Disengaged employees adversely affect organizational strategies to promote higher standards of care and quality of life for long-term residential patients. The purpose of this single case study was to explore strategies healthcare leaders use to engage employees. The targeted population for this study was the senior leaders of a long-term residential care agency located in South Carolina who had initiated strategies and practices to engage employees. Kahn's theory of personal engagement and disengagement was the conceptual framework for this study. Data collection included semistructured face-to-face interviews with open-ended questions, and the long-term residential agency's employee handbook, training agenda, and incentive program. Data were transcribed, coded, and then validated through member checking and triangulation, resulting in the development of 6 themes: leadership attentiveness to promote workplace meaningfulness, incorporation of robust communication policies and procedures, organizational support for engagement, fostering interpersonal relationships for increased employee value, meaningful rewards and recognition, and training and development for personal and professional growth. Leaders have a significant role in the development of conditions within the work environment that foster employee engagement. The implications for positive social change include the improvement of physical and social qualities of life for long-term residential patients and their families, the ease of financial burdens for healthcare professionals, and a reduction in the amount of tax revenue needed to support the needs of aging U.S. citizens.

The aging Canadian population is becoming increasingly ethno-culturally diverse primarily due to immigration. This, together with research indicating increased likelihood of long-term residential care (LTRC) use at older ages and challenges in providing these services, prompt important questions about whether LTRC services are prepared to provide culturally responsive and competent care to immigrant and ethno-cultural minority older adults (EMOA). This ethnographic study, informed by a critical theoretical perspective, explored these questions from the perspectives of South Asian older adults (SAOAs) and their family caregivers (FCGs). In-depth interviews with 18 SAOAs in LTRC, assisted living and those at home, their FCGs, and seven key informants from LTRC and the South Asian (SA) community (n=43) were undertaken. These interviews, in addition to 220 hours of participant observation in two LTRC facilities, provided information regarding the needs, preferences, experiences and situation of SAOAs in LTRC as well as how SA families make decisions regarding the use of such services. A select review of provincial policy, residential care regulation, health authority and facility documents, exposed taken-for-granted assumptions in how care and services are provided and the sociopolitical context of LTRC provision. Study findings suggest that LTRC services are challenged to meet the needs of immigrant and EMOA and reflect unequal and inequitable care, illuminated by the differential impact of macro-policies and resource-constrained LTRC environments on SAOAs and their families and on the ability of existing LTRC services to provide person-centred care. This inequity in service provision has implications for immigrant and EMOA and their family members in light of findings that the decision to move to LTRC is essentially a (non) decision influenced by a range of social structural factors that interact to necessitate the move to LTRC. Study findings revealed the salience of socio-economic status and economic resources in particular, in the (non) decision for LTRC placement. The findings from this study along with demographic shifts in the aging Canadian population call for LTRC service providers and policy makers to actively prepare for increasing ethno-culturally diverse resident populations and point to the need for equity informed approaches to the care of older adults. / Graduate / 2022-03-31