Death in Long-Term Care: Focus Groups and Interviews Identify Strategies to Alleviate Staff Burnout

Abstract

The 2016 Canadian Census highlighted that for the first time since records began, persons aged 65 and over outnumbered those aged 15 and under (Government of Canada SC. Historical Age Pyramid 2017). As the aging population has increased, there has been a growing trend for people to be cared for within their own homes. This has resulted in a change in the long-term care (LTC) population in care homes as such care is being accessed at a later stage when a person's cognitive and physical health are more likely to be precarious. Despite people staying in their homes longer, it has been estimated that by 2035, Canada will need 199,000 additional beds in long-term care facilities to accommodate this aging population (Gibbard R., 2017). Residents are moving into LTC homes with complex health conditions, require a high level of care, and for many of them, long-term care in this setting is palliative (General Practice Services Committee, British Columbia Ministry of Health, 2019). It was estimated that by 2020, 39% of residents would die in their LTC home each year (Menec et al., 2004; MacLean et al., 2000; Spector et al., 2000). While this trend impacts residents and their families, it also affects the stress of staff who are already challenged with caring for what is an unpredictable and complex care group (

Online Modules to Alleviate Burnout and Related Symptoms Among Interdisciplinary Staff in Long-Term Care: A Pre-post Feasibility Study

“…We developed the modules, named HOPE ( H elping O ptimize our P eople E nergy), based on inputs from experts in the fields of relationship-based practice, team wellness, end-of-life/palliative care, and our previous study findings. 6 , 8 Texts, emotionally evocative images, participant quotes from previous studies, 6 , 8 and audio recordings of team members conversing with experts were incorporated into the modules to highlight and enhance key messages.…”

“…A major strength of this study was that the intervention was developed by and for long-term care staff after several years of consultation across study sites. 6,8 The study, however, have some limitations. First, due to the absence of a control group, it is not possible to draw strong causal interpretations.…”

“…6 Demanding workload, time pressure, increasing complexity of healthcare demands, dealing with death and dying of patients, and, delivering bad news were identified as risk factors for burnout in palliative and long-term care settings. [7][8][9] These risk factors have increasingly become a feature of Canadian long-term care as the rising trend of providing palliative care in long-term care continues to place additional demands on care staff. The trend is largely driven by a rapid increase in the population of individuals 85 years of age and over, 10 residents' tendency to move in after experiencing significant deterioration in health, 8 and an increase in the proportion of residents with life-limiting conditions like cardiovascular and pulmonary diseases and dementia.…”

“…[7][8][9] These risk factors have increasingly become a feature of Canadian long-term care as the rising trend of providing palliative care in long-term care continues to place additional demands on care staff. The trend is largely driven by a rapid increase in the population of individuals 85 years of age and over, 10 residents' tendency to move in after experiencing significant deterioration in health, 8 and an increase in the proportion of residents with life-limiting conditions like cardiovascular and pulmonary diseases and dementia. 11 About 24% of residents who move in have less than 6 months to live; 9 the rest stay for about 2 years or until end of life, requiring support with symptom management, care planning, counselling and palliative care.…”

“… 6 Demanding workload, time pressure, increasing complexity of healthcare demands, dealing with death and dying of patients, and, delivering bad news were identified as risk factors for burnout in palliative and long-term care settings. 7 - 9…”