Changing the long-term care spectrum

Verbeek, Hilde; Mitchell, Gary

doi:10.1186/s12877-022-02909-8

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Lastly, several challenges have been reported in the implementation of digital technologies within the care home setting. Such challenges include time constraints for care home staff, and that many technologies require assistance from more than one person to work as intended [33][34][35][36]. However, through collecting evidence at a global, national, and local scale, and engaging with endusers through co-design, this study will develop an appropriate and well-accepted digital intervention to improve care home staff knowledge of HF.…”

Section: Limitations and Challengesmentioning

confidence: 99%

Optimising quality of life for people living with heart failure in care homes: Protocol for the co-design and feasibility testing of a digital intervention

et al. 2023

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Background Heart failure (HF) affects up to 64.3 million people globally. Advancements in pharmaceutical, device or surgical therapies, have led to patients living longer with HF. Heart failure affects 20% of care home residents, with these individuals presenting as older, frailer, and with more complex needs compared to those living at home. Thus, improving care home staff (e.g., registered nurse and care assistant) knowledge of HF has the potential to benefit patient care and reduce acute care utilization. Our aim is to co-design, and feasibility test, a digital intervention to improve care home staff knowledge of HF and optimise quality of life for those living with the condition in long-term residential care. Methods Using a logic model, three workstreams have been identified. Workstream 1 (WS1), comprised of three steps, will inform the ‘inputs’ of the model. First, qualitative interviews (n = 20) will be conducted with care home staff to identify facilitators and barriers in the provision of care to people with HF. Concurrently, a scoping review will be undertaken to synthesise current evidence of HF interventions within care homes. The last step will involve a Delphi study with 50–70 key stakeholders (for example care home staff, people with HF and their family and friends) to determine key education priorities related to HF. Using data from WS1, a digital intervention to improve care home staff knowledge and self-efficacy of HF will be co-designed in workstream 2 (WS2) alongside those living with HF or their carers, HF professionals, and care home staff. Lastly, workstream 3 (WS3) will involve mixed-methods feasibility testing of the digital intervention. Outcomes include staff knowledge on HF and self-efficacy in caring for HF residents, intervention usability, perceived benefits of the digital intervention on quality of life for care home residents, and care staff experience of implementing the intervention. Discussion As HF affects many care home residents, it is vital that care home staff are equipped to support people living with HF in these settings. With limited interventional research in this area, it is envisaged that the resulting digital intervention will have relevance for HF resident care both nationally and internationally.

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Section: Limitations and Challengesmentioning

confidence: 99%

Optimising quality of life for people living with heart failure in care homes: Protocol for the co-design and feasibility testing of a digital intervention

et al. 2023

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“…To enhance methodological rigour and consistency within and across analytical processes, the election of a compatible approach rested on the four stages identified previously, namely documentary collection, categorisation, ranking, and selection. The final inter-related, tiered approach was informed by two analytical frameworks–one centered on health-related policy analysis [ 73 , 74 ], and the other, contextualised to LTC settings [ 9 ]. The health policy triangle framework [ 73 , 74 ] offers a wide utility in terms of health contexts, systems, and issues [ 73 ], and rests on three apices, namely: environmental conditions (context–systemic factors: social, economic, political, cultural, and other environmental conditions); organisational content (structures: operational policies, legislation, regulations, guidelines); and developmental process (how policies are initiated, developed or formulated, negotiated, communicated); in effect, situations, structures and temporalities respectively.…”

Section: Analytical Approachmentioning

confidence: 99%

“…The health policy triangle framework [ 73 , 74 ] offers a wide utility in terms of health contexts, systems, and issues [ 73 ], and rests on three apices, namely: environmental conditions (context–systemic factors: social, economic, political, cultural, and other environmental conditions); organisational content (structures: operational policies, legislation, regulations, guidelines); and developmental process (how policies are initiated, developed or formulated, negotiated, communicated); in effect, situations, structures and temporalities respectively. These paralleled three key environmental mechanisms (physical aspects, organisational aspects, and social aspects) that underpin the LTC spectrum [ 9 ]–chosen to reflect the broad canvas of the current LTC environment.…”

Section: Analytical Approachmentioning

confidence: 99%

“…Historically, LTC policies in Canada have prioritised biomedically-oriented quality of care [ 2 ], but over time, a culture change towards a more person-centred model of care has evolved [ 3 ]. Additional research [ 4 – 7 ], among others, has indicated that a home-like approach to care creates more opportunities for residents’ overall quality of life (QoL) and wellbeing [ 8 , 9 ]. Accordingly, many LTC oriented policies now reflect a broad spectrum of person-centered QoL indicators, for instance, early research describing 11 domains, such as meaningful activity, relationships, dignity, autonomy, and privacy [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Provincial policies affecting resident quality of life in Canadian residential long-term care

2023

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Background The precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents’ quality of life. In deference to the risk mitigation measures in Canadian long-term care settings during Covid-19, some person-centred, quality of life policies were paused, unused, or under-utilised. This study aimed to interrogate these existing but latent policies, to capture their potentiality in terms of positively influencing the quality of life of residents in long-term care in Canada. Methods The study analysed policies related to quality of life of long-term care residents in four Canadian provinces (British Columbia, Alberta, Ontario, and Nova Scotia). Three policy orientations were framed utilising a comparative approach: situational (environmental conditions), structural (organisational content), and temporal (developmental trajectories). 84 long term care policies were reviewed, relating to different policy jurisdictions, policy types, and quality of life domains. Results Overall, the intersection of jurisdiction, policy types, and quality of life domains confirms that some policies, particularly safety, security and order, may be prioritised in different types of policy documents, and over other quality of life domains. Alternatively, the presence of a resident focused quality of life in many policies affirms the cultural shift towards greater person-centredness. These findings are both explicit and implicit, and mediated through the expression of individual policy excerpts. Conclusion The analysis provides substantive evidence of three key policy levers: situations–providing specific examples of resident focused quality of life policy overshadowing in each jurisdiction; structures–identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories–confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. It also demonstrates and contextualises examples of policy slippage, differential policy weights, and cultural shifts across existing policies. When applied within a resident focused, quality of life lens, these policies can be leveraged to improve extant resource utilisation. Consequently, the study provides a timely, positive, forward-facing roadmap upon which to enhance and build policies that capitalise and enable person-centredness in the provision of long-term care in Canada.

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“…Disruptive moves to hospices may cause significant stress and anxiety for residents and their families. Hospices, despite being staffed with experts in end-of-life care, may not be able to provide the same level of individualized care as care homes due to the lack of knowledge about residents' medical histories and preferences [60]. This lack of familiarity may lead to a less personalized care experience, which can be distressing for both the residents and their loved ones.…”

Section: Theme 3: End-of-life Needsmentioning

confidence: 99%

Exploring the Holistic Needs of People Living with Cancer in Care Homes: An Integrative Review

Craig,

Cao,

McMahon

et al. 2023

Healthcare

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Up to 26% of individuals residing in care homes are impacted by cancer. This underscores the importance of understanding the holistic needs of care home residents living with cancer to enhance the quality of their care. The primary objective of this integrative literature review was to consolidate the available evidence concerning the comprehensive needs of people living with cancer in care home settings, providing valuable insights into addressing their diverse needs. An integrative literature review was conducted using a systematic approach. Extensive searches were conducted in three databases, complemented by a thorough examination of grey literature and reference lists of relevant papers. The review focused on literature published between 2012 and 2022. The screening process involved two independent reviewers, with a third reviewer resolving any discrepancies. The review identified twenty research papers that met the eligibility criteria. These papers shed light on three primary themes related to the holistic needs of care home residents with cancer: physical, psychological, and end-of-life needs. Physical needs encompassed pain management, symptom control, and nutrition, while psychological needs involved social support, emotional well-being, and mental health care. End-of-life needs addressed end-of-life care and advance care planning. These themes highlight the multifaceted nature of cancer care in care homes and underscore the importance of addressing residents’ holistic needs in a comprehensive and integrated manner. Improving care home education about cancer and integrating palliative and hospice services within this setting are vital for addressing the diverse needs of residents with cancer.

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Changing the long-term care spectrum

Cited by 6 publications

References 31 publications

Optimising quality of life for people living with heart failure in care homes: Protocol for the co-design and feasibility testing of a digital intervention

Optimising quality of life for people living with heart failure in care homes: Protocol for the co-design and feasibility testing of a digital intervention

Provincial policies affecting resident quality of life in Canadian residential long-term care

Exploring the Holistic Needs of People Living with Cancer in Care Homes: An Integrative Review

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