (1) physical safety, mental and emotional impact of the COVID-19 pandemic; (2) staffing issues; and (3) challenges with guidelines in managing the ongoing pandemic. CONCLUSIONS Findings from this research study can be used to actively target training resources for facility administrators and staff that have been identified as most frequently used and relevant for emergency preparedness in these understudied facilities. Additionally, developing a better understanding of the staffing stress and morale difficulties in RCFs can provide insight on how policymakers can assist these critical facilities in better preparing for future crises.
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Affiliation(s)
- Kaitlin O Bahr
- Public Health Program, California State University Northridge, 18111 Nordhoff St., Northridge, CA, 91330, USA.
| | - Grishma P Bhavsar
- Health Administration Program, California State University Northridge, 18111 Nordhoff St., Northridge, CA, 91330, USA
| | - David Zhao
- Public Health Program, California State University Northridge, 18111 Nordhoff St., Northridge, CA, 91330, USA
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16
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Mueller KE, Van Puymbroeck M, Crowe BM, Davis NJ. Exploring Constraints to Well-Being for Older Adults in Transition Into an Assisted Living Home: A Qualitative Study. Can J Aging 2023; 42:688-695. [PMID: 37439106 DOI: 10.1017/s0714980823000284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Transitions into an assisted living home (ALH) are difficult and may impact the well-being of older adults. A thematic analysis guided by grounded theory was employed to better understand how a transition into an ALH influenced older adults' overall well-being. Individual, face-to-face interviews were conducted with a convenience sample of 14 participants at an ALH in the rural, southeastern U.S. Two central findings that influenced well-being during the transition process were revealed: loss of independence (sub-themes include loss of physical and mental health and loss of driving) and downsizing in space and possessions. The themes support and broaden the Hierarchical Leisure Constraints Theory, a Modified Constraints to Wellbeing model is proposed, and implications for older adult health care practitioners in ALHs are recommended. Further research is needed on the Modified Constraints to Wellbeing model and how to better describe these constraints to older adults' well-being when relocating into ALHs.
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Affiliation(s)
- Kaitlin E Mueller
- School of Health Science and Human Performance, Catawba College, Salisbury, NC, USA
| | | | - Brandi M Crowe
- Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA
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17
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Tuominen K, Pirhonen J, Lumme-Sandt K, Ahosola P, Pietilä I. No place to go? Older people reconsidering the meaning of social spaces in the context of the COVID-19 pandemic. J Aging Stud 2023; 67:101167. [PMID: 38012938 DOI: 10.1016/j.jaging.2023.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 11/29/2023]
Abstract
Under COVID-19 restrictions, older people were advised to avoid social contact and to self-isolate at home. The situation forced them to reconsider their everyday social spaces such as home and leisure time places. This study approached the meaning of social spaces for older people by examining how older people positioned themselves in relation to social spaces during the pandemic. The data were drawn from the Ageing and social well-being (SoWell) research project at Tampere University, Finland, and they consisted of phone interviews collected during the summer of 2020 with 31 older persons aged 64-96 years. The data were analysed using the frameworks of positioning analysis and environmental positioning. Results showed the positions of older people being manifold, flexible and even contradictory. Within home, the participants portrayed themselves as restricted due to limited social contact, but also as able to adapt to and content being alone. Virtual spaces were depicted as spaces for younger and healthy persons, and the participants themselves as sceptical technology users not satisfied with technology-mediated interaction. Within an assisted living facility, the participants described themselves as sensible and responsible persons who wanted to follow the facility's pandemic-related rules but also as independent persons having nothing to do with these rules. In the spaces outside the home, the participants portrayed themselves as persons who followed pandemic instructions but also as persons who were not required to follow the instructions because they could use their own judgement. These self-positions shed light on the social needs of older people in the spaces of their everyday lives. Our results provide useful insights for policy makers and professionals working with older people and will help to promote spaces of living, care and everyday life that can enhance and maintain social interaction and well-being both in times of change and in more stable times.
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Affiliation(s)
- Katariina Tuominen
- Tampere University, Gerontology Research Center (GEREC), Centre of Excellence in Research on Ageing and Care (CoE AgeCare), Faculty of Social Sciences, P.O. Box 100, 33014, Finland.
| | - Jari Pirhonen
- University of Helsinki, Centre of Excellence in Research on Ageing and Care (CoE AgeCare), Faculty of Social Sciences, P.O. Box 54, 00014, Finland.
| | - Kirsi Lumme-Sandt
- Tampere University, Gerontology Research Center (GEREC), Centre of Excellence in Research on Ageing and Care (CoE AgeCare), Faculty of Social Sciences, P.O. Box 100, 33014, Finland.
| | - Päivi Ahosola
- Tampere University, Gerontology Research Center (GEREC), Centre of Excellence in Research on Ageing and Care (CoE AgeCare), Faculty of Social Sciences, P.O. Box 100, 33014, Finland.
| | - Ilkka Pietilä
- University of Helsinki, Centre of Excellence in Research on Ageing and Care (CoE AgeCare), Faculty of Social Sciences, P.O. Box 54, 00014, Finland.
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18
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Moore RC, Hancock JT, Bailenson JN. From 65 to 103, Older Adults Experience Virtual Reality Differently Depending on Their Age: Evidence from a Large-Scale Field Study in Nursing Homes and Assisted Living Facilities. Cyberpsychol Behav Soc Netw 2023; 26:886-895. [PMID: 38011717 DOI: 10.1089/cyber.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
There is growing interest in applications of virtual reality (VR) to improve the lives of older adults, but the limited research on older adults and VR largely treats older adults as a monolith, ignoring the substantial differences across 65 to 100+ year olds that may affect their experience of VR. There are also few existing studies examining the experiences and challenges facing those who facilitate VR for older adults (e.g., caregiving staff). We address these limitations through two studies. In study 1, we explore variation within older adults' experiences with VR through a field study of VR use among a large (N = 245) and age-diverse (Mage = 83.6 years, SDage = 7.9, range = 65-103 years) sample of nursing home and assisted living facility residents across 10 U.S. states. Age was negatively associated with the extent to which older adults enjoyed VR experiences. However, the negative relationship between age and older adults' attitudes toward VR was significantly less negative than the relationship between age and their attitudes toward other technologies (cell phones and voice assistants). In study 2, we surveyed caregiving staff (N = 39) who facilitated the VR experiences for older adult residents and found that the caregiving staff generally enjoyed the activity relative to other activities and felt it to be beneficial to their relationship with residents.
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Affiliation(s)
- Ryan C Moore
- Department of Communication, Stanford University, Stanford, California, USA
| | - Jeffrey T Hancock
- Department of Communication, Stanford University, Stanford, California, USA
| | - Jeremy N Bailenson
- Department of Communication, Stanford University, Stanford, California, USA
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19
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Jonasson LL, Bångsbo A, Billhult A, Wolmesjö M. Older adults' experiences of participation in daily activities in Swedish assisted living. BMC Geriatr 2023; 23:762. [PMID: 37990295 PMCID: PMC10662507 DOI: 10.1186/s12877-023-04484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND According to Swedish law, older adults in Sweden should be able to live a good, safe, and independent life with social and healthcare provided, based on their individual needs. In assisted living in Swedish eldercare the environment affects the older adults' ability to participate in decision-making and strengthens their ability to feel meaningfulness. The ability of staff working in social and healthcare to invite older adults to participate varies. It is important to examine how older adults perceive their situation, as caregivers in eldercare tend to focus on routine work and experience difficulties in meeting the individual needs of older adults. The aim of this study was to explore how older adults in assisted living experienced participation in daily activities. METHODS A qualitative interview study was conducted in two municipalities in the western part of Sweden. An exploratory and inductive design was used. Individual interviews were conducted with 11 older adults living in two different assisted living facilities. The data were analysed using thematic analysis. RESULTS The interviews resulted in three themes: Being involved, Sense of well-being, and Influenced by the context. The older adults' experiences of participation were interpreted as feelings of being involved in daily life activities, and how they felt involved in their own care and nursing. Participation created prerequisites for well-being. Sense of well-being could be related to feelings of security and social community. The organisation and work environment of the healthcare staff had a great impact on their ability to increase the participation of the older adults. The older adults were aware of the everyday work situation of the providers of social and healthcare and were Influenced by the context. DISCUSSION/CONCLUSION Important conditions for a good quality of life and participation for the older adults are to be treated with respect, receive information, and be able to choose. The older adults expressed several good ideas for improvements and a willingness to be involved in the development of the organisation at different levels. It is essential to invite older adults in assisted living to participate in the design of care and nursing.
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Affiliation(s)
- Lise-Lotte Jonasson
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Angela Bångsbo
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Annika Billhult
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Wolmesjö
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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20
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Yoder CLM, Kyoshi-Teo H, Ochoa-Cosler O. Fall Prevention Care Management: Implementation and Outcomes of a Project to Reduce Fall Risks of Older Adults in Assisted Living Facilities. J Nurs Care Qual 2023; 38:374-380. [PMID: 37126440 DOI: 10.1097/ncq.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Accidental falls are common among older adults and may lead to devastating consequences. One promising approach to reduce falls is to engage older adults in fall risk reduction through care management. PURPOSE This article describes the implementation by undergraduate nursing students of a 6-week interdisciplinary Fall Prevention Care Management (FPCM) intervention to improve the safety of older adults living in assisted living facilities. METHODS A secondary qualitative descriptive analysis of narrative visit notes was conducted using the Meyer et al taxonomy to characterize fall prevention interventions with older adults. RESULTS Individualized fall prevention interventions including motivational interviewing and care management supported clients' engagement with fall prevention by facilitating behavior change related to fall prevention, helping clients identify and reflect on meaning and/or perceptions related to fall prevention. CONCLUSION The FPCM project was acceptable, facilitated high fall risk older adults' engagement with fall prevention, and yielded many positive outcomes.
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Affiliation(s)
- Claire L McKinley Yoder
- School of Nursing and Health Innovations, University of Portland, Portland, Oregon (Dr Yoder); School of Nursing, Oregon Health and Sciences University, Portland (Dr Kyoshi-Teo); and Oregon Health and Sciences University Hospital, Portland (Ms Ochoa-Cosler)
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21
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de Graaf L, Janssen M, Roelofs T, Luijkx K. Who's Involved? Case Reports on Older Adults' Alcohol and Tobacco Use in Dutch Residential Care Facilities. Qual Health Res 2023; 33:945-955. [PMID: 37429034 PMCID: PMC10494475 DOI: 10.1177/10497323231186879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities and aim to provide person-centered care (PCC). Maintaining residents' autonomy is important to provide PCC, for example, with shared decision-making (SDM). Residents are largely dependent on multiple stakeholders, which could jeopardize their autonomy, especially regarding unhealthy behaviors, such as smoking tobacco or drinking alcohol. This case study explores the dynamics of multiple stakeholders around four RCF residents regarding their alcohol and/or tobacco use. Four RCF residents who smoke tobacco and/or drink alcohol were selected from a previous study, and their (in)formal caregivers were additionally invited to participate. A qualitative research design was chosen, and semi-structured interviews were conducted. The Ethics Review Board from the Tilburg University School of Social and Behavioral Sciences (Reference: RP39) and the executive boards of the two participating organizations granted approval. Narrative portraiture resulted in four case descriptions. Two cases focused mostly on tobacco use, and two cases focused mostly on alcohol use. Multiple stakeholders were involved on different levels: family bought alcohol or cigarettes, and team managers supported care professionals. However, little interaction was found between stakeholders. In these cases, limited interaction between the stakeholders, including the resident, jeopardizes SDM and, in this way, PCC regarding residents' alcohol and/or tobacco use. SDM on this topic could enhance interaction between all stakeholders involved, which could increase PCC. Finally, the cases indicate a constant struggle between protecting residents from adverse outcomes of alcohol and tobacco use and enhancing their autonomy.
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Affiliation(s)
- Lisette de Graaf
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Mijzo, Waalwijk, The Netherlands
| | - Meriam Janssen
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Tineke Roelofs
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Archipel Zorggroep, The Netherlands
| | - Katrien Luijkx
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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22
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Williams C, Dedeo M. Digital communication use before and during COVID among residential older adults. Geriatr Nurs 2023; 53:116-121. [PMID: 37536002 DOI: 10.1016/j.gerinurse.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023]
Abstract
Many older adults living in residential care facilities do not use digital communication technologies. The study was a retrospective pre-post study testing the impact of a digital communication program instituted at two Continuing Care Retirement Communities. We distributed a survey between March 2021 and April 2021 to examine study objectives. Data analyses were performed using JMP Pro 16.1 and SAS 9.4. One hundred twenty-six people started the survey, with 120 completing the survey and included in the analysis. The mean age was 84 years, 67.5% were female, 95.8% were White, 64.2% were widowed, and 35.3% reported at least a bachelor's degree level of education. There were minimal increases in digital communication behavior and communication frequency. Older adults most notably reported privacy concerns and have mixed responses about the utility of digital communication for social engagement. We apply the results to the Stage of Change model and provide recommendations to promote behavior change.
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Affiliation(s)
- Cynthia Williams
- School of Global Health Management and Informatics, University of Central Florida, Orlando, USA.
| | - Michelle Dedeo
- Department of Mathematics, University of North Florida, Jacksonville, USA
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23
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Beck MS, Bi S, Atai FD, Rianon NJ. Effect of Quarantine on Body Weight Among Residents of Assisted Living Facilities During the COVID-19 Pandemic. J Gerontol Nurs 2023; 49:29-34. [PMID: 37650851 DOI: 10.3928/00989134-20230816-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Assisted living facility (ALF) residents are at greater risk of declining health and death from coronavirus disease 2019 (COVID-19) due to advanced age, frailty, chronic conditions, and transmission prevention methods. One method, room quarantine, can lead to isolation and potential weight changes. Continuous room quarantine was mandated by the state for all nursing home and ALF residents. The objective of the current study was to determine the degree and significance of weight loss during quarantine through retrospective chart review and use these findings to guide a quality improvement project. Pre-and post-COVID-19 weights were compared for 53 house call program residents. Descriptive statistics and logistic regression were used. This small convenience sample demonstrated significant weight loss for 40% of ALF residents quarantined during the COVID-19 pandemic. Males showed a greater risk of significant weight loss. Weight loss of 5% in 1 month is considered problematic in older adults. As quarantine measures continue to be used for COVID-19 outbreaks, weight changes, particularly among males, need to be monitored and reported for intervention. [Journal of Gerontological Nursing, 49(9), 29-34.].
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Manis DR, Katz P, Lane NE, Rochon PA, Sinha SK, Andel R, Heckman GA, Kirkwood D, Costa AP. Rates of Hospital-Based Care among Older Adults in the Community and Residential Care Facilities: A Repeated Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1341-1348. [PMID: 37549887 DOI: 10.1016/j.jamda.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE We examine annual rates of emergency department (ED) visits, hospital admissions, and alternate levels of care (ALC) days (ie, the number of days that an older adult remained in hospital when they could not be safely discharged to an appropriate setting in their community) among older adults. DESIGN Repeated cross-sectional study. SETTING AND PARTICIPANTS Linked, individual-level health system administrative data on community-dwelling persons, home care recipients, residents of assisted living facilities, and residents of nursing homes aged 65 years and older in Ontario, Canada, from January 1, 2013, to December 31, 2019. METHODS We calculated rates of ED visits, hospital admissions, and ALC days per 1000 individuals per older adult population per year. We used a generalized linear model with a gaussian distribution, log link, and year fixed effects to obtain rate ratios. RESULTS There were 1,655,656 older adults in the community, 237,574 home care recipients, 42,600 older adults in assisted living facilities, and 94,055 older adults in nursing homes in 2013; there were 2,129,690 older adults in the community, 281,028 home care recipients, 56,975 older adults in assisted living facilities, and 95,925 older adults in nursing homes in 2019. Residents of assisted living facilities had the highest rates of ED visits (1260.692019 vs 1174.912013), hospital admissions (482.632019 vs 480.192013), and ALC days (1905.572019 vs 1443.032013) per 1000 individuals. Residents of assisted living facilities also had significantly higher rates of ED visits [rate ratio (RR) 3.30, 95% CI 3.20, 3.41), hospital admissions (RR 6.24, 95% CI 6.01, 6.47), and ALC days (RR 25.68, 95% CI 23.27, 28.35) relative to community-dwelling older adults. CONCLUSIONS AND IMPLICATIONS The disproportionate use of ED visits, hospital admissions, and ALC days among residents of assisted living facilities may be attributed to the characteristics of the population and fragmented licensing and regulation of the sector, including variable models of care. The implementation of interdisciplinary, after-hours, team-based approaches to home and primary care in assisted living facilities may reduce the potentially avoidable use of ED visits, hospital admissions, and ALC days among this population and optimize resource allocation in health care systems.
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Affiliation(s)
- Derek R Manis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada.
| | - Paul Katz
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Natasha E Lane
- ICES, Toronto, ON, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paula A Rochon
- ICES, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada; Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; National Institute on Ageing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada; Schlegel Research Institute for Aging, Waterloo, ON, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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25
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Manis DR, Katz P, Lane NE, Rochon PA, Sinha SK, Andel R, Heckman GA, Kirkwood D, Costa AP. Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1356-1360. [PMID: 37507099 DOI: 10.1016/j.jamda.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We investigate the changes in the sociodemographic characteristics, clinical comorbidities, and transitions between care settings among residents of assisted living facilities. DESIGN Repeated cross-sectional study. SETTING AND PARTICIPANTS Linked, individual-level health system administrative data on residents of assisted living facilities in Ontario, Canada, from January 1, 2013, to December 31, 2019. METHODS Counts and proportions were calculated to describe the sociodemographic characteristics and clinical comorbidities. Relative changes and trend tests were calculated to quantify the longitudinal changes in the characteristics of residents of assisted living facilities between 2013 and 2019. A Sankey plot was graphed to display transitions between different care settings (ie, hospital admission, nursing home admission, died, or remained in the assisted living facility) each year from 2013 to 2019. RESULTS There was a 34% relative increase in the resident population size of assisted living facilities (56,9752019 vs 42,6002013). These older adults had a mean age of 87 years, and women accounted for nearly two-thirds of the population across all years. The 5 clinical comorbidities that had the highest relative increases were renal disease (24.3%), other mental health conditions (16.8%), cardiac arrhythmias (9.6%), diabetes (8.5%), and cancer (6.9%). Nearly 20% of the original cohort from 2013 remained in an assisted living facility at the end of 2019, and approximately 10% of that cohort transitioned to a nursing home in any year from 2013 to 2019. CONCLUSIONS AND IMPLICATIONS Residents of assisted living facilities are an important older adult population that has progressively increased in clinical complexity within less than a decade. Clinicians and policy makers should advocate for the implementation of on-site medical care that is aligned with the needs of these older adults.
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Affiliation(s)
- Derek R Manis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Paul Katz
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Natasha E Lane
- ICES, Toronto, Ontario, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paula A Rochon
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada; Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; National Institute on Ageing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada; Schlegel Research Institute for Aging, Waterloo, Ontario, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Wilson K, Wilson LA, Rusk KT, Henry JL, Denize KM, Hsu AT, Sveistrup H. Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities. Can J Aging 2023; 42:516-519. [PMID: 36794367 DOI: 10.1017/s0714980822000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
A disproportionate share of the health impacts of COVID-19 has been borne by older adults, particularly those in long-term care facilities (LTCs). Vaccination has been critical to efforts to combat this issue, but as we begin to emerge from this pandemic, questions remain about how to protect the health of residents of LTC and assisted living facilities proactively in order to prevent such a disaster from occurring again. Vaccination, not just against COVID-19, but also against other vaccine-preventable illness, will be a key component of this effort. However, there are currently substantial gaps in the uptake of vaccines recommended for older adults. Technology offers an opportunity to assist in filling these vaccination gaps. Our experiences in Fredericton, New Brunswick suggest that a digital immunization solution would facilitate better uptake of adult vaccines for older adults in assisted and independent living facilities and would help policy and decision makers to identify coverage gaps and develop interventions to protect these individuals.
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Affiliation(s)
- Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- CANImmunize Labs, Ottawa, Ontario, Canada
| | | | - Kelsey T Rusk
- Centre for Innovation and Research in Aging, Fredericton, New Brunswick, Canada
| | - Justine L Henry
- Centre for Innovation and Research in Aging, Fredericton, New Brunswick, Canada
| | | | - Amy T Hsu
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Rinaldi R, Duplat J, Kahwaji C, Wauthia E, Willaye E, Batselé E. Attachment behaviours in adults with intellectual disabilities in assisted living facilities: representations from direct-care staff. J Intellect Disabil Res 2023; 67:869-879. [PMID: 37344933 DOI: 10.1111/jir.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Studies on individuals with intellectual disabilities (IDs) indicate that primary care staff are potential attachment figures. Therefore, the ability to interpret and respond to attachment behaviours with sensitivity is crucial for professionals working with adults with IDs. However, little is known regarding representations and understanding of these attachment behaviours among professionals. This study investigated the representations of attachment behaviours among adults with IDs, as observed and interpreted by direct-care staff in assisted living facilities. METHODS Semi-structured interviews were conducted with 19 support workers in seven assisted living facilities in the French community of Belgium. A thematic content analysis was performed. RESULTS Professional discourse elicited various forms of attachment behaviours that were sometimes considered challenging. Staff reported difficulties in finding a balance between supporting selective attachment and maintaining 'the right distance' to prevent a negative impact on their work conditions. CONCLUSIONS This study gives insight to how using an attachment-informed framework may provide a new perspective on behaviours of adults with IDs in assisted living facilities, as well as the need to offer professionals the opportunity to reflect upon their practices in relation to this dimension.
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Affiliation(s)
- R Rinaldi
- Department of Clinical Orthopedagogy, Faculty of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - J Duplat
- Department of Clinical Orthopedagogy, Faculty of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - C Kahwaji
- Department of Clinical Orthopedagogy, Faculty of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - E Wauthia
- Association for Innovation in Orthopedagogy, University of Mons, Mons, Belgium
| | - E Willaye
- Department of Clinical Orthopedagogy, Faculty of Psychology and Educational Sciences, University of Mons, Mons, Belgium
- Service Universitaire Spécialisé pour personnes avec Autisme (SUSA), Mons, Belgium
| | - E Batselé
- Department of Clinical Orthopedagogy, Faculty of Psychology and Educational Sciences, University of Mons, Mons, Belgium
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Pudur R, Mpofu E, Prybutok G, Meier N, Ingman S. Social Connectedness Resource Preferences of Older Adults in Assisted Living: A Scoping Review Based on the WHO-ICF Framework. J Gerontol Nurs 2023; 49:35-42. [PMID: 37650849 DOI: 10.3928/00989134-20230816-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The current scoping review identified emerging evidence on social connectedness resource preferences of older adults in assisted living facilities (ALFs) and the community. A literature search was performed using several databases. We included review articles published between January 2000 and September 2022 in English and related to social connectedness resources in ALFs and the community. Of 134 titles and abstracts, eight studies were included. Study participants comprised 2,482 older adults from 233 ALFs in the United States. Themes were framed using the World Health Organization's International Classification of Functioning, Disability, and Health. For social activities, older adults preferred facility-based recreation and leisure resources. For community social connectedness, residents preferred participation in civic life activities. Participants of older age preferred facility resources, whereas those of younger age preferred more demanding physical activities. Those from larger enrollment facilities preferred facility-based resources compared to community resources. For moderately and less active residents, participation was limited to less demanding activities. Older adults' preferences varied based on age, physical limitations, and size and location of the facility. Findings suggest opportunities for further research on developing ALF- and community-based resources for older adults' social well-being and quality of life. [Journal of Gerontological Nursing, 49(9), 35-42.].
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de la Cova C, Mant M, Brickley MB. Structural violence and institutionalized individuals: A paleopathological perspective on a continuing issue. PLoS One 2023; 18:e0290014. [PMID: 37647256 PMCID: PMC10468073 DOI: 10.1371/journal.pone.0290014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/01/2023] [Indexed: 09/01/2023] Open
Abstract
Past and present institutions (e.g., state and public hospitals, assisted living facilities, public nursing homes) have struggled with structural issues tied to patient care and neglect, which often manifests in the form of fracture trauma, and may explain why institutionalized individuals are at higher risk for this injury. Six hundred individuals from the Robert J. Terry Anatomical Collection born between 1822-1877 were examined to investigate hip fracture prevalence. Analysis of associated records and documentary data, including death, morgue, and census records, revealed that 36.3% (n = 218) of these individuals died in institutions such as the St. Louis State Hospital, City Infirmary, and Missouri State Hospital No. 4. Of the institutionalized individuals, 4.3% had evidence of hip fracture, significantly higher than the non-institutionalized (2.3%). Records revealed that many hip fractures were suffered around the time of death in state hospitals and were preventable, resulting from structural issues tied to understaffing and underfunding. Forensic and clinical literature, as well as current news media, indicate that structural violence in the forms of underfunding and understaffing continues to manifest as hip fractures harming institutionalized individuals today. This paper demonstrates how an anthropological perspective using paleopathological analysis sheds light on the chronicity and time depth of this issue, with the aim of driving public policy to entrench the equitable care of institutionalized people as a human right.
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Affiliation(s)
- Carlina de la Cova
- Department of Anthropology, University of South Carolina, Columbia, South Carolina, United States of America
| | - Madeleine Mant
- Department of Anthropology, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Megan B. Brickley
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada
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Kemp CL, Bender AA, Morgan JC, Burgess EO, Epps FR, Hill AM, Perkins MM. Understanding Capacity and Optimizing Meaningful Engagement among Persons Living with Dementia. Dementia (London) 2023; 22:854-874. [PMID: 36913646 PMCID: PMC10789114 DOI: 10.1177/14713012231162713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Meaningful engagement is a key dimension of quality of life among persons living with dementia, yet little is known about how to best to promote it. Guided by grounded theory methods, we present analysis of data collected over a 1-year period in four diverse assisted living (AL) communities as part of the study, "Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia." Our aims are to: (a) learn how meaningful engagement is negotiated among AL residents with dementia and their care partners; and (b) identify how to create these positive encounters. Researchers followed 33 residents and 100 care partners (formal and informal) and used participant observation, resident record review, and semi-structured interviews. Data analysis identified "engagement capacity" as central to the negotiation of meaningful engagement. We conclude that understanding and optimizing the engagement capacities of residents, care partners, care convoys, and settings, are essential to creating and enhancing meaningful engagement among persons living with dementia.
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Affiliation(s)
- Candace L. Kemp
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
| | - Alexis A. Bender
- Division of Geriatric & Gerontology, Emory School of Medicine, Atlanta, GA
| | - Jennifer Craft Morgan
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - Elisabeth O. Burgess
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
| | - Fayron R. Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Molly M. Perkins
- Division of Geriatric & Gerontology, Emory School of Medicine, Atlanta, GA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC)
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Kiyoshi-Teo H, McKinley-Yoder C, Ochoa-Cosler O, Lemon E, Stoyles S, Tadesse R, McGuire J, Lee DSH. Feasibility study of student-led fall prevention care management: Reducing fall risks in assisted living facilities. Gerontol Geriatr Educ 2023; 44:59-74. [PMID: 34465276 DOI: 10.1080/02701960.2021.1969387] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Falls are common in Assisted Living Facilities (ALFs). We evaluated the feasibility, acceptability, and preliminary impact of student-led Fall Prevention Care Management (FPCM) on reducing fall risks in ALFs. Residents who were age ≥65, had a fall in the previous year Or considered high fall risk at the facility, and who had a MoCA cognition score>15 were enrolled. The FPCM interventions were semi-structured to facilitate students' learning while addressing participants' unique fall risks. Twenty-five older adults in the U.S. completed the study (recruitment rate: 55%; retention rate: 64%). Participants rated the study as 87.16 (100 = excellent), and likelihood to recommend the study to others was 80.85 (100 = most likely). Participants were 84% female, mean age 88.6 years old. Fall risks such as fear of falling decreased from 16.05 to 15.12 (p = .022), fall prevention behaviors increased from 2.94 to 3.07 (p = .048), and the level of confidence to prevent falls increased from 63.38 to 78.35 (p = .015). Students commonly provided education and coaching on fall prevention strategies, and addressed emotional and behavioral aspects of fall prevention. With improvement with recruitment and retention, student-led FPCM intervention is a promising approach for fall prevention in ALF.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Olivia Ochoa-Cosler
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Erin Lemon
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Ruth Tadesse
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Julie McGuire
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, Oregon, USA
| | - David S H Lee
- Department of Pharmacy Services, Oregon Health & Science University, Portland, Oregon, USA
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Nexø MA, Baumgarten SV, Willaing I, Olesen K. Staff experiences of diabetes care in residential care facilities for people with severe disabilities in Denmark: a mixed-methods assessment of access to screening for diabetes complications. BMJ Open 2022; 12:e062403. [PMID: 36600431 PMCID: PMC9772667 DOI: 10.1136/bmjopen-2022-062403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To identify the prevalence of diabetes among adults (>18 years) living in residential care facilities in Denmark and to identify the structural, practical, and individual barriers and drivers related to their participation in screening programmes. DESIGN SETTING: The register-based study included all residents living in residential care facilities in Denmark. The survey and qualitative analysis were carried out exclusively in the Capital Region of Denmark. PARTICIPANTS For the register-based study, we identified 11 620 residents of care facilities in Denmark (>18 years) and identified the number of residents with diagnosis codes of type 1 or type 2 diabetes or dispensed prescriptions of blood glucose-lowering medication. Staff from 102 psychiatric facilities housing adults with severe psychiatric disabilities were invited to participate in the survey. Of these, 56 facilities participated with one responder each, of which n=16 also participated in follow-up qualitative interviews. RESULTS Register-based study: of the residents at the facilities, 954 (8%) were diagnosed with diabetes. Descriptive statistics of responses and results from content analysis of interviews were summarised in five themes that illuminated how a screening programme could be tailored to the care facilities: (1) characteristics of residents and care facilities, (2) the care needs of residents, (3) the way care was organised, (4) the specific barriers and drivers for participating in programmes, (5) number of hours and settings for screening programmes. CONCLUSION To increase the participation of people living in psychiatric care facilities in screening programmes, future programmes should be tailored to the identified needs and barriers experienced by the residential care staff.
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Almalki M, Alsulami MH, Alshdadi AA, Almuayqil SN, Alsaqer MS, Atkins AS, Choukou MA. Delivering Digital Healthcare for Elderly: A Holistic Framework for the Adoption of Ambient Assisted Living. Int J Environ Res Public Health 2022; 19:16760. [PMID: 36554640 PMCID: PMC9779582 DOI: 10.3390/ijerph192416760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 06/17/2023]
Abstract
Adoption of Ambient Assisted Living (AAL) technologies for geriatric healthcare is suboptimal. This study aims to present the AAL Adoption Diamond Framework, encompassing a set of key enablers/barriers as factors, and describe our approach to developing this framework. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. SCOPUS, IEEE Xplore, PubMed, ProQuest, Science Direct, ACM Digital Library, SpringerLink, Wiley Online Library and grey literature were searched. Thematic analysis was performed to identify factors reported or perceived to be important for adopting AAL technologies. Of 3717 studies initially retrieved, 109 were thoroughly screened and 52 met our inclusion criteria. Nineteen unique technology adoption factors were identified. The most common factor was privacy (50%) whereas data accuracy and affordability were the least common factors (4%). The highest number of factors found per a given study was eleven whereas the average number of factors across all studies included in our sample was four (mean = 3.9). We formed an AAL technology adoption framework based on the retrieved information and named it the AAL Adoption Diamond Framework. This holistic framework was formed by organising the identified technology adoption factors into four key dimensions: Human, Technology, Business, and Organisation. To conclude, the AAL Adoption Diamond Framework is holistic in term of recognizing key factors for the adoption of AAL technologies, and novel and unmatched in term of structuring them into four overarching themes or dimensions, bringing together the individual and the systemic factors evolving around the adoption of AAL technology. This framework is useful for stakeholders (e.g., decision-makers, healthcare providers, and caregivers) to adopt and implement AAL technologies.
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Affiliation(s)
- Manal Almalki
- College of Public Health and Tropical Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | | | | | - Saleh N. Almuayqil
- College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
| | - Mohammed S. Alsaqer
- College of Computer Science, King Khalid University, Abha 62529, Saudi Arabia
| | - Anthony S. Atkins
- School of Computing and Digital Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK
| | - Mohamed-Amine Choukou
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
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Manis DR, Bronskill SE, Rochon PA, Sinha SK, Boscart V, Tanuseputro P, Poss JW, Rahim A, Tarride JÉ, Abelson J, Costa AP. Defining the Assisted Living Sector in Canada: An Environmental Scan. J Am Med Dir Assoc 2022; 23:1871-1877.e1. [PMID: 36007545 DOI: 10.1016/j.jamda.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/24/2022] [Accepted: 07/16/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES In this study, we (1) identify the terms used to describe the assisted living sector and the legislation governing operation in all Canadian provinces and territories; (2) identify the cost estimates associated with residency in these homes; and (3) quantify the growth of the sector. DESIGN Environmental scan. SETTING AND PARTICIPANTS Internet searches of Canadian provincial and territorial government websites and professional associations were conducted in 2021 to retrieve publicly accessible sources related to the assisted living sector. METHODS We synthesized data that identified the terms used to describe the sector in all provinces and territories, the legislation governing operation, financing, median fees per month for care, and growth of the sector from 2012 to 2020. Counts and proportions were calculated for some extracted variables. All data were narratively synthesized. RESULTS The terms used to describe the assisted living sector varied across Canada. The terms "assisted living," "retirement homes," and "supportive living" were prevalent. Ontario was the only province to regulate the sector through an independent, not-for-profit organization. Ontario, British Columbia, and Alberta had some of the highest median fees for room, board, and care per month (range: $1873 to $6726). The licensed assisted living sector in Ontario doubled in size (768 in 2020 vs 383 in 2012), and there was a threefold increase in the number of corporate-owned chain assisted living facilities (465 in 2020 vs 142 in 2012). CONCLUSIONS AND IMPLICATIONS The rapid growth of the assisted living sector that is primarily financed through out-of-pocket payments may indicate a rise in a two-tier system of housing and health care for older adults. Policymakers need better mechanisms, such as standardized reporting systems and assessments, to understand the needs of older adults who reside in assisted living facilities and inform the need for sector regulation and oversight.
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Affiliation(s)
- Derek R Manis
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Paula A Rochon
- ICES, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir K Sinha
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; National Institute on Ageing, Ryerson University, Toronto, Ontario, Canada
| | - Veronique Boscart
- Schlegel Research Institute for Aging, Waterloo, Ontario, Canada; Institute of Technology and Advanced Learning, Conestoga College, Kitchener, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Toronto, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Ahmad Rahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Éric Tarride
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Julia Abelson
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada; Schlegel Research Institute for Aging, Waterloo, Ontario, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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McGrath M, Bagul D, Du Toit SHJ. Barriers and facilitators of meaningful engagement among older migrants living with dementia in residential aged care facilities: A mixed studies systematic review. Scand J Occup Ther 2022; 29:530-541. [PMID: 33761300 DOI: 10.1080/11038128.2021.1898675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Migrants with dementia living in residential care may be at risk of disengagement. OBJECTIVE To synthesize research relating to the meaningful engagement of migrants with dementia who are living in residential care. METHOD Mixed studies systematic review following PRISMA guidelines. Nine electronic databases were searched for relevant studies. Studies were eligible for inclusion if they reported original research relating to meaningful engagement of migrants with dementia living in residential aged care and were published in English. Two independent reviewers screened the title and abstracts, full texts of eligible studies and conducted a quality appraisal of included texts. A convergent qualitative synthesis approach was used. RESULTS From 1460 articles, 14 papers representing 12 studies were included. Facilitators of meaningful engagement included: the presence of cultural artefacts in the care environment, the use of multimodal communication and a shared but flexible understanding of residents' culture. Barriers were the absence of a common language and a task-orientated approach to care. CONCLUSIONS Migrants with dementia who are living in residential care are at increased risk of disengagement. Our review highlights the need for culturally congruent residential care to go beyond issues of language and to consider how occupations can be tailored to support ongoing participation and engagement.
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Affiliation(s)
- Margaret McGrath
- Sydney School of Health Sciences, University of Sydney, Camperdown, Australia
| | - Deepali Bagul
- Sydney School of Health Sciences, University of Sydney, Camperdown, Australia
| | - Sanetta H J Du Toit
- Sydney School of Health Sciences, University of Sydney, Camperdown, Australia
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Cain P, Alan J, Porock D. Emergency department transfers from residential aged care: what can we learn from secondary qualitative analysis of Australian Royal Commission data? BMJ Open 2022; 12:e063790. [PMID: 36127100 PMCID: PMC9490620 DOI: 10.1136/bmjopen-2022-063790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To use publicly available submissions and evidence from the Australian Royal Commission into Aged Care Quality and Safety as data for secondary qualitative analysis. By investigating the topic of emergency department transfer from the perspective of residents, family members and healthcare professionals, we aimed to identify modifiable factors to reduce transfer rates and improve quality of care. DESIGN The Australian Royal Commission into Aged Care Quality and Safety has made over 7000 documents publicly available. We used the documents as a large data corpus from which we extracted a data set specific to our topic using keywords. The analysis focused on submissions and hearing transcripts (including exhibits). Qualitative thematic analysis was used to interrogate the text to determine what could be learnt about transfer events from a scholarly perspective. RESULTS Three overarching themes were identified: shortfalls and failings, reluctance and misunderstanding, and discovery and exposure. CONCLUSIONS The results speak to workforce inadequacies that have been central to problems in the Australian aged care sector to date. We identified issues around clinical and pain assessment, lack of consideration to advance care directives and poor communication among all parties. We also highlighted the role that emergency departments play in identifying unmet clinical needs, substandard care and neglect. Given the inadequate clinical care available in some residential aged care facilities, transferring residents to a hospital emergency department may be making the best of a bad situation. If the objective of reducing unnecessary transfers to emergency departments is to be achieved, then access to appropriate clinical care is the first step.
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Affiliation(s)
- Patricia Cain
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Janine Alan
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Davina Porock
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Wretman CJ, Zimmerman S, Sloane PD, Preisser JS. Staff Attitudes Related to Antipsychotic Prescribing in Assisted Living. J Am Med Dir Assoc 2022; 23:1503-1504. [PMID: 35605682 PMCID: PMC10575547 DOI: 10.1016/j.jamda.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Christopher J Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Philip D Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lam K, Covinsky KE. Ensuring Assisted Living Provides the Assistance Residents Need. JAMA Netw Open 2022; 5:e2233877. [PMID: 36173635 PMCID: PMC10173950 DOI: 10.1001/jamanetworkopen.2022.33877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kenneth Lam
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
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Myers DR, Rogers RK, Garrison BV, Singletary JE, Groce H. The Impact of Spirituality and Religious Practice on Senior Living Leader Career Resilience. J Appl Gerontol 2022; 41:2353-2361. [PMID: 35751168 DOI: 10.1177/07334648221110868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Experienced senior living leaders (SLLs) report the impact of spirituality and religious practice on SLL role adaptation and continuation. The sample included 18 SLLs in 18 skilled care settings representing public, non-profit, and for-profit types of incorporation, with oversampling of for-profit facilities. The average years of SLL experience was 24 years. In-depth interviews were examined through a thematic analysis approach using Excel software. Seventy-eight percent described how a higher power, religious beliefs, and faith practices were associated with their role. Their narratives revealed three major themes: Frame (calling and pre-dispositional spiritual beliefs and religious practices), Role Performance (how spirituality informed SLL administrative practice), and Benefits (perceived rewards of adherence to spiritual beliefs and practices). Further analysis of the three themes produced codes that added greater specification for each theme. Implications provided for normalizing the spirituality and work-life intersect and infusing ethical integration of spirituality and work-life in SLL educational programs.
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Tan SY, Poh L, Lim J. Governance of Assisted Living in Singapore: Lessons for Aging Countries. Front Public Health 2022; 10:868246. [PMID: 35774566 PMCID: PMC9237405 DOI: 10.3389/fpubh.2022.868246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
A global trend toward aging populations means that the challenge of providing adequate long-term care to older people looms large in many countries. In Singapore, a public discourse revolving around the expansion of assisted living to create age-friendly environments in long-term care has emerged. This study examines Singapore's experience in developing regulations for assisted living by documenting the different levels of regulation in place and by identifying the regulatory gaps remaining to govern assisted living. Anchoring in a conceptual framework on the governance of assisted living, different regulatory components of assisted living at the micro-, meso-, and macro-levels are analyzed. Using a case study method, primary and secondary data examining the experiences of governing and implementing assisted living in Singapore were collected. Analysis was conducted using a thematic analysis approach. Micro- and some macro-level regulations, which include admission assessment, staffing, and infrastructural requirements for assisted living, are maturing and evolving, while meso-level regulations, such as operational management, the monitoring framework, and stipulations for training requirements for staff, remain a work-in-progress in Singapore. The regulations for assisted living are currently primarily guided by soft laws, such as practice guidelines; the government has committed toward enacting permanent regulations for all long-term care facilities with the phased implementation of the Health Care Services Act from 2021 to 2023. We conclude that assisted living, despite the early stage of its development in Singapore, is a viable care model that should be expanded to meet the rising demand for care on the part of a majority of older people, who fall in the middle of the care continuum (that is, they can neither live independently nor need complete institutionalization). We also propose five policy recommendations for all aging countries to strengthen the governance of assisted living in long-term care. These include establishing (i) clear provisions on care quality assessment and the redress of grievance, (ii) minimum standards of care, (iii) differential regulations for assisted living, (iv) routine care assessment, and, (v) applying technology in assisted living facilities to address a shortage of care workers.
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Affiliation(s)
- Si Ying Tan
- Leadership Institute for Global Health Transformation, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- *Correspondence: Si Ying Tan
| | - Luting Poh
- Department of Pharmacology, Memory Aging and Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jeremy Lim
- Leadership Institute for Global Health Transformation, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Ulla L A, Mervi R, Anna-Liisa J, Hannu K, Kaisu H P. The effect of educational intervention on use of psychotropics in defined daily doses and related costs - a randomized controlled trial. Scand J Prim Health Care 2022; 40:246-252. [PMID: 35546060 PMCID: PMC9397433 DOI: 10.1080/02813432.2022.2074055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents. DESIGN A secondary analysis of a randomized controlled intervention study with 12 months of follow-up. SETTING Assisted living facilities in Helsinki, Finland. SUBJECTS Older (≥65 years) residents (N = 227) living in assisted living facility wards (N = 20) in Helsinki in 2011. INTERVENTION The wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group). MAIN OUTCOME MEASURES Change of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months. RESULTS A significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished. CONCLUSIONS Educational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions. REGISTRATION NUMBER ACTRN 12611001078943 KEY POINTSWe explored the effect of staff training on psychotropic use and associated costs among older long-term care residents.Educational training of nursing staff was beneficial as regards the actual drug doses of psychotropics, and cost savings in psychotropic medication were achieved.Educational training was efficient in the short-term, but further research is warranted to achieve long-term effects.
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Affiliation(s)
- Aalto Ulla L
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
- Department of General Practice, University of Helsinki, Helsinki, Finland
- CONTACT Ulla L Aalto Dept of Social Services and Health Care, Home-care services, PO BOX 72654, City of Helsinki, 00099, Finland
| | - Rantsi Mervi
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Juola Anna-Liisa
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Kautiainen Hannu
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Pitkälä Kaisu H
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
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Sengupta M, Singh P, Melekin A. Eligibility Rate Differences Among Residential Care Communities: 2010 National Survey of Residential Care Facilities and 2012-2018 National Study of Long-Term Care Providers. Vital Health Stat 1 2022:1-30. [PMID: 35604364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objectives Over the last decade, the National Survey of Residential Care Facilities (NSRCF) and multiple waves of the National Study of Long-Term Care Providers (NSLTCP) (renamed National Post-acute and Long-term Care Study in 2020) have collected data about residential care communities (RCCs). This report provides a review of RCC eligibility rates over survey years and describes design differences and methodological changes-including minor wording changes to screener questions and placement of question-specific instructions-that may be related toobserved differences in eligibility rates.
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Vos CM, Ambrose-Gallagher N, Webster KE, Larson JL. Physical Activity and Sedentary Behavior of Residents in Assisted Living: A Preliminary Study. Res Gerontol Nurs 2022; 15:117-123. [PMID: 35417270 DOI: 10.3928/19404921-20220408-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Low physical activity (PA) and high sedentary behavior (SB) place residents in assisted living at risk for physical decline, but little is known about factors that influence PA/SB in this setting. In the current cross-sectional study, we described objectively measured PA/SB (activPAL™) and examined the relationships between PA/SB and use of an assistive walking device, depression, sleep disturbance, pain, fatigue, social isolation, and the tendency to make social comparisons. Fifty-four residents from eight assisted living facilities participated. Mean time spent in PA was 252.9 (SD = 134.3) minutes/day. Mean time spent in SB was 660.8 (SD = 181.4) minutes/day. Depression predicted PA (R2 = 0.16). Residents using an assistive device spent significantly more time in SB (p = 0.02). Fatigue correlated with time in longer bouts of SB (r = 0.19, p = 0.04). The tendency to make social comparisons correlated with SB (r = 0.22, p = 0.04). Findings show residents in assisted living are inactive and further research is needed to fully understand factors that influence PA/SB. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Paudel A, Galik E, Resnick B, Doran K, Boltz M, Zhu S. Factors Associated With the Quality of Staff-Resident Interactions in Assisted Living. J Nurs Care Qual 2022; 37:168-175. [PMID: 34446666 PMCID: PMC8866198 DOI: 10.1097/ncq.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Care interactions are verbal or nonverbal interactions between staff and residents during social or physical care activities. The quality of care interactions could be positive, negative, or neutral. PURPOSE The purpose of this study was to examine the resident- and facility-level factors associated with the care interactions in assisted living (AL). METHODS Regression analysis was performed using a stepwise method utilizing baseline data of 379 residents from 59 AL facilities recruited in a randomized trial. RESULTS Accounting for 8.2% of variance, increased resident agitation was associated with negative or neutral quality interactions while for-profit ownership was associated with positive quality interactions. CONCLUSIONS To promote positive care interactions, findings suggest the need to educate staff about strategies to minimize resident agitation (eg, calm posture and respectful listening) and work toward optimizing care interactions in nonprofit settings. Future research could further explore the influence of staff-level factors on care interactions.
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Affiliation(s)
- Anju Paudel
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Kelly Doran
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Marie Boltz
- Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802
| | - Shijun Zhu
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
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June JW, Peterson L, Hyer K, Dobbs D. Implementation of an Emergency Power Rule: Compliance of Florida Nursing Homes and Assisted Living Facilities. Disaster Med Public Health Prep 2022; 17:e103. [PMID: 35293308 PMCID: PMC10463501 DOI: 10.1017/dmp.2022.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Thea aim of this study was to explore the relationship between Florida nursing home and assisted living facility characteristics and their ability to comply with a new emergency power rule in the aftermath of Hurricane Irma. METHODS This study used characteristics data on Florida nursing homes (NHs) (N = 680) and assisted living facilities (ALFs) (N = 2940) in operation between September 2017 and January 2019. Logistic regressions were used to determine whether certain characteristics were associated with compliance with the emergency power rule by January 1, 2019. RESULTS A total of 219 (32.9%) NHs and 2219 (75.5%) ALFs had an emergency power plan implemented by January 1, 2019. Results suggest having a dementia care unit increased the odds of compliance for NHs, while chain membership, for-profit status, and a higher reliance on Medicaid decreased the odds. Additionally, smaller size, mental health specialty license, and higher reliance on supplemental state funding increased the odds of compliance for ALFs, while nursing care specialty license and for-profit status decreased the odds of compliance. CONCLUSIONS Policy implications from these results include informing policy-makers on the barriers faced by NHs and ALFs to implement a new regulation that may cause financial difficulties and compromise quality care.
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Affiliation(s)
- Joseph W June
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Lindsay Peterson
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Kathryn Hyer
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Debra Dobbs
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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Abstract
The current quality improvement project aimed at replicating the implementation of a sit-to-stand exercise program in a small 20-bed assisted living facility (ALF) in rural North Carolina. The primary outcome was for residents to maintain or improve function in performance of activities of daily living (ADLs). Even with the challenges of the coronavirus disease 2019 pandemic, ALF staff and residents found a way to continue the exercise program with a high level of participation and thus prevent avoidable decline in residents' independence with ADLs. [Journal of Gerontological Nursing, 48(3), 30-36.].
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Affiliation(s)
- Paul R Katz
- Department of Geriatrics, Florida State University, College of Medicine, Tallahassee, FL, USA.
| | - Sarah Howd
- Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Casey Rust
- Department of Geriatrics, Florida State University, College of Medicine, Tallahassee, FL, USA
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Resnick B, Boltz M, Galik E, Fix S, Holmes S, Zhu S. Model Testing of the Factors That Influence Performance of Function Focused Care and Function Among Assisted Living Residents. J Appl Gerontol 2022; 41:401-410. [PMID: 35067104 PMCID: PMC8792441 DOI: 10.1177/0733464820976435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
The purpose of this study was to test a model of factors associated with participating in function focused care. Function focused care is a philosophy of care in which residents are encouraged to engage in functional and physical activities during care interactions. This was a secondary data analysis using data from the Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) study. Residents (n = 550) were recruited from 59 AL settings. The majority were female (n = 380, 69%) and White (n = 536, 97%). Model testing was done. Comorbidities, quality of interactions, environments, profit status, cognitive impairment, depression, and function were associated with function focused care and accounted for 17% of the variance. Next steps should include intervening on changeable factors (e.g., environments) and adding factors to better explain performance of function focused care such as motivation, resilience, and staff satisfaction.
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Affiliation(s)
| | - Marie Boltz
- Pennsylvania State University, University Park, USA
| | | | - Steven Fix
- University of Maryland School of Nursing, Baltimore, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
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Zhang H, Duong TTH, Rao AK, Mazzoni P, Agrawal SK, Guo Y, Zanotto D. Transductive Learning Models for Accurate Ambulatory Gait Analysis in Elderly Residents of Assisted Living Facilities. IEEE Trans Neural Syst Rehabil Eng 2022; 30:124-134. [PMID: 35025747 DOI: 10.1109/tnsre.2022.3143094] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Instrumented footwear represents a promising technology for spatiotemporal gait analysis in out-of-the-lab conditions. However, moderate accuracy impacts this technology's ability to capture subtle, but clinically meaningful, changes in gait patterns that may indicate adverse outcomes or underlying neurological conditions. This limitation hampers the use of instrumented footwear to aid functional assessments and clinical decision making. This paper introduces new transductive-learning inference models that substantially reduce measurement errors relative to conventional data processing techniques, without requiring subject-specific labelled data. The proposed models use subject-optimized input features and hyperparameters to adjust the spatiotemporal gait metrics (i.e., stride time, length, and velocity, swing time, and double support time) obtained with conventional techniques, resulting in computationally simpler models compared to end-to-end machine learning approaches. Model validity and reliability were evaluated against a gold-standard electronic walkway during a clinical gait performance test (6-minute walk test) administered to N=95 senior residents of assisted living facilities with diverse levels of gait and balance impairments. Average reductions in absolute errors relative to conventional techniques were -42.0% and -33.5% for spatial and gait-phase parameters, respectively, indicating the potential of transductive learning models for improving the accuracy of instrumented footwear for ambulatory gait analysis.
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50
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Morgan JC, Kemp CL, Barmon C, Fitzroy A, Ball MM. Limiting and Promoting Resident Self-Care in Assisted Living. J Gerontol B Psychol Sci Soc Sci 2021; 76:1664-1672. [PMID: 33471097 PMCID: PMC8577204 DOI: 10.1093/geronb/gbab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Assisted living (AL) residents often manage multiple chronic conditions, functional and/or cognitive decline along with their individual needs and preferences for a full life. Although residents participate in their own care, little is known about their self-care activities and how to support them. This analysis focuses on residents' self-care and theorizing the dynamic, socially embedded process of negotiating self-care. METHODS We analyze data from a grounded theory study informed by the Convoys of Care model. Participants included 50 focal residents and 169 paid and unpaid convoy members in eight AL homes; each resident convoy was followed up for 2 years. Data collection included participant observation, interviews, and resident record review. RESULTS To the extent possible, most AL residents were involved in self-care related to activities of daily living, health promotion, and social, emotional, and mental well-being. Residents and care partners engaged in a dynamic process of limiting and promoting self-care activities. Multiple factors influenced self-care, including residents' past self-care behaviors, caregiver fear and availability, and the availability of services and supports. DISCUSSION Strategies for promoting self-care must involve residents and care partners and include convoy education in collaborative goal-setting, prioritizing care that supports the goals, and putting resources in place to support goal achievement.
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Affiliation(s)
- Jennifer C Morgan
- Gerontology Institute, Georgia State University, Atlanta, USA
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Candace L Kemp
- Gerontology Institute, Georgia State University, Atlanta, USA
- Department of Sociology, Georgia State University, Atlanta, USA
| | - Christina Barmon
- Department of Sociology, Central Connecticut State University, New Britain, USA
| | - Andrea Fitzroy
- Department of Sociology, Georgia State University, Atlanta, USA
| | - Mary M Ball
- Gerontology Institute, Georgia State University, Atlanta, USA
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