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Giosa JL, Saari M, Holyoke P, Hirdes JP, Heckman GA. Developing an evidence-informed model of long-term life care at home for older adults with medical, functional and/or social care needs in Ontario, Canada: a mixed methods study protocol. BMJ Open 2022; 12:e060339. [PMID: 35953249 PMCID: PMC9379487 DOI: 10.1136/bmjopen-2021-060339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic exacerbated existing challenges within the Canadian healthcare system and reinforced the need for long-term care (LTC) reform to prioritise building an integrated continuum of services to meet the needs of older adults. Almost all Canadians want to live, age and receive care at home, yet funding for home and community-based care and support services is limited and integration with primary care and specialised geriatric services is sparse. Optimisation of existing home and community care services would equip the healthcare system to proactively meet the needs of older Canadians and enhance capacity within the hospital and residential care sectors to facilitate access and reduce wait times for those whose needs are best served in these settings. The aim of this study is to design a model of long-term 'life care' at home (LTlifeC model) to sustainably meet the needs of a greater number of community-dwelling older adults. METHODS AND ANALYSIS An explanatory sequential mixed methods design will be applied across three phases. In the quantitative phase, secondary data analysis will be applied to historical Ontario Home Care data to develop unique groupings of patient needs according to known predictors of residential LTC home admission, and to define unique patient vignettes using dominant care needs. In the qualitative phase, a modified eDelphi process and focus groups will engage community-based clinicians, older adults and family caregivers in the development of needs-based home care packages. The third phase involves triangulation to determine initial model feasibility. ETHICS AND DISSEMINATION This study has received ethics clearance from the University of Waterloo Research Ethics Board (ORE #42182). Results of this study will be disseminated through peer-reviewed publications and local, national and international conferences. Other forms of knowledge mobilisation will include webinars, policy briefs and lay summaries to elicit support for implementation and pilot testing phases.
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Affiliation(s)
- Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Margaret Saari
- SE Research Centre, SE Health, Markham, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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This was my Crimean War: COVID-19 Experiences of Nursing Home Leaders. J Am Med Dir Assoc 2022; 23:1827-1832. [PMID: 36084690 PMCID: PMC9371982 DOI: 10.1016/j.jamda.2022.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 12/05/2022]
Abstract
Objective To describe professional and personal experiences of nursing home care leaders during early waves of the COVID-19 pandemic. Design Qualitative interpretive description. Setting and Participants Eight sites across 2 Canadian provinces. Sites varied by COVID-19 status (low or high), size (<120 or ≥120 beds), and ownership model (for-profit or not-for-profit). We recruited 21 leaders as participants: 14 managers and 7 directors of care. Methods Remote Zoom-assisted semi-structured interviews conducted from January to April 2021. Concurrent data generation and inductive content analysis occurred throughout. Sampling ceased once we reached sufficient analytic variation and richness to answer research questions. Results Most participants were female, ≥50 years of age, and born in Canada. We found 4 major themes. (1) Responsibility to protect: Extreme precautions were employed to protect residents, staff, and leaders’ families. Leaders experienced profound distress when COVID-19 infiltrated their care homes. (2) Overwhelming workloads: Changing public health orders and redeployment to pandemic-related activities caused administrative chaos. Leaders worked double shifts to cope with pandemic demands and maintain their usual work. (3) Mental and emotional toll: All participants reported symptoms of anxiety, depression, and insomnia, leading to ongoing exhaustion. Shifting staff focus from caring to custodial enforcement of isolation caused considerable distress, guilt, and grief. (4) Moving forward: The pandemic spotlighted deficiencies in the nursing home context that lead to inadequate quality of resident care and staff burnout. Some leaders indicated their pandemic experience signaled an unanticipated end to their careers. Conclusions and Implications Nursing home leaders faced mental distress and inordinate workloads during the pandemic. This is an urgent call for systemic change to improve working conditions for leaders and quality of care and quality of life for residents. Nursing home leaders are at increased risk of burnout, which must be addressed to mitigate attrition in the sector.
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Thirsk LM, Stahlke S, Perry B, Gordon B. #Morethanavisitor: Experiences of COVID-19 visitor restrictions in Canadian long-term care facilities. FAMILY RELATIONS 2022; 71:FARE12712. [PMID: 35936016 PMCID: PMC9347746 DOI: 10.1111/fare.12712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/09/2021] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
Objective The purpose of this study was to understand the experiences of families, residents, and staff around visitor restriction policies in long-term care during the COVID-19 pandemic in Canada. Background Beginning in March 2020, public health orders across Canada restricted visitors to long-term care facilities to curb the spread of the infection. This included family caregivers who provide significant support to residents to meet their physical, psychological, social, and safety needs. Method We collected data from publicly available news and social media. News articles, blogs, and tweets from Canada were collected from March 2020 to April 2021. In total, 40 news articles, eight blogs, and 23 tweets were analyzed using generic qualitative description. Results Reports from family members indicate that some residents may have died from malnutrition, dehydration, and isolation, rather than from COVID-19, because of the sudden and prolonged absence of family caregivers. There are long-term impacts on family suffering and long-term care worker burnout. Policy and structural issues were identified. Conclusion Experiences in long-term care reflected not only impacts of pandemic-related visitor restrictions, but also long-standing funding and workforce issues. Implications Involvement of family, and specifically family caregivers, is crucial in policy decisions, even in unusual circumstances, such as the pandemic.
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Affiliation(s)
| | - Sarah Stahlke
- Department of SociologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Beth Perry
- Faculty of Health DisciplinesAthabasca UniversityAthabascaAlbertaCanada
| | - Brogan Gordon
- Faculty of Health DisciplinesAthabasca UniversityAthabascaAlbertaCanada
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Kirkham J, Shorey CL, Iaboni A, Quirt H, Grigorovich A, Astell A, Lin E, Maxwell CJ. Staff perceptions of the consequences of COVID-19 on quality of dementia care for residents in Ontario long-term care homes. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5725. [PMID: 35510483 PMCID: PMC9087411 DOI: 10.1002/gps.5725] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/20/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The first wave of the COVID-19 pandemic necessitated extensive infection control measures in long-term care (LTC) and had a significant impact on staffing and services. Anecdotal reports indicate that this negatively affected LTC residents' quality of care and wellbeing, but there is scarce evidence on the effects of COVID-19 on quality of dementia care in LTC. METHODS From December 2020 to March 2021, we conducted a cross-sectional online survey among staff who worked in LTC homes in Ontario, Canada. Survey questions examined staffs' perceptions of the impact of COVID-19 on dementia quality of care during the initial wave of the COVID-19 pandemic (beginning 1 March 2020). RESULTS There were a total of 227 survey respondents; more than half reported both worsened overall quality of care (51.3%) and worsening of a majority of specific quality of care measures (55.5%). Measures of cognitive functioning, mobility and behavioural symptoms were most frequently described as worsened. Medical and allied/support staff had the highest odds of reporting overall worsened quality of care, while specialized behavioural care staff and those with more experience in LTC were less likely to. LTC home factors including rural location and smaller size, staffing challenges, higher number of outbreaks and less COVID-19 preparedness were associated with increased odds of perceived worsening of quality of dementia care outcomes. CONCLUSIONS These findings suggest that COVID-19 pandemic restrictions and related effects such as inadequate staffing may have contributed to poor quality of care and outcomes for those with dementia in LTC.
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Affiliation(s)
- Julia Kirkham
- Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Carrie L. Shorey
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Andrea Iaboni
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada,Department of PsychiatryTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Hannah Quirt
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Alisa Grigorovich
- Recreation and Leisure StudiesBrock UniversitySt CatharinesOntarioCanada
| | - Arlene Astell
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada,Department of PsychiatryTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Esther Lin
- Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Colleen J. Maxwell
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada,School of PharmacyUniversity of WaterlooWaterlooOntarioCanada
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Changing Care: Applying the Transtheoretical Model of Change to Embed Equity, Diversity, and Inclusion in Long-Term Care Research in Canada. SOCIETIES 2022. [DOI: 10.3390/soc12030087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Healthcare policy reform is evident when considering the past, present and future of long-term care (LTC) in Canada. Some of the most pressing issues facing the LTC sector include the changing demographic composition in Canadian LTC homes, minimal consideration for the role of intersectionality in LTC data collection and analysis, and the expanding need to engage diverse participants and knowledge users. Using the Transtheoretical Model of Change (TTMC) as a framework, we consider opportunities to address intersectionality in LTC research. Engaging diverse knowledge users in LTC (e.g., unpaid caregivers, paid care staff), community (e.g., advocacy groups, service providers) and policy decision-makers (e.g., provincial government) is crucial. Empowering individuals to participate, modifying environments to support engagement, and facilitating ongoing partnerships with knowledge users are critical aspects of change efforts. Addressing structural barriers (e.g., accessibility, capacity, jurisdictional policies, and mandates) to research in LTC is also essential. The TTMC offers a framework for planning and enacting individual, organizational, and system-level changes for the future of LTC.
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Read EA, Gagnon DA, Donelle L, Ledoux K, Warner G, Hiebert B, Sharma R. Stakeholder Perspectives on In-home Passive Remote Monitoring to Support Aging in Place in the Province of New Brunswick, Canada: Rapid Qualitative Investigation. JMIR Aging 2022; 5:e31486. [PMID: 35544304 PMCID: PMC9133995 DOI: 10.2196/31486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The province of New Brunswick (NB) has one of the oldest populations in Canada, providing an opportunity to develop and test innovative strategies to address the unique health challenges faced by older adults. Passive remote monitoring technology has the potential to support independent living among older adults. Limited research has examined the benefits of and barriers to the adoption of this technology among community-dwelling older adults. OBJECTIVE This study aimed to explore perceptions of in-home passive remote monitoring technology designed to support aging in place from the perspective of older adults, their family or friend caregivers, social workers, and government decision-makers in the province of NB, Canada. METHODS Between October 2018 and March 2020, a rapid qualitative investigation of 28 one-on-one interviews was conducted in person or via telephone. Participants included 2 home support services clients and 11 family or friend caregivers who had used passive remote monitoring technology in their homes; 8 social workers who had worked as case managers for home support services clients; and 7 individuals who were key government decision-makers in the adoption, policy development, and use of the technology in the province of NB. The interviews focused on the following topics: decision to adopt the passive remote monitoring system, barriers to adopting the passive remote monitoring system, benefits of the passive remote monitoring system, impact on client health outcomes, and privacy concerns. The interviews were audio recorded, transcribed, and analyzed by a team of 6 researchers. Data analysis was conducted using a rapid assessment process approach that included matrix analysis. RESULTS Participants reported that the use of the remote monitoring system allowed older adults to live at home longer and provided caregiver relief. Stakeholders were invested in meeting the home support (home care) needs of older adults. However, when it came to the use of remote monitoring, there was a lack of consensus about which clients it was well-suited for and the role that social workers should play in informing clients and caregivers about the service (role ambiguity, gatekeeping, and perceived conflicts of interest). CONCLUSIONS Our findings highlight many benefits and challenges of the adoption of passive remote monitoring for clients, their family or friend caregivers, and public provincial health and social services systems. Passive remote monitoring is a valuable tool that can provide support to older adults and their family or friend caregivers when it is a good fit with client needs. Further work is needed in NB to increase public and social workers' awareness of the service and its benefits.
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Affiliation(s)
- Emily A Read
- Faculty of Nursing, University of New Brunswick, Moncton, NB, Canada
| | - Danie A Gagnon
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada
| | - Lorie Donelle
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Kathleen Ledoux
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Grace Warner
- Faculty of Health Sciences, School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Brad Hiebert
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Ridhi Sharma
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada
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Slam Bam, Thank you, Ma’am: The Challenges of Advance Care Planning Engagement in Long-Term Care. Can J Aging 2022; 41:443-450. [DOI: 10.1017/s0714980821000738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
This interpretative, qualitative study explored residents’ and families’ perspectives on advance care planning (ACP) in long-term care (LTC). Perspectives on when, how, and with whom ACP discussions should be introduced and barriers and solutions to improving ACP engagement were examined. Fifty-one residents and families participated in seven focus groups. The findings revealed that residents and families prioritized caring connections over professional rank when reflecting on staff involvement in ACP. The findings further revealed that the caring and compassionate environment considered to be a critical pre-condition for ACP engagement was more typically enacted at end of life when ACP was no longer an option. Our findings suggest that work practices and organizational structures within LTC play an important role in inhibiting ACP engagement.
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Which has more influence on a family's assessment of the quality of dying of their long-term care resident with dementia: Frequency of symptoms or quality of communication with healthcare team? Palliat Support Care 2022; 21:438-444. [PMID: 35346414 DOI: 10.1017/s1478951522000323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Symptoms present at the end of life and the quality of communication with the healthcare team have both been shown to impact family assessments of the quality of dying of their loved one with dementia. However, the relative contributions of these two factors to family assessments have not yet been investigated. To address this knowledge gap, we explored which of these two factors has more influence on family assessments of the quality of dying of long-term care (LTC) residents with dementia. METHOD This is a secondary analysis of a mortality follow-back study. Ninety-four family members of LTC residents who had died with dementia assessed the quality of dying (very good or not very good), the frequency of symptoms, and the quality of communication with the healthcare team using a self-administered questionnaire mailed 1 month after the resident's death. Logistic regression analyses were performed to determine the relative contributions of the two independent variables of primary interest (frequency of symptoms and quality of communication) to the families' assessments of the quality of dying. RESULTS Multivariate analyses revealed that the quality of communication with the healthcare team was closely linked to the quality of dying (p = 0.009, OR = 1.34, 95% CI = 1.09-1.65), whereas the frequency of symptoms was not (p = 0.142, OR = 1.05, 95% CI = 0.98-1.11) after controlling for potential confounders. SIGNIFICANCE OF RESULTS Our findings show that healthcare providers' ability to engage in the end-of-life conversations with families outweighs the frequency of symptoms in family assessments of the quality of dying of their relative with dementia. Enhancing healthcare providers' ability to communicate with families about the end-of-life care could improve families' perceptions of the quality of dying of their relative with dementia and, consequently, ease their grieving process.
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Plagg B, Piccoliori G, Engl A, Wiedermann CJ, Mahlknecht A, Barbieri V, Ausserhofer D, Koler P, Tauber S, Lechner M, Lorenz WA, Conca A, Eisendle K. Disaster Response in Italian Nursing Homes: A Qualitative Study during the COVID-19 Pandemic. Geriatrics (Basel) 2022; 7:32. [PMID: 35314604 PMCID: PMC8938780 DOI: 10.3390/geriatrics7020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
Nursing homes (NHs) have been among the care settings most affected by both the virus itself and collateral damage through infection protection and control measures (IPC). However, there is a paucity of research regarding disaster response and preparedness of these institutions. The present study aimed to analyze disaster response and management and to develop prospective strategies for disaster management in NHs. A qualitative survey including (i) residents, (ii) nursing staff, (iii) relatives of residents, and (iv) NHs' medical leads was performed. Data were collected by 45 in-depth interviews. Our results indicate that the shift from resident-centered care towards collective-protective approaches led through the suspending of established care principles to an emergency vacuum: implementable strategies were lacking and the subsequent development of temporary, immediate, and mostly suboptimal solutions by unprepared staff led to manifold organizational, medical, and ethical conflicts against the background of unclear legislation, changing protocols, and fear of legal consequences. IPC measures had long-lasting effects on the health and wellbeing of residents, relatives, and professionals. Without disaster preparedness protocols and support in decision-making during disasters, professionals in NHs are hardly able to cope with emergency situations.
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Affiliation(s)
- Barbara Plagg
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100 Bolzano, Italy
- Faculty of Education, Free University of Bolzano Bozen, 39100 Bolzano, Italy
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100 Bolzano, Italy
| | - Adolf Engl
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100 Bolzano, Italy
| | - Christian J Wiedermann
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100 Bolzano, Italy
- Department of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tyrol, Austria
| | - Angelika Mahlknecht
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100 Bolzano, Italy
| | - Verena Barbieri
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100 Bolzano, Italy
| | - Dietmar Ausserhofer
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100 Bolzano, Italy
| | - Peter Koler
- Nonprofit Organization Forum Prevention, 39100 Bolzano, Italy
| | - Sara Tauber
- Nonprofit Organization Forum Prevention, 39100 Bolzano, Italy
| | - Manuela Lechner
- Nonprofit Organization Forum Prevention, 39100 Bolzano, Italy
| | - Walter A Lorenz
- Department of Applied Social Sciences, Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic
| | - Andreas Conca
- Department of Psychiatry, Bolzano Central Hospital, 39100 Bolzano, Italy
| | - Klaus Eisendle
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100 Bolzano, Italy
- Academic Teaching Department of Dermatology, Venereology and Allergology, Bolzano Central Hospital, 39100 Bolzano, Italy
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Integrating Nurse Practitioners Into Long-term Care: A Call for Action. J Nurse Pract 2022; 18:488-492. [PMID: 35287369 PMCID: PMC8906654 DOI: 10.1016/j.nurpra.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The coronavirus disease 2019 pandemic exposed the devastating effects of inadequate primary care in long-term care (LTC) settings, both nationally and internationally. Deaths in LTC were compounded by the global shortage of physicians and limitations in existing funding models for these facilities. Nurse practitioners (NPs) can provide similar services as general practice physicians in LTC while meeting residents’ needs in a more timely, cost-effective manner. It is critical that NPs be integrated into LTC, particularly in the wake of the coronavirus disease 2019 pandemic. This article provides relevant literature and evidence to substantiate the effectiveness of integrating NPs into the Canadian LTC and highlights the urgent need for improved funding models and policy reform.
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Place-Making through Media: How Media Environments Make a Difference for Long-Term Care Residents’ Agency. SOCIETIES 2022. [DOI: 10.3390/soc12010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This paper explores the unique relationships care home residents have with communication media. Drawing on findings from an ethnographic case study at a long-term care site in British Columbia, Canada, I describe how care home residents’ everyday media practices are intertwined with their negotiations of longstanding attachments and new living spaces. The research draws connections between the spatiotemporal contexts of media use and residents’ experiences of social agency. Long-term care residents in this research were challenged to engage with the wider community, maintain friendships, or stay current with events and politics because their preferred ways of using communication media were not possible in long-term care. The communication inequalities experienced by care home residents were not simply about their lack of access to media or content but about their inability to find continuity with their established media habits in terms of time and place. While most research about communication media in care homes has been intervention oriented, this research suggests that long-term care service and funding policies require greater attention to create flexible, diverse, and supportive media environments.
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Daley S, Akarsu N, Armsby E, Farina N, Feeney Y, Fine B, Hughes L, Pooley J, Tabet N, Towson G, Banerjee S. What factors have influenced quality of life in people with dementia and their family carers during the COVID-19 pandemic: a qualitative study. BMJ Open 2022; 12:e053563. [PMID: 35144951 PMCID: PMC8845096 DOI: 10.1136/bmjopen-2021-053563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has led to significant disruption to health and social care services. For people with dementia and their family carers this is problematic, as a group who rely on timely and responsive services to live well with the condition. This study has sought to understand how COVID-19 has affected the quality of life of people diagnosed with dementia and their family carers. DESIGN Our mixed-methods study was nested in a larger cohort study of an education programme, Time for Dementia. SETTING The study took place in the South-East of England. PARTICIPANTS Existing study participants, family carers were approached about the COVID-19 nested study. A purposeful sample of participants were invited to take part in in-depth qualitative interview. The sample included family carers in a range of different caring situations. MEASUREMENT Interviews were undertaken remotely by telephone. Interviews sought to understand quality of life before the pandemic, impact of the restrictions on both the person with dementia and family carer, role of services and other agencies as well as supportive factors. Data were analysed using thematic analysis. RESULTS 16 family carers were interviewed. Seven themes were identified from our analysis: (1) decreased social interaction; (2) reduced support; (3) deteriorating cognitive and physical health for the person with dementia; (4) decreased carer well-being; (5) difficulties understanding COVID-19 restrictions; (6) limited impact for some and (7) trust and relationship with care home. There was little change between themes during the first and second wave of national lockdowns. CONCLUSIONS Our study provides an understanding the short-term impact of COVID-19 on the quality of life of people with dementia and their family carers. Our findings suggest that recovery between the first and second wave of the restrictions did not automatically take place.
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Affiliation(s)
- Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Nazire Akarsu
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Elise Armsby
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Yvonne Feeney
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Bethany Fine
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Laura Hughes
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Joanna Pooley
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Naji Tabet
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | | | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
- Faculty of Health, University of Plymouth, Plymouth, UK
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Naseer M, J McKee K, Ehrenberg A, Schön P, Dahlberg L. Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study. BMJ Open 2022; 12:e055484. [PMID: 35140159 PMCID: PMC8830250 DOI: 10.1136/bmjopen-2021-055484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors. DESIGN A register-based prospective cohort study. SETTING Swedish region of Dalarna. PARTICIPANTS Participants were 16 543 community-living adults aged 80 or older who were residents of the Dalarna region of Sweden, excluding older adults who moved out of Dalarna or into residential care during the study period. OUTCOME MEASURES Dependent variables were initial ED visit, and at least one ED revisit within 30 days of an initial ED visit. RESULTS Approximately 36% of the participants visited the ED during the study period with 18.9% returning to the ED within 30 days. For both initial ED visits and ED revisits, the addition of contextual factors to models containing individual factors significantly improved model fit (p<0.001; p<0.022) and the amount of variance explained in the outcome. In the final models, initial ED visit was significantly associated with older age, number of chronic diseases, receipt of home help, number of primary care visits, proportion of 80+ in the population and shorter distance to the ED; while an ED revisit was significantly associated with greater use of social care, number of hospital admissions and disposition (discharged; admitted to hospital) at initial ED visit. CONCLUSION Contextual factors explain variance in initial ED visit, additional to that explained by individual factors alone, which indicates inequitable access to ED care. These findings suggest considering local variations in contextual factors in order to improve health-related outcomes among older adults.
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Affiliation(s)
- Mahwish Naseer
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kevin J McKee
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Pär Schön
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lena Dahlberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Reimagining Nutrition Care and Mealtimes in Long-Term Care. J Am Med Dir Assoc 2022; 23:253-260.e1. [PMID: 34986411 DOI: 10.1016/j.jamda.2021.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 01/06/2023]
Abstract
Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents' nutrition and well-being is required.
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Perez H, Neubauer N, Marshall S, Philip S, Miguel-Cruz A, Liu L. Barriers and Benefits of Information Communication Technologies Used by Health Care Aides. Appl Clin Inform 2022; 13:270-286. [PMID: 35263800 PMCID: PMC8906996 DOI: 10.1055/s-0042-1743238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although information and communication technologies (ICT) are becoming more common among health care providers, there is little evidence on how ICT can support health care aides. Health care aides, also known as personal care workers, are unlicensed service providers who encompass the second largest workforce, next to nurses, that provide care to older adults in Canada. OBJECTIVE The purpose of this literature review is to examine the range and extent of barriers and benefits of ICT used by health care workers to manage and coordinate the care-delivery workflow for their clients. METHODS We conducted a literature review to examine the range and extent of ICT used by health care aides to manage and coordinate their care delivery, workflow, and activities. We identified 8,958 studies of which 40 were included for descriptive analyses. RESULTS We distinguished the following five different purposes for the use and implementation of ICT by health care aides: (1) improve everyday work, (2) access electronic health records for home care, (3) facilitate client assessment and care planning, (4) enhance communication, and (5) provide care remotely. We identified 128 barriers and 130 benefits related to adopting ICT. Most of the barriers referred to incomplete hardware and software features, time-consuming ICT adoption, heavy or increased workloads, perceived lack of usefulness of ICT, cost or budget restrictions, security and privacy concerns, and lack of integration with technologies. The benefits for health care aides' adoption of ICT were improvements in communication, support to workflows and processes, improvements in resource planning and health care aides' services, and improvements in access to information and documentation. CONCLUSION Health care aides are an essential part of the health care system. They provide one-on-one care to their clients in everyday tasks. Despite the scarce information related to health care aides, we identified many benefits of ICT adoption.
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Affiliation(s)
- Hector Perez
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Noelannah Neubauer
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Samantha Marshall
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Serrina Philip
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Antonio Miguel-Cruz
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada.,Glenrose Rehabilitation Hospital, Edmonton (AB), Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton (AB), Canada
| | - Lili Liu
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
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Iaconi A, Duan Y, Tate K, Penconek T, Cummings G, Norton P, Estabrooks C. Nursing Home Managers' High Risk of Burnout. J Am Med Dir Assoc 2021; 23:173-175. [PMID: 34788597 PMCID: PMC8590730 DOI: 10.1016/j.jamda.2021.08.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Ala Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kaitlyn Tate
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tatiana Penconek
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Greta Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Norton
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Impact of COVID-19 on Relationship-Centred Residential Dining Practices. Can J Aging 2021. [DOI: 10.1017/s0714980821000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractThis study describes changes in dining practices and provider perspectives on meal-related challenges due to the coronavirus disease (COVID-19) pandemic. An online survey was disseminated between July and September 2020 through stakeholder networks and social media with 1,036 respondents. Altered dining practices included residents eating in rooms (54.3%), spacing residents in common areas for meals (69.3%), and disposable dish use (44.9%). The most common mealtime challenges were reduced socializing opportunities at meals (29.3%), inadequate staffing (22.8%), reduced family/volunteer help (16.7%), and assisting residents to eat (10.5%). Many participants (72.2%) felt conflict balancing safety and relationship-centred care. Geographic region, home size, building age, respondent’s job title, pre-pandemic relationship-centred practices, and mealtime satisfaction, and some pandemic-initiated practices were associated with mealtime challenges and feeling conflicted in binary logistic regression analyses. Considering trade-offs between safety and relational aspects of mealtimes during the pandemic is crucial.
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Predictors of Acute Encephalopathy in Patients with COVID-19. J Clin Med 2021; 10:jcm10214821. [PMID: 34768339 PMCID: PMC8584437 DOI: 10.3390/jcm10214821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/30/2021] [Accepted: 10/17/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The majority of patients with severe COVID-19 suffer from delirium as the main sign of encephalopathy associated with this viral infection. The aim of this study was to identify early markers of the development of this condition. MATERIALS The prospective cohort-based study included patients with community-acquired pneumonia and confirmed pulmonary tissue infiltration based on CT data, with a lesion consisting of at least 25% of one lung. The main group included patients who have developed acute encephalopathy (10 patients, 3 (30%) women; average age, 47.9 ± 7.3 years). The control group included patients who at discharge did not have acute encephalopathy (20 patients, 11 (55%) women; average age, 51.0 ± 10.5 years). The study collected clinical examination data, comprehensive laboratory data, neurophysiological data, pulse oximetry and CT data to identify the predictors of acute encephalopathy (study ClinicalTrials.gov identifier NCT04405544). RESULTS Data analysis showed a significant relationship between encephalopathy with the degree of lung tissue damage, arterial hypertension, and type 2 diabetes mellitus, as well as with D-dimer, LDH, and lymphopenia. CONCLUSIONS The development of encephalopathy is secondary to the severity of the patient's condition since a more severe course of the coronavirus infection leads to hypoxic brain damage.
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Parmar J, Anderson S, Dobbs B, Tian PGJ, Charles L, Triscott J, Stickney-Lee J, Brémault-Phillips S, Sereda S, Poole L. Neglected Needs of Family Caregivers during the COVID-19 Pandemic and What They Need Now: A Qualitative Study. Diseases 2021; 9:70. [PMID: 34698124 PMCID: PMC8544374 DOI: 10.3390/diseases9040070] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
COVID-19 has had a negative impact on family caregivers, whether the care receivers lived with the caregiver, in a separate community home, in supportive living, or in long-term care. This qualitative study examines the points of view of family caregivers who care in diverse settings. Family caregivers were asked to describe what could have been done to support them during the COVID-19 pandemic and to suggest supports they need in the future as the pandemic wanes. Thorne's interpretive qualitative methodology was employed to examine current caregiver concerns. Thirty-two family caregivers participated. Family caregivers thought the under-resourced, continuing care system delayed pandemic planning, and that silos in health and community systems made caregiving more difficult. Family caregivers want their roles to be recognized in policy, and they cite the need for improvements in communication and navigation. The growth in demand for family caregivers and their contributions to the healthcare system make it critical that the family caregiver role be recognized in policy, funding, and practice.
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Affiliation(s)
- Jasneet Parmar
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
- Home Living Edmonton Zone, Alberta Health Services, Edmonton, AB T6G 2G4, Canada
| | - Sharon Anderson
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | - Bonnie Dobbs
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
- Medically At-Risk Driver Centre, University of Alberta, Edmonton, AB T6G 2T4, Canada
| | - Peter George J. Tian
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | - Lesley Charles
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | - Jean Triscott
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | - Jennifer Stickney-Lee
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | | | - Sandy Sereda
- Caregivers Alberta, Edmonton, AB T5B 1R1, Canada;
| | - Lisa Poole
- Dementia Advocacy Canada, Dementia Network Calgary’s Strategic Council, Gordie Howe C.A.R.E.S. & the Brenda Strafford Foundation Dementia Friendly Communities, Calgary, AB T3B 0K7, Canada;
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Rayner JA, Fetherstonhaugh D. What factors influence nursing home use of hospital avoidance programs? An interview study. J Adv Nurs 2021; 78:510-522. [PMID: 34617613 DOI: 10.1111/jan.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/05/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
AIMS To understand why some nursing homes use hospital avoidance programs more frequently than others. DESIGN Two hospital avoidance programs, called residential-in-reach services in Victoria, Australia, were evaluated using a qualitative descriptive design. METHODS Between 2014 and 2018, 127 semi-structured interviews were conducted with staff from nursing homes, general practitioners and staff from the residential-in reach services. The interviews took an average of 45 min and transcripts were thematically analysed. RESULTS Nursing home reliance on residential-in-reach services to manage deteriorating residents was evident in both evaluations. Irrespective of the model of service provision, reliance was associated with: the increased care needs of residents; difficulties accessing timely and appropriate medical care; and the reduced numbers of skilled registered nurses to assess and manage deteriorating residents. CONCLUSION The residential-in-reach services are highly regarded by nursing homes. However, some are reliant on these services to provide nursing assessment and management. Using residential-in-reach services to substitute for nursing care, deskills nurses and shifts the cost of providing care from the service provider to other agencies. To provide residents with quality nursing care, the number of skilled registered nurses able to work within their scope of practice needs to be increased in Australian nursing homes. IMPACT The findings highlight the challenges of providing care in older people living in aged care. Increasing the number of skilled registered nurses in Australian nursing homes, would support deteriorating residents to stay in familiar surroundings and reduce reliance on external services to provide nursing care.
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Affiliation(s)
- Jo-Anne Rayner
- Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Victoria, Australia
| | - Deirdre Fetherstonhaugh
- Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Victoria, Australia
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Stratil JM, Biallas RL, Burns J, Arnold L, Geffert K, Kunzler AM, Monsef I, Stadelmaier J, Wabnitz K, Litwin T, Kreutz C, Boger AH, Lindner S, Verboom B, Voss S, Movsisyan A. Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review. Cochrane Database Syst Rev 2021; 9:CD015085. [PMID: 34523727 PMCID: PMC8442144 DOI: 10.1002/14651858.cd015085.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Starting in late 2019, COVID-19, caused by the novel coronavirus SARS-CoV-2, spread around the world. Long-term care facilities are at particularly high risk of outbreaks, and the burden of morbidity and mortality is very high among residents living in these facilities. OBJECTIVES To assess the effects of non-pharmacological measures implemented in long-term care facilities to prevent or reduce the transmission of SARS-CoV-2 infection among residents, staff, and visitors. SEARCH METHODS On 22 January 2021, we searched the Cochrane COVID-19 Study Register, WHO COVID-19 Global literature on coronavirus disease, Web of Science, and CINAHL. We also conducted backward citation searches of existing reviews. SELECTION CRITERIA We considered experimental, quasi-experimental, observational and modelling studies that assessed the effects of the measures implemented in long-term care facilities to protect residents and staff against SARS-CoV-2 infection. Primary outcomes were infections, hospitalisations and deaths due to COVID-19, contaminations of and outbreaks in long-term care facilities, and adverse health effects. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full texts. One review author performed data extractions, risk of bias assessments and quality appraisals, and at least one other author checked their accuracy. Risk of bias and quality assessments were conducted using the ROBINS-I tool for cohort and interrupted-time-series studies, the Joanna Briggs Institute (JBI) checklist for case-control studies, and a bespoke tool for modelling studies. We synthesised findings narratively, focusing on the direction of effect. One review author assessed certainty of evidence with GRADE, with the author team critically discussing the ratings. MAIN RESULTS We included 11 observational studies and 11 modelling studies in the analysis. All studies were conducted in high-income countries. Most studies compared outcomes in long-term care facilities that implemented the measures with predicted or observed control scenarios without the measure (but often with baseline infection control measures also in place). Several modelling studies assessed additional comparator scenarios, such as comparing higher with lower rates of testing. There were serious concerns regarding risk of bias in almost all observational studies and major or critical concerns regarding the quality of many modelling studies. Most observational studies did not adequately control for confounding. Many modelling studies used inappropriate assumptions about the structure and input parameters of the models, and failed to adequately assess uncertainty. Overall, we identified five intervention domains, each including a number of specific measures. Entry regulation measures (4 observational studies; 4 modelling studies) Self-confinement of staff with residents may reduce the number of infections, probability of facility contamination, and number of deaths. Quarantine for new admissions may reduce the number of infections. Testing of new admissions and intensified testing of residents and of staff after holidays may reduce the number of infections, but the evidence is very uncertain. The evidence is very uncertain regarding whether restricting admissions of new residents reduces the number of infections, but the measure may reduce the probability of facility contamination. Visiting restrictions may reduce the number of infections and deaths. Furthermore, it may increase the probability of facility contamination, but the evidence is very uncertain. It is very uncertain how visiting restrictions may adversely affect the mental health of residents. Contact-regulating and transmission-reducing measures (6 observational studies; 2 modelling studies) Barrier nursing may increase the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent cleaning and environmental hygiene measures may reduce the number of infections, but the evidence is very uncertain. It is unclear how contact reduction measures affect the probability of outbreaks. These measures may reduce the number of infections, but the evidence is very uncertain. Personal hygiene measures may reduce the probability of outbreaks, but the evidence is very uncertain. Mask and personal protective equipment usage may reduce the number of infections, the probability of outbreaks, and the number of deaths, but the evidence is very uncertain. Cohorting residents and staff may reduce the number of infections, although evidence is very uncertain. Multicomponent contact -regulating and transmission -reducing measures may reduce the probability of outbreaks, but the evidence is very uncertain. Surveillance measures (2 observational studies; 6 modelling studies) Routine testing of residents and staff independent of symptoms may reduce the number of infections. It may reduce the probability of outbreaks, but the evidence is very uncertain. Evidence from one observational study suggests that the measure may reduce, while the evidence from one modelling study suggests that it probably reduces hospitalisations. The measure may reduce the number of deaths among residents, but the evidence on deaths among staff is unclear. Symptom-based surveillance testing may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Outbreak control measures (4 observational studies; 3 modelling studies) Separating infected and non-infected residents or staff caring for them may reduce the number of infections. The measure may reduce the probability of outbreaks and may reduce the number of deaths, but the evidence for the latter is very uncertain. Isolation of cases may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent measures (2 observational studies; 1 modelling study) A combination of multiple infection-control measures, including various combinations of the above categories, may reduce the number of infections and may reduce the number of deaths, but the evidence for the latter is very uncertain. AUTHORS' CONCLUSIONS This review provides a comprehensive framework and synthesis of a range of non-pharmacological measures implemented in long-term care facilities. These may prevent SARS-CoV-2 infections and their consequences. However, the certainty of evidence is predominantly low to very low, due to the limited availability of evidence and the design and quality of available studies. Therefore, true effects may be substantially different from those reported here. Overall, more studies producing stronger evidence on the effects of non-pharmacological measures are needed, especially in low- and middle-income countries and on possible unintended consequences of these measures. Future research should explore the reasons behind the paucity of evidence to guide pandemic research priority setting in the future.
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Affiliation(s)
- Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke L Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Laura Arnold
- Academy of Public Health Services, Duesseldorf, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Litwin
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Anna Helen Boger
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Saskia Lindner
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Booi L, Sixsmith J, Chaudhury H, O'Connor D, Young M, Sixsmith A. 'I wouldn't choose this work again': Perspectives and experiences of care aides in long-term residential care. J Adv Nurs 2021; 77:3842-3852. [PMID: 34235778 DOI: 10.1111/jan.14948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022]
Abstract
AIMS To provide insight into the everyday realities facing care aides working in long-term residential care (LTRC), and how they perceive their role in society. DESIGN A qualitative ethnographic case study. METHODS Data were collected over. 10 months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi-structured interviews (70 h) with 31 care aides; and naturalistic observation (170 h). Data were analysed using reflexive thematic analysis. RESULTS The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections - which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC. CONCLUSION Care aides remain an unsupported workforce that is essential to the provision of high-quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role. IMPACT What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings. What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care. Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings.
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Affiliation(s)
- Laura Booi
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Judith Sixsmith
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | | | - Melanie Young
- Origin Longwood Retirement Communities, Vancouver, Canada
| | - Andrew Sixsmith
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
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Alami H, Lehoux P, Fleet R, Fortin JP, Liu J, Attieh R, Cadeddu SBM, Abdoulaye Samri M, Savoldelli M, Ag Ahmed MA. How Can Health Systems Better Prepare for the Next Pandemic? Lessons Learned From the Management of COVID-19 in Quebec (Canada). Front Public Health 2021; 9:671833. [PMID: 34222176 PMCID: PMC8249772 DOI: 10.3389/fpubh.2021.671833] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
The magnitude of the COVID-19 pandemic challenged societies around our globalized world. To contain the spread of the virus, unprecedented and drastic measures and policies were put in place by governments to manage an exceptional health care situation while maintaining other essential services. The responses of many governments showed a lack of preparedness to face this systemic and global health crisis. Drawing on field observations and available data on the first wave of the pandemic (mid-March to mid-May 2020) in Quebec (Canada), this article reviewed and discussed the successes and failures that characterized the management of COVID-19 in this province. Using the framework of Palagyi et al. on system preparedness toward emerging infectious diseases, we described and analyzed in a chronologically and narratively way: (1) how surveillance was structured; (2) how workforce issues were managed; (3) what infrastructures and medical supplies were made available; (4) what communication mechanisms were put in place; (5) what form of governance emerged; and (6) whether trust was established and maintained throughout the crisis. Our findings and observations stress that resilience and ability to adequately respond to a systemic and global crisis depend upon preexisting system-level characteristics and capacities at both the provincial and federal governance levels. By providing recommendations for policy and practice from a learning health system perspective, this paper contributes to the groundwork required for interdisciplinary research and genuine policy discussions to help health systems better prepare for future pandemics.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Pascale Lehoux
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Richard Fleet
- VITAM Research Centre on Sustainable Health, Laval University, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Jean-Paul Fortin
- VITAM Research Centre on Sustainable Health, Laval University, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Joanne Liu
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Randa Attieh
- Research Centre of the University of Montreal Hospital Centre, University of Montreal, Montreal, QC, Canada
| | - Stéphanie Bernadette Mafalda Cadeddu
- Research Centre of the University of Montreal Hospital Centre, University of Montreal, Montreal, QC, Canada
- Faculty of Law, University of Montreal, Montreal, QC, Canada
| | | | | | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Sherbrooke University, Chicoutimi, QC, Canada
- The Institute of Tropical Medicine, Antwerp, Belgium
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74
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Harasym PM, Afzaal M, Brisbin S, Sinnarajah A, Venturato L, Quail P, Kaasalainen S, Straus S, Sussman T, Virk N, Holroyd-Leduc JM. Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life. BMC Geriatr 2021; 21:326. [PMID: 34022818 PMCID: PMC8140573 DOI: 10.1186/s12877-021-02271-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/04/2021] [Indexed: 06/29/2024] Open
Abstract
Background Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC. Methods A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC. Results 19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC. Conclusions Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02271-1.
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Affiliation(s)
| | - Misha Afzaal
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | - Sarah Brisbin
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Aynharan Sinnarajah
- Cumming School of Medicine, University of Calgary, Calgary, Canada.,Alberta Health Services, Calgary, Canada
| | | | - Patrick Quail
- Cumming School of Medicine, University of Calgary, Calgary, Canada.,Alberta Health Services, Calgary, Canada
| | | | - Sharon Straus
- Faculty of Medicine, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
| | - Navjot Virk
- Brenda Strafford Foundation, Calgary, Canada
| | - Jayna M Holroyd-Leduc
- Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Alberta Health Services, Calgary, Canada. .,Foothills Medical Centre, 1403-29th Street NW, T2N 2T9, Calgary, Alberta, Canada.
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75
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Chu CH, Wang J, Fukui C, Staudacher S, A Wachholz P, Wu B. The Impact of COVID-19 on Social Isolation in Long-term Care Homes: Perspectives of Policies and Strategies from Six Countries. J Aging Soc Policy 2021; 33:459-473. [PMID: 33969815 DOI: 10.1080/08959420.2021.1924346] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Preventing the spread of COVID-19 in long-term care homes is critical for the health of residents who live in these institutions. As a result, broad policies restricting visits to these facilities were put in place internationally. While well meaning, these policies have exacerbated the ongoing social isolation crisis present in long-term care homes prior to the COVID-19 pandemic. This perspective highlights the dominant COVID-19 LTC policies from six countries, and proposes five strategies to address or mitigate social isolation during the COVID-19 pandemic that can also be applied in a post-pandemic world.
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Affiliation(s)
- Charlene H Chu
- Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Scientist, KITE-Toronto Rehab Institute, University Health Network, Ontario, Toronto, Canada
| | - Jing Wang
- Assistant Professor, School of Nursing, Fudan University, Shanghai, China
| | - Chie Fukui
- Assistant Professor, Department of Gerontological Home-Care& Long-termCare Nursing, School of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sandra Staudacher
- Postdoc, Department of Public Health, University of Basel, Basel, Switzerland
| | - Patrick A Wachholz
- Collaborating Professor, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu - Universidade Estadual Paulista (UNESP), Ourinhos, Brazil
| | - Bei Wu
- Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
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76
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Denis JL, Côté N, Fleury C, Currie G, Spyridonidis D. Global health and innovation: A panoramic view on health human resources in the COVID-19 pandemic context. Int J Health Plann Manage 2021; 36:58-70. [PMID: 33647168 PMCID: PMC8014483 DOI: 10.1002/hpm.3129] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/11/2022] Open
Abstract
While policy‐makers in many jurisdictions are paying increasing attention to health workforce issues, human resources remain at best only partially aligned with population health needs. This paper explores the governance of human resources during the pandemic, looking at the Quebec health system as a revelatory case. We identify three issues related to health human resource (HHR) policies: working conditions, recognition at work and scope of practice. We empirically probe these issues based on an analysis of popular media, policy reports and participant observation by the lead authors in various forums and research projects. Using an integrated model of HHR, we identify major vulnerabilities in this domain. Persistent labour shortages, endemic deficiencies in working environments and inequity across occupational categories limit the ability to address critical HHR issues. We propose three ways to eliminate HHR vulnerabilities: reorganize work through participatory initiatives, implement joint policy making to rebalance power across the health workforce, and invest in the development of capacities at all system levels.
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Affiliation(s)
- Jean Louis Denis
- Département de gestion, d'évaluation et de politique de santé, School of Public Health, Université de Montréal-CRCHUM, Montreal, Quebec, Canada
| | - Nancy Côté
- Department of Sociology, Université Laval-Vitam, Quebec City, Quebec, Canada
| | - Charles Fleury
- Department of Industrial Relations, Université Laval, Quebec City, Quebec, Canada
| | - Graeme Currie
- Entrepreneurship and Innovation Group, Warwick Business School, University of Warwick', Public Management, Warwick Business School, Coventry, UK
| | - Dimitrios Spyridonidis
- Entrepreneurship and Innovation Group, Warwick Business School, University of Warwick', Public Management, Warwick Business School, Coventry, UK
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77
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Wong EKC, Thorne T, Estabrooks C, Straus SE. Recommendations from long-term care reports, commissions, and inquiries in Canada. F1000Res 2021; 10:87. [PMID: 34631013 PMCID: PMC8474099 DOI: 10.12688/f1000research.43282.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Multiple long-term care (LTC) reports have issued similar recommendations for improvement across Canadian LTC homes. Our primary objective was to identify the most common recommendations made over the past 10 years. Our secondary objective was to estimate the total cost of studying LTC issues repeatedly from 1998 to 2020. Methods: The qualitative and cost analyses were conducted in Canada from July to October 2020. Using a list of reports, inquiries and commissions from The Royal Society of Canada Working Group on Long-Term Care, we coded recurrent recommendations in LTC reports. We contacted the sponsoring organizations for a cost estimate, including direct and indirect costs. All costs were adjusted to 2020 Canadian dollar values. Results: Of the 80 Canadian LTC reports spanning the years of 1998 to 2020, 24 (30%) were based on a national level and 56 (70%) were focused on provinces or municipalities. Report length ranged from 4 to 1491 pages and the median number of contributors was 14 (interquartile range, IQR, 5-26) per report. The most common recommendation was to increase funding to LTC to improve staffing, direct care and capacity (67% of reports). A median of 8 (IQR 3.25-18) recommendations were made per report. The total cost for all 80 reports was estimated to be $23,626,442.78. Conclusions: Problems in Canadian LTC homes and their solutions have been known for decades. Despite this, governments and non-governmental agencies continue to produce more reports at a monetary and societal cost to Canadians.
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Affiliation(s)
- Eric K C Wong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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78
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Wong EKC, Thorne T, Estabrooks C, Straus SE. Recommendations from long-term care reports, commissions, and inquiries in Canada. F1000Res 2021; 10:87. [PMID: 34631013 PMCID: PMC8474099 DOI: 10.12688/f1000research.43282.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Multiple long-term care (LTC) reports have issued similar recommendations for improvement across Canadian LTC homes. Our primary objective was to identify the most common recommendations made over the past 10 years. Our secondary objective was to estimate the total cost of studying LTC issues repeatedly from 1998 to 2020. Methods: The qualitative and cost analyses were conducted in Canada from July to October 2020. Using a list of reports, inquiries and commissions from The Royal Society of Canada Working Group on Long-Term Care, we coded recurrent recommendations in LTC reports. We contacted the sponsoring organizations for a cost estimate, including direct and indirect costs. All costs were adjusted to 2020 Canadian dollar values. Results: Of the 80 Canadian LTC reports spanning the years of 1998 to 2020, 24 (30%) were based on a national level and 56 (70%) were focused on provinces or municipalities. Report length ranged from 4 to 1491 pages and the median number of contributors was 14 (interquartile range, IQR, 5-26) per report. The most common recommendation was to increase funding to LTC to improve staffing, direct care and capacity (67% of reports). A median of 8 (IQR 3.25-18) recommendations were made per report. The total cost for all 80 reports was estimated to be $23,626,442.78. Conclusions: Problems in Canadian LTC homes and their solutions have been known for decades. Despite this, governments and non-governmental agencies continue to produce more reports at a monetary and societal cost to Canadians.
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Affiliation(s)
- Eric K. C. Wong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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79
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Stratton C, Andersen L, Proulx L, Sirotich E. When apathy is deadlier than COVID-19. NATURE AGING 2021; 1:144-145. [PMID: 37118627 DOI: 10.1038/s43587-021-00030-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Catherine Stratton
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
- Disability Equity in Health, Ottawa, Ontario, Canada.
| | - Lene Andersen
- Disability Equity in Health, Ottawa, Ontario, Canada
| | - Laurie Proulx
- Disability Equity in Health, Ottawa, Ontario, Canada
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
| | - Emily Sirotich
- Disability Equity in Health, Ottawa, Ontario, Canada
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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80
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Blais JM. The first five years of FACETS: Canada’s multidisciplinary open access academy journal. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jules M. Blais
- Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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81
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Abstract
This article describes priority areas for research on the impact of the Covid-19 pandemic on older adults that have been identified by the CIHR Institute of Aging (CIHR-IA). The process used by CIHR-IA consists of several iterative phases and thus far has resulted in identification of three key areas for Covid-19 research needs and four cross-cutting thematic areas. The key research priority areas are as follows: response of older adults to disease, vaccination, and therapeutics; mental health and isolation; and supportive care environments. The four cross-cutting themes are equity, diversity, and inclusion (EDI); ethical/moral considerations; evidence-informed practices; and digital health technologies. The priorities outlined in this article will inform CIHR-IA’s responses to Covid-19 research needs.
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82
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Bethell J, Aelick K, Babineau J, Bretzlaff M, Edwards C, Gibson JL, Hewitt Colborne D, Iaboni A, Lender D, Schon D, McGilton KS. Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19. J Am Med Dir Assoc 2020; 22:228-237.e25. [PMID: 33347846 PMCID: PMC9186333 DOI: 10.1016/j.jamda.2020.11.025] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 01/23/2023]
Abstract
Objectives Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19. Design Scoping review. Settings and Participants Residents of LTC homes, care homes, and nursing homes. Methods We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies. Results We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents. Conclusions and Implications Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.
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Affiliation(s)
- Jennifer Bethell
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Katelynn Aelick
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, Canada; The Institute for Education Research, University Health Network, Toronto, Canada
| | - Monica Bretzlaff
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | | | | | - Debbie Hewitt Colborne
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Dee Lender
- Ontario Association of Residents' Councils, Newmarket, Canada
| | - Denise Schon
- Lakeside Long-Term Care Centre Family Council, Toronto, Canada
| | - Katherine S McGilton
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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83
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Asmundson GJ, Blackstock C, Bourque MC, Brimacombe G, Crawford A, Deacon SH, McMullen K, McGrath PJ, Mushquash C, Stewart SH, Stinson J, Taylor S, Campbell-Yeo M. Easing the disruption of COVID-19: supporting the mental health of the people of Canada—October 2020—an RSC Policy Briefing. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic has had a significant impact on the mental health of the people of Canada. Most have found it challenging to cope with social distancing, isolation, anxiety about infection, financial security and the future, and balancing demands of work and home life. For some, especially those who have had to face pre-existing challenges such as structural racism, poverty, and discrimination and those with prior mental health problems, the pandemic has been a major impact. The Policy Briefing Report focuses on the current situation, how the COVID-19 pandemic has exacerbated significant long-standing weaknesses in the mental health system and makes specific recommendations to meet these challenges to improve the well-being of the people of Canada. The COVID-19 pandemic has had a detrimental effect on mental health of people in Canada but the impact has been variable, impacting those facing pre-existing structural inequities hardest. Those living in poverty, and in some socially stratified groups facing greater economic and social disadvantage, such as some racialized and some Indigenous groups and those with preexisting mental health problems, have suffered the most. Some occupational groups have been more exposed to the virus and to psychological stress with the pandemic. The mental health care system was already overextended and under resourced. The pandemic has exacerbated the problems. The care system responded by a massive move to virtual care. The future challenge is for Canada to strengthen our knowledge base in mental health, to learn from the pandemic, and to provide all in Canada the support they need to fully participate in and contribute to Canada’s recovery from the pandemic.
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Affiliation(s)
| | - Cindy Blackstock
- First Nations Child and Family Caring Society of Canada, Ottawa, ON, Canada
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Marie Claire Bourque
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Glenn Brimacombe
- Policy and Public Affairs, Canadian Psychological Association, Ottawa, ON, Canada
| | - Allison Crawford
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - S. Hélène Deacon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Ken McMullen
- Emergency Services, The City of Red Deer, Red Deer, AB, Canada
| | - Patrick J. McGrath
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Chair of the Working Group, Halifax, NS, Canada
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
- Dilico Anishinabek Family Care, Thunder Bay, ON, Canada
| | - Sherry H. Stewart
- Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University and IWK Health, Halifax, NS, Canada
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