Identifying Changeable Barriers to Family Involvement in the Nursing Home for Cognitively Impaired Residents

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).

The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review

BACKGROUND

Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers' dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual's care. However, little is known of the informal caregivers' perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia.

METHODS

In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com, CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes.

RESULTS

We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances.

CONCLUSION

Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers' perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers' satisfaction with nursing home care for residents with dementia.

Determination of gaps in the spatial accessibility of nursing services for persons over the age of 65 with lowered self-sufficiency: Evidence from the Czech Republic

The subject of this research is one of the main preconditions for the provision of high-quality social care services for people over the age of 65 with lowered self-sufficiency. It involves the spatial accessibility of formally established nursing services examined in 76 districts of the Czech Republic. The aim of this article is to identify and evaluate the gaps in spatial accessibility of the selected residential and outpatient-clinic services at the level of districts in individual regions of the Czech Republic in 2018. A three-phase analysis was performed, including an ArcGIS network analysis, multi-criteria evaluation according to the TOPSIS method, and a correlation analysis encompassing the confidence interval gained via the Bootstrap method. Seven indicators were selected-recipients of the allowance for the care, capacity of residential and outpatient-clinic services, and four indicators of accessibility via individual and public transport within the set time intervals. The results show good availability of residential care (no gap) within 30 min. by individual and public transport in most districts (94%). However, day services centers do not have a space gap in only 28% of districts by individual transport, and 8% of districts by public transport. In the case of day care centers, 54% of districts by individual transport, and 29% of districts by public transport do not have a space gap. The results also show that the level of spatial availability of care (gaps) in the district is not related to the number of people aged 65+ with reduced self-sufficiency in the district. On the contrary, the correlation analysis shows that with the growing number of people aged 65+ with reduced self-sufficiency in the district, the capacity of residential and outpatient services increases and the gaps in spatial accessibility do not decrease.

The Predictors of and Motivations for Increased Family Involvement in Nursing Homes

BACKGROUND AND OBJECTIVES

Quantitative and qualitative data from a statewide survey of family members of nursing home residents were analyzed to determine the predictors of, and motivations for, family involvement.

RESEARCH DESIGN AND METHODS

We examined 3 types of involvement: visiting, providing personal care, and family-staff communication. Our mixed methods approach used (a) multilevel regression models to examine predictors of family involvement, including family member perceptions and resident, family member, and facility characteristics, and (b) a thematic analysis of qualitative data regarding the experiences of family members and their motivations for involvement.

RESULTS

Families were more involved when a short-term stay (<3 months) was expected, and when residents were in poorer physical condition. Spouses and female family members were more involved than others, yet the effect of gender varied by relationship type. At the facility level, families of residents in rural facilities reported less family involvement. Aside from these commonalities, predictors of each type of involvement varied. Themes from the qualitative data identify unique motivations for each type of involvement-to enhance residents' identity, care, or quality of life.

DISCUSSION

Families visit more and provide more hands-on assistance when they are not confident in the care being provided or the well-being and stability of their resident loved one. Receiving adequate information, perceiving staff as friendly, and residents as looking well cared for promote greater family-staff communication.

IMPLICATIONS

Findings can inform strategies to increase meaningful family involvement in nursing homes.

Communicating emotional support: family caregivers' visits with residents living with dementia in nursing homes

This study characterized emotional connections between largely female caregivers and female care recipients with dementia living in nursing homes with the research question: How does interpersonal communication between family caregivers and older adults with dementia convey enacted emotional support? Ten dyads (8 with at least one female) of regularly-involved family caregivers (7 female; 3 male) and their relatives with dementia (5 female; 5 male) were videotaped. Qualitatively, three themes emerged: 1) distinct conversational topics, 2) shared physical proximity and silence, and 3) catalysts for natural interaction. These findings may help improve the quality of life of these predominantly female dyads.

The experience of transportation to visit a nursing home resident: A case study

Maintaining social connections in the community can be accomplished through transportation access and opportunities. This includes relationships between family and residents in nursing homes. Previous research supports the relationship between transportation, social support, and visitation of residents in nursing homes (NHs), however no empirical research to date explores this relationship of family member transportation as a means to visit their loved one in this setting. Guided by a case study approach, a sample of 11 (N = 11) family members of residents in nursing homes across North Central Texas were selected to develop an in-depth understanding of transportation access and mobility, as it relates to visitation of residents in nursing facilities. Analyses revealed the following seven themes: Car access, Alternative modes, Flexibility, Travel time, Actual cost, Collateral cost, and Health and Mobility. Findings from this study uncover how cost, both actual cost and collateral cost, are greatly linked to car access, transportation access, and opportunities to visit, as well as the impact each of these features, and emergent themes, related to transportation have on maintained or fractured relationships of family and residents in nursing homes. This article concludes with implications for future research and social work practice.

Older residents' perceptions of family involvement in residential care

AIM

This study explored the Chinese older people's perceptions regarding family involvement and specific factors influencing family involvement in residential care homes.

BACKGROUND

Family involvement in residential care home is a multi-dimensional construct that connects the resident with their family, friends, neighbours and care professionals to facilitate their physical, psycho-emotional and social well-being. However, it remains unclear as to what Chinese residents perceive as the meaning of involving the family and components of it that are important to later live.

MATERIAL AND METHODS

A descriptive qualitative study using semi-structured interviews was conducted in two residential care homes in Macao. Ten Chinese residents were purposively sampled. The interview data were taped-recorded and transcribed. Fieldnotes and visitors' records were collected. The data were content-analyzed.

RESULTS

Chinese residents' perceptions of family involvement were captured by four themes: components of family involvement, factors influencing family involvement, impacts of family involvement on residents' lives, and promoting family involvement strategies.

CONCLUSION

Findings provided insights for geriatric care providers to acknowledge the contributions that family members can make to be more involved in the residents' live, and to strengthen relationships. Family involvement can also help to facilitate sense of blessing and feelings of achievements for the residents.

Investigating Barriers to Family Visitation of Nursing Home Residents: A Systematic Review

Families are integral in helping nursing home residents maintain feelings of social inclusion and an overall sense of belonging, thus reducing consequences of social exclusion. Preliminary research, particularly of the culture change movement in long-term care, shows there are barriers to family engagement and visitation of residents. The objective of this study is to: (1) identify and summarize the barriers most reported to family visitation and (2) synthesize the findings to determine which barriers are most often reported in literature, and which may pose the greatest challenges to family involvement. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a final sample of 15 articles across 11 databases report seven barriers to visitation: psychological, health, staff to family member relationship, employment/finances, travel time, access to transportation, and other. Findings suggest barriers to family visitation and point toward a need for further research as relationships between resident and family member is complex and warrants attention across professions. Interprofessional efforts between social work, allied professionals, and transportation planners are necessary to address this pressing concern experienced by residents in nursing homes, with the ultimate goal of lessening such barriers.

Developing the Family Involvement Questionnaire-Long-Term Care: A Measure of Familial Involvement in the Lives of Residents at Long-Term Care Facilities

INTRODUCTION

Existing measures designed to assess family involvement in the lives of older adults residing in long-term care facilities are basic, using visitation frequency as the prominent gauge of involvement in a situation specific fashion. The purpose of this study was to design and validate a measure of family involvement that could be used to gauge more aspects of family involvement than visitation alone and be useful in a variety of settings for both researchers and long-term care facility administrators.

METHODS

Long-term facility staff were asked to assist in creating a 40-item questionnaire that used 4-point Likert scales to measure various aspects of family involvement. The finalized Family Involvement Questionnaire-Long-Term Care (FIQ-LTC) was distributed to the family members of older adults residing in long-term care facilities around the country.

RESULTS

A total of 410 participants responded. Researchers found that the FIQ-LTC was highly reliable (α = .965). Results also indicated that a significant correlation between distance and overall involvement (r = -.121, p = .015) was no longer significant (r = .17, p = .740) when the effect of a question asking the frequency of visitation was controlled for.

DISCUSSION

These results indicate that existing measures that use visitation frequency as the sole measure of involvement are insufficient. The newly developed FIQ-LTC can serve as a more complete measure of family involvement.

Validation of family conflict scales for family caregivers of persons with dementia in long-term care facilities and exploration of family conflicts and support

ABSTRACTBackground:The aim of the study was to develop a family conflict scale for family caregivers of persons with dementia in long-term care facilities and to explore the relationship between family conflicts and family support.

METHODS

The scale was developed through forward- and back-translations, interviews with 12 staff members in long-term care facilities, and cognitive interviews with 12 family caregivers who met operational definitions in this study. The test was conducted with 334 family caregivers and a retest was conducted with 318 family caregivers who had indicated willingness to participate further.

RESULTS

The internal consistency was relatively high for all subscales (Cronbach's α >0.87); sufficient retest reliability was demonstrated for all subscales (intraclass correlation coefficient >0.69). Confirmatory factor analysis supported a three-factor model. Convergent and discriminant validity for each of the family conflict scale subscales, family APGAR, and the Symptom Check List-90 Items-Revised were acceptable. Family caregivers who received no family assistance for caregiving perceived more conflict in their family than those receiving family assistance.

CONCLUSIONS

The Japanese version of the family conflict scale for family caregivers of persons with dementia in long-term care facilities was developed. The reliability and validity of the scale were verified. When providing support to family caregivers in long-term care facilities, it is necessary to consider the family from multiple viewpoints, including family conflicts and support conditions from other family members.

Conflict between Family Caregivers and Staff in Nursing Homes: Feasibility of the Daily Diary Method

OBJECTIVE

The purpose of this study was to investigate the daily diary method (DDM) for assessing family-staff conflicts in nursing homes, to provide descriptive information on conflict, and to examine the relationship between conflict and mood among family caregivers.

METHODS

Participants were nine caregivers that experienced conflict with staff on an ongoing basis. They were contacted daily by telephone for 14 days and were asked (1) whether a conflict had occurred, (2) to describe the severity and type of conflict, and (3) to rate their positive and negative affect.

RESULTS

Compliance was excellent with no attrition, and there were only 2 missing data points over 126 potential observations. Conflicts occurred on 22% of the days, were rated as moderately severe, and were related to poor resident care, lack of information, and staff attitudes. Participants reported significantly lower positive affect (p < .05) and higher negative affect (p < .001) on conflict versus no-conflict days. Exit interviews indicated positive attitudes towards the DDM.

CONCLUSIONS

These results support the feasibility of the DDM for providing an in-depth understanding of family-staff conflict and its relationship to caregivers' mood.

CLINICAL IMPLICATIONS

The DDM would ideally be used as an outcome measure in studies that assess interventions that target high-conflict family-staff relationships.

Radiography on wheels arrives to nursing homes - an economic assessment of a new health care technology in southern Sweden

RATIONALE, AIMS AND OBJECTIVES

The process of transferring older, vulnerable adults from an elder care facility to the hospital for medical care can be an emotionally and physically stressful experience. The recent development of modern mobile radiography may help to ease this anxiety by allowing for evaluation in the nursing home itself. Up until this point, no health economic evaluation of the technology has been attempted in a Swedish setting. The objective of this study was to determine whether examinations of patients in elder care facilities with mobile radiography were cost-effective from a societal perspective compared with hospital-based radiological examinations.

METHODS

This prospective study included two groups of nursing home residents in two different areas in southern Sweden. All residents in the nursing homes were targeted for the study. Seventy-one patients were examined with hospital-based radiography at two hospitals, and 312 patients were examined using mobile radiography in nursing homes. Given that the diagnostic effects are regarded as equivalent, a cost minimization method was applied. Direct costs were estimated using prices from the county council, Region Skåne, Sweden.

RESULTS

From a societal perspective, mobile radiography was shown to have significantly lower costs per examination compared with hospital-based radiography. The difference in health care-related costs was also significant in favour of mobile radiography.

CONCLUSION

Mobile radiography can be used to examine patients in nursing homes at a lower cost than hospital-based radiography. Patients benefit from not having to transfer to a hospital for radiography, resulting in reduced anxiety for patients.

Effects of a Psychosocial Intervention on Caregivers of Recently Placed Nursing Home Residents: A Randomized Controlled Trial

Many caregivers continue to provide care and support to their care recipients after institutional placement. A two-group randomized controlled trial was carried out to test the efficacy of a psychosocial intervention for informal caregivers whose care recipients resided in a long-term care facility. The intervention was delivered during the 6 month period following baseline assessment. Follow-up assessments were carried out at 6, 12, and 18 months. Primary outcomes were caregiver depression, anxiety, burden, and complicated grief. Significant time effects were found for all three primary outcomes showing that caregiver depression, anxiety, and burden improved over time. No treatment effects were found for these outcomes. However, complicated grief was significantly lower for caregivers in the treatment condition.

Family caregiver involvement for long-term care residents at the end of life

OBJECTIVES

To examine family caregiver involvement for long-term care (LTC) residents during the last month of life. Researchers examined direct (personal care and meals) and indirect (management and monitoring) types of caregiver involvement and the relationship between the type of involvement and predisposing, enabling, and need characteristics. Researchers also examined whether the frequency of involvement changed during the end-of-life (EOL) period.

METHOD

Researchers used an expanded version of Andersen's Behavioral Model to conceptualize predictors of family involvement for 438 residents in 125 residential care/assisted living and nursing home settings. Bivariate and multivariate analyses examined relationships among variables.

RESULTS

More than one-half of family caregivers monitored, managed care and assisted with meals, and 40% assisted with personal care tasks. The enabling characteristic of days visited and the need characteristic of caregiver role strain were related to each of the 4 types of involvement. However, the other correlates were distinct to the type of involvement.

DISCUSSION

Families are involved in EOL care in LTC settings. Higher role strain is related to more involvement in each of the 4 types of involvement, suggesting that whether involvement is by desire, perceived need, or both, there is cause to more critically examine the family caregiver's desired role and need for support.

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.

Family oversight and the quality of nursing home care for residents with advanced dementia

BACKGROUND

The quality of nursing home (NH) care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor in the provision of NH care is the role of private oversight and monitoring by family members and friends.

OBJECTIVE

To examine the association between private oversight and the quality of end-of-life care for NH residents with advanced dementia.

RESEARCH DESIGN

This study employed longitudinal data on 323 NH residents with advanced dementia living in 22 Boston area facilities. Using bivariate and multivariate methods, we analyzed the association between visit time by the resident's health care proxy (HCP) and measures of quality of end-of-life care.

RESULTS

The relationship between visit time and quality was nonlinear. Residents who were visited 1 to 7 h/wk had less pain, fewer pressure ulcers, less dyspnea, and fewer hospital transfers compared with residents who had no visits or who were visited >7 h/wk. After adjusting for covariates, residents who were visited >7 h/wk had more pressure ulcers, more pain, greater dyspnea, fewer do-not-hospitalize orders, and lower HCP satisfaction with care compared with residents who were visited 1 to 7 h/wk.

CONCLUSIONS

Several measures of quality of NH care for end-stage dementia exhibit a nonlinear relationship with the degree of HCP oversight, such that no visiting or very high levels of visiting are associated with worse quality. Future research will need to address whether families with greater oversight tend to make decisions that promote worse quality of care, or whether worse quality of care promotes greater family oversight.

We're on the same side: improving communication between nursing home and family

Good communication between families and care providers is central to quality care, providing valuable insight into medical history and preferences, increasing family involvement and satisfaction, and reducing complaints. Two studies offer insight into sources of family-staff miscommunication and conflict. The Nursing Home Family Study (Study 1) interviewed 103 family caregivers to nursing home residents. The Long Term Care Community Coalition (Study 2) conducted focus groups and surveys with staff in six facilities: 323 certified nurse's assistants, 52 licensed practical nurses, and 71 registered nurses. Qualitative and quantitative data from both studies identified multiple barriers to good communication associated with both nursing homes and family caregivers. Institutional barriers include understaffing, turnover, inadequate training, policies based in a medical model, rigid routines, poor intrastaff communication, and work schedules that do not coincide with family visits. Psychosocial factors that hinder family communication include guilt, role confusion, clashes of culture and values, unrealistic expectations, and conflicting responsibilities. Specific communication problems identified by families were: making them feel guilty, criticism of their involvement, lack of information, changes made without consultation, staff have too little time to talk, high turnover, rotating shifts, and poor intrastaff communication. Similar issues were raised by nursing staff, who valued trusting, respectful relationships with supervisors and families, being consulted prior to changes, support in addressing racist or abusive comments, adequate staffing, and teamwork. Certified nursing assistants noted that family members are quick to complain but seldom offer praise, and that their intimate knowledge of the resident is rarely acknowledged. These data are applied to develop educational interventions to improve family-staff communication.

Can counseling and support reduce burden and depressive symptoms in caregivers of people with Alzheimer's disease during the transition to institutionalization? Results from the New York University caregiver intervention study

OBJECTIVES

To determine whether counseling and support reduce the burden and depressive symptoms of spouse caregivers of patients with Alzheimer's disease (AD) during the transition to institutionalization.

DESIGN

A randomized, controlled trial of an enhanced counseling and support program for spouse caregivers of persons with AD. Structured interviews were conducted with spouse caregivers at baseline, every 4 months during Year 1, and every 6 months thereafter for up to 16 years.

SETTING

Outpatient research clinic in the New York City metropolitan area.

PARTICIPANTS

Referred volunteer sample of 406 spouse caregivers of community-dwelling patients with AD enrolled over a 9.5-year period.

INTERVENTION

Enhanced counseling and support consisting of six sessions of individual and family counseling, support group participation, and continuous availability of ad hoc telephone counseling.

MEASUREMENTS

Outcome measures included burden (modified Zarit Burden Interview) and depressive symptoms (Geriatric Depression Scale).

RESULTS

Burden and depressive symptoms were significantly lower for caregivers in the treatment group than for controls receiving usual care at the time of and after institutionalization. Nursing home admission itself significantly reduced burden and depressive symptoms in the intervention and control groups.

CONCLUSION

Institutionalization alone can reduce caregiver burden and depressive symptoms, but enhanced counseling provides additional long-term benefits. The results offer some of the first clinical evidence of the benefits of enhanced counseling during the transition to institutionalization for caregivers of people with AD.

Partners in caregiving in a special care environment: cooperative communication between staff and families on dementia units

PURPOSE

This article reports the results of a randomized, controlled evaluation of Partners in Caregiving in a Special Care Environment, an intervention designed to improve communication and cooperation between staff and families of residents in nursing home dementia programs.

DESIGN AND METHODS

Participants included 388 family members and 384 nursing staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Project staff conducted training sessions on communication and conflict-resolution techniques with two groups at the intervention sites: staff and residents' family members, followed by a joint meeting with facility administrators.

RESULTS

Families, staff, residents, and facility programs in the intervention facilities all demonstrated positive outcomes from program participation. Families experienced significant improvement in communicating with staff and in staff behaviors toward them, and spouses of residents increased their care involvement. Staff reported reduced conflict with families and reduced depression; burnout for nurses increased for individuals in the control group but not those in the treatment group. Behavioral symptoms decreased for residents, and facilities implemented more family-focused programs.

IMPLICATIONS

Effective staff and family partnerships are critical in caring for residents with dementia. The Partners in Caregiving in a Special Care Environment program is an evidence-based intervention that enables these partnerships to develop and thrive, translating into improved experiences for residents, families, and staff.

Family Member Perception of Quality of Their Visits With Relatives With Dementia: A Pilot Study

OBJECTIVE

The purpose of the investigation was to identify factors influencing quality of visits with institutionalized patients suffering from dementia.

STUDY DESIGN

Two focus groups of family members of patients residing on a Dementia Special Care Unit.

SETTING

Dementia Special Care Unit in a Veterans Administration Hospital.

PARTICIPANTS

Spouses and adult children of institutionalized patients with dementia.

INTERVENTION

During the focus group the family members were asked to identify factors that contribute to the quality of their visits with loved ones suffering from dementia. The group sessions were recorded and transcribed verbatim. Data obtained during the sessions were analyzed and specific factors affecting the visiting experience were identified.

RESULTS

Numerous factors affecting the visiting experience were identified and were grouped into personal, interpersonal, and environmental domains.

CONCLUSIONS

The presence of visitors in the long-term care setting is very important. Visiting provides a link with the families and communities, and promotes the quality of life for patients with dementia. Satisfying experience during the visits helps the families to enjoy the interaction and promotes their involvement with their institutionalized relatives. Health care providers should make efforts to improve the quality of visits.

Informal caregiver involvement and illness detection among cognitively impaired nursing home residents

BACKGROUND

The participation of informal caregivers in the care of nursing home (NH) residents has the potential to positively impact care, especially for cognitively impaired residents whose own ability to advocate for their care is often limited. This study examined relationships between the level of informal caregiver involvement (ICI) in the NH and the degree to which residents' common medical conditions were detected by facility staff.

METHODS

One hundred pairs of cognitively impaired residents and their primary informal caregivers were enrolled from three facilities in the Baltimore, Maryland area. Data collection involved interviews with informal caregivers and facility staff, as well as a medical evaluation and chart review of residents. A measure of illness detection was created by comparing a medical examination of the resident with chart review information. ICI was measured via staff rating and informal caregiver self-report.

RESULTS

Correlations between illness detection and ICI were significant, with r = -.46 (p <.001) and r = -.39 (p <.001), for staff rating and self-reports, respectively. In regression models taking into account resident characteristics (age, race, gender, comorbidities, payment status, duration of stay, and cognitive impairment) and facility differences, higher ICI and being female predicted higher rates of illness detection.

CONCLUSIONS

Though the cross-sectional nature of the study prevents the analysis of causal relationships, the involvement level of informal caregivers in the NH care of cognitively impaired residents was statistically related to higher rates of illness detection. Ramifications for the role of informal caregivers in long-term care are discussed.

Reporting near-miss events in nursing homes

Since the Institute of Medicine report To Err Is Human was published in 1999, improving patient safety has become a major initiative for nurses working in all care settings. Nursing homes are a fertile environment for both a high frequency of adverse events to occur and a high number of institutional barriers to reporting them. This article outlines the barriers to reporting adverse events in nursing homes and provides support for why reporting near-miss events can serve as a means of reducing these barriers. It also provides recommendations and specific strategies for how to implement near-miss reporting systems in nursing homes such as policy changes, supportive leadership, and educating nurses about near-miss events. Further nursing research in this evolving area of patient safety is warranted.

Persistent Family Concerns in Long-term Care Settings: Meaning and Management

PURPOSE

The aim of this study was to understand institutional and family caregiver characteristics that contribute to the failure to resolve families' persistent complaints about nursing home care of their relatives.

DESIGN AND METHODS

Key informant interviews with 9 family members who had persistent concerns about the care of their relatives were conducted. Two focus groups with 5 nurse managers provided staff perceptions of families whose persistent concerns remained unresolved. Content analysis of both individual interviews and focus groups resulted in the extraction of salient themes.

RESULTS

Factors associated with persistent discord between families and staff included caregivers' perceptions of staff as incompetent, interfamilial conflicts, and unresolved psychosocial issues. Institutional factors contributing to persistent negative perceptions of care included staff's vulnerability in the face of challenges to their professional competence and stress due to disproportionate amounts of time spent educating and supporting health care aids to cope with distraught families.

IMPLICATIONS

The failure to settle, in a mutually satisfactory manner, the complaints of this subgroup of families is discussed in the context of unresolved family issues that interact with institutional failure to respond in a manner that conveys understanding of caregiver stress that is invariably exacerbated when a family member is placed in a long-term care facility.

Families Filling the Gap: Comparing Family Involvement for Assisted Living and Nursing Home Residents With Dementia

PURPOSE

The purpose of this study was to compare the sociodemographics, self-rated health, and involvement levels of family caregivers of residents with dementia in residential care/assisted living (RC/AL) versus nursing home settings.

DESIGN AND METHODS

We conducted telephone interviews with the family caregivers most involved with 353 residents of 34 residential care and 10 nursing home facilities. We measured involvement by caregiver self-report of monthly out-of-pocket spending, involvement and burden ratings, and the frequency of engaging in eight specific care activities. Open-ended questions elicited areas in which caregivers preferred different involvement and ways the facility could facilitate involvement.

RESULTS

Nursing home caregivers rated their health poorer than RC/AL caregivers, but there were no sociodemographic differences between the two. RC/AL caregivers rated both their perception of involvement and burden higher and engaged more frequently in monitoring the resident's health, well-being, and finances than did nursing home caregivers, although the reported time spent per week on care did not differ.

IMPLICATIONS

RC/AL and nursing home caregivers to residents with dementia may tailor their care to fit the needs of the resident and setting. Results are discussed in relation to the Congruence Model of Person-Environment Fit.