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Enriching opportunities for people living with dementia: the development of a blueprint for a sustainable activity-based model
- Authors:
- BROOKER Dawn J., WOOLEY Rosemary J.
- Journal article citation:
- Aging and Mental Health, 11(4), July 2007, pp.371-383.
- Publisher:
- Taylor and Francis
The aim of this paper is to describe the process of building a multi-level intervention called the Enriched Opportunities Programme, the objective of which is to provide a sustainable activity-based model for people with dementia living in long-term care. It is hypothesised that five key elements need to work together to bring about a sustainable activity-based model of care. These elements are specialist expertise-the staff role of Locksmith was developed as part of this programme; individualised assessment and case work; an activity and occupation programme; staff training; and management and leadership. These elements working together are known as the Enriched Opportunities Programme. This paper reports on the processes undertaken to develop Enriched Opportunities from its inception to the present, and focuses on lessons learnt from the literature, an expert working group and action research in four UK study sites. A blueprint for evaluation in other long-term care facilities is described.
Creating cultures of care: exploring the social organization of care delivery in long-term care homes
- Authors:
- CASPAR Sienna, et al
- Journal article citation:
- Journal of Long-Term Care, January 2020, pp.13-29. Online only
- Publisher:
- King's College London
- Place of publication:
- London
Context: As a result of changing demographics, the number of older adults living in long-term care homes (LTCHs) is expected to rise dramatically. Thus, there is a pressing need for better understanding of how the social organisation of care may facilitate or hinder the quality of work-life and care in LTCHs. Objectives: This study explored how the social organisation of work influences the quality of work-life and care delivery in LTCHs. Method: Institutional ethnography followed by theory building provided the conceptual underpinnings of the methodological approaches. Participants included 42 care team members who were employed by one of three participating LTCHs. Data were derived from 104 hours of participant observation and 42 interviews. Findings: The resident care aides (RCAs) were found to rely on supportive work-teams to accomplish their work successfully and safely. Reciprocity emerged as a key feature of supportive work-teams. Management practices that demonstrated respect (e.g., inclusion in residents’ admission processes), recognition, and responsiveness to the RCAs’ concerns facilitated reciprocity among the RCAs. Such reciprocity strengthened their resilience in their day-to-day work as they coped with common work-place adversities (e.g., scarce resources and grief when residents died), and was essential in shaping the quality of their work-life and provision of care. Discussion: The empowerment pyramid for person-centred care model proposes that the presence of empowered, responsive leaders exerts a significant influence on the cultivation of organisational trust and reciprocating care teams. Positive work-place relationships enable greater resilience amongst members of the care team and enhances the RCAs’ quality of work-life, which in turn influences the quality of care they provide. Limitations: Whether there were differences in the experiences, opinions, and behaviour of the people who agreed to participate and those who declined to take part could not be ascertained. Further research is required to determine and understand all of the factors that support or inhibit the development of empowered leaders in LTCHs. Implications: Cultures of caring, reciprocity and trust are created when leaders in the sector have the support and capacity to lead responsively and in ways that acknowledge and respect the contributions of all members of the team caring for some of the most vulnerable people. (Edited publisher abstract)
Paradoxes in the care of older people in the community: walking a tightrope
- Authors:
- JANSSEN Bienke, ABMA Tineke A., van REGENMORTEL Tine
- Journal article citation:
- Ethics and Social Welfare, 8(1), 2014, pp.39-56.
- Publisher:
- Taylor and Francis
- Place of publication:
- Abingdon
The expansion of the older population suggests that there will be significant numbers in need of care and support in their own home environment. Yet, little is known about the kind of situations professionals are faced with and how they intervene in the living environment of older people. Qualitative data were collected over a period of 1.5 years from a multi-disciplinary community-based geriatric team in the Netherlands, and participant observations carried out. Forty-two cases discussed within the team meetings were analysed. Results demonstrate that providing care to older people is a dynamic process and revolves around various paradoxes as experienced by professionals. This is illustrated by presenting three paradoxes that emerged within the data: respecting autonomy versus preserving safety; the care needs of the care recipients versus the capacity of their informal carers to cope; and holding a formal orientation versus a tailored orientation on tasks. Providing care in the home environment of older people requires from professionals a continuous anticipation of (un)expected evolutions in situations of their care recipients. In order to optimally support older people professionals need ‘professional discretion’. They must be supported to systematically reflect on and legitimize their intervention strategies. (Publisher abstract)
Evidence of empowerment in resident council groups: an examination of two leadership models in assisted living
- Authors:
- BONIFAS Robin P., HEDGPETH Jay, KRAMER Christie
- Journal article citation:
- Journal of Gerontological Social Work, 56(4), 2013, pp.281-298.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Individuals living in long-term care facilities and the professionals working with them are seeking methods to enhance resident choice and self-direction in personal care and internal community planning. This article presents findings from a study examining the incidence of empowerment opportunities in two resident council groups in assisted living facilities in the southwestern United States; one group used a resident leadership model and the other used an administrative leadership model by residents' choice. Results indicate that even with health and mental health challenges, residents were able to exercise choice in complicated situations under both leadership models, suggesting that resident council groups are a beneficial empowerment strategy. (Edited publisher abstract)
Consumer direction in long-term care policy: overcoming barriers to promoting older adults' opportunity for self-direction
- Author:
- RUGGIANO Nicole
- Journal article citation:
- Journal of Gerontological Social Work, 55(2), February 2012, pp.146-159.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Long term care policy in the US is undergoing something of a culture change as consumer-direction comes to the fore. Under such a system responsibility for managing care and support services is transferred from agencies to care recipients, thus supporting clients' self-determination. The idea of CD appears to have been accepted as an option for younger individuals with disabilities but barriers persist to promoting older adults' autonomy through CD. This article reviews the incorporation of CD in long-term care policy, addresses the current barriers to providing older adults the right to self-direct, and makes recommendations for overcoming these barriers through social work practice, policy, and research. The barriers discovered include; resistance to self-direction, limited support to facilitate consumer voice and choice in family decision making, and a lack of advocacy for CD by older adults. The author suggests that social workers may have a key role to play in promoting older adults’ autonomy by refocusing their efforts towards consumer–centred practice that emphasises empowerment and self-advocacy for older adults with disabilities.
Leading culture change in long-term care: a map for the road ahead
- Author:
- RONCH Judah L.
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(1/2), 2003, pp.65-79.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Leaders of culture change in long-term care should have a plan to guide the entire process before they begin. This optimizes the human and financial resources devoted to ongoing culture change programmes and prevents the serious mistakes that are usually visual with hindsight. An eight stage process for creating major change is presented as a basis of mapping culture change programmes in long-term care that aspire to be humanistic in nature and involve all stakeholder groups in ongoing, empowering activity.
Social work practice clinical programmatic and training dimensions
- Author:
- COX Enid Opal
- Journal article citation:
- Journal of Social Work in Long-Term Care, 1(2), 2002, pp.27-46.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Empowerment-oriented social a work practice seeks to engage participants in the process of increasing their knowledge and skills relative to their efforts to meet their own needs and those of other. The form of intervention focuses on personal, interpersonal, organizational and larger political economic a aspects of the issues faced by participants. This article outlines the theory and practice strategies of empowerment-oriented practice as a method of intervention with elders who require long-term care. Special content and strategies are suggested. Emphasis is on knowledge generated by the target population, as well as, knowledge generated through professional research and training. The role of social workers in these interventions and the special challenges facing empowerment-oriented practice with this population are also addressed.
Analysis of key decision-making incidents in the life of a nursing home resident
- Authors:
- SHAWLER Celeste, ROWLES Graham D., HIGH Dallas M.
- Journal article citation:
- Gerontologist, 41(5), October 2001, pp.612-622.
- Publisher:
- Oxford University Press
This American study examined change in the decision-making autonomy of a single nursing facility resident. This case analysis was part of a larger 3-year ethnographic investigation of decision-making events in four nursing facilities. In this case analysis, the resident, her daughter, and three staff members closely associated with the resident's care were each interviewed five times over a 15-month period. Analysis of interview transcripts revealed four themes in decision making. Temporal change was evident in a complex scenario regarding room changes. Spatial context reflected the need for predictability and adaptability in decisions using space. Interdependence of decisions and decision makers was most evident with medical treatment and health care decisions. Awareness, being informed, and knowing what was going on was the final theme. Despite having the best interests of the resident in mind, the process of decision making in nursing facilities may contribute to a pattern of gradual withdrawal of decisional autonomy form residents regardless of their ability to make decisions.
Standards bearers?
- Author:
- HUDSON Bob
- Journal article citation:
- Community Care, 20.9.01, 2001, pp.24-25.
- Publisher:
- Reed Business Information
Labour has upheld the principles underlying John Major's citizen charter and applied them to long term care. However their application varies widely across the UK as this article reports.
Personal care planning in long term social care of older people: empowering service users
- Authors:
- MALLINSON Ian, McLEAN Susan
- Publisher:
- Social Care Association
- Publication year:
- 2000
- Pagination:
- 107p.,bibliog.
- Place of publication:
- Surbiton
This book has a practical focus which is providing a series of practical tools that can be used to put personal care plans into action. This will help all staff to achieve an informed vision of a new style of personal care planning which empowers service users. It will assist them in making their own needs known, and help staff and service users to make decisions about how those needs may be met. It will assist staff, together with service users, to achieve decisions. The book includes a number of checklists to enable these needs to be met. Care staff with their colleagues and managers can use these checklists to evaluate the ways that they work, and the way that systems for personal care planning operate.