Purpose: The purpose of this project was to implement a screening program that would identify older adults with depressive symptoms. Data Sources: The Mini Mental Status Exam (MMSE) is a baseline cognitive screen used to identify which depression screening tool should be used for the patient. The Geriatric Depression Scale-15 is used to screen patients with a MMSE score of 19 or higher. The Cornell Scale for Depression in Dementia is used for patients with a MMSE of 18 or below. Conclusions: This project had a small, convenience sample size (n=17). All (n=17) patients were given the cognitive screening. Due to inability to obtain consent, only 70% (n=12) were screened for depression. All 17 patients shared a total of five providers, who were contacted on two different occasions to notify them of the screening results and asked to complete the six-item survey. Two providers responded to the notification and completed the survey. Providers who completed the Likert survey strongly agreed that the depression treatment and tracking (DTT) form: (1) was helpful in documenting depression in the long-term care patients, (2) was easy to use, (3) decreased time spent per patient visit, and (4) was the one they would like to see used in the facility. Implications for Practice: Implementing a depression screening program through the use of a depression treatment and tracking form will assist staff with ease of documenting and communicating screening results to the patient’s primary care provider. The DTT form supports improved health outcomes for the long-term care patients by giving primary care providers a quick and easy-to-use form they can evaluate to determine if further evaluation and treatment is needed.

Long-term residential care (LTRC) is a complex sociopolitical milieu where people from diverse backgrounds come to live and work together. In recent years health care restructuring has resulted in the closure of facilities; health care policy has narrowed the population that accesses LTRC so that only those who are the most medically and socially complex are admitted; and there has been a transformation of the work force, a workforce that is mainly comprised of Women of Colour and is among the lowest paid in health care. The purpose of this study was to critically examine the organization of care in LTRC within this context. The theoretical perspective guiding the study was informed by postcolonialism, postcolonial feminism, intersectionalities, and Foucaudian epistemology. The method of inquiry for the study was critical ethnography, which allowed for critical analysis of `taken for granted' assumptions in the organization of care. Over a period of ten months, I was immersed in two LTRC facilities in the Lower Mainland of British Columbia. Field work consisted of approximately 218 hours of participant observation. I conducted 51 interviews with administrators, family members, residents, and staff. I reviewed relevant provincial policies and facility-based policies and procedures. I also collected quantitative data related to resident transitions in the health care system (for example, admissions, discharges, and hospital admissions), and staffing levels. Findings from this study were discussed in three key themes. First, a systematic decommissioning of citizenship occurred for residents and staff in this setting. Second, the impact of health care restructuring over the past decade had important consequences for relationships between residents, family, and staff. Third, relational care took place in `stolen' moments that occurred despite heavy workloads. All of these themes were underscored by intra-gender oppression, relations of power, and influenced by discourses of ageism and corporatism, which ultimately played out in day to day interactions between those who live and work there. Recommendations from this study included: addressing the entrenched hierarchies in nursing, further examination of the public-private funding model in LTRC, and the introduction of an independent ombudsperson to ensure consistent, high quality care across the LTRC sector.

No description available.

The purpose of this study was, first, to further our understanding of the experience of dying in a long-term care (LTC) facility from the perspective of family members and second, to identify the relationships between the various factors which may influence satisfaction with end-of-life care. Using a sequential mixed methods design, a convenience sample of 87 family members completed a survey interview using a modified version of the Toolkit of Instruments to Measure End-of-life Care (TIME) Nursing Home Version in the first phase of the study. Findings from the parametric and non-parametric analyses indicated that family satisfaction with end-of-life care was best predicted by contact and communication with nursing staff, feeling that care provided at the end of life met expectations, staff providing consistent care, feeling that the health care aide listened to their concerns about care and that respondents felt they had received enough emotional support. Being transferred to hospital in the last month of life, dying in a place other than the LTC facility, and respondent age and employment status were all associated with significant mean differences in satisfaction scores. In the second phase, three focus groups were conducted to further explore areas of satisfaction and dissatisfaction with end-of-life care. Focus groups provided confirmation of the findings of the first phase of the study and were instrumental in developing a list of ten recommendations for improvements in end-of-life care delivery. Recommendations for future research are made based on the study results.

Introduction: Vitamin D deficiency is prevalent among older adults in long-term care (LTC) contributing to increased risk of falls and fractures, and decreased quality of life. The primary factors include limited dietary sources containing vitamin D, poor dietary intake, and low sunlight exposure. Vitamin D supplementation is recommended in LTC; however this practice varies across Canada. Objectives: The objectives of this study were to 1) examine the perceptions of LTC health professionals, staff, and visitors (family and friends) regarding vitamin D supplementation in LTC facilities; and (2) determine what barriers exist in providing vitamin D supplementation to all residents in LTC facilities. Methods: The study was conducted in two phases. Phase 1: Five focus group sessions (9-12 health professionals per group) were conducted in 5 LTC facilities within a Manitoba Regional Health Authority. Each focus group session was audio recorded to assist in generating themes. Phase 2: A self-administered nutrition survey was completed by LTC staff, health professionals, and visitors (family and friends) in all five recruited LTC facilities. Descriptive statistical analyses were conducted. Results: Phase 1: A total of 51 individuals participated (mean age = 46.7 years ± 10.3; female = 90.2%). The majority of participants consisted of Registered Nurses, Health Care Aides, Clinical Dietitians, Pharmacists, Social Workers, Recreation Therapists, and Administrators. Phase 2: A total of 102 individuals participated with an average age of 48.4 ± 13.8 years and were predominately (87.3%) female. Eighty-five percent of participants were LTC health professionals and staff, and 14.7% were visitors (family or friend) of a LTC resident. The results from both phases found that perceptions were positive about providing vitamin D supplementation to residents. Eighty-two percent (phase 1) and 92.2% (phase 2) of participants thought that receiving a supplement would make a difference to the overall health of LTC residents. The major barriers to vitamin D supplementation were: cost (healthcare cost, cost of the supplement, and cost of laboratory tests for serum vitamin D levels), the complexity of residents due to swallowing problems and reluctance with taking medications, polypharmacy, physician resistance, and differences between participants’ knowledge and education on vitamin D. Conclusions: Providing vitamin D supplementation to LTC residents was deemed important and would improve their overall health, but more education is needed to prevent vitamin D deficiency in LTC.

Background: Chronic pain is a frequent and undertreated ailment within the long-term care community (Herman et al, 2009). The likelihood of experiencing pain increases with age and failure to treat this condition may expose individuals to prolonged and unnecessary suffering (Ramage-Morin, 2008). Furthermore, undertreated pain can lead to a life of inactivity and a failure to carry out normal social and vocational roles which in term may result in higher rates of depression, anxiety and sleep disorders (Clark, 2000). The present study aimed to explore staff perceptions on current pain management within long-term care including insights to future needs in optimizing pain management. This work will contribute to the overall awareness surrounding possible reasons that current pain management within long-term care is viewed as suboptimal (Herman et al, 2009). Methods: A qualitative, post-positivist grounded theory study was carried out in order to investigate staff-perceived strengths, weaknesses and barriers surrounding the topic of pain-management within the long-term care setting. Semi-structured interviews with 17 long-term care staff members from a variety of vocations were conducted with a focus on identifying and clarifying properties surrounding the notion that pain management is currently suboptimal. A focus group session was implemented as a method to further develop the emerging grounded theory. Results: Nine themes surrounding pain management within the long-term care setting were identified in the present study. These themes gave rise to the core concept of creating an environment supportive of optimal pain management. The nine themes were integrated into the theory of optimization of pain management within long-term care through thematic interpretation. The focus group session further developed and confirmed themes identified throughout the one-on-one interviews as well as expanded the discussed theory. Discussion: The developed theory of optimization of pain management within the long-term care setting provides a comprehensive overview of the current barriers facing adequate pain management as well as outlines future suggestions for improvement of managing pain within the long-term care setting.

The purpose of this study was, first, to further our understanding of the experience of dying in a long-term care (LTC) facility from the perspective of family members and second, to identify the relationships between the various factors which may influence satisfaction with end-of-life care. Using a sequential mixed methods design, a convenience sample of 87 family members completed a survey interview using a modified version of the Toolkit of Instruments to Measure End-of-life Care (TIME) Nursing Home Version in the first phase of the study. Findings from the parametric and non-parametric analyses indicated that family satisfaction with end-of-life care was best predicted by contact and communication with nursing staff, feeling that care provided at the end of life met expectations, staff providing consistent care, feeling that the health care aide listened to their concerns about care and that respondents felt they had received enough emotional support. Being transferred to hospital in the last month of life, dying in a place other than the LTC facility, and respondent age and employment status were all associated with significant mean differences in satisfaction scores. In the second phase, three focus groups were conducted to further explore areas of satisfaction and dissatisfaction with end-of-life care. Focus groups provided confirmation of the findings of the first phase of the study and were instrumental in developing a list of ten recommendations for improvements in end-of-life care delivery. Recommendations for future research are made based on the study results.

This study set out to evaluate a small scale model of care for people with dementia that aimed to support residents within a daily household routine (termed household care). Stemming from a pluralistic evaluation, this thesis examines issues identified as important to residents' experience, namely the ability of the care houses to provide a home for life, the process and effectiveness of recreating a homely environment and the implications of group-living. Three case studies were investigated with multiple methods, including semi-structured interviews with staff, relatives and representatives of managing agencies, structured observation and assessment of dependency. Respondents believed care housing was superior to its alternatives and attributed perceived improvements in residents' well-being to the nature of staff support and the 'homely' setting. Agency representatives were preoccupied with their relationships with each other and how to sustain and expand this model of care. Staff focused on the nature and conditions of the work. Kin were keen that residents should settle and stay in the care houses. Residents' support needs at least matched entry criteria but over half had to move out to hospital because of physical illness and behavioural problems. This study suggests that it was very difficult for residents to accept the houses as 'home'. Residents' and their relatives' participation was, in practice, limited but one house was particularly successful in implementing household care; reasons are suggested for this. Residents' interactions with each other seemed to be increased by household care but their relationships were influenced by a number of factors, including the presence of dementia. The latter exacerbated the tensions of group-living. The challenge for care houses was to sustain care as dementia progressed and extend good quality care to those with more substantial behavioural and physical support needs.

Typescript. / Thesis (D.P.H.)--University of Hawaii at Manoa, 1987. / Bibliography: leaves 174-182. / xvii, 182 leaves, bound ill. 29 cm

Long-term residential care (LTRC) is a complex sociopolitical milieu where people from diverse backgrounds come to live and work together. In recent years health care restructuring has resulted in the closure of facilities; health care policy has narrowed the population that accesses LTRC so that only those who are the most medically and socially complex are admitted; and there has been a transformation of the work force, a workforce that is mainly comprised of Women of Colour and is among the lowest paid in health care. The purpose of this study was to critically examine the organization of care in LTRC within this context. The theoretical perspective guiding the study was informed by postcolonialism, postcolonial feminism, intersectionalities, and Foucaudian epistemology. The method of inquiry for the study was critical ethnography, which allowed for critical analysis of `taken for granted' assumptions in the organization of care. Over a period of ten months, I was immersed in two LTRC facilities in the Lower Mainland of British Columbia. Field work consisted of approximately 218 hours of participant observation. I conducted 51 interviews with administrators, family members, residents, and staff. I reviewed relevant provincial policies and facility-based policies and procedures. I also collected quantitative data related to resident transitions in the health care system (for example, admissions, discharges, and hospital admissions), and staffing levels. Findings from this study were discussed in three key themes. First, a systematic decommissioning of citizenship occurred for residents and staff in this setting. Second, the impact of health care restructuring over the past decade had important consequences for relationships between residents, family, and staff. Third, relational care took place in `stolen' moments that occurred despite heavy workloads. All of these themes were underscored by intra-gender oppression, relations of power, and influenced by discourses of ageism and corporatism, which ultimately played out in day to day interactions between those who live and work there. Recommendations from this study included: addressing the entrenched hierarchies in nursing, further examination of the public-private funding model in LTRC, and the introduction of an independent ombudsperson to ensure consistent, high quality care across the LTRC sector.