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Challenges faced by residential aged care staff in decision-making for residents with dementia
- Authors:
- CAMERON Nadine, FETHERSTONHAUGH Deirdre, BAUER Michael
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 20(4), 2021, pp.1270-1283.
- Publisher:
- Sage
Care staff in residential aged care facilities (nursing homes) in Australia are obligated, under the Australian National Framework for Action on Dementia 2015–2019, to support residents to exercise choice and make decisions. Research indicates, however, that care staff are often given little guidance regarding which residents’ decisions should be supported or how to make decisions on their behalf. This lack of guidance can result in a denial of residents’ rights and inconsistent treatment by staff, placing residents’ wellbeing at risk. Through providing an analysis of the responses of staff at RACFs in Victoria and Queensland to two case scenarios, this study seeks to provide some understanding of the difficulties staff face in supporting residents’ self-determination and their own need for greater organisational support. (Edited publisher abstract)
A critical review of research on hospitalization from nursing homes; what is missing?
- Authors:
- AGOTNES Gudmund, et al
- Journal article citation:
- Ageing International, 41(1), 2016, pp.3-16.
- Publisher:
- Springer
- Place of publication:
- New York
In this paper the authors seek to summarise research literature on hospitalisation from nursing homes, to identify shared themes, findings and approaches, and to analyse strengths and weaknesses of the literature. The main aim of the article is to critically review current research on the topic of hospitalisation from nursing homes, based on a variety of original research articles and literature overviews. First, the authors examine why studies of hospitalisation from nursing homes are considered to be important in the literature, focusing on what is described as large variation in rates of hospitalisation between institutions and geographical areas as well as the occurrence of unwanted and avoidable hospitalisations. Second, the authors present studies on reasons for rates of hospitalisations of nursing home patients based on patient characteristics. Third, studies that have focused on institutional characteristics that may explain rates of hospitalisations are presented. Fourth, the authors examine factors and conditions highlighted in parts of the literature on hospitalisation, more closely than others connected to practice and decision making. Finally, some of the weaknesses of these hospitalisation studies are discussed and areas for future research studies are discussed. (Edited publisher abstract)
Unfinished care in residential aged care facilities: an integrative review
- Authors:
- LUDLOW Kristiana, et al
- Journal article citation:
- Gerontologist, 61(3), 2021, pp.e61-e74.
- Publisher:
- Oxford University Press
Background and Objectives: When workload demands are greater than available time and resources, staff members must prioritize care by degree of importance and urgency. Care tasks assigned a lower priority may be missed, rationed, or delayed; collectively referred to as “unfinished care.” Residential aged care facilities (RACFs) are susceptible to unfinished care due to consumers’ complex needs, workforce composition, and constraints placed on resource availability. The objectives of this integrative review were to investigate the current state of knowledge of unfinished care in RACFs and to identify knowledge gaps. Research Design and Methods: We conducted a search of academic databases and included English-language, peer-reviewed, empirical journal articles that discussed unfinished care in RACFs. Data were synthesized using mind mapping techniques and frequency counts, resulting in two categorization frameworks. Results: We identified 17 core studies and 27 informing studies (n = 44). Across core studies, 32 types of unfinished care were organized under five categories: personal care, mobility, person-centeredness, medical and health care, and general care processes. We classified 50 factors associated with unfinished care under seven categories: staff member characteristics, staff member well-being, resident characteristics, interactions, resources, the work environment, and delivery of care activities. Discussion and Implications: This review signifies that unfinished care in RACFs is a diverse concept in terms of types of unfinished care, associated factors, and terminology. Our findings suggest that policymakers and providers could reduce unfinished care by focusing on modifiable factors such as staffing levels. Four key knowledge gaps were identified to direct future research. (Edited publisher abstract)
Advance care planning with residents in nursing homes in Singapore
- Authors:
- WEE Ng Tzer, WENG Suew Chee, HUAT Laurence Lim Eng
- Journal article citation:
- Asia Pacific Journal of Social Work and Development, 21(1), June 2011, pp.97-104.
- Publisher:
- Taylor and Francis
Project CARE is a pilot project which aims to promote advance care planning and to improve end-of-life care in 7 nursing homes managed by voluntary welfare organisations. Advance care planning refers to the process of discussion about future healthcare between an individual, their loved ones, and their care providers. The aim is to enable a person to make clear their wishes with regards to future treatment and care. This article provides preliminary observations from this project relating to the implementation of advance care planning and its challenges. Selected staff from the nursing homes received training to apply the Respecting Choices advance care planning framework. Since the implementation of Project CARE in September 2009, there have been approximately 400 advance care planning discussions held with residents and their family members. These discussions included exploring the preferred place of care at the end of life. The paper illustrates the range of challenges faced in these discussions. It also presents the roles of social workers in advance care planning, and concludes with factors that contribute to effective advance care planning facilitation.
Nursing homes and assisted living facilities: planning and decision making for sheltering in place or evacuation
- Authors:
- HYER Kathryn, POLIVKA-WEST LuMarie
- Journal article citation:
- Generations, 31(4), Winter 2007, pp.29-33.
- Publisher:
- American Society on Aging
This article addresses the challenges facing those in charge of long-term care facilities as they decide whether "to stay or go" - evaluating risk to residents from potential evacuation, weighing storm path and intensity projections, and reviewing their emergency preparedness plans. It draws on experiences in the United States.
Participation and knowledge related to a nursing home admission decision among a working age population
- Authors:
- MILLER Nancy, WEINSTEIN Marcie
- Journal article citation:
- Social Science and Medicine, 2(64), January 2007, pp.303-313.
- Publisher:
- Elsevier
The number of nursing home admissions for working age people (age 18–64) in the USA has increased. Minimal attention has been given to examining their participation in the admission decision. A conceptual framework proposed by Ong and colleagues was used to examine patient and provider predictors of perceived involvement in the admission decision and their relationship to both knowledge and preferences for continued care. In-person interviews were conducted with an admissions cohort of 205 working age individuals in 17 Maryland, USA nursing homes. Similar to previous profiles, participants were predominately male, of minority ethnic status, and of lower socioeconomic status. Common clinical conditions included cardiac disease (49.8%) and diabetes (27.3%). Slightly over half reported a lot (42.1%) or a moderate (15.2%) level of involvement in the admission decision, while 27.9% reported no involvement. Patient race, insurance source and knowledge of the health care decision maker were related to perceived involvement. Minority ethnic group patients were less likely to be aware of alternate settings for care, while patients who knew the medical decision maker were more aware of alternate settings, as well as their expected length of stay. Participants who perceived greater involvement in the decision more often preferred continued care in the nursing home, relative to their own home or other settings. Ethical, practical and legal concerns support involving individuals in this health care decision. Ways to foster improved communication and interpersonal relationships between patients and their health care provider(s) are thus required.
Choosing an adult foster home or a nursing home: residents' perceptions about decision making and control
- Authors:
- REINARDY James, KANE Rosalie A.
- Journal article citation:
- Social Work: A journal of the National Association of Social Workers (NASW), 44(6), November 1999, pp.571-585.
- Publisher:
- Oxford University Press
Nursing home residents in the USA were interviewed about the nature and circumstances surrounding their decision to move to a foster care or nursing home, including the alternatives they considered, the circumstances leading to the move, their perception of the decision-making process and who influenced it, the characteristics important to them in choosing the care environment, and their perception of their own control over the move.
A fit person to run a home: registered homes tribunal interpretations of the 'fit person' concept in the United Kingdom
- Author:
- BRAMMER Alison
- Journal article citation:
- Journal of Elder Abuse and Neglect, 10(1/2), 1999, pp.119-131.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The abuse of people living in residential care in the UK is well documented. A small but significant amount of hard evidence of abuse exists in the reports of the Registered Homes Tribunal decisions. This body has the jurisdiction to hear appeals concerning the running of registered and nursing homes in the UK. Many of the cases which concern the tribunal focus on whether a given individual is a 'fit person' to run a home. It is the aim of this article to consider and reflect on the tribunals' interpretation of that term, in relation to the operation and decisions of the tribunal.
Settling in and moving on: transience and older people in care homes
- Authors:
- REED Jan, PAYTON Valerie Roskell, BOND Senga
- Journal article citation:
- Social Policy and Administration, 32(2), June 1998, pp.151-165.
- Publisher:
- Wiley
Examines the experiences of older people who moved into nursing and residential care homes, interviewing them at four points, from before the move to up to six months afterwards. A key finding was that older people were actively involved in the process of settling into homes and forming new friendships. Participant data also indicated that these older people had often experienced many moves in recent years, as their need for care had changed, and following them through after their inclusion in the study indicated that, for some, there were more moves to come. These data place the debates about assessment, and the identified problem of 'misplacement' in a different light.
The relationship of demographic factors, locus of control and self-efficacy to successful nursing home adjustment
- Authors:
- JOHNSON Brian D., et al
- Journal article citation:
- Gerontologist, 38(2), April 1998, pp.209-216.
- Publisher:
- Oxford University Press
Presents the findings of one study investigating demographic and psychological predictors of older adults' successful adjustment to a nursing home. Predictors included demographic variables, locus of control, and self-efficacy beliefs. Successful adjustment was defined by activity level and by positive and negative affect. Findings suggest that demographic variables were not effective predictors of successful adjustment. Perceived self-efficacy accounted for more of the unique variance in adjustment than locus of control. Results are discussed in the context of improving resident adjustment to nursing home environments.