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Baker Rogers J, Cagle J. Change in U.S. Hospice Quality Measure Scores During the COVID-19 Pandemic and Correlation With Exposure to State Policies for Protection of Older Adults. Am J Hosp Palliat Care 2024; 41:840-847. [PMID: 37563122 DOI: 10.1177/10499091231194726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND To limit spread of COVID-19, many U.S. states adopted policies affecting access to older adults, including those in hospice. This study aimed to assess differences in hospice quality measures from before COVID-19 to during the COVID-19 pandemic and to evaluate for any correlation with these state policies. METHODS Scores (treatment preferences, believes/values, pain screening and assessment, dyspnea screening and treatment, bowel regimen, and a composite score) and Denominators (population being measured) for CMS's Hospice Item Set were compared using a paired t-test between a pre-pandemic period (01/2019-12/2019) and a period early in the pandemic in the U.S (7/2020-6/2021). Correlations between HIS composite scores from 9 months (7/2020-3/2021) and exposure to state policies for older adult protection, and covariates, were assessed by linear regression. RESULTS Data were collected on 3535 hospices. Seven of 8 HIS scores increased during the pandemic period. The remaining score was unchanged. All Denominators decreased. There was negative correlation between composite score (7/2020-3/2021) and exposure to state policies for protecting older adults. There were positive correlations with hospice age, for-profit status, 2019 average daily census, and 2019 composite score. CONCLUSION Most HIS scores increased during this COVID-19 pandemic period; there was a small, significant negative correlation between the composite quality score and exposure to state policies for older adult protection. Further research is needed to better understand the effects of the COVID-19 pandemic on hospice care in the U.S. and globally, and future additions in quality reporting may facilitate real-time assessment during future public health emergencies.
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Affiliation(s)
- Janna Baker Rogers
- Section of Geriatrics, Palliative Medicine, and Hospice, Department of Medicine, West Virginia University, Morgantown, WV, USA
- Palliative Care Graduate Program, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - John Cagle
- School of Social Work, University of Maryland, Baltimore, MD, USA
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Levy AM, Grigorovich A, McMurray J, Quirt H, Ranft K, Engell K, Stewart S, Astell A, Kokorelias K, Schon D, Rogrigues K, Tsokas M, Flint AJ, Iaboni A. Implementation of the Dementia Isolation Toolkit in long-term care improves awareness but does not reduce moral distress amongst healthcare providers. BMC Health Serv Res 2024; 24:481. [PMID: 38637814 PMCID: PMC11027277 DOI: 10.1186/s12913-024-10912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/27/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Healthcare providers may experience moral distress when they are unable to take the ethically or morally appropriate action due to real or perceived constraints in delivering care, and this psychological stressor can negatively impact their mental health, leading to burnout and compassion fatigue. This study describes healthcare providers experiences of moral distress working in long-term care settings during the COVID-19 pandemic and measures self-reported levels of moral distress pre- and post-implementation of the Dementia Isolation Toolkit (DIT), a person-centred care intervention designed for use by healthcare providers to alleviate moral distress. METHODS Subjective levels of moral distress amongst providers (e.g., managerial, administrative, and front-line employees) working in three long-term care homes was measured pre- and post-implementation of the DIT using the Moral Distress in Dementia Care Survey and semi-structured interviews. Interviews explored participants' experiences of moral distress in the workplace and the perceived impact of the intervention on moral distress. RESULTS A total of 23 providers between the three long-term care homes participated. Following implementation of the DIT, subjective levels of moral distress measured by the survey did not change. When interviewed, participants reported frequent experiences of moral distress from implementing public health directives, staff shortages, and professional burnout that remained unchanged following implementation. However, in the post-implementation interviews, participants who used the DIT reported improved self-awareness of moral distress and reductions in the experience of moral distress. Participants related this to feeling that the quality of resident care was improved by integrating principals of person-centered care and information gathered from the DIT. CONCLUSIONS This study highlights the prevalence and exacerbation of moral distress amongst providers during the pandemic and the myriad of systemic factors that contribute to experiences of moral distress in long-term care settings. We report divergent findings with no quantitative improvement in moral distress post-intervention, but evidence from interviews that the DIT may ease some sources of moral distress and improve the perceived quality of care delivered. This study demonstrates that an intervention to support person-centred isolation care in this setting had limited impact on overall moral distress during the COVID-19 pandemic.
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Affiliation(s)
- Anne Marie Levy
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, Ontario, Canada
| | - Alisa Grigorovich
- Recreation and Leisure Studies, Brock University, St. Catharines, Ontario, Canada
| | - Josephine McMurray
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, Ontario, Canada
| | - Hannah Quirt
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Kaitlyn Ranft
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katia Engell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Steven Stewart
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Arlene Astell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- School of Psychology & Clinical Language Sciences, University of Reading, Berkshire, UK
| | - Kristina Kokorelias
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Geriatrics, Sinai Health and University Health Network, Toronto, Ontario, Canada
| | - Denise Schon
- Chair of Family Council, Lakeside Long Term Care Centre, Toronto, Ontario, Canada
| | - Kevin Rogrigues
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Mario Tsokas
- Ontario Health Central, Toronto, Ontario, Canada
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Kirkham J, Keng A, Conn D, Benjamin S, Seitz D, Rivard MF, Martinussen B, Grief C, Checkland C, Rabheru K. Timely Yet Long Overdue: Canadian Standards for Long-Term Care Homes. Can Geriatr J 2024; 27:76-79. [PMID: 38433886 PMCID: PMC10896204 DOI: 10.5770/cgj.27.706] [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] [Indexed: 03/05/2024] Open
Abstract
The impact of the COVID-19 pandemic highlighted systemic problems in Canadian long-term care (LTC). While high mortality rates in LTC received significant attention, the pandemic also took an enormous toll on mental health of LTC residents, where mental health conditions, including cognitive disorders, are already much higher than in other community settings. The pandemic resulted in a renewed interest in improving quality of care in LTC and led to the recent development of several National Standards of Canada. The newly available Standards set ambitious targets, but many of the standards are practical and essential to moving beyond a focus on safety and physical needs in LTC and towards one that supports residents as whole persons. While the standards support good mental health indirectly, there is a need to recognize mental health in these settings as a fundamental human right and essential to quality of life, and for this to be reflected in ongoing and future standards development. Ensuring existing and forthcoming National Standards are meaningfully implemented, in whole or in part, will require extensive efforts at multiple levels. The guidance provided by Canadian Standards will shape this transformative process, necessitating aligned federal and provincial investments and policies, and stakeholder engagement to bring about the envisioned high-quality care.
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Affiliation(s)
- Julia Kirkham
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Alvin Keng
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Baycrest Health Sciences, Toronto, ON
| | - David Conn
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Baycrest Health Sciences, Toronto, ON
| | - Sophiya Benjamin
- Department of Psychiatry and Behavioural Neurosciences DeGroote School of Medicine, McMaster University, Hamilton, ON
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Dallas Seitz
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Marie-France Rivard
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | | | - Cindy Grief
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Baycrest Health Sciences, Toronto, ON
| | | | - Kiran Rabheru
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON
- Schlegel-UW Research Institute for Aging, Waterloo, ON
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Ohnishi Y, Otsuka H. Effect of COVID-19 on physical function decline predictors in nursing home residents. Geriatr Gerontol Int 2024; 24:326-328. [PMID: 38284179 DOI: 10.1111/ggi.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Yuki Ohnishi
- Department of Internal Medicine, Sosa Municipal Hospital, Chiba, Japan
| | - Hiroyuki Otsuka
- Department of Internal Medicine, Sosa Municipal Hospital, Chiba, Japan
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DeYoreo M, Anhang Price R, Haas A, Tolpadi A, Teno JM, Elliott MN. Changes in hospice care experiences during the COVID-19 pandemic. J Am Geriatr Soc 2024; 72:300-302. [PMID: 37725395 DOI: 10.1111/jgs.18598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Affiliation(s)
| | | | - Ann Haas
- RAND Corporation, Pittsburgh, Pennsylvania, USA
| | | | - Joan M Teno
- RAND Corporation, Arlington, Virginia, USA
- Brown University School of Public Health, Providence, Rhode Island, USA
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Doyle M, Louw JS, Corry M. Staff Perceptions of the Impact of the COVID-19 Pandemic on Older Adults Living in a Residential Long-Term Care Facility. J Gerontol Nurs 2023; 49:44-50. [PMID: 37768581 DOI: 10.3928/00989134-20230915-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Older adults residing in long-term care facilities (LTCFs) were an at-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Actions to prevent transmission in LTCFs included visitation restrictions, suspension of group activities, and isolating residents in their rooms. Despite these measures, this vulnerable cohort experienced high levels of infection and mortality. The current article reports RNs' and health care assistants' perceptions of the impact of COVID-19 on residents in a LTCF. Using a descriptive qualitative design, semi-structured interviews, which were conducted with seven RNs and four health care assistants, were thematically analyzed. Three themes emerged: Impact on Daily Routine, Disruption to Relationships With Staff, and Vulnerability. Staff perceived residents were negatively impacted physically, emotionally, and socially as a direct consequence of COVID-19 and by strategies introduced to protect them contracting the virus. It is recommended that the long-term impact of the COVID-19 pandemic on this cohort be evaluated from the perspective of all stakeholders (i.e., residents, staff, and families) using a longitudinal research design. [Journal of Gerontological Nursing, 49(10), 44-50.].
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Turcotte LA, McArthur C, Poss JW, Heckman G, Mitchell L, Morris J, Foebel AD, Hirdes JP. Long-Term Care Resident Health and Quality of Care During the COVID-19 Pandemic: A Synthesis Analysis of Canadian Institute for Health Information Data Tables. Health Serv Insights 2023; 16:11786329231174745. [PMID: 37220547 PMCID: PMC10196682 DOI: 10.1177/11786329231174745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Objective Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Design Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. Setting and participants LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Methods Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Results Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.06-1.18) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.01-1.09). Conclusions and implications The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.
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Affiliation(s)
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Jeff W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lori Mitchell
- Home Care Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | | | - Andrea D Foebel
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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de Melo RC, Schutz V, Wachholz PA, Villalonga-Olives E, Myer D, Corazzini K, Lepore M. Long-Term Care Staff Perspectives on the Care of Persons Living With Dementia During the COVID-19 Pandemic in São Paulo State, Brazil. J Gerontol Nurs 2023; 49:45-52. [PMID: 37126010 DOI: 10.3928/00989134-20230414-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the Brazilian long-term care (LTC) sector faced many challenges, which accentuated other common issues experienced by persons living with dementia (PLWD). The current pilot study evaluated staff perspectives regarding the care of institutionalized PLWD during the COVID-19 pandemic. Using an online survey, we collected the perspectives of 24 workers from seven long-term care facilities (LTCFs) located in São Paulo State, Brazil, about the impact of COVID-19 in caring for PLWD. Results highlight concerns about challenges related to following precautionary measures and the negative effects of social distancing on PLWD. Aspects related to workforce and staffing and person-centered care approaches were recognized by staff as important to provide good care for PLWD. Future research is needed to consider how to support LTCFs in achieving a balance between the protection and well-being of PLWD. [Journal of Gerontological Nursing, 49(5), 45-52.].
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Dai J, Moffatt K. Enriching Social Sharing for the Dementia Community: Insights from In-person and Online Social Programs. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2023. [DOI: 10.1145/3582558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The dementia community faces major challenges in social engagements, which have been further complicated by the prolonged physical distancing measures due to the COVID-19 pandemic. Designing digital tools for in-person social sharing in family and care facility settings has been well explored, but comparatively little HCI work has focused on the design of community-based social technologies for virtual settings. We present our virtual fieldwork on remote social activities explored by one dementia community in response to the impacts of the pandemic. Building upon our previously published on-site fieldwork in this community, we expand on our initial publication by follow-up interviewing caregivers and facilitators and reflecting on a virtual social program. Through thematic analysis and contrasting in-person and online formats of the program, we deepened the understanding of virtual social engagements of the dementia community, examining their efforts to leverage physical objects and environments, enhance open and flexible experiences, and expand collaborative space. We propose to open new design opportunities through holistic approaches, including reimagining community social spaces, rethinking agency in people with dementia and caregivers, and diversifying HCI support across communities and stakeholders.
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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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