"It's Been a Whole New World": Staff Perceptions of Implementing a Person-Centered Communication Intervention During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) has challenged the way nursing homes deliver person-centered care (PCC). Preferences for Activity and Leisure (PAL) Cards are a tool to communicate residents' important preferences to staff. Monthly interviews (N = 32) were conducted with champions who were conducting a PAL Card quality improvement project in Tennessee nursing homes (N = 11) between March and August 2020. Three major themes emerged: Structural Changes (e.g., halting admissions, adding an isolation unit), Resident Burden (e.g., physical isolation, loneliness), and Provider Burnout (e.g., increased workload, mental exhaustion). Further, providers expressed the benefits to using PAL Cards, specifically in regard to blunting the negative impact of each theme. Results showed the overall negative impact of COVID-19 on nursing home communities. Nursing staff experienced greater burden than other staff, reflecting their prominent role in providing direct care to residents with COVID-19. Staff reported that PAL Cards helped promote PCC. [Journal of Gerontological Nursing, 47(5), 9-13.].

Building Capacity in Long-Term Care: Supporting Homes to Provide Intravenous Therapy

Background

Typically, long-term care home (LTCH) residents are transferred to hospital to access intravenous (IV) therapy. The aim of this study was to pilot-test an in-home IV therapy service, and to describe outcomes and key informants’ perceptions of this service.

Method

This service was pilot-tested in four LTCH in the Hamilton-Niagara region, Ontario. Interviews were conducted with six caregivers of residents who received IV therapy and ten key informants representing LTC home staff and service partners to assess their perceptions of the service. A chart review was conducted to describe the resident population served and service implementation.

Results

Twelve residents received IV therapy. This service potentially avoided nine emergency department visits and reduced hospital lengths of stay for three residents whose IV therapy was initiated in hospital. There were no adverse events. The service was well received by caregivers and key informants, as it provided care in a familiar environment and was perceived to be less stressful and better quality care than when provided in hospital.

Conclusion

IV therapy is feasible to implement in LTCHs, particularly when there are supportive resources available and clinical pathways to support decision-making. This service has the potential to increase capacity in LTCHs to provide medical care.

The meanings of the unlicensed assistive personnel role in nursing homes: A triadic job analysis perspective

AIM

This study described and analyzed how older residents, professional nurses and unlicensed assistive personnel (UAP) perceive the meaning and content of the job carried out by UAP in nursing homes (NHs), as a basis for job analysis.

BACKGROUND

Increasing numbers of NH beds and financial restraints have led UAP to become a significant part of the long-term care service system, yet in numerous contexts, the UAP job remains misunderstood and underexplored.

METHOD

The research employed a qualitative phenomenological methodology. Data were collected from 50 semi-structured in-depth interviews with 18 UAP, 15 certified nurses and 17 older NH residents.

RESULTS

We identified six content dimensions in the participants' descriptions regarding the meanings of the roles and duties of the UAP: (a) care for the physical environment, (b) bodily-physical care, (c) psycho-social interpersonal care, (d) professional hierarchy and boundaries, (e) UAP personal traits and (f) UAP skills, or the need for training and professional education.

CONCLUSIONS

Future job definition and formal regulation of UAP should place more focus on the personal characteristics of UAP, as a prerequisite to enter the job.

IMPLICATIONS FOR NURSING MANAGEMENT

The study takes a step forward toward better defining the professional boundaries delineating the meaning of the UAP position.

Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered

Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work's PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood's concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.

But does it work? The role of regulation in improving the quality of residential care for older people in Europe

Purpose

– Regulation is the tool preferred by policy-makers to manage the quality of residential care for older people. However, it remains unclear which form of regulation is most effective. The residential care sector for older people in Europe offers a unique opportunity to explore this issue as countries vary in how they control quality in the sector. The paper aims to discuss this issue.

Design/methodology/approach

– The study used a comparative approach, collating secondary data from various sources and conducting qualitative comparative analysis on the data.

Findings

– Three regulatory approaches were in operation – many Northern European countries operate on a self-regulatory basis, and are associated with the highest quality. Many continental countries, the UK and Ireland operate a command-and-control regulatory approach, with a moderate standard of care. Mediterranean and Eastern European countries have limited regulation, with care of a lower standard. However, the type of regulation appears to be a product of the prevailing culture and philosophy of care within each country. Thus, quality outcomes are a measure of financial investment in care.

Social implications

– Consistent calls for command-and-control style regulation may be misguided; high-quality care requires high-public investment and a professional workforce with the freedom to focus on quality improvement mechanisms.

Originality/value

– The paper provides a framework for analysing outcomes associated with different types of regulation. While a self-regulatory model is linked with the best outcomes, financial investment and the philosophy of care may be more important factors influencing the quality of care.

National newspaper portrayal of U.S. nursing homes: periodic treatment of topic and tone

CONTEXT

Although observers have long highlighted the relationship of public distrust, government regulation, and media depictions of nursing-home scandals, no study has systematically analyzed the way in which nursing homes have been portrayed in the national media. This study examines how nursing homes were depicted in four leading national newspapers-the New York Times, Washington Post, Chicago Tribune, and Los Angeles Times-from 1999 to 2008.

METHODS

We used keyword searches of the LexisNexis database to identify 1,704 articles pertaining to nursing homes. We then analyzed the content of each article and assessed its tone, themes, prominence, and central actor. We used basic frequencies and descriptive statistics to examine the articles' content, both cross-sectionally and over time.

FINDINGS

Approximately one-third of the articles were published in 1999/2000, and a comparatively high percentage (12.4%) appeared in 2005. Most were news stories (89.8%), and about one-quarter were on the front page of the newspaper or section. Most focused on government (42.3%) or industry (39.2%) interests, with very few on residents/family (13.3%) and community (5.3%) concerns. Most were negative (45.1%) or neutral (37.0%) in tone, and very few were positive (9.6%) or mixed (8.3%). Common themes were quality (57.0%), financing (33.4%), and negligence/fraud (28.1%). Both tone and themes varied across newspapers and years.

CONCLUSIONS

Overall, our findings highlight the longitudinal variation in the four widely read newspapers' framing of nursing-home coverage, regarding not only tone but also shifts in media attention from one aspect of this complex policy area to another. The predominantly negative media reports contribute to the poor public opinion of nursing homes and, in turn, of the people who live and work in them. These reports also place nursing homes at a competitive disadvantage and may pose challenges to health delivery reform, including care integration across settings.

The Commonwealth Fund Survey of Long-Term Care Specialists

The Commonwealth Fund Survey of Long-Term Care of Specialists was administered via the World Wide Web from September 2007 through March 2008. The primary purpose was to characterize the views of those with known or demonstrable experience and expertise with at least one aspect of long-term care. Among 2,577 potential respondents, 1,147 completed the entire survey for an overall response rate of 44.5%. This special supplement of Medical Care Research and Review uses data collected from the survey to explore several issue areas, namely, reforming long-term care financing, improving government oversight, adopting nursing home culture change, and rebalancing long-term care away from institutions toward home- and community-based services. Analyses documenting the opinion networks of long-term care specialists and the relationship between network characteristics and attitudes toward reform are also reported. Two leading experts provide commentary as well. Details of the study's methodology and issue content are described.