Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

No description available.

This study examined the influence of three predictor variables on perceptions of assisted living: psychological well-being, functional status, and coping strategies. A multiple regression analysis was used to examine the influence of these factors on perceptions of the transition to assisted living.

Pain is the most prevalent medical problem that elderly persons experience in a long-term care home. Nurses play an essential role in managing their pain. The purpose of this study was to explore nurses’ pain management practices in Ontario long-term care homes facilities. The ultimate aim was to recommend measures for effective pain management in aged people. The setting for this study was a selected long-term care home in Ontario, Canada, a 160-bed nursing home for aged people offering various medical care services. Semi-structured focus group interviews, averaging approximately one hour, were conducted. The population of this study was 45 nurses. The researcher used a purposive sampling method to select a sample of 25 nurses. Open-ended questions were used to explore pain management practices and to find barriers to effective pain management. Qualitative data analysis was used to review the data to identify common issues that recurred, and they were summarised in a narrative form. This study demonstrated the importance of recognising and overcoming barriers to the effective management of pain and reinforcing good practices in long-term care homes. Therefore, improved pain management practices are required to manage pain in a long-term care home effectively. / Health Studies / M.A. (Nursing Sciences)

Social contact is known to be vital for older adults' mental and physical health, but few studies of social interactions have taken place in long-term care settings. The current study investigated whether the psychological well-being of assisted living residents was influenced by factors associated with residents' social interactions involving humor. Specific aims of the present study were to develop and test a measure related to humor-related social exchanges, to examine how humor-related social exchanges affect residents' mental health, and to explore whether humor-related social exchanges mediated the effects of resident and facility characteristics on indices of mental health. One hundred and forty older adults residing in 14 assisted living facilities in the Portland, Oregon metropolitan area were interviewed about the frequency and types of social interactions they experienced with members of their facility-based social networks, as well as depression, mood, loneliness, self-esteem, and self-rated health. A 12-item, two-factor model of humor-related social exchanges was identified through confirmatory factor analysis, including both positive and negative humor-related social exchange factors. The newly developed scale displayed evidence of adequate reliability and validly in the current sample. Results indicated that both positive and negative humor-related exchanges were associated with various aspects of mental health, although negative humor-related exchanges appeared to be a stronger predictor of mental health than positive humor-related exchanges. Both positive and negative humor-related exchanges also served as mediators between resident and facility characteristics and indicators of mental health. Cultivating a better understanding of the relationships between humor-related social exchanges and mental health may be beneficial for researchers interested in the way humor impacts older adults' ability to cope with stress. This research may also be of value to long-term care providers who create interventions designed at improving residents' mental health and overall quality of life.

No description available.

The purpose of this study was to evaluate the recreational activities provided in special care units located in the Inland Empire. The population that this study sought to assist was patients diagnosed with Alzheimer's disease and living in an Alzheimer's special care unit.

Les défis associés au phénomène du vieillissement démographique de la population se manifestent sous plusieurs formes et à de nombreux égards. Il y a des questions générales comme celles qui touchent l’économique et d’autres, plus spécifiques et situées, comme celles des modalités assurant des services et des soins adéquats aux personnes vulnérables. Par exemple, le colloque « La qualité de l’expérience des usagers et des proches : vers la personnalisation des soins et des services sociaux », programmé dans le cadre des Entretiens Jacques Cartier à l’automne 2014, s’était donné comme objectif d’examiner l’expérience personnelle des usagers relativement aux prestations de soins de santé et à l’organisation des services sociaux. L’origine de ces réflexions réside dans la nécessité de trouver un meilleur équilibre des pouvoirs dans les relations d’aide ou la prestation de soin. Cette problématique sous-entend l’idée de rendre les usagers capables d’un certain contrôle par l’adoption d’approches permettant aux professionnels de faire des ajustements personnalisés. Cette thèse de doctorat s’inscrit directement dans le prolongement de cette problématique. La recherche vise à examiner les conditions en mesure de rendre possible, dans les Centres d’hébergement et de soins de longue durée (CHSLD), un rapport au monde catégorisé par ce que le sociologue Laurent Thévenot nomme le régime de la familiarité. Le régime de la familiarité fait référence aux réalités où l’engagement des personnes se déploie dans l’aisance. Autrement dit, ce régime d’engagement correspond à un rapport au milieu où la personne est en mesure de déployer ses habitudes, d’habiter le moment et de se sentir chez elle. Comme le montre Thévenot, ce type d’engagement commande la conception d’un monde qui offre aux personnes la possibilité d’articuler les modalités de leurs actions sur des repères qui font sens personnellement pour eux. Ainsi, l’objet de la recherche consiste à mieux comprendre la participation du design à la conception d’un milieu d’hébergement capable d’accueillir ce type d’engagement pragmatique. Les orientations associées à la conception de milieux d’hébergement capables de satisfaire de telles exigences correspondent largement aux ambitions qui accompagnent le développement des approches du design centrées sur l’usager, du design d’expériences et plus récemment du design empathique. Cela dit, malgré les efforts investis en ce sens, les capacités d’appropriation des usagers restent un problème pour lequel les réponses sont précaires. La thèse interroge ainsi le fait que les développements des approches de design, qui ont fait de l’expérience des usagers une préoccupation de premier plan, sont trop souvent restreints par des questions de méthodes et de procédures. Le développement de ces connaissances se serait fait au détriment de l’examen précis des savoir-être également nécessaires pour rendre les designers capables de prendre au sérieux les enjeux associés aux aspirations de ces approches. Plus spécifiquement, la recherche précise les qualités de l’expérience des établissements dont le design permet l’engagement en familiarité. L’enquête s’appuie sur une analyse des jugements posés par des équipes d’évaluation de la qualité du milieu de vie des CHSLD présents sur le territoire Montréalais. L’analyse a mené à la caractérisation de cinq qualités : l’accueillance, la convivialité, la flexibilité, la prévenance et la stabilité. Finalement, sous la forme d’un essai réflexif, un tableau de savoir-être est suggéré comme manière de rendre les designers capables de mettre en œuvre des milieux d’hébergement présentant les qualités identifiées. Cet essai est également l’occasion du développement d’un outil réflexif pour une pédagogie et une pratique vertueuse du design. / The phenomenon of an aging population brings with it a whole host of diverse challenges. Some of these challenges are of a general nature, such as those related to economics, while others are much more specific, such as the conditions and procedures needed to ensure that vulnerable individuals receive adequate care and services. For instance, a symposium entitled “Providing a quality experience for users and loved ones: personalization of care and social services,” held during the fall 2014 Entretiens Jacques-Cartier, aimed to examine personal user experiences pertaining to the delivery of health care services and the organization of social services. This meeting’s initial hypothesis underscored the need for a more balanced power dynamic with caregivers or in the delivery of care. This hypothesis is based on the concept of user capabilities, achieved through the adoption of practices which enable professionals to provide personalized care. Further exploration of this particular issue is at the core of this doctoral thesis. This research aims to examine the conditions which would allow people living in long-term care facilities to engage with their environment in a way the sociologist Laurent Thévenot categorized as “familiar engagement.” Familiar engagement refers to realities in which people are able to rest on an accustomed dependency with the things and people that surround them. In other words, this type of engagement refers to a relationship with one’s environment which allows individuals to take part in their usual habits, and where they feel at home and at ease in their surroundings. As Thévenot’s analysis shows, this type of engagement requires the conception of a world which allows people to frame their actions around reference points which are personally relevant to them. Thus, this research aims to better understand the role of designers in the conception of nursing homes where this type of pragmatic engagement is made possible. The guidelines for the development of residential facilities able to satisfy these criteria are largely in line with the expectations surrounding the development of user-centered design, experience design, and empathic design. That being said, despite the efforts put forth towards this initiative, self-identification with one’s environment remains an unresolved problem. Our hypothesis is that the evolution of user-centered design is too often restricted by methodological or procedural issues. Development in this direction has been done to the detriment of the precise examination of the virtues needed by designers in order to be able to seriously take on the issues associated with the goals of this design approach. More specifically, this research identifies the qualities of long-term care facilities’ experience whose design allows for familiar engagement. For our study, we analyzed the findings and judgments of living environment evaluation teams concerning the quality of living environments of the long-term care facilities in the Montreal area. Through this survey, five qualities have been identified: welcomeness, conviviality, flexibility, thoughtfulness and stability. Finally, as a reflective essay, a portrait of virtues is suggested as a way for designers to implement facilities that share those qualities. The dissertation also presented a reflexive tool for a virtuous design practice and pedagogy.

Indiana University-Purdue University Indianapolis (IUPUI) / A move toward care of residents in nursing homes where they are respected and heard is finally emerging. Common strategies used in nursing homes to improve quality of care for residents are integration of person-centered care and assessing care using satisfaction surveys. Although approaches of integrating person-centered care and satisfaction surveys have been valuable in improving nursing home quality, strategies of care that include things that matter from residents’ perspectives while living in nursing homes need investigation. The purpose of this qualitative descriptive study was to describe things that residents age 65 and older state matter to them while living in the long-term care sections of nursing homes. A qualitative mode of inquiry using purposeful sampling led to a natural unfolding of data that revealed things that mattered to residents. Content analysis was used to reduce the data in a manner that kept the data close to the context yet moved the data toward new ideas about including things that mattered to residents in nursing care. The findings revealed residents’ positive and negative experiences and addressed the question: How can nurses manage residents’ positive and negative aspects of care in nursing homes? This study substantiated the importance of developing nursing care strategies derived from residents’ descriptions of care. Finding ways to promote nurses’ investment in attitudes about a person-centered care philosophy is essential for successful person-centered care implementation. Enhancing nurses’ knowledge, skills, and attitudes with an investment in person centeredness will be more likely to put nurses in a position to role-model care that is person-centered from residents’ perspectives.