Como conseqüência dos processos de desinstitucionalização psiquiátrica, situam-se as moradias para pessoas com sofrimento psíquico com longo tempo de internação psiquiátrica, que retornam ao território. O presente estudo teve como objetivo narrar e refletir sobre o cotidiano de duas moradias para pessoas com transtornos mentais na cidade de Londres, Reino Unido, de 2002 a 2005. O caminho metodológico emergiu sob a abordagem qualitativa, com o uso da narrativa como recurso metodológico. Essas moradias abrigavam 11 pessoas de diferentes crenças e nacionalidades, tendo em comum o diagnóstico de doenças mentais crônicas e com diversos graus de dependência de cuidados em seu cotidiano, necessitando de atenção nas 24h. O acompanhamento dos moradores era realizado pelos profissionais, que não tinham necessariamente uma formação técnica na área da saúde. Estes recebiam treinamento específico para o acompanhamento e auxílio das atividades diárias dentro e fora da residência. Entre os cuidadores e os profissionais de saúde, que atuavam havia diferenças no olhar e no cuidar de cada morador. Nestas moradias, a convivência suscitou uma reflexão sobre o cotidiano das práticas de cuidado em saúde mental no ambiente de uma moradia e a noção de habitar. Destacaram-se como pontos que merecem atenção: as possibilidades de reconstrução de vidas dentro dessas moradias; as diferenças entre morar e habitar; a importância de se valorizar as ações diárias realizadas no cotidiano desses espaços como possibilidades de resgatar as subjetividades de todos seus habitantes / As a consequence of the deinstitutionalizationof psychiatric patients, housing for people who have suffered long term institutionalization and are now back in society comes to light. This research narrates and reflects about the daily life of two care homes for people with mental disorders in the city of London, England, between 2002 and 2005. A qualitative approach was followed, with the use of narrative as a methodological resource. Eleven people lived in these particular homes, having in common the diagnostic of chronic mental health problems with varied levels of dependency, needing care 24 hours a day. The patients were aided by workers who did not necessarily have a technical degree in health care. These workers received specific training for handling daily activities inside and out of the homes. Between the care workers and the health professionals involved in caring, there were differences in how they envisioned the patients care needs. In these homes, the daily routine suscitated reflexion about mental health practices in a care home and the notion of \"inhabiting\". The following points can be highlighted: possibility of reconstructing lives; difference between live and inhabit; the importance of valuing ordinary actions accomplished in these spaces as a way to redeem the subjectivity in all its inhabitants

Diabetes mellitus is common among older people. Hypoglycemia is a sign of poorly controlled diabetes mellitus and may lead to irritability, agitation, anxiety, hunger, and an excessive food intake, which in turn may make the control of diabetes more difficult. Excessive, inappropriate food intake is also a sign of Fronto-Temporal Dementia (behavioral variant: bvFTD). In this case study, we describe the events leading to an altercation that developed between an older diabetic patient with bvFTD and the staff in an Assisted Living Facility. His first dose of insulin was given early that morning while he was still asleep. He, subsequently, woke up feeling hungry, agitated, and irritable. This, in turn, exacerbated the hyperorality associated with bvFTD. We examine what went wrong in the patient/caregiver interaction and how this potentially catastrophic situation could have been avoided or defused.

Tese de mestrado integrado. Engenharia Informática e Computação. Faculdade de Engenharia. Universidade do Porto. 2010

While play therapy is primarily used with children, recent research has begun to explore the use of this approach with adults and the elderly. The purpose of this study was to explore and describe in detail the process of Client Centered Play Therapy (CCPT) with an elderly assisted living facility resident through use of a qualitative case study. A single elderly resident participated in 12 CCPT sessions over a period of six weeks. Qualitative data were obtained through observational session notes, pre- and post-treatment interviews with the resident and the facility’s Licensed Practical Nurse, pre- and post-treatment administrations of the Geriatric Depression Scale, and review of the resident’s case file in order to gain insight into the process of CCPT with one elderly assisted living facility resident. Data collected were examined in relation to the play behaviors exhibited by the resident, typical stages of play therapy, potential therapeutic benefits, and the resident’s view of the CCPT approach. Results indicate that the play behaviors of one elderly resident were markedly similar to those of children participating in CCPT and that this may be an appropriate and enjoyable method for addressing mental health needs of the elderly. Implications and recommendations for future research are discussed.

Background: An essential component of managing the health care system effectively as the population ages is to provide care to seniors in the care setting that can best meet their needs. The majority of seniors wish to remain at home, to maintain their independence. Informal caregivers (family, friends and neighbours) provide as much as 80% of care to seniors who reside at home. The absence of or loss of an informal caregiver and/or a decline in a senior’s health may necessitate a change in care setting. Supportive Housing (SH) is a rapidly emerging alternative care setting for seniors who can no longer have their needs met at home. Objective: The objectives of this dissertation were: to provide a comprehensive description of the profile of SH clients in Ontario; to determining the role of SH in the continuum of care; to develop an algorithm to support care placement decisions; and to explore the longitudinal outcomes of SH clients including quality of life, and long-term care placement. The following four research questions were addressed: What are the socio-demographic and clinical characteristics of persons currently residing in SH units in Ontario? How do the profiles of current SH clients differ from the profiles of persons residing in other care settings? What changes occur in the appropriateness of SH to meet care needs over time? What factors are associated with discharge from SH to a long-term-care facility (LTC)? Methodology: The research questions were answered primarily using two Ontario interRAI data sets: A pilot sample of 1,720 SH clients collected using the interRAI Community Health Assessment and a sample of 29,790 Community Care Access Centre (CCAC) clients collected as part of normal clinical practice from clients residing in residential care setting, including SH. Data from LTC (N=832) and complex continuing care (CCC; N=425) clients in the Mississauga-Halton (MH) LHIN were also used. Data on care placement decisions were collected using a Staff Rating Form (N=332 in SH). Results: SH clients are a relatively light-care population who require support with instrumental activities of daily living (IADLs) and tend to lack an informal caregiver. SH clients who receive care from a CCAC are in the minority but represent a much more clinically complex sub-population. According to staff members, the majority (80%) of SH clients are appropriately placed; of the remaining 20%, 17% were prematurely admitted to SH and would be best cared for at home, a further 3% require LTC placement. Moreover, about 10% of seniors who receive care in the MH LHIN, have been inappropriately placed and would be best cared for in a SH unit. A Decisions Support Algorithm for SH (DASH) was developed to inform care placement decisions in Ontario. The algorithm was based on both resource availability and client care needs. Level of impairment in: IADLs, cognition, continence and score on the MAPLe algorithm (an interRAI prioritization algorithm; see Figure 11), were found to be significant predictors of care placement. Poor QoL was relatively rare (~5%) among SH clients and regression analysis was used to determine the variables associated with a decline in QoL. Finally, survival analysis determined that 20% of SH clients are discharged to LTC within one year. Age, dependence on others to perform IADLs, bladder incontinence, cognitive impairment, and higher MAPLe scores were associated with this discharge. Conclusions: Analyses in this dissertation have clearly indicated the need for a standardized assessment instrument in this sector. Arbitrary decisions around eligibility and discharge criteria for supportive housing have led to inappropriate placement of clients and confusion over the role supportive housing is to play in the continuum of care. Evidence-informed care placement decisions should consider client care needs as well as both the availability of formal and informal support. An integrated health information system, such as the interRAI instruments, facilitates a culture of evidence and improves communication across the care continuum. SH is a rapidly emerging alternative care setting for seniors. If managed carefully, SH has the potential to help address many health system level concerns as the population ages. It is hoped that this dissertation has answered some key questions and also inspired further research into an important and growing field.

Regular walking has several physical and psychological benefits for frail older people. However, many residents in long-term care facilities are too sedentary to achieve these benefits. Indoor walking appears to be a feasible way to promote active living among these residents and yet, there is little research that has been done in this regard. The researcher conducted two studies in Central Texas to explore how corridor design features influenced indoor walking behaviors among assisted living residents. In the first study, the researcher carried out six focus groups with 50 assisted living residents, discussing how they perceived the indoor corridor as "walkable." Residents reported that a walkable corridor should be safe, comfortable, and having beautiful/interesting things to see. In the second study, the researcher further examined the relationship between the built environment and walking behaviors among 326 residents from 18 facilities in a major city of Texas. The results indicated that 'perceived looped corridor' and 'number of stories' were significantly associated with residents' frequencies of indoor recreational walking. In addition, the availability and quality of sitting space around mailbox areas influenced the number of "walking to mailbox" trips. This research provides empirical evidence to develop activity-friendly facility design guidelines, and to create environmental interventions to facilitate active lifestyles among long-term care residents.

Life expectancy has continuously increased in most countries over the last decades and will probably continue to increase in the future. This leads to new challenges relative to the autonomy and the independence of elderly. The development of Smart Homes is a direction to face these challenges and to enable people to live longer in a safe and comfortable environment. Making a home smart consists in placing sensors, actuators and a controller in the house in order to take into account the behavior of their inhabitants and to act on their environment to improve their safety, health and comfort. Most of these approaches are based on the real-time indoor Location Tracking of the inhabitants. In this thesis, a whole new approach for model-based Location Tracking of an a priori unknown number of inhabitants is proposed. This approach is based on Discrete Event Systems paradigms, theory and tools. The usage of Finite Automata (FA) to model the detectable motion of the inhabitants as well as different methods to create such FA models have been developed. Based on these models, algorithms to perform efficient Location Tracking are defined. Finally, several approaches aiming at evaluating the relevance of the instrumentation of a Smart Home with the objective of Location Tracking are proposed. The approach has also been fully implemented and tested. Throughout the thesis, the different contributions are illustrated on case studies.

Background: An essential component of managing the health care system effectively as the population ages is to provide care to seniors in the care setting that can best meet their needs. The majority of seniors wish to remain at home, to maintain their independence. Informal caregivers (family, friends and neighbours) provide as much as 80% of care to seniors who reside at home. The absence of or loss of an informal caregiver and/or a decline in a senior’s health may necessitate a change in care setting. Supportive Housing (SH) is a rapidly emerging alternative care setting for seniors who can no longer have their needs met at home. Objective: The objectives of this dissertation were: to provide a comprehensive description of the profile of SH clients in Ontario; to determining the role of SH in the continuum of care; to develop an algorithm to support care placement decisions; and to explore the longitudinal outcomes of SH clients including quality of life, and long-term care placement. The following four research questions were addressed: What are the socio-demographic and clinical characteristics of persons currently residing in SH units in Ontario? How do the profiles of current SH clients differ from the profiles of persons residing in other care settings? What changes occur in the appropriateness of SH to meet care needs over time? What factors are associated with discharge from SH to a long-term-care facility (LTC)? Methodology: The research questions were answered primarily using two Ontario interRAI data sets: A pilot sample of 1,720 SH clients collected using the interRAI Community Health Assessment and a sample of 29,790 Community Care Access Centre (CCAC) clients collected as part of normal clinical practice from clients residing in residential care setting, including SH. Data from LTC (N=832) and complex continuing care (CCC; N=425) clients in the Mississauga-Halton (MH) LHIN were also used. Data on care placement decisions were collected using a Staff Rating Form (N=332 in SH). Results: SH clients are a relatively light-care population who require support with instrumental activities of daily living (IADLs) and tend to lack an informal caregiver. SH clients who receive care from a CCAC are in the minority but represent a much more clinically complex sub-population. According to staff members, the majority (80%) of SH clients are appropriately placed; of the remaining 20%, 17% were prematurely admitted to SH and would be best cared for at home, a further 3% require LTC placement. Moreover, about 10% of seniors who receive care in the MH LHIN, have been inappropriately placed and would be best cared for in a SH unit. A Decisions Support Algorithm for SH (DASH) was developed to inform care placement decisions in Ontario. The algorithm was based on both resource availability and client care needs. Level of impairment in: IADLs, cognition, continence and score on the MAPLe algorithm (an interRAI prioritization algorithm; see Figure 11), were found to be significant predictors of care placement. Poor QoL was relatively rare (~5%) among SH clients and regression analysis was used to determine the variables associated with a decline in QoL. Finally, survival analysis determined that 20% of SH clients are discharged to LTC within one year. Age, dependence on others to perform IADLs, bladder incontinence, cognitive impairment, and higher MAPLe scores were associated with this discharge. Conclusions: Analyses in this dissertation have clearly indicated the need for a standardized assessment instrument in this sector. Arbitrary decisions around eligibility and discharge criteria for supportive housing have led to inappropriate placement of clients and confusion over the role supportive housing is to play in the continuum of care. Evidence-informed care placement decisions should consider client care needs as well as both the availability of formal and informal support. An integrated health information system, such as the interRAI instruments, facilitates a culture of evidence and improves communication across the care continuum. SH is a rapidly emerging alternative care setting for seniors. If managed carefully, SH has the potential to help address many health system level concerns as the population ages. It is hoped that this dissertation has answered some key questions and also inspired further research into an important and growing field.

This study examined the influence of personal and workplace factors on direct care workers¡¯ retention in Assisted Living Facilities (ALFs). The sample includes 11 ALFs in urban areas in Atlanta, Georgia and 13 participants from the sample facilities. The findings show that personal and workplace factors interact with each other to influence retention in the long-term care field and retention in a particular facility. The findings of this study may have implications for facility policy and practice to retain workers.

This thesis explores the transition experiences of 21 older adults who moved to the Cridge Village Seniors’ Centre, an assisted living facility in Victoria, BC. A review of other studies on the transition to seniors’ housing revealed that most new residents of assisted living facilities did not feel at home in their new residence. Using Ritual Process Theory as a framework through which to analyze participant interviews, this qualitative study examines the factors which aided new residents of the Cridge in making a full transition and developing a sense of home in their new residence. Positive social relationships, the ability to develop routines and personal rituals, furnishing suites with personal possessions, the ability to exercise control over their daily lives and a noninstitutionalized environment were found to be important factors in Cridge residents’ successful transitions to assisted living.