The Palliative and Therapeutic Harmonization (PATH) program was designed to help frail older adults and their family members prepare for and make medical decisions, in the context of frailty and dementia. This sandwich thesis includes three manuscripts that present the findings from a mixed methods study exploring the implementation and outcomes of the PATH program, in three long-term care (LTC) home settings. The purpose of the first sub study was to describe both the perceived need for the PATH program, and initial reactions following its training and implementation. Quantitative surveys and qualitative interviews with bereaved family members showed that prior to implementation, they were mostly satisfied with their relatives’ end-of-life care. Through qualitative interviews, clinical leaders shared a positive impression of the training and PATH principles. They also explained how the PATH program could help them improve palliative and end-of-life care planning and communication with residents and families. In the second sub study, qualitative interviews were conducted with family members to learn about their experiences with and perceived outcomes from the PATH program. All family members had a positive experience. They shared perceived outcomes such as, opportunities to share and learn about their relative’s health status and trajectory, creating a mutual understanding of directions for care, and receiving support and reassurance for health care decision making. Finally, the purpose of the third sub study was to describe both the perceived outcomes of the staff who implemented the PATH program, and differences in documenting residents’ advance care plans and discussions. Staff described both personal and practice related outcomes. In addition, documentation around advance care planning changed with the program’s implementation. Overall, the PATH program offered frail older adults, their family members and their professional caregivers an opportunity to communicate about and prepare to make decisions for palliative and end-of-life care. / Dissertation / Doctor of Philosophy (PhD)

Thesis (M.S.)--University of Wisconsin-Madison, 1989. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 78-81).

This research examined notions of belonging and sense of community through a set of layered lenses that integrated a social model of aging with phenomenology to gain a better understanding of the lived experiences of individuals residing in a long-term care (LTC) home. Conducted in a for-profit LTC home in Ontario, this study analyzed messaging in marketing materials supplied to potential residents and their families in anticipation of a move to a LTC home and in the staff policies and procedures manuals using document and narrative analysis. Themes emerging from this phase were then compared with the first-hand experiences of living in a LTC home as told by residents through the use of a focus group (n=6) and individual interviews (n=6) and experiences of working in a LTC home as described by interviews with staff (n=6). Analysis of marketing documents revealed the theme of let us be your caring community. As messaged in these documents, the LTC home supported residents by caring, embodying the ideals of home through natural living spaces, and supporting meaningful personal connections. This contrasted with messages found in the staff policy manuals. Divided discourses highlighted the tangible complexities of implementing a person-centered philosophy within a business model by describing the industry of care, prescribed customer service, fabricating normalcy and, to a much lesser extent, promoting the practice of person-centered care. Residents’ phenomenological stories illustrated variable un/belonging within a LTC home. Personal experiences of the institutional erosion of belonging, congregate nature of living in a LTC home, changing nature of personal relationships and the prescriptive living environment routinized day-to-day experiences and provided a stark contrast between belonging in community and un/belonging in a LTC home. Weaving belonging into daily tasks described how staff members laboured daily at working to personalize LTC home living, and how they were helpless to prevent losses in community and belonging. After completing the research and analysis of the promotional materials, policy and procedures manuals, and resident and staff transcripts I conducted a broader level analysis of all four sets of themes in order to get a sense of the whole. I concluded there were five tensions of: constructing home from the outside; person-centered care within a biomedical, business model; promoting individuality in a congregate structure; synthetic connections at the expense of long-standing relationships; and fostering living in a death-indifferent culture which justified society’s need to divide and regulate. Incorporating a range of data including promotional materials, policy and procedures manuals, and the voices of both residents and staff, these tensions are not only implicit in the culture of Manor House but within the overarching structure of LTC homes in general and have deep implications on the standing and status bestowed upon older adults in Canadian culture. My intention was to bring to light the contextualized lived experiences of individuals living at Manor House and highlight the structural and social barriers that continue to produce discrimination by “problematizing” aging and subsequently fostering notions of presumably acceptable dividing practices (Foucault, 1982) within society. By examining meanings and experiences of community in a LTC home, and also recognizing the systemic, structural and cultural factors that may shape those experiences, I sought to gain a more comprehensive understanding of the lifeworlds of individuals living within a LTC home.

The presence of human pharmaceuticals in the aquatic environment is now becoming a well-established fact. The identified problems associated with their presence include the fact that these compounds are biologically active, some of them are toxic in nature, and a number of compounds have potential to foster and maintain drug resistant microorganisms. They are discharged into the aquatic environment from a variety of sources, but mainly by the excretion of incompletely metabolized pharmaceuticals by individuals into the wastewater. This situation makes finding a source-control strategy difficult. However, healthcare facility (hospitals and long-term-care homes) effluents are suspected to have relatively higher concentrations of these compounds, as such facilities use pharmaceuticals in large amounts for diagnostic, cure and research purposes. It is expected that controlling discharges from these facilities may provide a cost-effective solution to reduce the pharmaceutical loads entering the aquatic environment.

The presence of human pharmaceuticals in the aquatic environment is now becoming a well-established fact. The identified problems associated with their presence include the fact that these compounds are biologically active, some of them are toxic in nature, and a number of compounds have potential to foster and maintain drug resistant microorganisms. They are discharged into the aquatic environment from a variety of sources, but mainly by the excretion of incompletely metabolized pharmaceuticals by individuals into the wastewater. This situation makes finding a source-control strategy difficult. However, healthcare facility (hospitals and long-term-care homes) effluents are suspected to have relatively higher concentrations of these compounds, as such facilities use pharmaceuticals in large amounts for diagnostic, cure and research purposes. It is expected that controlling discharges from these facilities may provide a cost-effective solution to reduce the pharmaceutical loads entering the aquatic environment.

This research examined notions of belonging and sense of community through a set of layered lenses that integrated a social model of aging with phenomenology to gain a better understanding of the lived experiences of individuals residing in a long-term care (LTC) home. Conducted in a for-profit LTC home in Ontario, this study analyzed messaging in marketing materials supplied to potential residents and their families in anticipation of a move to a LTC home and in the staff policies and procedures manuals using document and narrative analysis. Themes emerging from this phase were then compared with the first-hand experiences of living in a LTC home as told by residents through the use of a focus group (n=6) and individual interviews (n=6) and experiences of working in a LTC home as described by interviews with staff (n=6). Analysis of marketing documents revealed the theme of let us be your caring community. As messaged in these documents, the LTC home supported residents by caring, embodying the ideals of home through natural living spaces, and supporting meaningful personal connections. This contrasted with messages found in the staff policy manuals. Divided discourses highlighted the tangible complexities of implementing a person-centered philosophy within a business model by describing the industry of care, prescribed customer service, fabricating normalcy and, to a much lesser extent, promoting the practice of person-centered care. Residents’ phenomenological stories illustrated variable un/belonging within a LTC home. Personal experiences of the institutional erosion of belonging, congregate nature of living in a LTC home, changing nature of personal relationships and the prescriptive living environment routinized day-to-day experiences and provided a stark contrast between belonging in community and un/belonging in a LTC home. Weaving belonging into daily tasks described how staff members laboured daily at working to personalize LTC home living, and how they were helpless to prevent losses in community and belonging. After completing the research and analysis of the promotional materials, policy and procedures manuals, and resident and staff transcripts I conducted a broader level analysis of all four sets of themes in order to get a sense of the whole. I concluded there were five tensions of: constructing home from the outside; person-centered care within a biomedical, business model; promoting individuality in a congregate structure; synthetic connections at the expense of long-standing relationships; and fostering living in a death-indifferent culture which justified society’s need to divide and regulate. Incorporating a range of data including promotional materials, policy and procedures manuals, and the voices of both residents and staff, these tensions are not only implicit in the culture of Manor House but within the overarching structure of LTC homes in general and have deep implications on the standing and status bestowed upon older adults in Canadian culture. My intention was to bring to light the contextualized lived experiences of individuals living at Manor House and highlight the structural and social barriers that continue to produce discrimination by “problematizing” aging and subsequently fostering notions of presumably acceptable dividing practices (Foucault, 1982) within society. By examining meanings and experiences of community in a LTC home, and also recognizing the systemic, structural and cultural factors that may shape those experiences, I sought to gain a more comprehensive understanding of the lifeworlds of individuals living within a LTC home.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2008. / Title from first page of PDF document. Includes bibliographical references (p.66-68).

For older adults, functional independent mobility is essential to well-being. Many care home residents have physical and cognitive impairments and use wheelchairs. Residents with difficulty self-propelling manual wheelchairs may benefit from power mobility; however, those with cognitive impairments may be precluded because of the potential for injury. My research goals were to apply novel power wheelchair technology to enable safe, independent mobility. Technology was developed to examine the value and implications of power mobility for residents with restricted mobility and mild or moderate cognitive impairments. The first study tested a prototype anti-collision wheelchair with a contact sensor skirt. Six single subject studies were completed. Distances travelled in manual and anti-collision wheelchairs were compared. Observational and interview data were collected. Focus groups (37 staff) and interviews (18 staff, six other residents, one spouse) were performed. Three of six residents were able or had potential to operate the prototype. One resident chose to use it beyond the study, and his mobility and well-being improved. Case analyses showed factors limiting prototype acceptance. Residents were unsatisfied with the appearance and slow speed, and found the interface frustrating to operate because of inadequate feedback. Social isolation and reduced autonomy restricted independence achievable with technology. Socialization and affective benefits of mobility were demonstrated in one case where prototype use was continually assisted. Residents and staff supported the anti-collision concept. On observation, the prototype compensated for absent or delayed responses of residents to obstacles below sensors and decreased injury risk. However, full sensor coverage of the environment was needed. The second study addressed acceptance and interface usability issues. A simulated collision-avoidance wheelchair with a multimodal feedback interface was evaluated. The interface provided audio, visual and haptic feedback to guide navigation away from obstacles. Through observations, interviews and questionnaires, five residents evaluated the device. High device acceptance and usability were found. The device was easy to use and assisted with performance of indoor mobility goals. Further research is necessary before power wheelchairs with new features are available for users; however, these results could play a fundamental role in shaping technology development and mobility interventions for this neglected population.