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<p><strong>Objectives</strong>: Research shows that Montessori-based activities can help address responsive behaviours experienced by persons with dementia by increasing their participation in and enjoyment of daily life. The purpose of this study was to investigate staff perceptions of factors that affect the implementation of Montessori Methods for Dementia™ (MMD) in Ontario long-term care (LTC) homes.</p> <p><strong>Methods</strong>: Qualitative data was obtained during semi-structured telephone interviews with 17 participants who were putting MMD into practice in Ontario LTC homes. The study was guided by a political economy of aging perspective using thematic analysis to elucidate the various factors that affected the implementation of MMD.</p> <p><strong>Results</strong>: Several themes emerged from the data: Regulating and Funding Medical Practices; Shifting Practice Amidst Resistance to Change; Educating and Understanding; Seeing Results is Believing; Being Supported; (Re-)Connecting People and Passions; and Improving Residents’ Quality of Life. Barriers such as insufficient funding and negative attitudes toward activities and MMD reinforced a task-oriented biomedical model of care, whereas various forms of support and understanding helped put MMD into practice as a person-centred program, which improved the quality of life of residents with dementia, staff and family members.</p> <p><strong>Conclusions</strong>:<strong> </strong>The results from this research can help ensure that MMD are as practical and easy to implement as possible despite perceived barriers so that persons with dementia in LTC and their partners in care can have a good quality of life. The findings include suggestions for future research, reducing staff hierarchies and ensuring there is sufficient organizational, financial, educational, and personal support. <strong><br /> </strong></p> / Master of Arts (MA)

This study is an investigation of the long-term care planning entered into by 170 adult children who had independent parents. A decision-making process with four stages was hypothesized. Sons and daughters entered into planning activities primarily at the "consideration" and "discussion" stages. This involvement proceeds along a sequence of stages with lower stage activities being completed before entering into more advanced stages. Minimal involvement from adult children in "preliminary planning" and "making final decisions" suggests the process does not continue unless independence is threatened. Age and family stressors positively influenced the likelihood that respondents gave consideration to future needs of their parents. The likelihood that discussion occurs between the generations was influenced negatively by family stressors and positively by personal authority. No variables were significant for the "preliminary planning" and "final decision" stages. Application is made to educational and clinical practice. / Ph. D.

The purpose of this study is to report the current state of employer offering and employee participation in Long-Term Care Health Insurance within the Central Florida area. By distributing a voluntary survey to numerous businesses, information was collected from employers throughout the area regarding the plans and options available within their organizations. Through assessment and analysis of the information, a gauge of the present state of the workplace and Long-Term Care Insurance coverage in Central Florida has been established. What you will find within these pages is the availability and involvement of this insurance along with the options, awareness, advantages, and disadvantages it encompasses. I hope that you will in some way benefit from it.

Attacks on public administration are commonplace in today’s anti-bureaucratic approach to government. The legitimacy of public administration has long been questioned. Public administration is not one of the three branches of government explicitly formed by the Constitution. Further, public administrators are not elected by the people. Numerous attempts have been made to develop an idea of legitimacy that is grounded in the Constitution and that renders public administration consistent with the representative character of American government. A recent attempt presents public administration as an institution of governance that is derived from, and grounded in, the Agency Perspective. This perspective provides a new foundation stone for the legitimacy of public administration. Central to the perspective is public administration’s ability to evoke dialogue in a way that takes into account the public interest and brings about communities of shared meaning. This literature, however, does not provide a specific enough perspective, i.e., a perspective that has been given a practical specification. Simply exhorting public administrators to evoke dialogue is not sufficient. Public administrators who are encouraged in this general manner will have no choice but to look to what they know: interest group liberalism. Public administration needs a more specific alternative to interest group liberalism and a new methodology from which public administrators can work. In the research at hand, a new methodology is developed and demonstrated. The outline of the new methodology can be seen through the lens of principled negotiation. This literature maintains that negotiation from the positions of the various parties involved in a conflict, as is characteristic of interest group liberalism, is inefficient. Principled negotiation, on the other hand, recognizes that vital interests, not positions, are the key to creating consensus and achieving collaboration. The difficulty with this approach is that people, either as individuals or as role occupants in organizations, typically are unaware of their vital interests. Therefore, it is the task of the negotiator or, in this case, the public administrator to help surface these deeper interests. The new methodology is grounded in the literature of structuralism. Structuralism is a social theory and a method of inquiry (Gibson, 1984:2) that provides a means of looking beneath the surface of events or issues to identify patterns of meaning that are not evident at the surface. The work of linguist Ferdinand de Saussure served as the basis for modern structuralism (Sturrock, 1988:6). Working from Saussure’s writings, Claude Levi-Strauss "treats all forms of cultural expression as language and he assumes that like language it is all [structured] by unconscious laws that constitute a grammar for each" (White, 1983:12). In a similar vein, the structuralist undertaking in this research views the vital interests of the related groups and role occupants as the "underlying grammar" that structures the various approaches to policy formulation. This research employs a case study design to which the theory of structuralism and the technique of structural analysis have been applied. The case study is that of national long-term care policy. Role occupants from 23 national organizations involved in long-term care policy were interviewed. The role occupants are key people involved in long-term care policy formulation for the organizations for which they work. The organizations' long-term care position papers were obtained. Using a process of structural analysis, the position papers and interview transcripts were analyzed to identify vital interests. An analysis of linguistic elements such as metaphors and other figures of speech, justifications, preferred meanings, and recurrent terms was conducted. In addition, content analysis was carried out with the aid of a computer program. The vital interests identified through these analyses served as the basis for the development of a strategy to shape the national long-term care policy debate. / Ph. D.

Yes / As the ageing population in China continues to grow, more people will be living with long-term health conditions and require support from family care-givers. This scoping review therefore aims to explore sources of stress and coping mechanisms adopted by care-givers of older relatives living with long-term conditions in mainland China. Literature searches were conducted in English (CINAHL, EMBASE, MEDLINE, PsycINFO and SCOPUS) and Chinese (CNKI, WANFANG DATA, CQVIP and CBM) databases between October and November 2019. The searches focused on the stressors and coping mechanisms utilised by family care-givers residing in the community. Narrative synthesis was used to identify themes within the data. Forty-six papers were included: 20 papers from English and 26 from Chinese databases. Six themes captured stressors: care-giving time (N = 22), financial resources (N = 17), role and personal strains (N = 42), preparedness (N = 4), social roles (N = 10) and lack of adequate formal support (N = 22); and one theme captured coping (N = 14). Unmet needs of care-givers of older relatives in mainland China were found to be extensive. Only a few studies had attempted to explore the causal link between stressors, coping and the influence of culture. Findings underscore the significance of adequately capturing intricacies around care-givers’ unmet needs, rather than generalising on the basis of culture. Qualitative studies are critical to providing a better understanding of the relationship between stressors, coping and resources afforded to care-givers by their cultural environment. Having such understanding is crucial to inform the development of competent care, which promotes self-efficacy and self-actualisation in care-givers in mainland China. / This work was supported by Research England: Quality Related Global Challenge Research Fund (QR-GCRF).

面對國人的人口老化及老年人慢性疾病逐年升高趨勢，隨著國人生活水準改善，醫療技術提升，平均餘命亦逐年提高；尤其，近年來國人平均餘命上升幅度較往年更為快速，加上少子化現象，對於衍生之老人照護問題，值得政府及民間各界重視。政府近年來大力推動長期照護政策，2007年推動「我國長期照顧十年計畫」，2009年底將「長期照護保險法」草案送立法院審議，預定2011年後實施長期照護保險制度。給付型態以實物給付（服務提供）為主，現金給付為輔，給付水準區分四級，且有補助時數限制。草案中引進「部分負擔」作法，超過政府補助時數，將由民眾全部自行負擔照護費用，可見被照護者或家屬所須負擔之照護費用及精神壓力，仍是一項沈重的負擔。 依據經建會委託長期照護服務需求評估報告及我國長期照護資源供給調查報告，顯示未來長期照護服務需求與照護資源供給相差甚遠。綜觀各國政府所提供之長期照護保障，以基本保障及服務為原則，若要達到讓身心功能障礙者，能夠增進獨立生活能力，提升生活品質，以維持尊嚴與自主之目的，當然，須要靠商業長期看護保險的補充，才能架構完整的長期照護保障網絡。 觀察國內在1995年全民健保制度實施後，明顯激發了民眾對於商業保險之健康醫療保險商品需求的重視與認同。以全民健保制度開辦當年(即1995年)至2004年，此十年間的商業健康保險保費收入來看，十年之間健康險保費收入成長超過七倍。顯示政府推動全民健保制度後，不但激發民眾潛在需求意識，而且促進商業保險商品多元化快速發展。依照先進國家在長期看護保險商品市場的發展經驗，保險公司除重視其商品架構之開發，針對消費者對於長期看護保險的各種認知問題，也應要求業務人員在銷售過程說明清楚，以擴大潛在商機，及避免日後產生非必要之爭議。 有鑑於此，本研究除了詳細彙整介紹德國、日本及台灣政府長期照護制度現況，並對於美國、日本及台灣長期看護保險商品市場進行深入介紹與探討，且對於美國、英國長期看護保險消費者購買須知進行深入介紹與探討。目的在藉由本研究之介紹與探討之結果，提供台灣保險產業長期看護保險之商品開發、業務推動及編製長期看護保險消費者購買須知等實務運作之重要參考。拋磚引玉，期待保險產業有志之士一起掌握藍海商機，協助消費者購買到適合自己的長期看護保險保單。 / Aging population is a topical issue to today’s society, with improved living standard, advanced medical technology, and rising trend of chronic diseases; causing life expectancy to increase year by year. As a result of faster increase in life expectancy in recent years, together with the phenomenon of low birth rates, long-term care is an issue that should be taken seriously to both the public and the government. Recently, the government has been promoting long-term care policy vigorously, where it published “Taiwan’s 10 Years Long-term Care Program” in 2007, submitted “Long-term Care Insurance Law ” draft to the Legislative Yuan of Republic of China by end of 2009, and is scheduled to implement “Long Term Care Insurance” by 2011. Long-term care benefits provided by the government can be classified into four levels, and the benefits will mainly be service based, with hours limit, supported by cash payments. This means that, any long-term care exceeding government’s limit will have to be paid by the user, which may be a stress and burden, financially and mentally, to the family of those needing long-term care. According to “Long-term Care Service Needs Assessment Report” and “Supply of Long-term Care Resources Survey Report” consigned by the Council for Economic Planning and Development, it can be seen that the supply of long-term care resources can never quite meet the demand of long-term care services. After studying long-term care benefits provided by other governments, it is clear that commercial insurance is essential to allow people requiring long-term care to maintain a full standard of living. This may includes being able to live independently, to improve the quality of life, and to maintain one’s dignity. By observing the National Health Insurance （NHI） in Taiwan, implemented in 1995, it has stimulate people to be aware of their personal needs towards private health insurance products. The premium of private health insurance products had been increased by seven times from 1995 to 2004. It has been proven that government’s strong support on the NHI has help people to better understand the demands on their health protection, and at the same time, diversify private health insurance products. An overview on the experience of developing private long-term care insurance products in developed countries, insurance companies not only focus their core competence on developing insurance products but also pay attention on maintaining customers’ satisfaction, customer loyalty and customer retention. It is essential that insurance sales agents should help clients choose insurance policies that suit their needs by explaining policies in detail, in order to create new business opportunities and prevent from any future claim conflict or argument. In view of this, the purpose of this research is to firstly introduce the long-term care system in countries such as German, Japan and Taiwan, study on the experience of developing private long-term care insurance products in developed countries, and follow by an in-depth study and discussion about U.S. and U.K. shopper’s guide to long-term care insurances. Moreover, the findings of this dissertation can hopefully provide suggestions to insurance companies on development of long-term care insurance products and help building consumers satisfaction and consumer retention. To conclude, it is important to create a win-win solution to both customers and insurance companies, where insurers shall develop long-term care products that satisfy customers’ need and in return profit from the market opportunities.

Qualitative, exploratory and descriptive research study was conducted using the case study approach. The purpose of this study was to explore and describe the experiences of family members caring for a long term mentally ill patient suffering from schizophrenia. Purposive sampling was used to select one family who cared for the patient for more than two years. Data was collected through the process of in-depth, unstructured individual interviews. Interviews were tape recorded and transcribed verbatim. Themes, categories and sub-categories were finally identified. The findings revealed that although the family was willing to care for the patient at home, they experienced challenges to provide basic care. Other challenges included were lack of adherence to treatment, financial constraints, substance abuse, social stigma, fear and concerns about the patient’s future. A conceptual map was designed to reflect the major concepts of the findings / Health Studies / M.A. (Health Studies)

published_or_final_version / Urban Planning / Master / Master of Science in Urban Planning

The purpose of this study was to examine a select set of organizational variables and determine their relationship to nursing assistants' intentions to quit in state-owned veterans' long-term care facilities located across the United States. America's long-term care industry (e.g., nursing homes, assisted living facilities) is a multibillion dollar industry. Because the U.S. government is projecting a 250% increase in the elderly population, staffing these nursing homes and related facilities is a critical concern. A vitally important but often overlooked factor of the long-term care industry is employee turnover. Of the staff in long-term care facilities, the nursing assistant (NA) position is particularly susceptible to turnover. Approximately 80% of NAs who enter the workforce leave within the 1st year and many leave within the first 3 months of employment. Some facilities report that they are unable to accept new residents because of a lack of qualified NAs. While many studies have researched this issue, staff turnover in long-term care facilities remains a serious and widespread problem. This study provides a foundation for future research related to the perceptions of intentions to quit of nursing assistants (NAs) working in state-owned veterans long-term care facilities by providing primary data regarding NAs intentions to quit. Results of this study indicate that NA intentions to quit might be reduced provided that pay and rewards are increased, workplace violence is addressed, and better access to patient care plans is provided. This research is useful to state-owned and operated long-term care facilities by giving them additional insights into nursing assistants' intentions to quit perhaps resulting in lower rates of turnover. It is suggested that future research be performed using populations of individuals from other segments of the long-term care industry, mainly, for-profit institutional care nursing homes, and federally owned veterans long-term care facilities.