From Compliance to Care: Qualitative Findings from a Survey of Essential Caregivers in Ontario Long-Term Care Homes

BACKGROUND

The COVID-19 pandemic highlighted the importance of the care provided by family members and close friends to older people living in long-term care (LTC) homes. Our implementation science team helped three Ontario LTC homes to implement an intervention to allow family members to enter the homes during pandemic lockdowns.

OBJECTIVE

We used a variety of methods to support the implementation, and this paper reports results from an Ontario-wide survey intended to help us understand the nature of the care provided by family caregivers.

METHODS

We administered a survey of essential caregivers in Ontario, and a single open-ended question yielded a substantial qualitative data set that we analysed with a coding and theming procedure that yielded 13 themes.

FINDINGS

The 13 themes reveal deficiencies in Ontario's LTC sector, attempts to cope with the deficiencies, and efforts to influence change and improvement.

DISCUSSION

Our findings indicate that essential caregivers find it necessary to take on vital roles in order to shore up two significant gaps in the current system: they provide psychosocial and emotional (and sometimes even basic) care to residents, and they play a monitoring and advocacy role to compensate for the failings of the current regulatory compliance regime.

The Family Involvement in Care Questionnaire-An instrument measuring family involvement in inpatient care

BACKGROUND

Family involvement in care can be seen as a prerequisite for high-quality family-centered care. It has been identified to improve both patient safety and the quality of care by reducing patient complications and hospital length of stay.

OBJECTIVE

To develop and evaluate the content validity of a questionnaire measuring family involvement in inpatient care.

METHODS

The study followed a systematic approach in building a rigorous questionnaire: identification of domain, item generation, and assessment of content validity. The content validity index was calculated based on ratings of item relevance by an expert group consisting of seven senior nurses. Subsequently, 19 online cognitive interviews using the Think-aloud method were conducted with family members of former patients who had undergone open-heart surgery.

RESULTS

Five aspects of family involvement were identified, and the initial pool of items were selected from two preexisting questionnaires. The experts' ratings resulted in item content validity of 0.71-1.00, and the scale content validity/averaging was 0.90, leading to rewording, exclusion, and addition of items. The pretesting of items through two rounds of cognitive interviews with family members resulted in the identification of three main problem areas: defining family involvement, misinterpretation of different terms, and underuse of the not relevant response option. The problems were adjusted in the final version of the questionnaire, which consists of 16 items with a four-point Likert scale and two open-ended items.

CONCLUSIONS

The Family Involvement in Care Questionnaire has demonstrated potential in evaluating family involvement in inpatient care. Further psychometric properties regarding reliability and validity need to be established.

A Systematic Review of Tools Assessing the Perspective of Caregivers of Residents With Dementia

In collaboration with stakeholders, we conducted a systematic review of psychometric evidence for self-report tools measuring the perspective of family caregivers of nursing home residents with dementia. Our rationale for this review was based on evidence that nonpharmacological interventions can ameliorate dementia symptoms in nursing home residents. Such interventions require caregiver participation, which is influenced by perspectives. Yet, no existing tool measures the multidomain caregiver perspective. Our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The final sample included 42 articles describing 33 tools measuring domains of nursing home dementia care such as behavioral and psychological symptoms of dementia, resident quality of life, dementia-specific knowledge, communication, and medication use. We uncovered evidence gaps for tools measuring dementia-specific knowledge, communication, and medication use, all of which were important to our stakeholders. Future research should focus on development of psychometrically sound tools in alignment with the multidomain caregiver perspective.

The perceptions, needs and preferences of informal caregivers of nursing home residents with dementia regarding physical therapy: A qualitative study

INTRODUCTION

Informal caregivers often support nursing home residents with dementia in making therapeutic decisions. We explored the perceptions, needs and preferences of informal caregivers of nursing home residents with dementia regarding physical therapy.

METHOD

We conducted eleven semi-structured interviews. Thematic analysis was used.

RESULTS

Five themes emerged: 1) visibility and familiarity; 2) communication; 3) aim and content; 4) dosage and location; 5) level of expertise and the role of the physical therapist within the interdisciplinary team. Informal caregivers' perceptions of physical therapy included a lack of visibility and familiarity. They needed more communication, and empathic communication skills of the physical therapists. Preferences included physical therapy to be enjoyable, accessible and tailored to the needs of the resident.

CONCLUSION

Physical therapists need to involve informal caregivers in physical therapy care. Implementing shared decision-making will help to get informal caregivers more involved, but has yet to be studied in this setting.

Interventions promoting family involvement with care homes following placement of a relative with dementia: A systematic review

There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident’s quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family–staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.

Family involvement with care homes following placement of a relative living with dementia: a review

This review updated a previous review [Gaugler JE (2005) Family involvement in residential long-term care: a synthesis and critical review. Aging and Mental Health9, 105–118] and focused on dementia. Fourteen years of development in family involvement with care homes following placement of a relative was explored. The review aimed to investigate two questions: (1) What types of involvement do families have with care homes following placement of people living with dementia? (2) Which factors influence family involvement with care homes? PsycINFO, MEDLINE and CINAHL Plus were searched for publications between January 2005 and December 2018. Thirty-three papers representing 30 studies were included. Papers were appraised using a quality rating tool designed for use with mixed study designs. Studies were of a reasonable quality though some weaknesses included single-site samples, high attrition rates and poor reporting. Twenty-eight papers highlighted types of involvement including collaboration, family–staff relationship development, decision making and visiting. Twenty-five papers pertained to factors influencing involvement, which included outcome of care quality evaluation, wish for recognition and sense of integration into the care team. Type of family involvement has changed over time with increased emphasis on families’ desire for partnership, to be active rather than passive advocates, and to focus on care monitoring and evaluation. Seven themes of family involvement activities are featured and a non-linear process is proposed. When compared to patient and family-centred care principles, an analysis of family involvement types found good fit overall and potential for framework improvements. Over 30 diverse factors influence inter-family variation in the level and nature of family involvement. Consideration of these factors and resolution of the gaps in evidence, including intergenerational and cultural concerns, can improve care home facilitation of family participation. This dementia-specific review is a comprehensive timely complement to Gaugler's seminal work about older adults in care.

Person-Centred Care for older people: Convergence and assessment of users' relatives' and staff's perspectives

AIM

Develop two psychometrically sound questionnaires to assess users' and relatives' opinions of Person-Centred Care. Evaluate the convergence between the perspectives of the different agents involved in Person-Centred Care in the older people: Users, relatives and staff. Examine the relationships between Person-Centred Care and care quality and the users' perceived psychological well-being.

DESIGN

We used the psychometric technology involved in the development and analysis of tests for the first objective. For the second and third objectives, we used a descriptive-correlational design.

METHOD

The sample comprised 636 clients of older people care residences, 742 relatives and 844 healthcare professionals. The mean age of the centre residents was 81.62 years old (SD = 9.51), the mean age of relatives was 56.7 (SD = 10.15) and the mean age of healthcare professionals was 39.94 (SD = 10.56). Data collection lasted 10 months, between May 2017 and March 2018. Two new Person-Centred Care instruments were developed and the correlations between different agents were calculated.

RESULTS

The newly developed measurement instruments demonstrated a unidimensional structure and high internal consistency and stability over time (users: α = .96, ω = .96, r = .91; relatives: α = .97, ω = .97, r = .95). There was high convergence between the Person-Centred Care evaluations from the staff, users and relatives, with correlations ranging between .62 and .76.

CONCLUSION

The new measurement instruments were reliable and valid. The opinions of the staff, users and relatives about Person-Centred Care in the residential centres were in good agreement. Furthermore, Person-Centred Care was associated with care quality and residents' psychological well-being.

IMPACT

A gap in the literature is an examination of the extent to which assessments of Person-Centred Care made by staff agree with those by users of the services and their relatives. In order to do that, two new measuring instruments were developed, which showed excellent psychometric properties, and are able to reliably, validly evaluate Person-Centred Care.

Cross-sectional investigation of relationships between the organisational environment and challenging behaviours in support services for residents with intellectual disabilities

Background

This study was conducted to assess relationships between the organisational environment and three types of challenging behaviour (self-injurious, aggressive/destructive and stereotypical) in support services for residents with intellectual disabilities using ecological theory.

Method

A cross-sectional questionnaire-based design was used to identify relationships between ecological system aspects at multiple levels (micro-, meso-, exo-, macro- and chronosystems) and challenging behaviours of residents. A questionnaire was distributed to care professionals and managers working in specialised Dutch service organisations for residents with intellectual disabilities and challenging behaviour. The data were examined by Pearson correlation and multivariate regression analyses.

Results

The questionnaire was completed by 922 respondents from 21 organisations. Responses revealed that organisational aspects at the micro-, meso-, exo- and macrosystem levels play roles in residents' challenging behaviour. These aspects range from staff members' ability to sensitively interact with residents to grouping of residents with challenging behaviour, and staff turnover.

Conclusions

In the prevention and management of challenging behaviour of residents with intellectual disabilities, the consideration of ecological aspects at all system levels in the organisational environment is required.

Individualized Care Scale-patient: A Spanish validation study

Background:

I suggest this individualized care is a fundamental principle closely linked to nursing ethics and has important benefits for the patients, however, nurses do not always take into consideration the principles of individualized care. Moreover, there is no validated instrument to assess patients’ views of individualized care in Spanish-speaking countries.

Objectives:

To assess the validity and reliability of the Spanish version of the Individualized Care Scale-patient.

Design:

A cross-sectional study design was conducted. A questionnaire survey, including the Individualized Care Scale-patient, was used for data collection. Psychometric properties of reliability and validity were assessed. Fit indices of the overall model were computed.

Participants and research context:

Survey data were collected from a sample of 118 inpatients at a public hospital in Spain.

Ethical considerations:

Informed consent from participants and ethical approval was obtained from a regional Clinical Research Ethics Committee.

Findings:

Ordinal Cronbach’s alphas were 0.966 for Individualized Care Scale-patient subscale A and 0.969 for Individualized Care Scale-patient subscale B. The polychoric correlation between each item and the subscale ranged between 0.653–0.874 and 0.604–0.916, respectively. The exploratory factor analysis revealed a three-factor solution. Personal life situation explained relatively large amounts of the variance. Goodness of fit index showed a good fit for the model.

Discussion:

This study confirms three factors underlining the individualized care concept, but some differences were found in the load of the factors, such as the relevance of “personal life situation” subscale, that need further research.

Conclusion:

The Spanish version of the Individualized Care Scale-patient is reliable, valid, user-friendly, and suitable to be used in Spanish-speaking countries showing satisfactory properties. This instrument may help managers better understand and develop areas in which patients perceive lower individualized care received and the factors influencing it. Such key information will help ensure the right of the patient to be respected as an individual.

Predictors of activity involvement in dementia care homes: a cross-sectional study

Background

Despite the finding that involvement in activities is one of the most important needs of residents with dementia living in care homes, care facilities struggle to fulfill this need. Over the years, various factors are suggested which may contribute to or disable activity provision in dementia care homes. These include limited financial resources, task oriented staff and disease-related characteristics of residents. This study aims to further clarify which of these factors predict higher activity involvement.

Methods

Data were derived from the second measurement (2011) of the Living Arrangements for people with Dementia study. One thousand two hundred eighteen people residing in 139 dementia care homes were involved. Forty predictors of higher involvement were studied. Multilevel backward regression analyses were performed.

Results

The most important predictors of higher involvement were: absence of agitation, less ADL dependency, and a higher cognitive status of the residents, higher staff educational level, lower experienced job demands by care staff and a smaller number of residents living in the dementia care wards of a facility. More social supervisor support as perceived by staff was found to predict less activity involvement.

Conclusions

To increase the activity involvement of care home residents with dementia it seems vital to: 1) reduce staff’s experienced job demands; 2) elevate their overall educational level; 3) train staff to provide suitable activities, taking account of the behavior and preserved capabilities of residents; and 4) foster transition towards small-scale care. In order to achieve these aims, care organizations might need to evaluate the use of their financial means.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-017-0564-7) contains supplementary material, which is available to authorized users.

Advancing the Big Five of user-oriented care and accounting for its variations

Purpose

– Care process quality (i.e. how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The purpose of this paper is to describe the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care.

Design/methodology/approach

– Two municipalities were selected for in-depth field studies. First, in each municipality, the authors interviewed and observed care workers’ interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, the authors conducted interviews with care workers and care unit managers (Study 2).

Findings

– A new taxonomy for categorizing process quality variation, the Big Five of user-oriented care (task-focus, person-focus, affect, cooperation, and time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality level).

Originality/value

– The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

Conceptualizaciones sobre la atención a personas con demencia en residencias de mayores

A pesar de la importancia de las percepciones familiares en el análisis de la atención en residencias de mayores, apenas se han indagado estos ascpetcos. El objetivo de este estudio es conocer las preferencias y las áreas de mejora percibidas por los familiares sobre los cuidados a personas con demencia. Se realizó un estudio cualitativo, a partir de la Teoría Fundamentada, combinando dos técnicas de recogida de datos (observación participante y entrevistas en profundidad) en una muestra teórica de familiares de personas con demencia institucionalizadas. El modelo de atención óptima a personas con demencia, percibido por los participantes, se basó en una atención especializada e individualizada y en la participación de la familia en el cuidado. Entre las áreas de mejora se incluyeron aspectos relacionados con una mayor formación específica en Geriatría, relaciones humanas y con la cultura del trabajo institucional. Frente a la vigente tendencia de tecnificación del cuidado, las familias exigen una atención personalizada y en pequeña escala, donde ellas mismas sean parte activa del proceso de atención.

Multiple perspectives on quality of life for residents with dementia in long term care facilities: protocol for a comprehensive Australian study

BACKGROUND

Dementia is a chronic illness without cure or effective treatment, which results in declining mental and physical function and assistance from others to manage activities of daily living. Many people with dementia live in long term care facilities, yet research into their quality of life (QoL) was rare until the last decade. Previous studies failed to incorporate important variables related to the facility and care provision or to look closely at the daily lives of residents. This paper presents a protocol for a comprehensive, multi-perspective assessment of QoL of residents with dementia living in long term care in Australia. A secondary aim is investigating the effectiveness of self-report instruments for measuring QoL.

METHODS

The study utilizes a descriptive, mixed methods design to examine how facility, care staff, and resident factors impact QoL. Over 500 residents with dementia from a stratified, random sample of 53 facilities are being recruited. A sub-sample of 12 residents is also taking part in qualitative interviews and observations.

CONCLUSIONS

This national study will provide a broad understanding of factors underlying QoL for residents with dementia in long term care. The present study uses a similar methodology to the US-based Collaborative Studies of Long Term Care (CS-LTC) Dementia Care Study, applying it to the Australian setting.

A systematic review of reliable and valid tools for the measurement of patient participation in healthcare

INTRODUCTION

Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators.

AIM

This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy.

METHODS

Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion.

RESULTS

From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction.

CONCLUSION

Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.

Family Involvement in Nursing Homes: Are Family Caregivers Getting What They Want?

The provision of person-centered care for nursing home residents with dementia suggests the need for family caregiver involvement. In this article, we argue that optimal family involvement differs by family caregiver and therefore depends on the degree to which family caregivers consider their own involvement to be important. In this Canadian study, we compare the importance that 135 family caregivers of residents with dementia place on 20 kinds of involvement with the degree to which they perceive opportunities for involvement. Family Involvement Congruence Scores are calculated in three ways: those for whom involvement is important, those for whom involvement is not important, and an overall congruence score. Congruence scores varied by involvement type. These scores show promise for use in future research on family caregiver involvement and as tools for use by facilities as they endeavor to meet family caregiver expectations for involvement.

Do Family Proxies Get It Right? Concordance in Reports of Nursing Home Residents' Everyday Preferences

Limited work has examined how well family proxies understand nursing home residents' preferences. With 85 dyads of a nursing home resident and relative, we utilize descriptive statistics and multi-level modeling to examine the concordance in reports of importance ratings of 72 everyday preferences for residents. Results reveal significant mean differences at the p < .001 level between proxies and residents on 12 of 72 preferences; yet, perfect agreement in responses is poor and only increases when dichotomizing responses into an important versus not important outcome. Multi-level modeling further indicates that dyads are discrepant on reports of the importance of growth activities for residents, with residents reporting higher levels of importance than proxies. This discrepancy is associated with residents' hearing impairment and proxies' perception of resident openness. The findings highlight not only how proxies may be able to inform care for residents in nursing homes but also where further discussions are warranted.

Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire-family version

BACKGROUND

In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed.

SETTING

Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden.

METHOD

The Person-centred Climate Questionnaire-Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality--three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P.

AIM

The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context.

RESULTS

The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item-total correlations were >0.3 and <0.7.

CONCLUSION

In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.

Family perceptions of quality of hospice care in the nursing home

CONTEXT

Nursing homes (NHs) are increasingly the site of hospice care. High quality of care is dependent on successful NH-hospice collaboration.

OBJECTIVES

To examine bereaved family members' perceptions of NH-hospice collaborations in terms of what they believe went well or could have been improved.

METHODS

Focus groups were conducted with bereaved family members from five diverse geographic regions, and included participants from inner city and rural settings, with oversampling of African Americans.

RESULTS

A total of 28 participants (14.8% African American, mean age 61.4 years) identified three major aspects of collaboration as important to care delivery. First, most (67.9%) voiced concerns with knowing who (NH or hospice) is responsible for which aspects of patient care. Second, nearly half (42.9%) stated concern about information coordination between the NH and hospice. Finally, 67.9% of the participants mentioned the need for hospice to advocate for high-quality care rather than their having to directly do so on behalf of their family members.

CONCLUSION

The important concerns raised by bereaved family members about NH-hospice collaboration have been incorporated into the revised Family Evaluation of Hospice Care, a post-death survey used to evaluate quality of hospice care.

Person-centered care in Chinese residential care facilities: a preliminary measure

OBJECTIVES

Person-centered care (PCC) is one of the most desirable approaches for elderly with dementia. However, it has not been initiated and systematically studied in China, on which lacking of reliable and valid measurement tools is one of the key barriers. This paper aims to validate person-centered care assessment tools (P-CAT) in a Chinese context.

METHOD

The original 13-item was translated and back translated. And 11 items were added based on literature review and expert consultation. The resulting 24-item P-CAT-C was validated among a sample of formal caregivers (n = 330) in all 34 residential care facilities in urban Xi'an, a representative city in north-western China. Chinese versions of staff-based measures of individualized care for institutionalized persons with dementia (IC) and caregiver psychological elder abuse behavior (CPEAB) scale were used to test the criterion validity.

RESULTS

Confirmatory factor analysis (CFA) showed that a three-factor 15-item solution provided adequate fit indices to the data (χ(2) = 145.691, df = 81, p < 0.001, comparative fit index (CFI) = 0.926, Tucker-Lewis index (TLI) = 0.905, root mean square error of approximation (RMSEA) = 0.050). Four new items were identified and two original items were excluded. The three factors are named as (1) individualized care (6-item); (2) organizational support (6-item); and (3) environmental accessibility (3-item). The internal consistency coefficient (Cronbach's α = 0.684) is satisfactory. The interscale correlation among P-CAT-C, IC, and CPEAB showed good criterion validity.

CONCLUSION

P-CAT-C is a culturally adapted version of the original P-CAT, which showed satisfactory reliability and validity for evaluating PCC in Chinese residential care facilities. It also provides insight to other developing countries.

'It's the little things that count'. Families' experience of roles, relationships and quality of care in rural nursing homes

BACKGROUND

Entry to long-term care is an emotional time for older people and their families. Poor communication and uncertainty about roles and responsibilities in the post-placement period can cause distress for families and staff, further exacerbating an already difficult situation. However, there are limited studies that specifically address roles and relationships between families and care home staff in the post-placement period.

AIM

The aim of this study was to explore the experiences of families following the nursing home placement of an older relative.

DESIGN

A qualitative approach using grounded theory methodology was used to conduct the study.

METHOD

Semi structured interviews were conducted with 29 relatives of nursing home residents in a region of the UK. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously.

FINDINGS

Data analysis revealed five distinct categories that captured the experience of families in the post-placement period. These were: communication with staff, involvement in relative's care, the importance of 'the little things', quality of care and areas for improvement.

CONCLUSIONS

Developing caring partnership is crucial if the resources of care home staff and families are to be maximised for the benefit of all concerned.

IMPLICATIONS FOR PRACTICE

A number of programmes and initiatives already exist to enhance the quality of life of older people in care homes and their families. Serious consideration should be given to more widespread uptake of these initiatives.

Change and predictors of change in social skills of nursing home residents with dementia

BACKGROUND

Social skills are of primary importance for those with dementia and their care providers, yet we know little about the extent to which basic social skills can be maintained over time and the predictors of change.

METHODS

A total of 18 nursing homes with 149 newly admitted residents with moderate to severe dementia, 195 direct care staff, and 135 family members, in British Columbia, Canada, contributed data on change in social skills from admission to 6 months and 1 year later.

RESULTS

Three-quarters of residents maintained or improved their basic social skills during both the time periods. Decline was explained primarily by cognitive status at the time of admission, notably present orientation. However, staff-to-resident communication becomes more important over time.

CONCLUSIONS

Social skills appear to present an opportunity to maintain interaction with these residents. The findings also suggest that a focus on the present orientation before and following admission and on staff-to-resident communication may be beneficial.

Organisational culture in residential aged care facilities: a cross-sectional observational study

BACKGROUND

Organisational culture is increasingly recognised as important for provision of high-quality long-term care. We undertook this study to measure organisational culture in residential aged care facilities in two Australian states.

METHODOLOGY/PRINCIPAL FINDINGS

Cross-sectional observational study in 21 residential aged care facilities in Western Australia (n = 14) and Queensland (n = 7), Australia. Staff and next-of-kin of residents participated. Measurement comprised surveys of facility staff and residents' next-of-kin, and structured observation of indicators of care quality. Staff tended to rate organisational culture positively. Some qualitative feedback from staff emphasised negative perceptions of communication, leadership and teamwork. Staffing levels were perceived as a dominant challenge, threatening care quality. Direct observation revealed variability within and between facilities but suggested that most facilities (n = 12) were in the typical range, or were quality facilities (n = 8).

CONCLUSION

There was scope to strengthen organisational culture in participating aged care facilities.

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.

Psychometric evaluation of the Norwegian version of the Person-centred Care Assessment Tool

The Person-centred Care Assessment Tool (P-CAT) was developed as a self-reporting assessment scale for staff ratings of the person-centredness of their nursing practice. This study investigates the psychometric properties of P-CAT in a sample of staff working in residential units for older people. Descriptive characteristics were calculated for each item and an independent-sample t-test was used to compare ratings from different groups. Internal consistency and reliability were examined using the Cronbach's alpha coefficient. Exploratory factor analysis was used to evaluate construct validity. Test-retest reliability was examined by means of intra-class correlation and the Pearson correlation coefficient. The mean score of P-CAT was 45.3 (standard deviation 7.8). Cronbach's alpha was 0.83. The factor analysis resulted in a two-component solution organizing the items into two subscales. There were significant differences between ordinary care units and special-care units and between various occupational groups, indicating a discriminating ability of the tool.

Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT)

BACKGROUND

Person-centered care is a multidimensional concept describing good care, especially within aged care and care for people with dementia. Research studies evaluating person-centered care interventions seldom use direct measurement of levels of person-centeredness. Existing scales that measure person-centeredness need further testing. This study evaluated the psychometric properties of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT).

METHODS

A cross-sectional sample of 1465 staff from 195 residential care units for older people in Sweden participated in the study. Validity, reliability, and discrimination ability of the scale were evaluated.

RESULTS

Confirmatory factor analysis, parallel analysis and exploratory factor analysis supported the construct validity of a two-factor solution. Reliability and homogeneity were satisfactory for the whole P-CAT as demonstrated by a Cronbach's α of 0.75. Test-retest reliability showed temporal stability of the scale, and the discrimination ability of the scale was satisfactory.

CONCLUSION

The Swedish version of the P-CAT was found to be valid, reliable, and applicable for further use. Two subscales are recommended for the Swedish version.

Measuring Person-centered Care: A Critical Comparative Review of Published Tools

PURPOSE OF THE STUDY

to present a critical comparative review of published tools measuring the person-centeredness of care for older people and people with dementia.

DESIGN AND METHODS

included tools were identified by searches of PubMed, Cinahl, the Bradford Dementia Group database, and authors' files. The terms "Person-centered," "Patient-centered" and "individualized" (US and UK spelling), were paired with "Alzheimer's disease," "older people," and "dementia" in various combinations. The tools were compared in terms of conceptual influences, perspectives studied and intended use, applicability, psychometric properties, and credibility.

RESULTS

twelve tools eligible for review were identified. Eight tools were developed for evaluating long-term aged care, three for hospital-based care, and one for home care. One tool, Dementia Care Mapping, was dementia specific. A common limitation of the tools reviewed is that they are yet to be used and validated beyond the development period; thus, their validity, reliability, and applicability needs further exploration. Also, the perspective of people with dementia remains absent.

IMPLICATIONS

the review demonstrates the availability of a multitude of tools for measurement of person-centered care in different settings and from different perspectives, even if further testing of the tools is needed. The conceptual underpinnings of the tools are rarely explicit, which makes it difficult to ascertain the conceptual comparability of the tools.

Pain, Ageing and Dementia: The Crisis is Looming, but are We Ready?

Pain in older people, and particularly for those people with dementia, is an underrecognised and undertreated problem of growing magnitude. Occupational therapists, although well positioned with a range of skills and resources to help older people with pain and their caregivers, must first become educated about the issues of pain assessment and management for this unique population.

Despite the fact that pain is a pervasive symptom of many occupational therapy clients, the occupational therapy educational curricula and professional literature fail to alert therapists to the urgent need for research and guideline development in this rapidly expanding practice area.