This study examined whether training staff in preparation for organizational changes, such as the implementation of new practices, can increase levels of change readiness in residential aged care. ...Four aspects of organizational readiness were compared across time and between training and control conditions. Participants (n = 129) were employed in eight residential aged care facilities in Australia. Survey data were collected at four time-points: preintervention and three postintervention time-points. The two conditions (training and control) differed significantly from one another on the subscales of appropriateness, personal valence, and efficacy postintervention but not at preintervention. The finding of support diminishing at 6 month and 12 months following the intervention for the training group was unexpected. The findings suggest that within aged care facilities, training in change processes may enhance an organization’s readiness for change, and booster training may be needed to help to sustain all aspects of change readiness over time.
Hospitalized patients are designated alternate level of care (ALC) when they no longer require hospitalization but discharge is delayed while they await alternate disposition or living arrangements. ...We assessed hospital costs and complications for general internal medicine (GIM) inpatients who had delayed discharge. In addition, we developed a clinical prediction rule to identify patients at risk for delayed discharge.
We conducted a retrospective cohort study of consecutive GIM patients admitted between 1 January 2015 and 1 January 2016 at a large tertiary care hospital in Canada. We compared hospital costs and complications between ALC and non-ALC patients. We derived a clinical prediction rule for ALC designation using a logistic regression model and validated its diagnostic properties.
Of 4311 GIM admissions, 255 (6%) patients were designated ALC. Compared to non-ALC patients, ALC patients had longer median length of stay (30.85 vs. 3.95 days p < 0.0001), higher median hospital costs ($22,459 vs. $5003 p < 0.0001) and more complications in hospital (25.5% vs. 5.3% p < 0.0001) especially nosocomial infections (14.1% vs. 1.9% p < 0.0001). Sensitivity analyses using propensity score and pair matching yielded similar results. In a derivation cohort, seven significant risk factors for ALC were identified including age > =80 years, female sex, dementia, diabetes with complications as well as referrals to physiotherapy, occupational therapy and speech language pathology. A clinical prediction rule that assigned each of these predictors 1 point had likelihood ratios for ALC designation of 0.07, 0.25, 0.66, 1.48, 6.07, 17.13 and 21.85 for patients with 0, 1, 2, 3, 4, 5, and 6 points respectively in the validation cohort.
Delayed discharge is associated with higher hospital costs and complication rates especially nosocomial infections. A clinical prediction rule can identify patients at risk for delayed discharge.
Aim
To explore and compare the views of both staff and residents about barriers to sexual expression in residential aged care facilities.
Background
Although remaining sexually active in older age ...helps to preserve and promote well‐being, the percentage of sexually active persons living in residential aged care facilities is low. Previous research has identified several barriers to sexual expression in such settings. Most of this research has focused on staff perceptions, neglecting the residents' perspective.
Design
A qualitative descriptive study.
Methods
Fifty‐three staff members and 47 older people living in five residential aged care facilities were interviewed. They were asked about barriers to sexual expression in residential settings. Data were analysed using content analysis, aimed at identifying common ideas in the responses. Data were collected over 7 months in 2012.
Results
About 40% of the residents subsample did not identify any barrier to sexual expression, although all other participants identified at least one. The most oft‐cited barriers were lack of privacy, residents' attitudes and lack of communication about sexuality.
Conclusion
A substantial number of residents were unable to identify or mention barriers to sexual expression. Generational factors and group pressure could affect residents' attitudes towards sexuality.
Before the availability of vaccines, many countries have resorted multiple times to drastic social restrictions to prevent saturation of their health care system, and to regain control over an ...otherwise exponentially increasing COVID-19 pandemic. With the advent of data-sharing, computational approaches are key to efficiently control a pandemic with non-pharmaceutical interventions (NPIs). Here we develop a data-driven computational framework based on a time discrete and age-stratified compartmental model to control a pandemic evolution inside and outside hospitals in a constantly changing environment with NPIs. Besides the calendrical time, we introduce a second time-scale for the infection history, which allows for non-exponential transition probabilities. We develop inference methods and feedback procedures to successively recalibrate model parameters as new data becomes available. As a showcase, we calibrate the framework to study the pandemic evolution inside and outside hospitals in France until February 2021. We combine national hospitalization statistics from governmental websites with clinical data from a single hospital to calibrate hospitalization parameters. We infer changes in social contact matrices as a function of NPIs from positive testing and new hospitalization data. We use simulations to infer hidden pandemic properties such as the fraction of infected population, the hospitalisation probability, or the infection fatality ratio. We show how reproduction numbers and herd immunity levels depend on the underlying social dynamics.
This scoping review mapped out the existing literature pertaining to health and social care personnel experiences during the coronavirus disease‐2019 (COVID‐19) pandemic and their work in a long‐term ...care setting for older people. This review identified the gaps in the implications of health and social care personnel's own health and well‐being during the pandemic as well as the ethical dilemmas inherent in providing care during the COVID‐19 pandemic. The authors utilised the PRISMA checklist for undertaking scoping reviews. The Databases Medline, PsychINFO, CINAHL, SCOPUS, Web of Science and Google Scholar were searched for relevant articles in English that were published between March 28, 2020 and June 1, 2022. This time period was selected to focus specifically on the COVID‐19 pandemic. In the context of this review, long‐term care facilities were defined to include institutions such as nursing homes, skilled nursing facilities, retirement homes and residential care homes. The gaps identified were a paucity of research on the experiences of health and social care personnel in long‐term care facilities, the impact on their mental health, and the wider challenges experienced during the COVID‐19 pandemic is discussed. The findings of this scoping review indicate a need for adequate preparedness during a pandemic within the health and social care sector to protect health and social care personnel and the individuals they care for.
The aged care sector requires transformation. The havoc wreaked by the COVID-19 pandemic globally and nationally may create an environment where the required changes are lost to other priorities.
...Australia’s success with the emergency response and management of COVID-19 pandemic are in a large part due to inherent underlying geographic and population factors.
When reflecting on this pandemic we must objectively examine the domains of governance, workforce, models of care, evaluation and finally, resources and infrastructure. The COVID-19 pandemic highlighted major gaps in each domain. A prudent approach is required if we are to guard against the high COVID-19 case fatality rate of residents in aged care homes and to progress with much needed long-term changes.
Zusammenfassung
Hintergrund
Stationäre Altersinstitutionen durchlaufen derzeit einen digitalen Transformationsprozess, der durch die Orientierung an einer zunehmenden Digitalisierung von ...Arbeitsprozessen und der institutionellen Infrastruktur gekennzeichnet ist. Doch wie sieht die Vielfalt der eingesetzten technischen Lösungen in den Altersinstitutionen überhaupt aus, und wie wird der digitale Transformationsprozess von den Leitungspersonen der Institutionen bewertet?
Material und Methoden
Die Befragung erfolgte als standardisierte Onlinebefragung bei stationären Alterseinrichtungen in der gesamten Schweiz. Befragt wurden die jeweiligen Leitungspersonen. Die Stichprobe bildeten 466 Institutionen.
Ergebnisse
Etablierte Technologien, wie z. B. Fernseher, Kontakt- und Sturzmatten sowie Softwarelösungen im Verwaltungsbereich, werden fast flächendeckend eingesetzt, während Roboter zur Aktivierung der Klientel, Spielkonsolen oder telemedizinische Technologien nur sehr selten verwendet werden. Die befragten Personen sehen in der Anwendung technischer Hilfsmittel eher Vor- als Nachteile. Die größten Hindernisse, die bei der Einführung neuer Technik wahrgenommen werden, sind die damit verbundenen Kosten, fehlende Mitarbeiterkompetenzen und eine nichtvorhandene Infrastruktur. Die multivariate Analyse zeigt, dass der Digitalisierungsgrad in einer Einrichtung nicht nur von deren Größe abhängt, sondern auch von der Technikaffinität der leitenden Mitarbeitenden.
Diskussion
Der Technologisierungsgrad in Altersinstitutionen ist unterschiedlich hoch, insgesamt aber eher ernüchternd niedrig, hinsichtlich der Verwendung neuer Technologien wie der Robotik oder Telemedizin. Barrieren für die digitale Transformation wurden aus der Befragung herausgearbeitet und diskutiert.
This paper describes the collection and integration of mixed methods data to facilitate the final selection of items for the Quality of Life - Aged Care Consumers (QOL-ACC) instrument. The aim of the ...wider project is to develop a preference-based quality of life instrument that can be used for quality assessment and economic evaluation. Older people have been involved at every stage of the development of the QOL-ACC to ensure that the final instrument captures their perspectives and preferences.
Mixed methods data was collected on draft items for the QOL-ACC instrument across six key quality of life dimensions (mobility, pain management, emotional well-being, independence, social connections, and activities). Qualitative face validity data was collected from older people (aged 66 to 100 years) living in the community and in residential aged care via semi-structured interviews (n = 59). Quantitative data was collected from older people (aged 65 to 91 years) receiving aged care services in the community via an online survey (n = 313). A traffic light pictorial approach was adopted as a practical and systematic way to categorise and present data in a meaningful way that was easy for non-academic workshop members to understand and to be able to discuss the relative merits of each draft item.
The traffic light approach supported the involvement of consumer and aged care provider representatives in the selection of the final items. Six items were selected for the QOL-ACC instrument with one item representing each of the six dimensions.
This methodological approach has ensured that the final instrument is psychometrically robust as well as meaningful, relevant and acceptable to aged care consumers and providers.
Aims and objectives
To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities.
Background
Incontinence is ...a highly stigmatising condition that affects a disproportionally large number of people living in long‐term aged care facilities. Its day‐to‐day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long‐term aged care facilities. This paper presents one finding, i.e. how careworkers in long‐term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work.
Design
Grounded theory.
Methods
Eighty‐eight hours of field observations in two long‐term aged care facilities in Australia. In addition, in‐depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long‐term aged care facility in Australia.
Results
Occupational exposure to incontinence contributes to the low occupational status of carework in long‐term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers’ affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status.
Conclusion
The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long‐term aged care facilities.
Relevance to clinical practice
This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long‐term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as ‘dignity work’.
This thesis seeks to provide insights into the interdependence of the micro preferences, meso positions and macro priorities of older people living in affordable Retirement Housing and Extra Care ...properties in England. Despite Extra Care and Retirement Housing being long established and much discussed forms of specialist housing provision for older people, there still appears to be a lack of clarity or understanding about why these forms of provision exist, what services and facilities they should provide and how to address the priorities of the residents who live in them. In order to expose and explore the mix of similar and different perspectives of residents and avoid the study being confined to existing theories and assumptions, Q methodology was adopted to support an abductive research strategy. Q studies were undertaken with 68 Extra Care residents from 5 sites and 157 Retirement Housing residents from 11 sites to provide the variables that were subject to factor analysis. Patterns of preference are identified that provide an indication of the features and aspects of living in Extra Care or Retirement Housing that influence micro level satisfaction within different segments of the population of residents. The extent and basis for consensus or divergence of meso perspectives within and between sites and communities are revealed in order to give scope to speculate about how and why these differences occur. A second order analysis of factors also gives insight into tensions inherent in the macro intent and purpose of older people living in Extra Care or Retirement Housing. The results and conclusions provide the basis for proposing a theoretical model that recognises the interdependence of micro, meso and macro perspectives and provides a means to combine them in order to gain an integrated appreciation of the preferences, provision and purposes of Extra Care and Retirement Housing.
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