The impact of health-related supports in senior housing on ambulance transfers and visits to emergency departments: The Right Care, Right Place, Right Time Project.

OBJECTIVE: To test the impact of placing a wellness team (nurse and social worker) in senior housing on ambulance transfers and visits to emergency departments over 18 months. DATA SOURCES/STUDY SETTING: Intervention sites included seven Boston-area buildings, with five buildings at comparable settings acting as controls. Data derive from building-level ambulance data from emergency responders; building-level Medicare claims data on emergency department utilization; and individual-level baseline assessment data from participants in the intervention (n = 353) and control (n = 208) sites. STUDY DESIGN: We used a pre/postdifference in difference quasi-experimental design applying several analytic methods. The preintervention period was January 2016-March 2017, while the intervention period was July 2017-December 2018. DATA COLLECTION/EXTRACTION METHODS: Emergency responders provided aggregate transfer data on a daily basis for intervention and control buildings; the Quality Improvement Organization provided quarterly aggregate data on emergency department visit rates; and assessment data came from a modified Vitalize 360 assessment and coaching tool. PRINCIPAL FINDINGS: The study found an 18.2% statistically significant decline in ambulance transfers in intervention buildings, with greater declines in buildings that had fewer services available at baseline, compared to other intervention sites. Analysis of Medicare claims data, adjusted for the proportion of residents over 75 per building, found fewer visits to emergency departments in intervention buildings. CONCLUSIONS: Health-related supports in senior housing sites can be effective in reducing emergency transfers and visits to emergency departments.

Helpful Approaches for Older Adults Living in a Retirement Community to Move Forward After the Death of a Significant Other.

The loss of a significant other often creates emotional distress for family members that can hamper the ability to meet everyday challenges and pursue wellness. The aim of this qualitative study was to understand the challenge of losing a significant other for older adult family members and the approaches identified as most helpful to promote their own well-being after this person dies. Story inquiry method guided the interview process with 15 older adult bereaved family members residing in a continuing care retirement community. Theory-guided content analysis was used for data analysis. Two themes described the challenges: uneasiness that permeates everyday living and precious memories and patterns of disconnect that breed discontent. Appreciating the rhythmic flow of everyday connecting and separating and embracing reality as situated in one's lifelong journey are the themes that encompass the helpful approaches used by participants. This study provided insights about the benefits of living in this community such as social networking and a possible drawback such as the frequency of death among residents. Future research should continue to investigate social service resources that older adults find most helpful after a significant other dies and the use of reminiscence groups as a form of bereavement support.

Supporting Aging-in-Place Well: Findings From a Cluster Analysis of the Reasons for Aging-in-Place and Perceptions of Well-Being.

Prior research on gerontology and housing has frequently adopted a perspective that aging-in-place is the "goal." Despite these meaningful results and policy implications, opportunities to explore consequences of aging-in-place, such as the association of this with overall well-being, have been overlooked. This study aims to fill this gap by investigating perceptions of well-being that could act as a driver or result of aging-in-place. With a nationwide random sample of non-Hispanic White, older individuals (60+), living in their homes (N = 328), three segments of senior residents based on their reasons for aging-in-place were identified. Results reinforce the importance of community-based integrative programs and policies by indicating that the three identified clusters were not homogeneous; however, inclusive community-based supports and services can provide what each cluster needs to successfully age-in-place. Discussion provides a perspective on how to support successful aging-in-place, including the role of the federal government in funding and legislation.

'You have got to stick to your times': Care workers and managers' experiences of working in extra care housing.

Extra care housing (ECH) has been lauded as an innovative model of housing with care for older people that promotes and supports independent living. The study used a qualitative design to explore how care is delivered in four extra care settings in England over 20 months during 2016-2017. This paper reports findings from semi-structured interviews with 20 care workers and seven managers. The article argues that, despite being heralded as a new model, care workers in ECH face similar organisational pressures as those working in more conventional settings and, in turn, the care which they are able to provide to residents mimics traditional forms of care.

The Impact of Cohousing on Older Adults' Quality of Life.

The global population including Canada's is aging, which demands planning for housing that will support older adults' quality of life. This mixed-method study is the first Canadian study to examine the impact of cohousing on older adults' quality of life and involved 23 participants. The older adults rated their quality of life very high, especially in the environmental, physical, and psychological domains of the World Health Organization Quality of Life (WHOQOL_BREF) survey; quality of life in the social domain was rated low, which was surprising in light of the focus group data findings. Four themes of "belonging in a community", "life in the community", "changes associated with aging," and "aging in place" emerged from the qualitative data to explain factors that influence older adults' quality of life. This research provides foundational, strong evidence that seniors' cohousing is an innovative housing solution that can support older adults' quality of life.

Comparing Changes and Transitions of Home Care Clients in Retirement Homes and Private Homes.

Long-stay home care clients mostly reside in private homes or retirement homes, and the type of residence may influence risk factors for long-term care placement. This multi-state analytic study uses RAI-Home Care and administrative data from the Hamilton Niagara Haldimand Brant Local Health Integration Network to model conceptualized states of risk at baseline through a 13-month follow-up period. Modifiable risk factors in these states were client loneliness or depressive symptoms, and caregiver distress. A higher adjusted likelihood of being discharged deceased was found for the lowest-risk clients in retirement homes. Adjusting for client, service, and caregiver characteristics, retirement home residency was associated with higher likelihood of placement in a long-term care home; reduced caregiver distress; and increased client loneliness/depression. As an alternative to private home settings as the location for aging in place among these long-stay home care clients, retirement home residency represents some trade-offs between client and informal caregiver.

Establishing Effective Resident and Family Councils: A Pilot Project to Increase Family and Resident Engagement in Alberta's Continuing Care Sites.

Resident and family councils aim to improve resident and family satisfaction, but guidelines for councils are scarce. This project developed a toolkit and tested its ability, along with networking meetings, to promote successful councils. Nine continuing care sites participated with residents, family and staff from each site who received the toolkit, completed surveys, attended meetings and participated in post-pilot interviews. Participants found that the toolkit helped improve council function and, with the networking meetings, increased participation. All sites found the toolkit and networking meetings to be valuable resources and had a strong desire to have them available in the future.

Psychosocial Factors Associated With Reduced Muscle Mass, Strength, and Function in Residential Care Apartment Complex Residents.

Sarcopenia is a major source of disability in older adults. However, limited data are available about sarcopenia components (i.e., muscle mass, strength, and function) and their relationship to psychosocial factors among older adults living in residential care apartment complexes (RCACs). The current study examined muscle mass, strength, and function and explored their relationship to self-efficacy for exercise, depressive symptoms, and social support in 31 RCAC residents. RCAC residents had lower muscle mass, strength, and function compared to values reported in studies of community-dwelling older adults. Men had higher muscle mass and strength than women. The current findings showed a trend for individuals with high self-efficacy, without depressive symptoms, and with strong social support to present numerically greater muscle mass, strength, and function. Further studies with larger samples are needed to confirm the current study findings and inform development of interventions implemented in RCAC settings. [Res Gerontol Nurs. 2018; 11(5):238-248.].

Pain Treatment Practices of Community-Dwelling Black Older Adults.

Black older adults often experience disparities in pain treatment that results in unmet pain needs. The aims of this study were to assess the pain management experiences of a group of community dwelling Black older adults and identify gaps in clinical practice. A qualitative, descriptive design was employed using the methodology of ethnography. The setting was an urban, low-income, community elderly housing high-rise facility. Participants included facility residents (n = 106); of these, 20 completed structured qualitative interviews. The Brief Pain Inventory and qualitative interviews were used to determine pain prevalence, treatment practices, and barriers. Eighty-six percent of the participants had severe pain with a mean worst pain rating of 7 on a 0 to 10 scale. Pain interfered moderately with general activity (5.59), walking (5.73) and normal work (5.70), also measured on 0 to 10 scales. Participants preferred non-opioid analgesics, topical over-the-counter treatments, and nonpharmacological interventions such as prayer/meditation, and exercise for treatment. Medications most commonly used by participants for pain management included, hydrocodone with acetaminophen (28.6%), nonsteroidal anti-inflammatory drugs (13.2%), acetaminophen with codeine (12%), and tramadol (9.9). Qualitative interviews revealed that pain management barriers were centered around communication concerns about side effects, fears of addiction, and provider mistrust. A communication gap exists between patients and providers. Discussing patient treatment preferences, providing balanced treatment information, and following-up with patients on treatment plan effectiveness by phone can improve how pain is managed for Black older adults.

An in-depth discussion and illustration of partial least squares structural equation modeling in health care.

Partial least squares structural equation modeling (PLS-SEM) has become more popular across many disciplines including health care. However, articles in health care often fail to discuss the choice of PLS-SEM and robustness testing is not undertaken. This article presents the steps to be followed in a thorough PLS-SEM analysis, and includes a conceptual comparison of PLS-SEM with the more traditional covariance-based structural equation modeling (CB-SEM) to enable health care researchers and policy makers make appropriate choices. PLS-SEM allows for critical exploratory research to lay the groundwork for follow-up studies using methods with stricter assumptions. The PLS-SEM analysis is illustrated in the context of residential aged care networks combining low-level and high-level care. Based on the illustrative setting, low-level care does not make a significant contribution to the overall quality of care in residential aged care networks. The article provides key references from outside the health care literature that are often overlooked by health care articles. Choosing between PLS-SEM and CB-SEM should be based on data characteristics, sample size, the types and numbers of latent constructs modelled, and the nature of the underlying theory (exploratory versus advanced). PLS-SEM can become an indispensable tool for managers, policy makers and regulators in the health care sector.

Perceptions of Older Residents and Their Adult Children Regarding Continuing Care Retirement Community Staff.

This study examined the perspectives of continuing care retirement community (CCRC) residents and their adult children regarding services provided by staff in the CCRC. The study is based on semistructured qualitative interviews with 49 residents and their 34 adult children from 11 CCRCs. Transcripts were analyzed using qualitative content analysis. Three major themes emerged: (a) "Reliance on the CCRC staff," (b) "Dissatisfaction with the CCRC staff," and (c) "Disregard to the CCRC staff." Findings suggest that staff should maintain constant contact with all residents, including those who are not satisfied with staff's function and those who do not use staff services, to identify and respond to the residents' changing needs. Attention should be paid in meeting residents' physical needs prior to meeting their social and emotional needs, as these tend to be the most urgent.

Availability of services in registered retirement villages in Queensland, Australia: A content analysis.

OBJECTIVE: The study investigates and compares the services available in different types of registered retirement villages in Queensland (QLD). METHODS: A content analysis based on official websites of 175 registered villages in QLD, Australia, is presented. RESULTS: This study identifies 82 services, with activity organisation, emergency response, hairdressing and transportation being most frequently available to residents. The number of services available is associated with the village size and financial type, with residents living in large private villages having access to significantly more services. CONCLUSION: The research findings reveal the state of the art of current industry practice. They provide useful implications for stakeholders. For instance, residents who prefer to get access to various services should focus more on large private villages. Developers can check their service delivery environment to confirm its balance with residents' competencies. The government can propose innovative initiatives to promote the delivery of appropriate services in villages.

Enhancing resiliency for elderly populations : Shelter-in-place planning and training at facilities serving elderly populations through the Rhode Island Senior Resiliency Project.

Elderly populations are disproportionately affected by disasters. In part, this is true because for many older adults, special assistance is needed to mitigate the consequences of disasters on their health and wellbeing. In addition, many older adults may reside in diverse living complexes such as long-term care facilities, assisted living facilities and independent-living senior housing complexes. Planning for each type of facility is different and the unique features of these facilities must be considered to develop readiness to deal with disasters. Based on this, the Rhode Island Department of Health established the Senior Resiliency Project to bolster the level of resiliency for the types of living facilities housing older adults. The project involves performing onsite assessments of energy resources, developing site-specific sheltering-inplace and energy resiliency plans, and educating and training facility employees and residents on these plans and steps they can take to be better prepared. Based on the feasibility of conducting these activities within a variety of facilities housing older adults, the project is segmented into three phases. This paper describes survey findings, outcomes of interventions, challenges and recommendations for bridging gaps observed in phases 1 and 2 of the project.

[Potential of cooperative learning in project development : Relevance of cooperative participation procedure for the further development of generation-appropriate accomodation in structurally weak rural areas]. / Potenziale kooperativen Lernens in der Projektentwicklung : Relevanz kooperativer Beteiligungsverfahren für die Weiterentwicklung generationengerechter Wohnformen in strukturschwachen ländlichen Räumen.

BACKGROUND: A joint initiative of existing senior care organizations, the municipality of Meyenburg and the state of Brandenburg was further developed by affiliation of an institute of the Brandenburg University of Technology Cottbus-Senftenberg (ABV) in cooperation with members of the architecture and social work departments in 2014. MATERIAL AND METHODS: A cooperative process between different players was central to create an appropriate structure of services for this region. RESULTS: Cooperative projects are necessary to establish new forms of generation-appropriate living and care concepts in rural areas. CONCLUSION: Cooperative learning methods are needed to develop new forms of generation-appropriate living and care concepts in rural areas, which take the diversity of elderly people, the rural context, intergenerational residential arrangements and affordable accommodation that meets the requirements of the social security system into account. Furthermore, the project had to reflect the recent developments of the German care insurance. The article describes the participatory methods, the coordination process and the resulting concept.

Do not hear, see, or speak: views of older residents and their adult children about the nursing unit in the continuing care retirement community.

BACKGROUND: The present study evaluated views of continuing care retirement community (CCRC) residents and their adult children concerning the nursing unit (NU) within the CCRC. METHODS: Qualitative interviews with older adults and their adult children were conducted. Analysis consisted of 187 interviews with older adults and their adult children over a period of up to six years. Analysis relied on constant comparisons within the same interview, over interviews of the same person over time, and between CCRC residents and their adult children. Major themes were identified to construct a coherent storyline. RESULTS: The NU was viewed as a different universe that should be avoided at all costs. This was attributed to: (1) the association of the NU with one's impending decline and dependence and (2) beliefs about substandard care in the NU. CONCLUSIONS: The findings point to the ambivalence expressed by CCRC residents and their adult children concerning the NU, even though to some degree, the NU represents the main reason for the transition to a CCRC.

The rote administrative approach to death in senior housing: Using the other door.

Understanding death in long-term care (LTC) facilities and the preexisting standards and policies pertaining to the death experience in LTC is essential. Qualitative interviews were conducted with 10 administrators of CCRCs and data analyzed through content analysis. Results of the current study reveal that administrators spoke of approaching death in their facility similar to any other procedural task, removal of the residents' bodies varied by community, and coordination responsibilities ranged from maintenance crews to management. Notification practices for residents and staff were also inconsistent. Differences existed in internal cultures on providing forms of respect. These practices were standard for some facilities while others were flexible to accommodate family requests. The majority of the sites did not offer additional training on death and dying for staff members. Findings suggest the need for consistency regarding how senior housing administrators approach the death of a resident and provide support for staff members.