Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 46-01, page: 0311. Adviser: Osama Mikhail. Includes bibliographical references.

The purpose of this study was to determine the extent to which nursing home organizational structure and cultural variables were related to the outcomes reported by the Health Care Finance Administration public use data set (HCFA-NHCD). A second purpose was to examine the effects of a new style of nursing home management called the Eden Alternative™ concept. A related purpose was to test the usefulness of the HCFA-NHCD in predicting the quality of care for residents in federally approved nursing homes. Secondary data analysis was conducted on the HCFA-NHCD, as published in December 2001. Descriptive statistics and measures of association were used to assess the degree of relationship between the organizational structure and culture variables and the eight clinical health indicators of the HCFA-NHCD. Multiple regression analyses were conducted to measure the impact of the organizational structure and culture variables on the quality of care for residents in federally approved nursing homes. When compared with previously collected statistics, these findings suggest that there is a nationwide trend towards smaller nursing homes; smaller Eden homes were associated with a higher level of individualized attention. Smaller Eden homes with council representation had better scores on a majority of the eight clinical health indicators when compared to their counterparts with no council representation. Council representation was inversely related to a nursing homes' reliance on RN and LPLVN services. However, a regression model assessing the impact of organizational structure and cultural variables on the quality of care for residents in federally approved nursing homes had very limited predictive power (R2=2.2%). The findings of this study suggest that quality improvements in the HCFA-NHCD are needed in order to better serve families.

The purposes of this secondary study were to explore the case detection phenomena of elder abuse by determining the congruence between nurses' assessments of abuse and elders' self-reports of abuse; to identify factors that may account for differences between abusive situations and nonabusive situations; then to describe differences between abused elders correctly identified and abused elders incorrectly identified by nurses. Both quantitative and qualitative data were used. The theory of attribution directed this research. The conceptual framework consisted of four concepts: structural factors, relationship factors, elder factors, and caregiver factors. A descriptive-comparison design was used to address the research questions. The sample included 48 elder-caregiver dyads, of whom 24 were self-reported abused elders and 24 self-reported nonabused elders. Descriptive analysis was used, including chi-square and t-tests. Results indicated that the nurses' assessments of elder abuse and elders' self reports of abuse were congruent in only one-fifth (N = 5) of the abused cases (N = 24). The findings confirmed allegations that nurses have difficulty identifying elder abuse unless outright battering is observed. Five variables were significant between abused and nonabused elders, and 10 variables were significant between abused elders correctly identified by nurses and abused elders incorrectly identified by nurses.

The documentation of Recreation Therapy and Leisure Opportunities in Long-term Care The Recreation Therapy discipline at Sunnybrook Health Sciences Centre (SHSC) has undergone a series of research initiatives to ensure a patient focused philosophy is integrated into their practice. The purpose of the study is the development of documentation procedures that will enable the recreation therapy practitioners to engage in authentic and professional documentation of the residents??? experiences in recreation therapy and leisure opportunities based on a patient focused philosophy. This research project followed an action research methodology and was guided by a hermeneutic framework adapted from Karkainen and Eriksson (2004). The recreation therapists at SHSC were involved in all aspects of the project as co-research participants. This project employed a variety data collection techniques including focus groups, a hermeneutic dialogue, self-reflective activities and active application sessions. The information collected through the various data collection phases in this project led to the creation of a new documentation framework and associated sample documentation, which allow for a more patient focused documentation process. A series of quality indicators were also developed in this project to help authentically express the experiences in leisure and recreation of the residents living at SHSC. This research project has added to the growing base of knowledge focused on the integration of a patient focused care philosophy into the recreation therapy practice at SHSC.

Abstract It is estimated that by 2038 over a million Canadians will be diagnosed with some form of dementia with nearly 443.000 living in long-term care facilities. Non-professional health care workers such as health care aides provide most of the direct care to these residents. The interaction skills of health care aides have a significant impact on the function, communication skills and wellbeing of residents with dementia. The purpose of this study using Strauss and Corbin’s mode of grounded theory was to develop a mid-range theory to describe and explain how health care aides perceive and understand residents with dementia and how this perception impacts the way they interact with these residents. The sample for this study was made up of 24 health care aides who worked with residents with dementia in personal care homes in Winnipeg. Data from audiotaped individual and group interviews were analyzed using grounded theory methodology: open, axial and selective coding. The central category was “The Resident being perceived as a Respected Person”. The resulting theory shows that when health care aides perceive the resident as a respected person with whom they have a relationship and as a care recipient with challenging behaviors, the health care aides use communication enhancement strategies and modify their caregiving to meet the resident’s unique physical and emotional needs and challenging behaviors. The interactions of these health care aides in this study were consistent with the principles of person-centered care and the literature about communication and dementia. The facilitators of this perception of the resident were primarily the personal characteristics of the health care aide and the inhibitors were the time constraints, workload, and lack of support of peers and supervisors. This theory has implications for the training and supervision of health care aides and the organizational structures in which they work. Key words: Health care aides; dementia; communication; long term care; personhood / May 2017

Master of Arts / Department of Sociology, Anthropology, and Social Work / Laszlo Kulcsar / This study provided an exploratory qualitative analysis of printed brochures to evaluate the conceptualization of successful aging. Data was collected from a sample of 39 printed brochures derived from Kansas Department on Aging Directory (KDAD) of Adult Care Homes 2009. Content analysis methodology was employed to investigate how these brochures reflect the core elements of successful aging as constructed in the gerontological literature (Rowe and Kahn’s and Baltes and Baltes), as well as compare across the ‘traditional’ and ‘culture-change’ models. Other variables of ‘licensure classification’, ‘residency cost’ and ‘gender’ were explored. An overall perspective indicated several brochures met the core elements of successful aging delineated by the literature. In most cases, these elements showed no significance difference for brochures representing facilities by model types, licensure classifications, residency cost and by the demographic of gender.

This research is focused on the experiences of older adults participating in an innovative visual arts program at a long-term care facility in Victoria, British Columbia. The program offers participants an opportunity to explore their creativity and identity as artists. Conceptually, the study draws from Tornstam’s gerotranscendance framework (Tornstam, 2005) and the theory of meaning (Frankl, 1963). A narrative inquiry approach was used with data collected through face-to-face interviews and observations of 10 residents and three staff involved in the visual arts program. Findings indicate that the program fostered a sense of community among participants and enhanced their quality of life. The public exhibition of their artwork at a community-based art exhibit validated the merit of their work and gave meaning and purpose to their participation in the program. Findings contribute to a greater understanding of the importance of arts programs that foster creativity in later life and resonate with Tornstam’s (2005) argument that older people living in institutions can experience multiple dimensions of the self through individualized forms of expression. This study concludes by highlighting the need to increase access to arts programs for older people living in residential care. / Graduate / lyciar@yahoo.com

Magister Curationis - MCur / Worldwide concerns have been raised about the presence and association of depressive symptoms, cognitive impairment, and dementia in older adults (60 years and older), which are often unrecognised and untreated in long-term care facilities (LTCF’s). The progression of cognitive impairment to dementia reduces quality of life with negative consequences of physical, mental, and psychosocial health. In many LTCF’s internationally, the standardised interRAI system is used to capture depressive symptoms and cognitive impairment. However, there is a fragmentation of systems for making evidence-based decisions to plan and manage care for residents with depressive symptoms, cognitive impairment, and dementia. This study, being the first of its kind in South Africa, addressed this gap, by describing a profile of depressive symptoms and cognitive impairment in residents, and analysing their coexistence, using the interRAI-LTCF in a LTCF in the Cape Metropole in South Africa. A quantitative, descriptive, and analytical cross-sectional secondary data analysis was conducted using the records of all 173 resident’s medical records of residents with a last interRAI-LTCF assessment from 2014 and 2016. The objectives were to determine the levels of depressive symptoms and cognitive impairment, and to assess variously associated demographics and clinical variables between depressive symptoms and cognitive impairment of the interRAI-LTCF in residents in a LTCF. Secondary data were analysed, using the IBM Statistical Package for Social Sciences (SPSS) software, version 25, to test any statistically significant relationship between the extracted variables (Significance was set as p˂0.05).

The first chapter investigates whether East German women became used to the requirement of working full-time under communism and thereby continued to work much longer hours than did their counterparts in the West after unification. The second chapter develops a rational habit formation model in labor supply using the idea of habits outlined in the first chapter. I show that the proposed model avoids the extreme behavior observed in the standard model in the literature where in the long-run hours of work could increase indefinitely or decrease to zero over time. The third chapter examines whether disabled elders who have private long-term care insurance consume fewer acute or post-acute Medicare covered services. / Thesis (PhD) — Boston College, 2004. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

Thesis advisor: Lisa S. Cahill / Informed by Gaudium et Spes and Ron Thiemann's "public theology," this dissertation examines the role of the church in responding to the contemporary ethical challenge of providing long-term care for the elderly in a manner that respects and promotes their human dignity. Biblical sources and the theological concepts of discipleship and friendship found in Karl Barth and Paul Wadell insist on the agency of older people as called by God and as participating members of the community. This vision complements and connects with secular visions of justice such as Martha Nussbaum's "capabilities approach" and the concept of justice as participation found in United Nations' documents. Two concrete examples--the Community of Sant'Egidio and the Green House project--provide important models of long-term care that foster the agency of older people and their ongoing participation in human community and fellowship. An ethical vision based upon the elderly themselves as subjects with ongoing agency and purpose demands the church's engagement with the wider society to reform the United States' current long-term care system so that care is provided at a level and in a manner that overcomes marginalization of the frail elderly. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.