Examining a "Household" Model of Residential Long-term Care in Nova Scotia

Keefe, Janice; Dill, Donna; Ogilvie, Rachel; Fancey, Pamela

doi:10.13162/hro-ors.v5i1.2748

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…Transformations in staffing are achieved through increasing direct care (i.e. care aide) staffing ratios and incorporating additional tasks into their scope of practice, such as light housekeeping and meal preparation (Keefe et al , 2017). Architecturally, culture change manifests in neighborhood or cottage-style unit configurations, with 8-12 private resident rooms surrounding a central kitchen and living space (Rabig, 2009; Rabig et al , 2006).…”

Section: Introductionmentioning

confidence: 99%

What makes a nursing home a home? Insights from family members and friends

Weeks

Chamberlain

Keefe

2017

HCS

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Purpose The purpose of this paper is to explore the concept of homelikeness from the perspective of family members and friends of nursing home residents across different models of nursing homes. Design/methodology/approach This mixed-methods study examined survey data collected from 397 family members and friends of residents living in 23 nursing homes representing three models of care (traditional, new augmented, and full scope). Participants completed a homelikeness scale and a measure of the importance of nursing home spaces to family members and friends. This study also involved conducting three focus groups with 20 family members and friends to provide further insights into the findings. Findings Analysis of survey data indicated quite high levels of homelikeness overall. Significant differences did emerge between traditional model nursing homes compared to new full-scope and new augmented models for all items in the homelikeness scale and for many items about nursing home spaces. Qualitative results provided insights into how homelikeness can be fostered through public and private spaces and through care and relationships. Research limitations/implications As this study was conducted in one Canadian province, the results may not be applicable to other geographic areas. In addition, there are limitations in survey response rate. Practical implications Homelikeness can be supported across models of care by fostering relationships between residents and staff, ensuring that that family and friends feel welcome, and creating public and private physical spaces that are conducive to new and ongoing relationships. Originality/value The results provide evidence to nursing home decision makers about how to foster a homelike environment in various models of nursing homes.

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Section: Introductionmentioning

confidence: 99%

What makes a nursing home a home? Insights from family members and friends

Weeks

Chamberlain

Keefe

2017

HCS

Self Cite

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“…In contrast, there have been few quantitative and more rigorously controlled studies of the household model, and those that have been performed have yielded mixed evidence as to its effectiveness at improving residents’ psychosocial well-being. A relatively large, mixed methods study of HH facilities more generally versus traditional facilities found no direct effect of the care model on resident quality of life ( Keefe, 2017 ). Two smaller quantitative studies found that Green House residents reported better quality of life in several domains, and that compared to control facility residents, Green House residents’ probability of being socially engaged appeared to increase over time ( Kane, Lum, Cutler, Degenholtz, & Yu, 2007 ; Yoon, Brown, Bowers, Sharkey, & Horn, 2015 ).…”

Section: Background and Objectivesmentioning

confidence: 99%

“…Partial adoption, in contrast, typically includes dividing an institutional layout into “neighborhoods”—larger areas than HHs that often include 20–30 residents living in one part of the building, as well as incorporating some degree of resident choice into dining and sleeping options, consistently assigning staff to the same residents, and implementing some employee empowerment measures ( Elliot et al, 2014 ; Miller, Looze, et al, 2014 ). Facilities are facing growing pressure to adopt culture change, and increasingly, to redesign themselves as HHs (e.g., Keefe, 2017 ). Yet, there remains little evidence regarding whether any resident psychosocial benefits produced by the HH model exceed those of more typical, partial culture change adoption within a traditional environment.…”

Section: Background and Objectivesmentioning

confidence: 99%

Does Comprehensive Culture Change Adoption via the Household Model Enhance Nursing Home Residents’ Psychosocial Well-being?

Hermer

Bryant

Pucciarello

et al. 2017

Innovation in Aging

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Background and ObjectivesSeveral studies suggest that to substantially improve residents’ psychosocial well-being, traditional-model nursing homes should redesign themselves as small, homelike “households” along with comprehensively adopting other aspects of “culture change,” a set of reforms meant to improve residents’ quality of life. But this evidence mainly comes from qualitative studies. This comparative, observational study tested quantitatively whether residents in a household-model nursing home that had comprehensively adopted culture change reforms displayed greater positive affect, increased cognitive engagement, more extensive social interactions with staff and greater use of the environment than did residents at partial culture-change-adopting facilities with traditional, institutional environments.Research Design and MethodsHousehold-model residents were matched on clinical and demographic factors with residents at two institutional control facilities that had partially adopted culture change and were observed for 8 hours each. To provide potentially converging evidence, aides and nurses were also observed. Finally, a culture change implementation assessment was conducted.ResultsThe implementation assessment showed that the household-model home had implemented culture change beyond national norms, whereas the control facilities were U.S.-typical partial adopters. It also revealed that household-model staff cared for residents in a more person-centered manner. Observation analyses revealed that household-model residents spent less time idle and less time stationary at wheelchair hubs. Moreover, although household-model residents did not spend the most time in the dining area overall, they spent the greatest percentage of time there talking with staff, displaying positive affect, and displaying active engagement. Finally, household-model residents and staff spent the most time in task-oriented interactions, including personal care.Discussion and ImplicationsThese results suggest that the intended psychosocial benefits materialize in household-model facilities, particularly in the dining area and in resident–staff relationships. The findings raise the possibility that facilities may be able to achieve these outcomes without entirely redesigning their environment.

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“…Chamberlain, Weeks, and Keefe (2017) note that in the Maritime provinces, new design models emerged from a culture-change movement that aimed, among other things, to install a physical design based on a resident-centered care approach. The influence of the culture-change movement can be observed in the architectural designs of neighborhood and cottage-style units with private resident rooms and central kitchens (Chamberlain, Weeks, and Keefe, 2017;Keefe et al, 2017).…”

Section: Long-term Home Care (Home For Whom?)mentioning

confidence: 99%

Racialized Workers in White Spaces: Exploring the Experiences of Racialized, Immigrant Care Workers in Rural and Small Town Canadian Long-Term Care Homes

Owusu

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What are the everyday life experiences of racialized immigrant care workers in rural and smalltown Canadian long-term care homes, and how do they navigate white spaces in these contexts? This pre-Covid study centers the experiences of immigrant care workers and describes how they navigate white dominance in rural and small-town Canadian long-term care homes.The study is timely and provides relevant implications for long-term care homes, pandemic and beyond. While several authors have offered excellent scholarship on long-term care home work and immigrant, racialized workers, the focus has been mainly on urban centers. As a result, little is known about their conditions of work and care in rural and small-town long-term care homes.My research contributes to extant research by bringing into focus the experiences of racialized care workers in rural and small-towns and demonstrating how white dominance exacerbates poor conditions of work for immigrant care workers. The study utilizes feminist political economy, critical race theory and critical whiteness theory as theoretical foundations, to center their voices in care processes.The analysis draws on data collected in a sub-study of the Seniors' Adding Life to Years (SALTY) project, in which rapid team-based ethnographies were conducted in rural and small towns in Ontario, Nova Scotia, and British Columbia. The study analyses white environments and demonstrates how white-settler culture is woven into long-term care spaces, excluding racialized immigrants. Further, it draws on auto-ethnographic stories from my experiences as a racialized immigrant in the research field and stories from immigrant care workers to explain processes of racialization in long-term care home settings. Parsing out the implications of the casualization of long-term care home labour and burdensome credential validation processes, the study demonstrates how immigrant care workers are set up to experience the most precarious conditions of work in long-term care homes. EXPLORING THE EXPERIENCES OF RACIALIZED IMMIGRANT CARE WORKERSiii AcknowledgementsThank you is an underestimation of the gratitude I owe my supervisor, Susan Braedley, who has contributed immensely to my development as an academic. For the incredible amount of patience that has challenged the very limits of her patience, I am grateful.To my committee, I say a big thank you for shaping my ideas from the onset and for challenging me to do better. Thank you, Colleen Lundy, Lisa Mills, and Paul Mkandawire.

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Examining a "Household" Model of Residential Long-term Care in Nova Scotia

Cited by 7 publications

References 8 publications

What makes a nursing home a home? Insights from family members and friends

What makes a nursing home a home? Insights from family members and friends

Does Comprehensive Culture Change Adoption via the Household Model Enhance Nursing Home Residents’ Psychosocial Well-being?

Racialized Workers in White Spaces: Exploring the Experiences of Racialized, Immigrant Care Workers in Rural and Small Town Canadian Long-Term Care Homes

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