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Old age in a new age: the promise of transformative nursing homes
- Author:
- BAKER Beth
- Publisher:
- Vanderbilt University Press
- Publication year:
- 2007
- Pagination:
- 248p.
- Place of publication:
- Nashville, TN
For this book, the author visited more than two dozen nursing homes across the United States and interviewed residents, caregivers, administrators, advocates and gerontological experts. Her visits include those associated with the Eden Alternative, Green House, Kendal, and the Pioneer Network. She concludes that there are profound changes going on. Nursing homes do not have to be institutionalised places, unhealthy for residents and staff alike. They can be extraordinary places where people live in dignity and greet the day with contentment, assisted by employees who feel valued and appreciated. Common threads running through the successful transformative models she visited are strong leadership, environments that encourage interpersonal relationships, and commitment to creating a real home for residents. Perhaps most surprising, these homes prove that a high quality of life does not have to cost more. Some of the best homes in the nation serve primarily low-income people who are on Medicaid. Although each home is different, they share common values: respecting individual choices; empowering staff; fostering a strong community of elders, staff, family members, and volunteers; redesigning buildings from a hospital model to a home (where pets and children are part of everyday life); and honouring people when they die.
Evaluation of subscription-based culture change models in care settings: findings from a systematic review
- Authors:
- PETRIWSKYJ Andrea, et al
- Journal article citation:
- Gerontologist, 56(4), 2016, pp.e46-e62.
- Publisher:
- Oxford University Press
Purpose of the study: Person-centred culture change models to which aged care service providers subscribe are gaining increasing traction. It has been suggested that culture change initiatives broadly are subject to a range of issues. It is difficult, however, to draw out from the existing literature specific information about the scope and quality of evidence regarding subscription-based approaches. The purpose of this study was to identify and review the peer-reviewed literature regarding these subscription-based models. Design and methods: The review used the Joanna Briggs Institute process and tools. Studies reporting on subscription-based person-centred culture change models in health and aged care, published in peer-reviewed literature in English up to and including 2015 were identified and assessed. In all, 28 articles reporting on 33 studies were included in the review. Results: There was no single model for which a significant body of evidence was identified, and approaches to outcomes were fragmented. Research approaches varied. Rigor and reporting were of concern; however, strengths of the evidence base included generally adequate sample sizes and the use of multiple methods including large data sets and standardised scales. Implications: Despite their structured approaches, research and evaluation for subscription-based models are limited, ad hoc, and fragmented. A more comprehensive programme of research that is embedded in the implementation process is needed. Recommendations include use of longitudinal study designs, attention to implementation and contextual factors, and measurement of both process and outcomes across the full range of culture change domains. (Edited publisher abstract)
The influence of organizational factors on the attitudes of residential care staff toward the sexuality of residents with dementia
- Authors:
- ROELOFS Tineke S. M., et al
- Journal article citation:
- BMC Geriatrics, 19(8), 2019, Online only
- Publisher:
- BioMed Central Ltd
Background: The attitudes of care staff toward the sexuality of residents with dementia they care for is assumed to influence the residents’ expression of their sexuality in the way they want. This paper examines the effect of organisational factors, person-cantered care, and the culture of the organisation on the attitudes of care staff toward the sexuality of residents with dementia in residential care facilities (RCF). Methods: Care staff in different functions at six RCF organisations (N = 187) participated. Using a survey, information were gathered on demographics and care-staff careers, attitudes toward resident sexuality, the culture of the organisation, person-cantered care, and knowledge of resident sexuality. Ordinary least square (OLS) hierarchical analyses were performed to analyse results. Results: Care staff attitudes were found to be positively affected by person-cantered care, and marginally positively affected by a supportive culture in the organisation, Moreover, knowledge of resident sexuality positively affected care staff ‘attitudes toward resident sexuality, and the presence of policy regarding resident sexuality affected them negatively. Conclusions: Despite different study limitations, these results give a first insight in a broad perspective on care staff attitudes toward resident sexuality. In addition to improving knowledge of the care staff, enhancing person-centred care and a supportive culture in the organisation will improve care-staff attitudes toward resident sexuality. (Edited publisher abstract)
Feasibility of LifeFul, a relationship and reablement-focused culture change program in residential aged care
- Authors:
- LOW Lee-Fay, et al
- Journal article citation:
- BMC Geriatrics, 18(129), 2018, Online only
- Publisher:
- BioMed Central Ltd
Background: The protective, custodial, task-oriented care provided in residential aged care facilitates decreases health and wellbeing of residents. The aim of the study was to conduct a feasibility study of LifeFul – a 12 month reablement program in residential aged care. Methods: LifeFul was developed based on systematic reviews of reablement and staff behaviour change in residential aged care, and in consultation with aged care providers, consumers and clinicians. LifeFul includes: engaging and supporting facility leaders to facilitate organisational change, procedural changes including dedicated rostering, assigning each resident a ‘focus’ carer and focusing on the psychosocial care of residents part of handovers and staff training. The study was conducted in three Australian residential aged care facilities. A pre-post mixed methods design was used to evaluate recruitment and retention, fidelity and adherence, acceptability, enablers and barriers and suitability of outcome measures for the program. Results: Eighty of 146 residents agreed to participate at baseline and 69 of these were followed up at 12 months. One hundred and four of 157 staff participated at baseline and 85 of 123 who were still working at the facilities participated at 12 months. Staff perceived the program to be acceptable, barriers included having insufficient time, having insufficient staff, negative attitudes, misunderstanding new procedures, and lack of sufficient leadership support. Quantitative data were promising in regards to residents’ depression symptoms, functioning and social care related quality of life. Conclusion: It is feasible to deliver and evaluate LifeFul. The program could be improved through increased leadership training and support, and by focusing efforts on residents having a ‘best week’ rather than on completing a document each handover. (Edited publisher abstract)
How being appreciative creates change: theory in practice from health and social care in Scotland
- Authors:
- SHARP Cathy, et al
- Publication year:
- 2016
- Pagination:
- 45
This paper develops understanding of appreciative action research that generates curiosity and motivation as a better platform for collaborative change. Blending theory and practice it draws on the example of the My Home Life leadership programme in Scotland that explores the concepts and approaches of 'Caring Conversations' and 'playful provocation' in care homes for older people. The paper shows how they expand notions of appreciation and help people to deepen inquiry, explore values, acknowledge and express emotion without dispute or judgement, articulate tacit knowledge and give voice to things previously thought to be 'unsayable'. The authors explore how these generative approaches act as a powerful positive ‘disruption’ that brings existing relationships to life, supports a positive attitude to risk-taking and helps to devise new approaches to the local design and testing of approaches to problems. Ultimately these approaches play an important part in developing understanding of how to do appreciative action research to enhance relationships and more strengths or assets-based and collaborative ways of working and so, to develop new possibilities for changing social systems and a more future-making orientation to action research. The paper is the text of an article submitted to the Action Research Journal. (Edited publisher abstract)
Models of change for care homes
- Author:
- LACY Pamela
- Publisher:
- Thomas Pocklington Trust
- Publication year:
- 2015
- Pagination:
- 8
- Place of publication:
- London
Drawing on the findings of a study carried out by Skills for Care, this paper aims to stimulate discussion about how care homes may support people with sight loss and suggest areas for further research and development. The study used a rapid evidence assessment (REA) and qualitative work with five care homes to identify models of change and their impact on the quality of care homes. The REA identified seven models which care homes could adopt to change culture and service delivery. Each model has links to the prevailing policy of person-centred care, along with choice, flexibility and quality improvements. The research also identified seven key characteristics in care homes that were important for supporting change, including the need for strong leadership and the participation from staff and residents. While the evidence of the impact of change, either positive or negative, was limited, some formal evaluations indicated positive outcomes for residents’ physical and mental health, as well as improvements in staff satisfaction. The paper ends with discussion points for care home owners and managers to encourage them to make appropriate changes. (Edited publisher abstract)
What makes a real difference to resident experience? Digging deep into care home culture: the CHOICE (Care Home Organisations Implementing Cultures of Excellence) research report
- Authors:
- KILLETT Anne, et al
- Publisher:
- Prevention of Abuse and Neglect in the Institutional Care of Older Adults
- Publication year:
- 2013
- Pagination:
- 174
- Place of publication:
- London
This is the report of the Care Homes Organisation Implementing Cultures of Excellence (CHOICE) project to examine the relationship between good and poor care experiences in care homes, particularly of residents with high levels of complex needs, and the organisational culture of the care homes. This report identifies key elements of care which are relevant for care home organisational culture in providing high quality care. The research used a comparative case study design combining structured observation using the PIECEdem tool and ethnographic case study research. A linked series of 11 case studies of care home settings were carried out across the United Kingdom. Data was collected from a purposive sample of homes varying in terms of their characteristics as types of provider, ‘locale’ and resident population’, which included 6 homes in England, 3 homes in Scotland and 2 in Wales. The findings highlight the key elements that are associated with positive care experience, including shared purpose in providing the best person-centred care; a sense of community between all involved in the care home; managers ensuring external pressures do not have a negative impact on care delivery; staff empowered to take responsibility for resident well-being by active management processes; openness to change for the benefit of residents; using the care home environment to the benefit of residents; person-centred activity and engagement as integral to care work. (Edited publisher abstract)
Improving hospital care for older people: a call for action: key messages for commissioners and NHS hospital providers
- Author:
- ROYAL COLLEGE OF NURSING
- Publisher:
- Royal College of Nursing
- Publication year:
- 2012
- Pagination:
- 6p.
- Place of publication:
- London
The Improving Hospital Care for Older People summit event was held in October 2012. It brought together invited delegates from royal colleges, charities, think tanks and practitioners with an interest in the care of older people in hospital, to discuss key issues and concerns, to identify good practice and latest thinking, and to form consensus on key action areas. It identified 7 main themes as being necessary to support improvement in hospital care for older people: person-centred care; dignity and compassion, training and competence, staffing levels, safeguarding, resources, and culture and structure. This paper calls on commissioners and hospital providers to demonstrate that they are addressing the 3 priority areas selected from the main themes: training and competence of staff, culture and structure within hospitals, and person-centred care. It also invites evidence about good practice examples. It includes a list of participants attending the summit, and links to reports and resources promoting good practice in the care of older people in hospital.
Leadership from the bottom up: reinventing dementia care in residential and nursing home settings
- Authors:
- CHALFONT Garuth, HAFFORD-LETCHFIELD Trish
- Journal article citation:
- Social Work and Social Sciences Review, 14(2), 2010, pp.37-54.
- Publisher:
- Whiting and Birch
The quality of dementia care in residential and nursing homes has been a cause for concern and the subject of a number of policy initiatives. This paper discusses the potential for different styles of leadership in developing a suitable organisational culture in which quality dementia care might develop and thrive. In-depth individual interviews of 4 residential home managers sought to explore their perspectives on what constitutes effective leadership within institutional residential care settings. Drawing on the findings of these interviews, the article argues that alongside strategic imperatives coming from the UK National Dementia Strategy (DH, 2009), there is a corresponding need for more 'bottom-up' approaches within dementia care settings themselves through the empowerment of staff. It argues that this would enable more participatory approaches to organisational development. The paper specifically discusses the concepts of both 'climate' and 'culture' in institutional care for older people and how these features can be enhanced to support a more person-centred approach. Particular emphasis is given to the significance of leading a culture of staff learning.
Doing it well: seven steps to dignity and compassion in caring for older people. Guidance for those who care
- Author:
- WARING Amanda
- Publisher:
- Beth Johnson Foundation
- Publication year:
- 2018
- Pagination:
- 52
- Place of publication:
- Stoke-on-Trent
This resource explores how older people living in care homes can be better looked after, taking account of their individuality, what they think and want, and their feelings. It focuses on helping those who are directly responsible for the care of older people to do their job as well as possible. Emphasis is on a person-centred approach that highlights dignity, compassion and respect. The resource covers seven steps that can help improve the quality of care for older people. Each step introduces topics that can be expanded upon within your own care setting. The steps cover: dignity awareness; recognising ageism; understanding dementia; addressing stress and burnout; growing a meaningful activity and relationships; and spiritual and emotional care. For each of the seven steps, the guide includes discussion points, issues to consider, and exercises. The guidance can best be used as part of a blended approach to learning in the workplace, supported by coaching, supervision and mentoring. It can be used by groups of staff or individuals who can take themselves through some of the exercises as an aid to learning. It will be relevant for health care and social services professionals, managers, nursing staff and care workers, whether working in care homes and hospices or in private domiciliary care. (Edited publisher abstract)