The Importance of Family Relationships With Nursing Facility Staff for Family Caregiver Burden and Depression

Coping and guilt in informal caregivers: a predictive model based on structural equations

Caregivers experience great stress, and coping can be one of the factors, which determine the extent of stress. The aim of the present paper is to analyze the effects of coping strategies on distress of the older adult's caregiver, including guilt as a mediating factor in those maladaptive strategies. The sample consisted of 201 informal caregivers of institutionalized older adults. The three constructs measured were: stress, guilt, and coping strategies. Results showed that strategies that have a better ability to reduce stress are active, positive reframing and acceptance; on the contrary, behavioral disengagement, self-distraction, self-blame and venting positively predicted the feeling of guilt that facilitated the perception of stress. Given the important association obtained between the experience of guilt and psychological distress in caregivers, it could be relevant to develop psychoeducational interventions with caregivers including techniques to reduce this feeling of guilt and develop cognitive behavioral strategies that facilitate adaptation.

[Guilt and well-being in institutionalized family caregivers of dependent elderly people]

INTRODUCTION AND OBJECTIVE

The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons.

MATERIALS AND METHODS

Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed.

RESULTS

Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R²adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461).

CONCLUSIONS

Paying attention to family caregivers' feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization.

Perspectives of substitute decision-makers and staff about person-centred physical activity in long-term care

INTRODUCTION

This paper aims to explore the care processes that best exemplify person-centred care during physical activity (PA) for long-term care (LTC) residents with dementia from the perspectives of substitute decision-makers (SDMs) and LTC home staff. Little is known about how person-centred care is reflected during PA for residents with dementia, or the barriers and benefits to enacting person-centred care during PA.

METHODS

Semistructured interviews were used to collect SDMs and LTC home staffs' perspectives on the importance of person-centred care during PA from two LTC homes in Canada. The McCormack and McCance person-centredness framework was used to guide thematic content analysis of responses.

RESULTS

SDM (n = 26) and staff (n = 21) identified actions categorized under the sympathetic presence or engagement care processes from the person-centredness framework as most reflecting person-centred care. Benefits of person-centred care during PA were categorized into three themes: functional and physical, behavioural and communication and psychosocial improvements. Barriers to person-centred care during PA identified were lack of time, opportunities for meaningful activity in LTC setting and staff experiences with resident aggression.

SIGNIFICANCE

Understanding the care processes that are most recognized as person-centred care and valued by SDMs and LTC home staff has implications for education and training. Insights into SDMs' care expectations regarding person-centred care can inform staff about which actions should be prioritized to meet care expectations and can foster relationships to the benefit of residents with dementia.

PATIENT AND PUBLIC CONTRIBUTION

Study participants were not involved in the development of research questions, research design or outcome measures of this study.

Family member roles in long term care: Lessons for the future from COVID-19

This study investigates nursing home residents' and care partners' experiences during COVID-19 visitation restrictions. A nonprobability purposive sample of care partners was recruited via social media and email listservs. Care partners completed surveys (N = 30) and follow-up interviews (n = 17). Before COVID-19, care partners visited residents 3+ times per week for socialization and care. After restrictions, communication between care partners and nursing homes deteriorated. Families experienced reduced communication about residents' health statuses and little COVID-19 case information. Care partners expanded their advocacy roles, proposing policies to protect residents' rights. Care partners reported losing irreplaceable time with residents during restrictions. In future emergencies, we must balance the value of family visits with public health protection such as personal protective equipment (PPE).

Social Interactions between Family and Community-Based Service Providers in Dementia Caregiving

Objectives: This study aimed to evaluate the psychosocial experiences in community-based dementia caregiving by assessing the characteristics of social interactions between family caregivers and community-based service providers and associated psychological responses.Methods: Two independent groups of participants (family caregivers and community-based service providers) completed a one-time survey to report their social interactions and psychological states. A linear regression model was fit for each outcome (satisfaction, 10-item CES-D) while controlling for significant relevant covariates.Results: Higher perceived levels of collaboration were associated with higher job satisfaction and lower depression score among service providers, and higher satisfaction with providers among family caregivers. Higher perceived social support from the provider was associated with higher satisfaction among family caregivers.Conclusions: Participants reported varying levels of provider-family collaboration. The extent of collaborations and support exchange may have implications on the psychological well-being of those providing care to individuals with dementia including families and providers.Clinical implications: It may be beneficial to identify providers and families who perceive low levels of collaboration and implement intervention to facilitate positive social interactions. Developing organizational culture and payment systems that value high-quality social interactions may help enhance the psychological well-being of service providers and satisfaction among families who receive their services.

Transitioning to Long-Term Care: Family Caregiver Experiences of Dementia, Communities, and Counseling

Objectives: Previous analyses of interventions targeting relationships between family caregivers of people with Alzheimer's disease and related dementias and residential long-term care (RLTC) staff showed modest associations with caregiver outcomes. This analysis aimed to better understand interpersonal and contextual factors that influence caregiver-staff relationships and identify targets for future interventions to improve these relationships. Methods: Using a parallel convergent mixed methods approach to analyze data from an ongoing counseling intervention trial, descriptive statistics characterized the sample of 85 caregivers and thematic analyses explored their experiences over 4 months. Results: The findings illustrated that communication, perceptions of care, and relationships with staff are valued by family caregivers following the transition of a relative with dementia to RLTC. Discussion: The findings deepen understanding of potential intervention targets and mechanisms. These results can inform future psychosocial and psychoeducational approaches that assist, validate, and empower family caregivers during the transition to RLTC.

A Pilot Study of An Intervention to Increase Family Member Involvement in Nursing Home Care Plan Meetings

BACKGROUND AND OBJECTIVES

Many family members struggle to negotiate their aging relative's care with nursing home staff, potentially leading to depression and other negative outcomes for residents' families. This pilot study tested an intervention designed to empower residents' family members to attend and participate in nursing home care plan meetings.

RESEARCH DESIGN AND METHODS

We conducted a small, randomized, controlled trial of the Families Involved in Nursing home Decision-making (FIND) intervention, which used web conferencing to facilitate family participation in care plan meetings.

RESULTS

Overall, FIND was feasible and acceptable. Family members who received the FIND intervention were more likely to experience decreased depressive symptoms than those who did not.

DISCUSSION AND IMPLICATIONS

FIND is a promising approach to reduce depression among family members of nursing home residents. Findings support the need for a follow-up clinical trial.

The Concept of Aging in Place as Intention

OBJECTIVES

This study aimed to frame the aging in place (AIP) concept within an extended theory of planned behavior (TPB) model incorporating environmental domains. The proposed model depicts the direct and indirect effects of environmental domains on AIP intention. The environmental domains related to meanings of home embrace personal, built, and interpersonal environments. As partial mediators between the environmental domains and AIP intention, TPB components (attitude, subjective norm, and perceived behavioral control toward AIP) were included to the model.

METHODS

The study sample comprised older adults aged 60 and older living in their own homes in the United States. Participants (N = 650) were obtained through an online survey with a nationwide sample. Path analyses were used to test hypothesized relationships within the proposed model.

RESULTS

The results confirmed the significant mediating role of the TPB components between the path from personal, built, and interpersonal environments to AIP intention. Except for one built environmental construct (housing satisfaction), personal and interpersonal environmental constructs were found to indirectly affect AIP intention. One of the interpersonal environmental constructs, social connectedness, was revealed as the strongest factor in this relationship.

IMPLICATIONS

One major implication was drawn from the role of social connectedness and neighborhood satisfaction toward AIP intention. These factors operate beyond an individual level and are closely interrelated. Because social connectedness can be promoted or discouraged by community-level physical or social interventions, the findings of this study confirm the critical role of community-level planning and programs to support healthy aging among older adults.

[In the Same Boat: How to Support Relatives of Patients with Dementia Using Diverse Interventions]

In the Same Boat: How to Support Relatives of Patients with Dementia Using Diverse Interventions Abstract. Caring for people with dementia has great psychological, physical, social, financial and spiritual effects on relatives. Support and counseling can contribute to an improved health of the relative, to the relationship with the dementia patient, as well as to better treatment (through shared decision-making/care planning) of the patient. This article reviews data from Switzerland and international studies.

Nursing home care for people with dementia: Update of the design of the Living Arrangements for people with Dementia (LAD)-study

AIM

The aim of the current study is to describe the extended design of the Living Arrangements for people with Dementia (LAD)-study.

BACKGROUND

The demand for long-term care in care homes increases with the growing number of people with dementia. However, quality of care in care homes needs improvement. It is important to monitor quality of care in care homes for the purposes of conducting scientific research, providing input for policy, and promoting practice improvement.

DESIGN

The Living Arrangements for people with Dementia -study monitors changes in - quality of - care in care homes since 2008. With its extended design, the Living Arrangements for people with Dementia -study now also focuses on additional topics that are considered to improve quality of care: implementation of person-centred care, involvement of family carers and volunteers and reducing psychotropic drugs and physical restraints using a multidisciplinary approach.

METHODS

The data collection of the Living Arrangements for people with Dementia -study entails an interview with the manager and questionnaires are completed by care staff, family carers, volunteers, and multidisciplinary team members. This study is partly funded by the Dutch Ministry of Health, Welfare and Sports, grant number 323,088 and partly funded by the participating care homes.

DISCUSSION

Results of the Living Arrangements for people with Dementia -study will shed more light on variables related to quality of care in care homes for people with dementia.

IMPACT

Based on the obtained information, appropriate efforts to improve quality of care can be discussed and implemented. Furthermore, the results of this study guide policy making, because it expands knowledge about the effects of changing policies and exposes topics that need further attention.

TRIAL REGISTRATION

Not applicable. This article does not report the results of a healthcare intervention on human participants.

Social support and self-rated health among caregivers of people with dementia: The mediating role of caregiving burden

The purpose of this study was to examine the associations between three indicators of social support and self-rated health among caregivers of people with dementia, and whether caregiving burden mediated such associations. Data from the Resources for Enhancing Alzheimer's Caregiver Health II (REACH II; N = 637) was used and multivariate analyses were conducted to test the mediation effects of caregiving burden by PROCESS for v3.2.03. The results revealed that three indicators of social support (received support, social network, and negative interactions) were all significantly associated with self-rated health. Findings also showed that caregiving burden acted as a mediator mechanism through which the associations between social network and self-rated health, negative interactions and self-rated health occurred. Results suggest that there is a need for more comprehensive caregiving assessments as well as multicomponent interventions that include improving and expanding social networks for caregivers of people with dementia. Findings also highlight the importance of minimizing interpersonal conflicts with others and providing more multicomponent programs aimed at reducing caregiving burden.

Unmet Expectations in Alzheimer's Family Caregiving: Interactional Characteristics Associated With Perceived Under-Contribution

Background and Objectives

Perceptions about family members not contributing enough to caregiving are documented to create psychological stress among caregivers. This study investigated whether individuals' perception that family members are under-contributing in caregiving processes was associated with their psychological well-being and explored the factors that may contribute to such perception borrowing concepts from a previous study: malfeasance, nonfeasance, and uplift.

Research Design and Methods

Seventy-two members of 30 families recruited through residential and adult daycare settings provided information about 960 familial network members (e.g., family, friends). Perceived levels of participation in caregiving about each network member, whether the level met respondents' expectations, and interactions representing malfeasance, nonfeasance, and uplift were assessed.

Results

Number of family members respondents identified as under-contributing in caregiving was associated with higher, whereas numbers of family participating in caregiving and supportive staff were associated with lower distress (Center for Epidemiologic Studies Depression Scale [CES-D]). Factor analyses identified a set of social interactions among familial network members capturing three constructs: malfeasance, nonfeasance, and uplift. Network members for whom respondents reported higher levels of nonfeasance were more likely to be identified as under-contributing in direct care (odds ratio [OR] = 1.92), care decision making (OR = 1.89), and social support (OR = 1.74) compared with those identified as contributing enough. Members with higher levels of malfeasance were more likely to be identified as under-contributing in direct care (OR = 1.19) than those identified as contributing enough.

Discussion and Implications

Social interactions characterized as nonfeasance may explain the perception of unmet expectations in caregiving within families and may represent a potential focus of family-level interventions.

Psychosocial Predictors of Anxiety in Nursing Home Staff

OBJECTIVES

Although research shows that nursing home staff experience significant levels of stress and burnout, studies analyzing the relationship of psychosocial variables on their feelings of anxiety are scarce. This study aims to analyze the relationship between psychosocial variables and levels of anxiety among staff.

METHOD

Participants were 101 nursing home professionals. In addition to anxiety, socio-demographic variables, depersonalization, burden, relationship with families of the residents, and guilt about the care offered to the residents were assessed. A hierarchical regression analysis was carried out to analyze the contribution of the assessed variables to staff anxiety levels.

RESULTS

The obtained model explained 57% of the variance in anxious symptomatology. Guilt about the care offered and poor quality of the relationship with residents' family were associated with anxiety. Further, working at nursing homes where the staff report higher levels of anxiety symptoms, the presence of depersonalization and burden were also associated with anxiety.

CONCLUSION

The findings suggest that in addition to work-related variables (burden and burnout), problems with family members and guilt about the care offered are relevant variables for understanding staff's anxious symptomatology.

CLINICAL IMPLICATIONS

Interventions that address issues of guilt about the quality of care, and problematic relationships with family members of residents, may have potential to reduce staff anxiety and promote their well-being.

'It's Like Chicken Talking to Ducks' and Other Challenges to Families of Chinese Immigrant Older Adults in Long-Term Residential Care

Immigrant older adults are increasingly moving into long term residential care (LTRC) homes; however, most were designed and continue to be run in accordance with Anglocentric norms and values. Participation and interest in Family Councils-through which they might collectively voice concerns-was low within our purposive sample of nine Chinese-origin residents living in LTRC homes and 11 family carers. Our study, conducted in two LTRC homes in British Columbia, Canada between January and March 2016, further explored participants' perceptions of quality of care by staff and quality of life of residents. Our findings negate participants' rationale that they do not attend because they have no issues to raise. Solutions must recognize that carers' time is precious and care-work is gendered; language incongruity and failure to address it marginalizes residents and their family members. A culturally informed reticence to speak out is reinforced when attempts to do so are silenced.

Perceptions of Older Residents and Their Adult Children Regarding Continuing Care Retirement Community Staff

This study examined the perspectives of continuing care retirement community (CCRC) residents and their adult children regarding services provided by staff in the CCRC. The study is based on semistructured qualitative interviews with 49 residents and their 34 adult children from 11 CCRCs. Transcripts were analyzed using qualitative content analysis. Three major themes emerged: (a) "Reliance on the CCRC staff," (b) "Dissatisfaction with the CCRC staff," and (c) "Disregard to the CCRC staff." Findings suggest that staff should maintain constant contact with all residents, including those who are not satisfied with staff's function and those who do not use staff services, to identify and respond to the residents' changing needs. Attention should be paid in meeting residents' physical needs prior to meeting their social and emotional needs, as these tend to be the most urgent.

Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities

Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.

A tool to aid talking about dementia and dying--development and evaluation

BACKGROUND

Health professionals often avoid talking about death and dying with patients and relatives, and this avoidance is compounded in cases of dementia by lack of knowledge of trajectory and prognosis. Unfortunately, this impacts on care, with many terminally ill dementia clients receiving inadequate palliation and excessive intervention at end-of-life. This study developed and evaluated a tool to facilitate conversations about death and dying in aged care facilities.

METHODS

This study utilised available best-practice evidence, feedback from aged care facility nursing and care staff and specialist input to develop the 'discussion tool', which was subsequently trialled and qualitatively evaluated, via thematic analysis of data from family interviews and staff diaries. The study was part of a larger mixed method study, not yet reported. The tool provided knowledge and also skills-based 'how to' information and specific examples of 'what to say'.

RESULTS

The tool facilitated a more open dialogue between dementia palliation resource nurses (a role specifically developed during this project) and family members. Both resource nurses and family members gained confidence in discussing the death of their relative with dementia, and in relevant cases discussed specific decisions around future care. Family members and nurses reported satisfaction with these discussions.

CONCLUSION

Providing specific skills-based support, such as the 'discussion tool' can help staff to gain confidence and change practice in situations where unfamiliar and uncomfortable practices might normally be avoided. As our populations age, health professionals will increasingly need to be able to openly discuss care options towards end-of-life.

Turbulent life: the experiences of the family members of patients suffering from depression

Families of patients suffering from depression have an important role in provision of care to the patients, which also may impose a great amount of stress on them. The purpose of this study was to explore and describe the experiences of the family members of patients suffering from depression on the impact of provision of care to the patients. A qualitative design using a content analysis approach was used to gather and analyse data. Unstructured interviews were conducted with 26 family members of patients suffering from depression chosen using purposeful sampling. During data analysis, 'turbulent life' was developed as the main theme along with five other categories including: 'penetration of the illness in the family', 'daily life's hardship', 'too much attention to the patient', 'delay in the acceptation of the illness' and 'concern about the patient's current and future conditions'. Each category consisted of several subcategories. It is concluded that the psychological, physical and financial factors imposed on families result in 'turbulent life'. Nurses can reduce the burden of providing care to patients suffering from depression through improving the knowledge of family members about how to communicate with patients and increase emotional supportive resources to the patients and their family members.

Invisible hands: the role of highly involved families in long-term residential care

Care work by family and friends is recognized as a cornerstone of community-based care for older adults; however, the role of families in institutional-based care work has been less well understood and researched. Drawing on findings from a critical ethnographic study, this article aims to examine the unique role of highly involved family members within long-term residential care. The study took place between October 2006 and April 2008 in two facilities in British Columbia, Canada. A purposive sample of 11 highly involved family members participated in in-depth interviews and participant observations. The main themes were "Hands-On," "Hands-Off," "Surveillance," and "Interlopers." These themes illuminate the ways in which highly involved family members engaged in care work, including how they positioned themselves and were positioned by staff and administrators. Implications of the study focus on the need to include families in philosophies of care and policies that shape care work in long-term residential care.

Sense of community in long-term care: the views of family caregivers of elderly military veterans

BACKGROUND

Family involvement in long-term care (LTC) is important but it can prove challenging and result in conflict with staff if families do not feel connected to the LTC facility or if they believe that their contributions are undervalued. According to McMillan & Chavis (1986), sense of community (SOC) refers to a feeling of belonging, having influence, having needs met, and having an emotional connection to individuals in a community, and may be particularly essential for family caregivers of military veterans in LTC. This is the first study that evaluates SOC among family caregivers in LTC.

METHODS

Semi-structured interviews and self-report questionnaires assessing caregiver demographics, caregiving variables, and SOC were administered to 46 family caregivers.

RESULTS

Caregivers endorsed a SOC that was positively related to key caregiving variables, such as family adjustment and satisfaction with care, and was negatively related to conflict with staff. Notably, caregivers' connections to the military community were positively related to SOC in LTC. Multiple regression analyses indicated that satisfaction with care accounted for the most variance in SOC (32.7%).

CONCLUSIONS

This is the first study that examines SOC among family caregivers of military veterans in LTC, a subgroup of family caregivers with unique histories and needs. Although there are measures designed to assess family members' level of satisfaction with different facets of LTC, SOC provides unique information about whether family members feel part of the LTC community as valued partners in care. SOC is an important yet understudied construct that could contribute substantially to our understanding of family-focused care.

Staff–Family Relationships in Residential Aged Care Facilities

The aim of the study was to examine staff and family members’ perceptions of each other’s roles and responsibilities in the Australian residential aged care setting. Data was collected by interview and focus group from 27 staff and 14 family members at five residential aged care facilities in the state of Victoria, Australia. Findings highlight “communication” as the core category supporting the formation of constructive staff–family relationships, as described by three main themes; “building trust,” “involvement,” and “keeping the family happy.” Staff attitudes, mutual cooperation, meaningful engagement, and shared expectations lay the foundation for relationships. Findings suggest that further efforts to establish and sustain good relationships with families are required by facilities. Characteristics, roles, and expectations of staff and family that can both promote and hinder the formation of constructive staff–family relationships are discussed.

Does race influence conflict between nursing home staff and family members of residents?

OBJECTIVES

This study examines the influence of race on perceived similarity and conflict between nursing home staff and family members of residents. Despite evidence that the caregiving experience varies by race for both family and professional caregivers, little is known about how race plays a role in staff conflict with residents' family members.

METHODS

We used a representative sample of Certified Nursing Assistants (CNAs) to test relationships between race, treatment from family members, similarity to family members in expectations for care by CNAs, and conflicts with family members concerning aspects of resident care.

RESULTS

Results of structural equation modeling indicated that race was not a predictor of staff perception of conflict with family members or of poor treatment from residents' families. However, Black nursing assistants were more likely to perceive that their own expectations of nursing care are dissimilar from those of residents' family members. Dissimilarity predicted reports of poor treatment from family members, and poor treatment was a positive predictor of perception of conflict.

DISCUSSION

The personal long-term nature of nursing home care necessitates a high level of connectedness between family caregivers and nursing home staff. Results highlight the importance of establishing organizational pathways for communication of expectations between nursing staff and residents' families.

The long-term effect of group living homes versus regular nursing homes for people with dementia on psychological distress of informal caregivers

OBJECTIVE

In this follow-up study, the long-term influence of group living homes (GLHs) on informal caregiver distress was compared with modern yet regular nursing homes (NHs).

METHOD

Informal caregivers of GLH (N = 37) and NH residents (N = 49) were studied at the time of admission, 6 months thereafter, and approximately 24 months after admission. Repeated measures of ANOVA were performed to study group-by-time effects on psychopathology, role overload, and feelings of competence.

RESULT

All outcomes of psychological distress in GLH caregivers showed significantly greater decline compared with NH caregivers during the first six months after admission. The course of psychological distress stabilized in both caregiver groups after six months.

CONCLUSION

GLHs may have played a role in reducing caregiver burden during the first six months after the nursing home admission of the care recipient. The stabilization of caregivers' psychological distress between T1 and T2 may indicate that there is no further room for improvement in the GLH and NH groups after six months. The implication would be that both GLHs and NHs succeeded in keeping caregivers' distress relatively low over the long term. More knowledge is needed on whether and how caregivers' psychological distress after institutionalization of the care recipient can be reduced to a greater extent.

A telephone-delivered psychosocial intervention improves dementia caregiver adjustment following nursing home placement

OBJECTIVE

Study the preliminary efficacy of a telephone intervention, Family Intervention: Telephone Tracking-Nursing Home (FITT-NH) for improving dementia caregivers' adjustment following nursing home placement.

METHODS

Caregivers were enrolled on average 6 weeks following the care-recipients' placement in a nursing home. Baseline assessment included self-report measures of caregiver emotional functioning, staff-caregiver interactions, placement satisfaction, health-related quality of life, and social support. Caregivers were randomly assigned to FITT-NH (n = 24) or a non-contact control condition (n = 22). Caregivers were urn randomized to balance groups on caregiver gender, relationship (spouse versus other), and facility type (dementia special care versus general). The intervention was entirely telephone-delivered in 10 contacts over 3 months. Caregivers randomized to non-contact control were not prevented from using other community-based mental health or support resources, therefore reflecting standard care. Intervention strategies were based on assessment of caregiver emotional adjustment, family functioning, staff-caregiver interactions, health, and social support. Treatment strategies are based on models of stress and coping process and family functioning.

RESULTS

Groups did not differ in caregiver age, education, gender, relationship to the care recipient, length of caregiving, length of dementia diagnosis, or time since placement. Using mixed model analysis of variance, caregivers receiving FITT-NH showed a significant reduction in feelings of guilt related to placement, F(1,43) = 5.00, p < 0.05, and reported more positive perceptions of interactions with staff, F(1,43) = 4.59, p < 0.05, compared to standard care.

CONCLUSION

Findings provide preliminary evidence for FITT-NH as a potentially efficacious, brief, targeted psychosocial intervention for improving caregiver emotional adjustment following nursing home placement.

A Cultural Paradox: Elder Abuse in the Native American Community

An emerging cultural paradox in the Native American community is the long history of respect for elders and the emergence of elder abuse as a problem. Elders commonly hold a special and respected place in traditional Native American societies due largely to their experience, knowledge, wisdom, and power as dreamers, healers, and teachers. Although violence against other tribal members is considered as unnatural and a threat to internal spiritual harmony, victimization, and abuse of elders and is recognized as a clandestine but increasing problem in the Native American community. This challenges health care providers and tribal members to provide safe and culturally congruent care to the elderly as well as coming to terms with this cultural paradox. There is a growing commitment by tribes to address this problem and to provide and honor the Native American elder. This article provides information for health care providers to better understand elder abuse in the cultural context of the Native American community as well implications for care.

Improving family-staff relationships in assisted living facilities: the views of family

AIMS

This article is a report of a study of the key influences on family-staff collaboration in low level residential aged care (assisted living) facilities in Australia as seen by the family carers of residents.

BACKGROUND

Collaboration with the willing family is widely acknowledged to be important in the care of the older person. Previous work in nursing homes has shown that staff-family relationships are often ambiguous. Relatively little is known about the issue of staff-family relationships in assisted living facilities.

METHODS

Using qualitative methodology twelve family carers from five assisted living facilities were interviewed and transcripts analysed thematically. Data were collected in 2006/2007.

RESULTS

Four factors important to the establishment and maintenance of collaborative staff-family relationships were identified: comfort, communication, consultation and confidence.

CONCLUSION

Low level care facilities need to create environments that are conducive to the establishment and maintenance of constructive staff-family relationships. A number of practice considerations for care staff to foster relationship-centred care with the family in these types of facilities are presented.

Know thy residents: an exploration of long-term care nursing staff's knowledge

Nursing staff's knowledge of residents' lives in long-term care is critical to the provision of quality care, the formation of strong relationships between staff and residents, and the promotion of psychosocial well-being for residents. This study examines the degree to which nursing staff in assisted living facilities and nursing homes know residents in terms of their lives and occupations, family members, tastes and interests, and medical conditions. Quantitative surveys were administered to nursing staff-resident dyads (N = 199) as part of a larger study on quality of life in long-term care. Results indicated that while nursing staff generally knew residents fairly well, a significant percentage of nursing staff reported knowing nothing at all in each of the categorical areas of residents' lives. Implications center on eliminating barriers to knowledge attainment and implementing educational interventions that may augment nursing staff's knowledge of residents.

Conflict Between Nursing Home Staff and Residents’ Families

Objective: In this study, the authors examine the influence of conflict between nursing home staff and family members of residents on staff burnout. Method: Data were collected from interviews with a representative sample of 655 nursing home nurses and nursing assistants. Hypotheses were tested using structural equation modeling. Results: Results indicate that conflict with family members increases staff burnout and decreases staff satisfaction. Staff and family conflict increases when staff members feel they do not have enough time to complete required tasks. Level of conflict decreases when staff perceive that family members have care expectations that are similar to their own. Interestingly, staff who have personal experience as family caregivers are more likely to report conflict with family members of residents, a result that necessitates further study. Discussion: Staff burnout and dissatisfaction affects both individuals and organizations. Policy that addresses staff and family interaction can have an important place in the design and delivery of long-term care.