The Modified CSI can be a useful method for detecting strain levels among informal caregivers, and is easily administered and scored. The CSI continues to be a useful measure of caregiver strain for long-term care research and practice.
Background. Even under the new long-term care mantra for increased home-and community-based care options, attention to and an understanding of the ways that family caregivers are managing complex care for dependent elderly persons, for example, with medication administration, have been slow to materialize.
Purpose: This exploratory study used a set of four obstacle constructs derived from both the existing literature and our earlier work to describe the diverse end-of-life scenarios observed for a group of residents in a long-term care facility. Design and Methods: Data from a retrospective chart review and both quantitative and qualitative methods of data collection and analysis were used to examine in-depth the end-of-life experiences of all nursing home residents ( N ϭ 41) who died on the nursing care unit of a large continuing care retirement community during an 18-month period. Results: A hierarchy of obstacles to palliation and end-of-life care seems to exist in long-term care settings that begins with the lack of recognition that restorative, rehabilitative, or curative treatment futility has commenced. The next three obstacles in sequence include lack of communication among decision makers, no agreement on a course of care, and failure to implement a timely plan of care. Implications: The findings highlight the importance of determining treatment futility as an initial step in the successful delivery of palliative and end-oflife care to residents in long-term care followed by the need for a deliberate and proactive series of actions and care planning processes.
Transitions from active curative care to palliative care are important for residents in permanent long-term care placements. Improved end-of-life care requires more attention to these transitions and to the decisions that residents, their families, and care teams are called upon to make.
In this article, the personal, idiosyncratic elements of the nursing home search and selection process from the point Of king that institutionalization was necessary through thermal selection decision, is investigated. Data are derived from interviews with 25 nursing home patient "sponsors" (the individuals identified by nursing homes as the primary contact person or responsible person for the patient) of recently admitted nursing home patients and 3 significant other informants for a total sample size of 28. Their stories reveal a rather hectic and stressful processor which families were ill-prepared, and often undertaken during the crisis of hospitalization. Most respondents did not comment on the use or benefit of printed nursing home guides. Instead, respondents simply looked for facility that was convenient to home or work and relied heavily on word-of-mouth recommendations by friends and family members.
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