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Risk recognition policies for the long-term care workforce during the first year of the COVID-19 pandemic: a multi-country study
- Authors:
- REED Anna Cooper, et al
- Journal article citation:
- Journal of Long-Term Care, February 2022, pp.22-39. Online only
- Publisher:
- King's College London
- Place of publication:
- London
Context: The precarious work arrangements experienced by many long-term care workers have led to the creation of a “shared” workforce across residential, home, and community aging care sectors. This shared workforce was identified as a contributor to the spread of COVID-19 early in the pandemic. Objective: This analysis sought to review policy measures targeting the long-term care workforce across seven high income jurisdictions during the first year of the COVID-19 pandemic. The focus was on financial supports introduced to recognize long-term care workers for the increased risks they faced, including both (1) health risks posed by direct care provision during the pandemic and (2) economic risks associated with restrictions to multi-site work. Method: Environmental scan of publicly available policy documents and government news releases published between March 1, 2020 and March 31, 2021, across seven high income jurisdictions. Findings: While there was limited use of financial measures in the United States to compensate long-term care workers for the increased health risks they faced, these measures were widely used across Canada, as well as in Wales, Scotland, and Australia. Moreover, there was a corresponding use of financial measures to protect workers from income loss in parts of Canada, Australia and the UK. Limitations: Our analysis did not include additional policy measures such as sick pay or recruitment incentives. We also relied primarily on publicly available policy documentation. In some cases, documents had been archived or revised, making it difficult to ascertain and clarify original information and amendments. Implications: While these financial measures are temporary, they brought to light long-standing issues related to the supply of and support for workers providing care to older adults in long-term care homes. (Edited publisher abstract)
Impairment and abuse of elderly by staff in long-term care in Michigan: evidence from structural equation modelling
- Authors:
- CONNER Tom, et al
- Journal article citation:
- Journal of Interpersonal Violence, 26(1), January 2011, pp.21-33.
- Publisher:
- Sage
A number of risk factors are known to be associated with elder abuse in long-term care. This study aimed to provide a model to place these risk factors in a causal structure that relates the factors to each other and to whether abuse occurs. Nine hypotheses focusing on cognitive impairment, physical impairment, behaviour problems, and age were generated regarding the susceptibility to abuse among the elderly in long-term care. In 2006, a random digit dial survey in Michigan was completed by 1,002 respondents who were knowledgeable relatives of, or adults responsible for, a person in long-term care. The survey measured the level of impairment of the person in long-term care, covering various health-related problems and the ability to do activities of daily living. The survey also asked about the incidence of staff abuse over the previous 12 months, including physical, caretaking, verbal, emotional, neglect, sexual and material abuse. The results were used in the construction of a structural equation model which corresponds to the 9 hypotheses and specifies the relationships between factors and from factors to susceptibility to abuse. In this model, susceptibility to abuse, physical impairment, and cognitive impairment are latent variables, and behaviour problems and age are directly measured. The article concludes by discussing the pattern of relationships between these risk factors for abuse.
Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people
- Author:
- FRIEDMAN Susan M.
- Journal article citation:
- Gerontologist, 45(2), April 2005, pp.157-166.
- Publisher:
- Oxford University Press
This study determined overall risk and predictors of long-term nursing home admission within the Program of All-Inclusive Care for the Elderly (PACE) in the USA. PACE records for 4,646 participants aged 55 years or older who were enrolled in 12 Medicare- and Medicaid-capitated PACE programs during the period from June 1, 1990, to June 30, 1998, were obtained. Participants were enrolled for at least 30 days and had baseline evaluations within 30 days of enrollment. Cox proportional hazard models predicting an outcome of nursing home admission of 30 days or longer were estimated. The cumulative risk of admission to nursing homes for 30 days or longer was 14.9 percent within 3 years. Individuals enrolled from a nursing home were at very high risk for future admission, when compared with those living alone. Among individuals enrolled in PACE from the community, age, instrumental activity of daily living dependence, and bowel incontinence were predictive of subsequent nursing home admission. Concludes that despite the fact that 100 percent of the PACE participants were nursing home certifiable, the risk of being admitted to a nursing home long term following enrollment from the community is low. The presence of some reversible risk factors may have implications for early intervention to reduce risk further, although the effect of these interventions is likely to be modest. Individuals who received long-term care in a nursing home prior to enrollment in PACE remain at high risk of readmission, despite the availability of comprehensive services.
Rapid review: what risk factors are associated with COVID-19 outbreaks and mortality in long-term care facilities and what strategies mitigate risk?
- Author:
- NATIONAL COLLABORATING CENTRE FOR METHODS AND TOOLS
- Publisher:
- McMaster University. School of Social Work
- Publication year:
- 2020
- Pagination:
- 32
- Place of publication:
- Hamilton, ON
This rapid review was produced to support public health decision makers’ response to the COVID-19 pandemic. It seeks to identify, appraise, and summarise emerging research evidence to support evidence-informed decision making. The review includes evidence available up to October 5, 2020 to answer the question: What risk factors are associated with COVID-19 outbreaks and mortality in LTC facilities and what strategies mitigate risk? Across studies, incidence in the surrounding community was found to have the strongest association with COVID-19 infections and/or outbreaks in LTC settings. Several resident-level factors including, racial/ethnic minority status, older age, male sex, receipt of Medicaid or Medicare were associated with risk of COVID-19 infections, outbreaks and mortality; severity of impairment was associated with infections and outbreaks, but not mortality. Most guideline recommendations include surveillance, monitoring and evaluation of staff and resident symptoms, and use of personal protective equipment (PPE). Other interventions demonstrating some effect on decreased infection rates within syntheses and a small number of single studies include promotion of hand hygiene, enhanced cleaning measures, social distancing, and cohorting. Technological platforms and tools (e.g., digital contact tracing, apps, heat maps) are being developed and show potential for decreased transmission through efficient case and/or contact identification that further informs infection control planning strategies. (Edited publisher abstract)
Rapid review update 1: what risk factors are associated with COVID-19 outbreaks and mortality in long-term care facilities and what strategies mitigate risk?
- Author:
- NATIONAL COLLABORATING CENTRE FOR METHODS AND TOOLS
- Publisher:
- McMaster University. School of Social Work
- Publication year:
- 2020
- Pagination:
- 49
- Place of publication:
- Hamilton, ON
This rapid review was produced to support public health decision makers’ response to the COVID-19 pandemic. It seeks to identify, appraise, and summarise emerging research evidence to support evidence-informed decision making. The review is based on the most recent research evidence available at the time of release. A previous version was completed on October 16, 2020. This updated version includes evidence available up to November 30, 2020 to answer the question: What risk factors are associated with COVID-19 outbreaks and mortality in LTC facilities and what strategies mitigate risk? Across studies, incidence in the surrounding community was found to have the strongest association with COVID-19 infections and/or outbreaks in LTC settings. Several resident-level factors including, racial/ethnic minority status, older age, male sex, receipt of Medicaid or Medicare were associated with risk of COVID-19 infections, outbreaks and mortality; severity of impairment was associated with infections and outbreaks, but not mortality. At the organisational level, increased staffing, particularly Registered Nurse (RN) staffing was consistently associated with reduced risk of COVID-19 infections, outbreaks and mortality while for-profit status, facility size/density and movement of staff between facilities was consistently associated with increased risk of COVID-19 infections, outbreaks and mortality. Most guideline recommendations include surveillance, monitoring and evaluation of staff and resident symptoms, and use of personal protective equipment (PPE). Other interventions demonstrating some effect on decreased infection rates within syntheses and a small number of single studies include promotion of hand hygiene, enhanced cleaning measures, social distancing, and cohorting. Technological platforms and tools (e.g., digital contact tracing, apps, heat maps) are being developed and show potential for decreased transmission through efficient case and/or contact identification that further informs infection control planning strategies. (Edited publisher abstract)
Risk factors related to the admission of people with dementia into a long-term care institution in Spain: an explorative study
- Authors:
- RISCO Ester, et al
- Journal article citation:
- Ageing and Society, 38(1), 2018, pp.192-211.
- Publisher:
- Cambridge University Press
Risk factors associated with admission of people with dementia to long-term care institutions need to be identified to support health-care professionals in dementia care at home. An explorative study, combining quantitative and qualitative data collection methods, was performed in people with dementia in Spain. The sample, consisting of people with dementia receiving formal care from health-care professionals but at risk of institutionalisation, and their informal care-givers; and people with dementia recently admitted to a long-term care institution, and their informal care-givers, was interviewed between November 2010 and April 2012. Perceived reasons for admission were determined through an open-ended question put to both groups. Presumed risk factors were collected with validated questionnaires and analysed using bivariate analysis. A total of 287 people with dementia and informal care-givers were studied. Reasons given by the institutionalised group were mostly related to the level of dependency of the person with dementia. People recently admitted to a long-term care institution had more cognitive impairment, a greater degree of dependency and poorer quality of life than those still living at home. Home-care services in Spain need to develop or improve interventions based on the risk factors identified in this study: informal care-giver profile, high cognitive impairment, high level of dependency and the poor quality of life of the person with dementia. (Publisher abstract)
Predicting discharge to institutional long-term care following acute hospitalisation: a systematic review and meta-analysis
- Authors:
- HARRISON Jennifer Kirsty, et al
- Journal article citation:
- Age and Ageing, 46(4), 2017, pp.547-558.
- Publisher:
- Oxford University Press
Background: Moving into long-term institutional care is a significant life event for any individual. Predictors of institutional care admission from community-dwellers and people with dementia have been described, but those from the acute hospital setting have not been systematically reviewed. Our aim was to establish predictive factors for discharge to institutional care following acute hospitalisation. Methods: The authors conducted a systematic review (PROSPERO: CRD42015023497) searching the databases MEDLINE; EMBASE and CINAHL Plus in September 2015. The review included observational studies of patients admitted directly to long-term institutional care following acute hospitalisation where factors associated with institutionalisation were reported. Results: From 9,176 records, 23 studies (n = 354,985 participants) were included. Studies were heterogeneous, with the proportions discharged to a care home 3–77% (median 15%). Eleven studies (n = 12,642), of moderate to low quality, were included in the quantitative synthesis. The need for institutional long-term care was associated with age, female sex, dementia and functional dependency. Conclusions: Discharge to long-term institutional care following acute hospitalisation is common, but current data do not allow prediction of who will make this transition. Potentially important predictors evaluated in community cohorts have not been examined in hospitalised cohorts. Understanding these predictors could help identify individuals at risk early in their admission, and support them in this transition or potentially intervene to reduce their risk. (Edited publisher abstract)
Predictors of long-term care placement in persons with dementia: a systematic review and meta-analysis
- Authors:
- CEPOIU-MARTIN Monica, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(11), 2016, pp.1151-1171.
- Publisher:
- Wiley
Objective: This review summarises the effects of various individual, caregiver, and system-related factors on the risk of long-term care (LTC) placement for persons with dementia. Methods: Searches were carried out on electronic databases for longitudinal studies reporting on predictors of LTC placement for persons with dementia residing in the community or supportive care settings. Researchers carried out meta-analyses with hazard ratios (HRs) of various predictors using random effects models and stratified the HRs with several study variables. Data on predictors not included in the meta-analyses were summarised descriptively. Results: Full-text reviews of 360 papers were performed with data from 37 papers used to calculate pooled HRs for LTC placement of select person with dementia (age, sex, race, marital status, type of dementia, living arrangement, and relationship to caregiver) and caregiver (age, sex, and depressive symptoms) characteristics. White race, greater dementia severity, and older age increased the risk of LTC placement. Married persons with dementia and living with their caregiver had a lower risk. Behavioural and psychological symptoms of dementia, the degree of functional impairment, and caregiver burden had a consistent effect on the risk of LTC placement in the descriptive review. Conclusion: The authors quantified the predictive effect of several risk factors for LTC placement. These estimates could be used to more precisely categorise the risk of institutionalisation and potentially link those at higher risk to appropriate services. (Edited publisher abstract)
Understanding contextual factors in falls in long-term care facilities
- Authors:
- SIXSMITH Andrew, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 14(3), 2013, pp.160-166.
- Publisher:
- Emerald
Purpose – Despite the growing area of research involving falls in the residential care setting, the link between contextual and environmental factors in falls is poorly understood. This paper aims to draw upon existing research being undertaken in long-term care (LTC) in Metro Vancouver, Canada, with a particular focus on identifying contextual factors contributing to fall events. Design/methodology/approach – This paper presents the results of a qualitative observational analysis of video-captured data collected through a network of high-quality video systems in two LTC facilities. The research comprised workshops involving experienced researchers who reviewed six video sequences of fall events. The outcome of the workshops was a written narrative summarising the discussion and researchers’ interpretation of fall sequences. Findings – The analysis indicates that there are a broad range of environmental, behavioral and situational factors that contribute to falls in LTC. This suggests that a limited conceptualisation of a fall as an outcome of the person's impairment and environmental hazards fails to convey the complexity of potential contributory factors typical of most fall incidents. Research limitations/implications – Broadening our understanding of falls provides the potential to make recommendations for falls prevention practice across multiple levels, including the individual, social and organisational context. Originality/value – The paper evaluates the potential of video-based data in fall analysis and points to the development of a case study approach to analysing fall incidents to capture the complex nature of contributory factors beyond research that focuses solely on intrinsic and extrinsic risk factors. (Publisher abstract)
Suicidal ideation and its correlates among elderly in residential care homes
- Authors:
- MALFENT Daniela, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(8), August 2010, pp.843-849.
- Publisher:
- Wiley
Studies have shown that the highest suicide rates are found among the elderly, with suicidal ideation prevalent in long-term care facilities. Despite these facts most residents show no signs of suicidal ideation. However, there is a lack of information on which factors protect against suicidal thoughts among the elderly. This study aimed to assess the prevalence and correlates of suicidal ideation with risk and protective factors among older residential care home residents in Vienna. Participants included 129 residents, aged 60 and older, from 15 Viennese residential care homes, who completed a self-report questionnaire containing socio-demographic factors, physical health, mental health, and protective factors like self-efficacy, and internal locus of control as well as satisfaction with life. They were also asked about active and passive suicidal thoughts. Results indicated active suicidal ideation during the last month in 7% of the elderly, 11% reported active suicidal ideation during the past year. Depressive symptoms and current psychotherapeutic treatment were important predictors. In conclusion, the authors suggest that research and prevention strategies could not only target risk, but also include protective factors.