Journal of long-term care最新文献

{"title":"What Long-Term Care Interventions and Policy Measures Have Been Studied During the Covid-19 Pandemic? Findings from a Rapid Mapping Review of the Scientific Evidence Published During 2020","authors":"William Byrd, M. Salcher-Konrad, Siân Smith, A. Comas-Herrera","doi":"10.31389/jltc.97","DOIUrl":"https://doi.org/10.31389/jltc.97","url":null,"abstract":"pandemic, long-term care researchers have aimed to generate evidence rapidly to inform the pandemic response. It is unclear which areas were prioritised during this period of rapid evidence generation. Objectives: We aimed to map the international scientific evidence on interventions and policy measures to mitigate the impacts of the Covid-19 pandemic on people who use and provide long-term care. Methods: We conducted a pragmatic, rapid mapping review of international evidence to identify the range of interventions, policies, and measures in long-term care studied during the Covid-19 pandemic and published throughout 2020. Studies were primarily identified from two academic databases (MEDLINE; Web of Science). Findings: We included 137 studies from 22 countries, mostly focusing on the United States, Europe, and Canada. Half of the studies focused on preventing or controlling Covid-19 infections. Other common types of interventions were measures to treat Covid-19 or improve access to general healthcare and studies of possible targets for policies and interventions, such as care home ownership. Only 13 studies covered home-based or community-based care. Limitations: This was a pragmatic review that aimed to map key areas of research in long-term care during the pandemic, rather than a systematic review of all available studies. Implications: During the first year of the Covid-19 pandemic, a substantial body of evidence on interven tions to mitigate impacts of the pandemic in the long-term care sector emerged. However, reflecting the context and speed with which they were carried out, most studies did not apply an analytical lens and instead provided descriptive findings only. There were very few studies on home-based or community-based care settings. As countries assess the lessons that can be learnt from the pandemic and improve the preparedness of their long-term care systems for future pandemics and other shocks, it will be important to consider the importance of facilitating rapid generation of more robust evidence.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47970295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Long-Term Care Facilities’ Crisis Response: Lessons From the COVID-19 in Chile","authors":"Josefa Palacios, Maureen Neckelmann, Pablo Villalobos Dintrans, J. Salas","doi":"10.31389/jltc.93","DOIUrl":"https://doi.org/10.31389/jltc.93","url":null,"abstract":"Context: The COVID-19 pandemic hit Chile hard and affected older people the most. Through its National Service for Older Adults, the country implemented a strategy to prevent and mitigate infection and spread in long-term care facilities (LTCF), reaching regulated and registered residences and, for the first time, informal and unregistered residences. Objective: Identify the challenges and lessons from the COVID-19 response in LTCF with respect to the support received, the implementation of infection control measures, workforce challenges experienced and the measures adopted to promote residents’ wellbeing. Methods: An online questionnaire was sent to all LTCF managers (N = 385, Response Rate = 32.4%). Statistical tests compare results to identify differences across LTCF characteristics: residence size, location and management type (private, public or subsidized, or informal). Findings: Irrespective of their location, size or management, managers highlight common challenges during the crisis. They include limited personal protective equipment (PPE) availability, staff shortages, low quality of replacement staff, reduced staff mental health, and the difficulty to understand and implement protocols. Managers acknowledge receiving institutional support in the form of PPE provision and opportunities for staff training, but managers noted the need to expand this support to cover staffing surge needs, staff psychological needs, and ensure the continuity of clinical support for residents as well. Managers share a common demand for a more coordinated response from public institutions. Managers recognize that the pandemic and the measures implemented to mitigate it negatively affected staff morale and residents’ wellbeing. Many noted that peer-to-peer support was a mechanism to support staff. Limitations: Results might be subject to selection bias. Data collection covered a limited period of time at the early stage of the pandemic. Implications: Findings are relevant to assess the COVID-19 response and to better prepare for another COVID-19 wave or similar health or environmental threats in the future. © 2021 The Author(s).","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47241376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Track and Trace of Administrative Costs in the Dutch Long-Term Care System","authors":"L. Hagenaars, O. V. Hilten, N. Klazinga, P. Jeurissen","doi":"10.31389/jltc.68","DOIUrl":"https://doi.org/10.31389/jltc.68","url":null,"abstract":"Context: Practitioners and politicians alike emphasise the wish to reduce administrative costs (AC) in Dutch LTC, but a robust empirical body of evidence on the components, determinants and value of AC in LTC is absent. Neither has the expert consensus of ways to track and trace AC in LTC been sought. Objective(s): We investigated whether it is possible to reach consensus on operationalising AC in Dutch LTC. Successively we also explored whether the Dutch LTC reform in 2015 had the intended effect of reducing AC. Methods: We differentiated between AC for governing and financing LTC (macro), overhead costs of LTC delivery organisations (meso) and AC on the level of professional care delivery activities (micro). We identified possible data sources in grey literature and national accounts. The quality and completeness of identified data and potential determinants of AC were validated by experts via a survey and focus group discussions. Findings: We were able to reach agreement on how to track AC in Dutch LTC, but current research instruments and data systems are not robust and consistent enough to trace differences before and after the 2015 reform. Limitations: We did not investigate AC experienced by patients and self-selected participating experts. Implications: AC concern a considerable share of total LTC spending, but AC are hidden in regular health expenditure statistics. Our study highlights three approaches for a more sophisticated and fact-based policy debate on reducing low-value AC; defining AC on macro, meso and micro levels of the health care system, determining the underlying value/use of activities; and focusing on interactions of AC between system levels.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45588500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value for Money in Social Care: The Role of Economic Evidence in the Guideline Development Process of the National Institute for Health and Care Excellence in England","authors":"Annette Bauer, M. Tinelli, H. Weatherly, B. Anderson, Bernadette Li, B. Naidoo, Rachel Kettle, M. Knapp","doi":"10.31389/jltc.84","DOIUrl":"https://doi.org/10.31389/jltc.84","url":null,"abstract":"In England, the National Institute for Health and Care Excellence (NICE) has been responsible for developing social care guidelines since 2012. Internationally, it is the first health technology assessment and guideline agency that specifically includes social care. As is the case for NICE’s clinical and public health guidance, social care guidelines comprise recommendations based on the best available evidence of effectiveness and cost-effectiveness. This paper provides an overview of how economic evidence is used within social care guideline development. Firstly, the paper describes the guideline development and quality assurance process, in addition to the roles and responsibilities of the technical team and guideline committee members. Secondly, the paper summarises how economic evidence is reviewed, generated, and used to inform recommendations, with examples given to highlight some of the challenges and opportunities that can be encountered. The paper culminates with proposals for the use of economic evidence in social care in England going forward and makes recommendations for further research in this area. The paper posits that guidelines are an important vehicle for supporting evidence-based practice in social care and that economic evidence is a critical kind of evidence to include. As economic evidence in social care becomes more widely available, it can be increasingly used to produce useful and accessible information for decision makers. Further research is needed to understand the impact of implementing economic evidence-based recommendations in social care practice.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89509397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nature-Based Video with Music for Individuals Experiencing an Episode of Sundown Syndrome","authors":"R. Rados, Jun Kim, Shintaro Kono, J. Horton","doi":"10.31389/jltc.69","DOIUrl":"https://doi.org/10.31389/jltc.69","url":null,"abstract":"Context: There is currently little research using short duration activities like a six-minute nature-based video with classical music to assist in improving tranquility levels of individuals with dementia. Previous studies have shown that the combined use of a nature-based video with music has improved the tranquility levels of individuals with dementia living in a dementia care unit. Objectives: The current study attempts to assess the efficacy of a six-minute nature-based slideshow video accompanied with classical music and its effect on the tranquility levels of individuals with dementia during an episode of sundown syndrome. Methods: A one-group pre-test/post-test quasi-experimental design with mixed-methods data collection was used for this exploratory study. Ten participants living in a dementia care unit, who were experiencing an episode of Sundowning had their tranquility levels collected along with comments before and after the research intervention. Findings: Descriptive statistics of both CNA and participant statistics indicated improved tranquility levels and comments appeared to be more positive after the research intervention. Discussion: Increased levels of tranquility, more positive participant behaviors, and improved attitudes after the nature-based video with music occurred. The research video with music appeared to assist in the mitigation of sundown syndrome symptoms. Limitations: A limited number of participants were studied before and after only one episode of Sundowning. Multiple occurrences of Sundowning and implementation of the research intervention may add more evidence-based findings. Implications: A simple short duration six-minute nature-based video with music intervention could be integrated into a care home worker’s daily routine for residents with dementia and who are Sundowning to assist in mitigating symptoms of sundown syndrome. This method could also be used by home health care workers and family caregivers.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42857200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of COVID-19 on the Organization of Personal Support Work in Ontario, Canada","authors":"H. Marani, Sandra McKay, G. Marchildon","doi":"10.31389/jltc.70","DOIUrl":"https://doi.org/10.31389/jltc.70","url":null,"abstract":"The COVID-19 pandemic has exposed fault-lines in the organization of personal support work, including low wages, part-time employment, and risky working condition, despite its essential nature in long-term care (LTC). This is, in part, because personal support work has long-existed on the fringes of what is considered health work, thereby precluding its status as a health profession. In this perspective paper, we explore how the pandemic may contribute to the semi-professionalization of personal support work based on the provision of LTC by personal support workers (PSWs) working in LTC facilities in Ontario, Canada. We first characterize personal support work to illustrate its current organization based on the logics of work control. We then speculate how the pandemic may shift control and map speculated changes onto existing checklists of professionalism and semi-professionalism in health work. We propose the pandemic will shift control away from existing market and hierarchical controls. At most, personal support work may undergo changes that are more characteristic of semi-professional control (semi-professionalism), characterized by the formation of a PSW registry that may improve role clarity, provide market shelter, and standardize wages. We do not believe this shift in control will solve all organizational problems that the pandemic has exposed, and continued market and hierarchical controls may be necessary. This perspective may provide insights for other high-income settings, where the pandemic has exposed similar fault-lines in the organization of personal support work in LTC.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73778605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Austerity Measures on People with Intellectual Disabilities in England","authors":"R. Forrester-Jones, J. Beecham, A. Randall, R. Harrison, M. A. Malli, L. Sams, G. Murphy","doi":"10.31389/jltc.59","DOIUrl":"https://doi.org/10.31389/jltc.59","url":null,"abstract":"Context. UK austerity measures following the 2008 financial crisis included budget reductions for health and social care. We aimed to investigate the extent to which austerity-measures had impacted the lives of people with intellectual disabilities in England, and whether their support costs were associated with their characteristics, needs and outcomes. \u0000Objectives. We report on what services people with intellectual disabilities were using, whether they had lost care, the costs of their support, and what impact any loss of benefits and services had on individuals’ lives. \u0000Methods. 150 participants with intellectual disabilities across England were interviewed about their services and their well-being. Service and individual support costs were calculated. Statistical and thematic analyses were employed. \u0000Results. The largest proportion (42%) of our sample had lost care. 14% had experienced changed care, and care had remained the same for 36%. Only 7% said their care had improved. No associations were found between costs and characteristics and needs except for whether the person had mild or severe intellectual disabilities. Those who had lost care engaged in fewer activities and had significantly lower self-esteem and quality-of-life scores compared with those who had not lost care. Loss of care impacted on individuals’ independence and future aspirations. \u0000Limitations. A comparative study of austerity impacts across the whole of England was not possible. Our costs data may be underestimated because full information on support from home, key, or support workers was unavailable. \u0000Implications. In attempting to mitigate against COVID-19 impacts on people with intellectual disabilities, policy-decisions will need to consider the backlog of a decade of cuts.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90248634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Based Approaches to Supporting the Work Related Wellbeing of Frontline Care Workers in Care Homes: A Scoping Review","authors":"Lucy Johnston, C. Malcolm, L. Rambabu, Jo Hockely, S. Shenkin","doi":"10.31389/jltc.66","DOIUrl":"https://doi.org/10.31389/jltc.66","url":null,"abstract":"The COVID-19 pandemic has reinforced the need to ensure that strategic and operational approaches to retain high quality, resilient frontline care home workers are informed by context specific, high quality evidence. A targeted scoping review asked the question: what is the current evidence base for practice based approaches that support the work related wellbeing of frontline care workers in care homes? The aim was to map the extent and nature of the care home specific evidence base and identify key interventions, theories and practice components. Thirty studies were included. Thematic synthesis identified the following four key themes: Culture of Care; Content of Work; Connectedness with Colleagues and Characteristics and Competencies of Care Home Leaders. Evidence for best practice in supporting care home work related wellbeing is extremely limited, of variable quality and lacks generalisability. Overall, the evidence base was found to be theoretically, empirically and practically fragmented and as a result, there is at present, no consensus about which areas of work related wellbeing, if addressed, would have most impact. Compounding this lack of coherence, is the limited specificity of the studies. The implicit nature of the current evidence base is also a result of the limited number of care home specific studies, their variable focus and quality, and the marked heterogeneity in the outcome measures and related indicators used by different studies. This scoping review has distilled important areas that warrant further exploration and research from within a very limited and diffuse evidence base, for example, the potential of Person Centred Care (PCC) as a protective mechanism for both resilience and retention and the more nebulous concepts of support and job satisfaction. The insight provided by the scoping review will inform future strategic and operational approaches to retain high quality, resilient frontline care home workers. However, the evidence base must move from its current state of implicitness to one of detailed explication. Future research should focus on high quality, adequately powered and co-designed intervention studies to determine which practice-based approaches are of most importance, how they ‘work’ or ‘don’t work’ alone or in combination to support the work related wellbeing of frontline care workers in care homes.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48987128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental Evaluation of the CHOICE+ Champion Training Program","authors":"Sarah A. Wu, H. Keller, Rachael Donnelly, Emily Lambe, Hilary Dunn-Ridgeway","doi":"10.31389/jltc.61","DOIUrl":"https://doi.org/10.31389/jltc.61","url":null,"abstract":"Context: Mealtimes in residential care homes are important for social engagement and can encourage resident relationships. Yet, training programs to improve mealtime care practices in residential care settings remain limited in learning approaches and scope. Objectives: To determine whether a one-day Champion Training session would improve participants’ knowledge, skills, and confidence to implement a relationship-centred mealtime program (CHOICE+) in their homes. Methods: The study employed a pre-/post-test design to evaluate a train-the-trainer model using paper-based questionnaires. Thirty-four participants attended the training session; 25 participants completed pre/post training questionnaires based on Kirkpatrick’s evaluation model. Training included: 1) program implementation manual, 2) best-practices document, 3) educational resources and evaluation tools, 4) presentation on theory-based implementation strategies and behaviour change techniques, and 5) group discussion on applying strategies and techniques, problem-solving for implementation facilitators and barriers. Findings: More than half of attendees worked as Food Service Managers or Registered Dietitians. Participants identified several organizational factors that could impact their home’s readiness to implement CHOICE+, though they felt training to be acceptable and feasible for their homes. Participants reported increase in knowledge (8.4 ± 1.1), confidence (8.3 ± 1.4), and commitment (8.8 ± 1.4) to implement the relationship-centred mealtime program. There was no association with pre-training readiness, leadership, or home characteristics. Limitations: Generalizability is limited due to small sample size. Follow-up interviews on results of training could not be conducted due COVID-19 pandemic research restrictions. Implications: Champion Leader training is an effective and feasible learning approach to up-skill staff on change management and relationship-centred mealtime practices in residential care.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81257064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Lived Experience of Implementing Infection Control Measures in Care Homes during two waves of the COVID-19 Pandemic. A mixed-methods study","authors":"D. Bunn, J. Brainard, K. Lane, C. Salter, I. Lake","doi":"10.1101/2021.07.08.21260181","DOIUrl":"https://doi.org/10.1101/2021.07.08.21260181","url":null,"abstract":"CONTEXT During COVID-19 care-homes had to implement strict Infection Control Measures (ICMs), impacting on care and staff morale. OBJECTIVES To explore the lived experiences of care-home staff in implementing ICMs. METHODS Mixed-methods study comprising 238 online survey responses and 15 in-depth interviews with care-home staff, November 2020-January 2021 in England. RESULTS Three themes were identified: Integrating COVID-19 ICMs with caring, Conveying knowledge and information, Professional and personal impacts of care-work during the pandemic. Reported adherence to ICMs was high but fatalistic attitudes towards COVID-19 infection were present. Challenges of providing care using personal protective equipment (PPE), especially for residents with dementia, were highlighted. Interviewees reported dilemmas between strictly implementing ICMs and conflicts with providing best care to residents and preserving personal space. Nine months into COVID-19, official guidance was reported as confusing, constantly changing and poorly suited to care-homes. Care-home staff appreciated opportunities to work with other care-homes and experts to interpret and implement guidance. ICM training was undertaken using multiple techniques but with little evaluation of these or how to sustain behaviour change. Limitations Results may not be generalizable to other countries. Implications COVID-19 has had a profound effect on well-being of care-home staff. Despite challenges, participants reported broadly good morale, potentially a consequence of supportive colleagues and management. Nevertheless, clear, concise and care-home focussed ICM guidance is still needed. This should include evidence-based assessments on implementing and sustaining adherence. Groups of care-home staff and ICM experts working together to co-create, interpret and implement guidance were viewed positively.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79117033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}