Family members’ perceived meaning of visiting nursing home residents in Taiwan

Family Caregivers' Needs in Long-Term Care Facilities: A Descriptive Qualitative Study

PURPOSE

To explore the needs of family caregivers (FCs) and how these are addressed in long-term care facilities (LTCFs).

METHOD

A descriptive qualitative study was performed, using semi-structured interviews with 23 FCs from seven LTCFs in Japan.

RESULTS

Inductive content analysis revealed three main themes: Coexistent Needs Related to Residents' and FCs' Own Well-Being, Means by Which FCs Promote Residents' and Their Own Well-Being, and Managing Conflicting Needs by Prioritizing and Compromising. FCs recognized that their needs relate to the well-being of residents and themselves, and both needs coexist. To address these multifaceted needs, FCs engaged in various activities while seeking support. However, limited availability of means often made it challenging to meet multiple needs simultaneously, leading FCs to manage these conflicting needs by prioritizing or compromising.

CONCLUSION

The current study underscores the significance of comprehensive support that simultaneously addresses FCs' conflicting needs, rather than approaching each need separately. [Research in Gerontological Nursing, 17(4), 177-187.].

Sleep quality as a mediator between family function and life satisfaction among Chinese older adults in nursing home

BACKGROUND

The life satisfaction of the elderly in nursing home is the focus of social concern.The purpose of this study was to evaluate the effects of family function and sleep quality on life satisfaction among elderly individuals in nursing homes and examine the mediating effect of sleep quality between family function and life satisfaction.

METHODS

A cross-sectional observational study was conducted .A total of 127 older adults who completed the Life Satisfaction Index A (LSI-A), the Family APGAR Index and the Pittsburgh Sleep Quality Index (PSQI) were recruited from four nursing homes in Chongqing, China.

RESULTS

Life satisfaction was positively correlated with family function (r=0.434, p<0.01) and negatively correlated with PSQI (r = -0.514, p<0.01). PSQI was found to be negatively associated with family function (r=-0.387, p<0.01).Family function had a significant effect on PSQI (path a: β=-0.8459, 95% CI=-1.2029, -0.4889), and PSQI had a significant effect on life satisfaction (path b: β=-0.3916, 95% CI=-0.5407, -0.2425). The total effect (path c) and direct effect (path c') of family function on life satisfaction were significant (β=0.8931, 95% CI=0.5626, 1.2235 and β=0.56181, 95% CI=0.2358, 0.8879, respectively). The coefficient for the indirect effect of family function on life satisfaction through PSQI was statistically significant (β=0.3312, 95% CI=0.1628, 0.5588). PSQI played a partial mediating role between family function and life satisfaction, and PSQI mediated 32.58% of the total effect of family function on life satisfaction.

CONCLUSIONS

Family function and sleep quality were significant predictors of elderly people's life satisfaction in nursing homes. Sleep quality partially mediated the relationship between family function and life satisfaction.The interventions focused on promoting family function and improving sleep quality may be more helpful in improving elderly people's life satisfaction in nursing homes.

Satisfaction with care quality and anxiety among family members during nursing home visiting restrictions: The chain mediating effect of emotional regulation and perceived stress

Introduction

This study aimed to investigate the psychological well-being (perceived stress and anxiety) of Chinese family members during nursing home visiting restrictions and to elucidate the relationships among satisfaction with care quality, emotion regulation, perceived stress, and anxiety.

Methods

An online survey was conducted with a cross-sectional study design. From 18 to 29 January 2022, a total of 571 family members of nursing home residents completed online questionnaires comprising socio-demographic characteristics, satisfaction with care quality, emotion regulation, perceived stress, and anxiety. Mediation analyses were performed to estimate the direct and indirect effects of satisfaction with care quality on anxiety using the PROCESS macro for SPSS.

Results

The results showed that approximately one-quarter of Chinese family members had anxiety symptoms during nursing home visiting restrictions. Satisfaction with care quality affected anxiety via three mediating paths: (a) through cognitive reappraisal (effect = 0.028); (b) through cognitive reappraisal and perceived stress sequentially (effect = −0.057); and (c) through perceived stress (effect = −0.212). The chain mediating effect (path b) accounted for 23.7% of the total effect.

Conclusions

These findings corroborated our hypothesis that cognitive reappraisal (a kind of emotion regulation strategy) and perceived stress mediated the relationship between satisfaction with care quality and anxiety during nursing home visiting restrictions. Efforts to address family members’ psychological well-being by focusing on cognitive reappraisal should be considered.

Depression in nursing home residents and its correlation with meaning of family involvement and depression of family

OBJECTIVES

This study aimed to investigate the relationship between depression in older nursing home residents and family caregivers' (FCGs) depressive status and reasons for involvement with residents.

DESIGN

This study employed a cross-sectional design.

SETTING

Eight nursing homes in northern Taiwan.

PARTICIPANTS

A total of 139 older resident-FCG pairs were recruited.

MEASUREMENTS

Depression was measured with the Geriatric Depression Scale-Short Form for nursing home residents and the Center for Epidemiologic Studies Depression Scale-Short Form for family members. Depression and demographic data were collected with face-to-face interviews. The meaning ascribed to caregivers' nursing home visits was calibrated using the Family Meaning of Nursing-Home Visits scale. Multiple logistic regression was used to understand the factors related to residents' depressive symptoms.

RESULTS

Depressive symptoms were present in 58.3% of the nursing home residents (n = 81). Depressive status of family members (Chi-square = 1.46, p = 0.23) or family's visiting frequency (Chi-square = 1.64, p = 0.44) did not differ between residents with or without depressive symptoms. Factors associated with an increased risk of residents having depressive symptoms were age, self-perceived health status, and having a caregiver motivated to visit to assuage their guilt.

CONCLUSIONS

Visiting a family member to assuage their guilt was the only caregiver variable associated with depressive symptoms for nursing home residents. This finding suggests that developing interventions to improve personal relationships between nursing home residents and family members might facilitate the emotional support of caregivers and psychological support for older nursing home residents in Taiwan.

Implementation of a Sense of Home in High-Density Multicultural Singapore Nursing Homes: Challenges and Opportunities

Many studies have introduced principles for creating a sense of home in nursing homes, yet they mostly feature cases from low-density developments in Western countries. This raises a question about how those principles are interpreted and implemented in other cultural contexts, especially in high-density, multicultural environments such as Singapore. This paper examines how a sense of home is implemented in Singapore nursing homes, with a specific focus on the role of the built environment. Participant observations were conducted in five nursing homes in Singapore comprising various architectural design typologies, with the focus on the residents’ everyday interactions with their built environment. The study identified the extent of the presence of a sense of home in Singapore’s nursing homes and the prevalence of an institutional care model. More specifically, the study explicates Singapore nursing home residents’ management of privacy and personalization in shared spaces, illuminates the need for holistic implementation of homelike environments integrated with building designs and care programs and reiterates the pivotal role of social relationships in fostering a sense of home for the residents in the nursing homes.

Reimagining Family Involvement in Residential Long-Term Care

Although descriptions of family involvement in residential long-term care (RLTC) are available in the scientific literature, how family involvement is optimized in nursing homes or assisted living settings remains underexplored. During the facility lockdowns and visitor restrictions of the COVID-19 pandemic, residents experienced social deprivation that may have resulted in significant and adverse health outcomes. As with so many other critical issues in RLTC, the COVID-19 pandemic has magnified the need to determine how families can remain most effectively involved in the lives of residents. This article seeks to better understand the state of the science of family involvement in RTLC and how the COVID-19 pandemic has expedited the need to revisit, and reimagine, family involvement in RLTC.

Motivations for Family Members' Visits to Nursing Home Residents With Dementia in Taiwan: A Qualitative Study

PURPOSE

The purpose of this study was to explore what motivates family members to visit a relative with dementia who has been transferred to a nursing home in Taiwan.

DESIGN AND METHODS

Data were collected for this qualitative descriptive study using audiotaped, semi-structured, in-depth, face-to-face interviews. A total of 20 family members of elderly nursing home residents participated in the study. Nursing home residents were from four nursing homes in Taiwan and had been diagnosed with probable or possible dementia by a psychiatrist or neurologist. Transcribed audiotaped interviews were analyzed using thematic analysis.

FINDINGS

Most family members were the children of the residents (n =17, 85%). The theme describing the core motivation for family members' visits to nursing home residents was "to maintain the unforgotten family affection." This motivation comprised four relevant categories: hoping to slow degeneration, providing a congruous environment, honoring filial and karmic duty, and ensuring the quality of care.

CONCLUSIONS

Motivations for Taiwanese family members' visits to nursing home residents with dementia were similar to those in Western cultures. However, "hoping to slow degeneration" and "providing a congruous environment" were unique categories.

CLINICAL RELEVANCE

Nurses and policymakers could use these findings to design interventions that might increase holistic care for both family members and nursing home residents with dementia. Providing programming focused on family members' unique priorities could address swallowing difficulties, management of dementia symptoms, nutritional needs, and selection of residents' roommates. These programs could improve the quality of family members' visits as well as the quality of staff-family relationships.

"Tailoring homely meals": Family members' motivations underlying nursing home visits during residents' meals

AIM

Elderly nursing home residents are often malnourished or at risk of malnutrition. Family members often visit residents during mealtimes, which might be an ideal opportunity for interventions targeted at improving the nutritional status of older residents. Therefore, this study aimed to explore motivations behind family member visits with nursing home residents during mealtime in Taiwan.

METHODS

This phenomenological study was conducted with family members of residents from four nursing homes in Taiwan. Participants were purposively sampled. Data were collected with individual face-to-face interviews from 18 family members. Data from transcribed audio-recorded interviews were analyzed using the approach of van Manen.

RESULTS

Analysis of the interview data identified the essence of motivations underlying family members' visits to nursing home residents during mealtimes, which we termed "tailoring homely meals." This referred to providing food tailored to residents' needs, providing a comforting family atmosphere, assisting residents during mealtime, and monitoring food consumption.

CONCLUSIONS

The motivations of family members to visit during mealtime could guide healthcare professionals working with East Asian populations in developing interventions to reduce the possibility of malnutrition, while also improving their quality of life. We recommend providing the following for nursing home residents: a nutritious and balanced diet, supporting their independence and ability to feed themselves, and encouraging involvement of family members during mealtimes.

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.

Medical Foster Homes: Can the Adult Foster Care Model Substitute for Nursing Home Care?

OBJECTIVE

To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs.

DESIGN

Descriptive, unmatched study.

SETTING

VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs).

PARTICIPANTS

Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011.

MEASUREMENTS

Using VA and Medicare data from fiscal years 2010 and 2011, demographic characteristics, healthcare use, and costs of 388 veterans in MFHs were compared with 26,037 of those in HBPC, 5,355 in CLCs, and 5,517 in CNHs in the year before and the year after enrollment.

RESULTS

Veterans enrolled in the MFH program were more likely to be unmarried than those in other LTC programs and had higher levels of comorbidity and frailty than veterans receiving HBPC but had similar levels of comorbidity, frailty, and healthcare use as those in CLCs and CNHs. MFH veterans incurred lower costs than those in CNHs and CLCs.

CONCLUSION

MFHs served a distinct subset of veterans with levels of comorbidity and frailty similar to those of veterans cared for in CLCs and CNHs at costs that were comparable to or lower than those of the VHA. Propensity-matched comparisons will be necessary to confirm these findings.

Attitudes Toward and Predictors of Videoconferencing Use Among Frequent Family Visitors to Nursing Home Residents in Taiwan

BACKGROUND

Videoconferencing with family members benefits nursing home residents by decreasing their depression and loneliness. Nevertheless, the rate of participation in videoconferencing by family members is low. The purpose of this study was to explore attitudes toward and factors related to videoconferencing by family visitors to nursing home residents in Taiwan.

MATERIALS AND METHODS

For this cross-sectional study, data were collected from 231 family members of residents at 16 medium to large (>70 beds) nursing homes in Taiwan. Data were collected on participants' and residents' demographic and clinical characteristics, acceptance of and attitudes toward using videoconferencing as a form of nursing home visit, and reasons for/roles during visits to nursing home residents. Factors related to the use of videoconferencing were analyzed by logistic regression.

RESULTS

Family members' acceptance rate of videoconferencing use was low (7.8%). The findings also showed that videoconference use was predicted by hiring a private caregiver (odds ratio=6.90), the role during/reason for family visits being to maintain residents' emotional status (odds ratio=5.46), and the frequency of in-person visits to the nursing home.

CONCLUSIONS

We recommend encouraging family use of videoconferencing by available equipment such as smartphones or tablet programs that can address residents' emotional issues in a timely fashion. We also suggest developing more interactive content for videoconferencing, such as a family-oriented picture program to help broaden topics of conversation.

Prevalence and factors related to depressive symptoms among family caregivers of nursing home residents in Taiwan

PURPOSE

The purpose of this cross-sectional study was to understand the prevalence and risk factors for depressive symptoms among nursing home residents' family caregivers in Taiwan.

METHODS

Family caregivers (n = 191) of nursing home residents were recruited by stratified random sampling from 16 nursing homes throughout Taiwan. Data were collected from caregivers in face-to-face interviews on depressive status (using the Center for Epidemiologic Studies Depression Scale; CES-D), on meaning ascribed to visiting nursing home residents (using the Family Meaning of Nursing-Home Visits scale), and on demographic data. Factors related to depressive symptoms were analyzed by multiple logistic regression.

RESULTS

The prevalence of depressive status among family caregivers was 29.8 % as determined by the CES-D cutoff score of ≥10. The non-depressed group (CES-D <10) tended to visit residents for emotional maintenance (odds = 0.54), while the depressed group (CES-D ≥10) tended to visit due to sense of responsibility for monitoring care quality (odds = 3.25). These results demonstrate that risk factors for depressive symptoms in family caregivers were their age, self-perceived health status, education level, and being the resident's main caregiver before admission.

CONCLUSION

These results fill a gap in knowledge by providing detailed, evidence-based data on family caregivers' priorities for visiting nursing home residents and it is related to depression. These results also provide useful information for designing intervention protocols to reduce depressive symptoms in family caregivers of nursing home residents, not only in Asian countries, but also in western countries with many Chinese/Asian immigrants.

Development and validation of the Family Meaning of Nursing-Home Visits Scale

AIMS AND OBJECTIVES

The purpose of this study was to develop and test a Family Meaning of Nursing-Home Visits Scale that can be used to assess and document family members' rationale for visiting nursing home residents.

BACKGROUND

Understanding the meaning ascribed by families for visiting nursing home residents is necessary to develop intervention programmes that facilitate the quality of families' nursing home visits. No valid and reliable instrument is available in Taiwan or elsewhere to accurately document the meaning of family visits to nursing home residents.

DESIGN

A cross-sectional design was used to collect survey data from family members of nursing home residents as the quantitative component of a mixed-methods study. Items were developed based on qualitative data from our previous research and that of others. This initial pool of items was used to develop and validate the scale.

METHODS

The validity of the scale was confirmed by exploratory factor analysis and criterion-related validity testing. Internal consistency reliability was assessed by Cronbach's alphas.

RESULTS

Factor analysis yielded a six-factor final solution (32 items), accounting for 66·76% of the variance. For criterion-related validity, 'responsibility for care quality' was negatively correlated with satisfaction with nursing home caregiving (r = -0·23, p < 0·01) and nursing home rehabilitation activities (r = -0·17, p < 0·05). Cronbach's α for each subscale ranged from 0·68-0·98, and Cronbach's α for the total scale was 0·83.

CONCLUSIONS

The Family Meaning of Nursing-Home Visits Scale has acceptable internal consistency reliability, good content validity and acceptable construct validity.

RELEVANCE TO CLINICAL PRACTICE

The Family Meaning of Nursing-Home Visits Scale provides nurses and healthcare providers an objective and consistent method to explore the priority of meanings family members assign to nursing home visits. Based on this priority for visiting, interventions could be designed to increase the quality of visits, thus promoting families' continued incentive to visit in person.