Quality of life for adults living in adult family homes requires further attention as the elderly population continues to grow and moves from minority to majority. There is a lack of data on residents in adult family home settings and their quality of life. The purpose of this project was to identify if individualized nursing care plans had an impact on the residents' quality of life in the adult family home. In this study, a registered nurse assessed the residents to create an individualized nursing care plan that would be implemented to improve quality of life. These care plans were comprised of 3 distinct nursing needs: risk of falls, self-care deficit, and nutrition imbalance less than the body needs. Each care plan was created with nursing-specific interventions that could be tested, replicated, and evaluated. A test of this premise was conducted using a sample of 6 residents in an adult family home. Only one resident met the criteria of mild to moderate dementia for testing. The single qualifying resident who participated in the project demonstrated improvement in her quality of life after the proposed intervention was implemented. This change was evaluated using quantitative data gathered with the Dementia Quality of Life assessment, and qualitatively with the caregiver and registered nurse evaluation tool. The interventions of the nursing care plans were relevant and as a result, the Dementia Quality of Life assessment did show an improvement in scores, which reflected an improvement in quality of life. Elderly adults with dementia living in an adult family home may benefit from individualized nursing care plans, which may improve their quality of life.

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I have created a modular concept for holiday homes that is shared by hundred families. The concept uses simple means - to improve the quality of life for many people. My aim has been to create a system for maximizing the use of the buildings and efficiently use the benefits of sharing. To keep cost down in order to make the concept as accessible as possible for the average consumer.Therefore the materials and construction have been carefully planned in order to minimize cost at initial building process and maintenance in the long term.  Hundred Holiday Homes- is a concept that - • Makes living in nature available to people of all         economic means - Increases availability • Bring people together – Increased social exposure • Uses buildings more efficiently – Maximizes utilization  • Modular building blocks - Easier adaptation for future neeads • All this whilst reducing the environmental impact         by 71%  - Reduced footprint

Nursing home resident choice in daily life is recognized as vital to resident quality of life and quality of care. Advocacy and policy activities to promote resident choice abound, yet little research exists to guide nursing home staff in how to enable resident choice on a moment to moment basis. Our three studies developed conceptual and practical tools to elucidate the factors, challenges, and behaviors involved in enabling resident choice. We first crafted a conceptual model, the “REAlizing Resident CHoice (REACH)” model, as described in the first paper. The REACH model identifies the factors influencing staff efforts to enable resident choice and the broader contextual dimensions within which the resident-staff member relationship exists. The REACH model was developed through a literature review of 1,969 abstracts and expert opinion. The second study assessed 1) tensions nursing home staff members encounter when trying to enable resident choice and 2) resolutions employed in the face of these tensions. We conducted semi-structured, qualitative interviews with 26 staff participants in two Veterans Health Administration (VHA) Community Living Centers (i.e., nursing homes). Participants highlighted intra-personal, inter-personal, and organizational tensions that affected their resident choice enabling efforts. Resolutions to these tensions focused on preventive practices, education, reinforcement, deliberation, collaboration, and leadership. A formative assessment tool, the “Supporting Choice Observational Tool (SCOT),” was developed in the third study. The SCOT provides nursing home staff with detailed, non-graded feedback on how to offer and enable resident choice in-the-moment. We created the SCOT using the following methodologies, in order: ethnographic observation, tool piloting, expert panel consultation, and a representational algorithm. SCOT results can inform discussion amongst co-workers and supervisors on how to advance their resident choice enabling efforts. These three studies address an important research gap. They provide scientifically grounded concepts and tools to assist nursing home staff, researchers, and policy makers in advocating for and instituting resident choice. The REACH model can be used to frame future research, and future studies can be undertaken to validate the SCOT. Findings from the second study could improve quality improvement initiatives targeting tensions and resolutions in enabling resident choice. / 2018-02-17T00:00:00Z

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