The aging of the nation in the coming decades will contribute to an increased demand for long-term care. Given this trend, it is becoming increasingly important to understand utilization of services along the continuum of care and to determine factors that influence the provision of quality care. These insights are needed to reduce national expenditures on long-term care and to maximize independence and well-being among older adults. The purpose of the present dissertation was to explore factors that influence the utilization and quality of long-term care by conducting three separate studies. The first study examined risk of nursing home (NH) placement in a frail sample of older adults receiving publicly-funded long-term care in two settings: home and community-based services (HCBS) or assisted living (AL). Specifically, it explored whether these settings of care modify the relationship between dementia and NH placement. The second study examined NH organizational characteristics and job characteristics of staff in relation to turnover of nursing assistants (NAs) in a nationally representative sample of NHs. Using the same sample, the final study examined the presence of employment-based benefits of NAs and explored the relationship between NH organizational characteristics and the availability of staff benefits. Findings from this dissertation can contribute to a greater understanding of the use of long-term care services and the retention of staff to provide quality care. In the first study, AL was associated with longer time to NH placement for individuals with dementia when compared to HCBS. In the second study, the provision of competitive wages and benefits, involvement of NAs in resident care planning, and high levels of nurse staffing were associated with lower NA turnover, which may be important for quality of NH care. In the final study, for-profit ownership and high Medicaid occupancy were negatively associated with NA benefits whereas facility size, chain membership, occupancy level, union involvement, and education of the NH administrator were positively associated with benefits offered to these staff. Collectively, the findings from this dissertation may have important implications for policy makers, providers, and consumers of long-term care.

Syftet med studien var att undersöka skillnader i arbetsmotivation och arbetstillfredsställelse bland omsorgspersonal beroende på om de hade en fast eller flexibel arbetsplats. I studien ingick två deltagargrupper där den ena gruppen tillhörde en fast avdelning medan de anställda i den andra gruppen flyttade runt mellan avdelningar beroende på var det för tillfället fanns behov. Studien genomfördes som en enkätundersökning inom omsorgsförvaltningen i en mindre kommun. Totalt besvarade 55 personer på enkäten som var uppdelad i två delar; Basic need satisfaction at work scale som mätte arbetsmotivation med delskalorna autonomi, kompetens och samhörighet och Minnesota job satisfaction som mätte inre och yttre arbetstillfredsställelse. Studien visade att anställda med en flexibel arbetsplats hade lägre arbetsmotivation och arbetstillfredsställelse än anställda med fast arbetsplats. Autonomi, samhörighet och inre arbetstillfredsställelse visade ett signifikant resultat, kompetens och yttre arbetstillfredsställelse hade en tendens till signifikant effekt / The aim of the study was to examine differences in work motivation and job satisfaction among nursing assistants, depending on whether they had a permanent or flexible workplace. The study involved two groups of participants, the one belonging to a permanent ward while the employees of the other group moved around between wards depending on where they were currently needed. The study was conducted as a survey in care administration in a small municipality. A total of 55 people responded to the questionnaire, which was divided into two parts; Basic need satisfaction at work scale measuring the motivation subscales of autonomy, competence and connectedness and Minnesota job satisfaction scale measuring job satisfaction based on intrinsic and extrinsic aspects. The study showed that employees with a flexible workplace had lower motivation and job satisfaction than workers with permanent workplace. Autonomy, connectedness and internal job satisfaction showed a significant result, competence and external job satisfaction tended to significant effect.

No description available.

The majority of individuals in nursing homes have cognitive-communication impairments which impact quality of care because direct care providers, certified nursing assistants, (CNAs) are unsure how to respond to resident’s communication behaviors. One intervention that facilitates staff-resident communication in nursing homes is communication plans; however, the research to date about communication plans has not specifically involved CNAs. The purpose of this study, using a grounded theory qualitative approach, was to describe development, implementation and evaluation of communication care plans (CCPs) for residents with cognitive-communication impairments in nursing homes by CNAs who did and did not receive professional support. Communication care plans are communication plans with the addition of autobiographical information. Twenty residents and ten CNAs from two nursing homes participated in the study. Once CCPs were created, CNA participants in one facility received support each day. Following two weeks, CNAs participated in a semi-structured interview. Interviews were transcribed and analyzed using open, axial and selective coding. Findings revealed a core category, meeting resident’s needs through professional support and communication, which describes the progressive process these CNAs underwent to effectively communicate with residents in nursing homes using CCPs. Evolution of this process occurred as CNA participants became familiar with residents. An underlying component facilitating this familiarity was support during CCP implementation. Initially, these CNAs had negative views about nursing home care because they were unsure how to communicate with residents and received little support from higher levels of nursing authority. Over time and with application of CCPs, CNAs became familiar with residents and their communication behaviors. Application of specific communication strategies on CCPs required ongoing support from the investigator/speech-language pathologist which was evident by the comments between CNA participants from each facility. Participants from both facilities reported positive experiences during application of the autobiographical information on the CCPs. This personal information coupled with increased knowledge about resident’s specific communication abilities fostered the formation of a relationship between residents and CNAs. In summary, support during application of CCPs supplements CNAs’ abilities to meet residents’ needs.

In this study, certified nursing assistants (CNAs) who work regularly with long-term care residents with dementia were interviewed to investigate whether they considered providing social and emotional support to people with dementia an important part of their jobs. They were given an online survey, then each participated in an in-person interview that was recorded and later transcribed and analyzed for common themes. Through data analysis, I found that the participating CNAs unanimously considered social support to be an important aspect of caring for someone with dementia, and several personal values were associated with this perspective. They also reported the trainings they had received in preparation for dementia care were largely not sufficient to prepare them for interacting effectively with the residents. Additionally, they cited various other barriers that impede their ability to provide the social support they feel is necessary to provide. Overall, this sample of CNAs did not provide great diversity, and future research should compare these results to more diverse groups.

There is a worldwide shortage of direct care workers who help older adults in their own homes. The purpose of this multiple case study was to explore strategies that owners of home health care businesses can use to retain adequate direct care workers for their businesses. Five home care agency owners from Wake County, North Carolina, participated. Each owner had successfully implemented strategies to ensure adequate caregivers to sustain the business. Human relations theory was used to address the business problem. Data collection involved interviewing the 5 owners of home care agency businesses in their offices. Through a process of methodological triangulation, observations and documentary evidence supplemented data collected through semistructured interviews. Deductive and inductive coding were used to arrange and identify 3 emergent themes: company reputation, training and career development, and the role of government. The results of this study may contribute to social change because home care agency owners and other business owners can use the findings to improve on their treatment of low income workers which may help eradicate discrimination to ethnic minorities.

No description available.

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.

Nursing assistants’, as frontline caregivers in the care of older people, have a unique opportunity to encourage physical activity and exercise in older people. Hence, the perceptions by these care providers of physical activity and exercise among older people are an essential factor. The aim of this study is to  describe how nursing assistants perceive physical activity and exercise for older people, over the age of 65, receiving home care and home help. Method: Data was collected through interviews with 19 nursing assistants, selected by strategic sampling and analysed using a phenomenographic approach. Results: The findings show two different perceptions of physical activity for the older people: “physical activity is to  move” described as everyday movements i.e. everyday activities and outdoors activities and “physical activity is to make an effort”, described as older people handling their day-to-day tasks and outdoor activities or struggling to be less inactive and performing healthy activities. Three different perceptions of exercise for the older people emerged: “exercise as physical activity”, described as movement performed, based on individual exercise programmes from the physiotherapist or through day-to-day tasks such as dressing, cleaning or shopping; “exercise as rehabilitation” described as part of the rehabilitation process or as a prescription to follow, and “exercise as an agent” described as enhancing the health and well-being of older people, principally related to mobility or enhancing the older people’s social activities. Conclusion: This study shows that there are a variety of perceptions of physical activity and exercise among nursing assistants which can be important for health professionals to be aware of, in order to provide targeted support. This study also shows two different approaches by nursing assistants towards older people: a health-promotion one and a preventive one; it would seem to be important to be aware of these approaches, if a shift towards promoting health and well-being should be implemented in the care of older people.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-08-23T12:15:57Z No. of bitstreams: 1 Priscila Leite Gonçalves.pdf: 1424011 bytes, checksum: 72d92aff7878a8bf2a5deb5286e2196b (MD5) / Made available in DSpace on 2016-08-23T12:15:57Z (GMT). No. of bitstreams: 1 Priscila Leite Gonçalves.pdf: 1424011 bytes, checksum: 72d92aff7878a8bf2a5deb5286e2196b (MD5) Previous issue date: 2016-03-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aims to systematize an educational experience in a Mid-Level Course of Professional Training Program for Health (PROFAPS), from Ministry of Health, held in São Paulo on the year 2015, whose purpose was to qualify assistants and nursing technicians of Primary Health Care for the integrated and comprehensive care to the elderly. To compose the experience report, we used the qualitative research, with exploratory and descriptive character and the participant observation was the methodological procedure elected, and Field Diary was the instrument for data collection. The Qualification Course in Gerontology, organized into eight modules, had its theoretical and practical proposition based on the methodology of questioning and culminated in the construction of a territorial action plan focusing on soft technologies. The methodology and didactic procedures adopted led the students to awaken their critical sense to the analysis of its own territory, its work process and its stereotypical vision of the old age (based on themselves and the other individuals), leading to the transformation of your own reality. The results were positive, particularly with regard to strengthening of health care networks, lines of care, continuing education and SUS itself / Este estudo objetivou sistematizar uma experiência de ensino em um Curso do Programa de Formação de Profissionais de Nível Médio para Saúde (PROFAPS), do Ministério da Saúde, realizado na cidade de São Paulo no ano de 2015, cujo propósito foi o de qualificar auxiliares e técnicos de enfermagem da Atenção Básica em Saúde para o cuidado integrado e integral ao idoso. Para compor o relato de experiência, utilizou-se a pesquisa de abordagem qualitativa, de caráter exploratório-descritivo, tendo a Observação Participante como procedimento metodológico e o Diário de Campo como instrumento da coleta de dados. O Curso de Qualificação em Gerontologia, organizado em oito módulos, teve sua proposição teórico-prática fundamentada na metodologia da problematização e culminou na construção de um plano de intervenção territorial com enfoque em tecnologias leves. A metodologia e os procedimentos didáticos adotados levaram o discente a despertar seu senso crítico para a análise de seu território, de seu processo de trabalho e da visão estereotipada da velhice (de si mesmo e do outro), conduzindo à transformação da sua realidade. Os resultados foram positivos, em especial no que tange ao fortalecimento das redes de atenção à saúde, das linhas de cuidado, da educação permanente e da própria escola formadora – o SUS