Monitoring falls in residential aged care facilities: Agreement between falls incident reports and progress notes.

OBJECTIVES: Accurate fall reporting is essential for assessing the effectiveness of fall prevention strategies. This study aimed to investigate the level of agreement between incident reports and resident progress notes as data sources for falls monitoring in residential aged care facilities. METHODS: A retrospective observational study was conducted involving 46 older people from six residential aged care facilities who had consented to join the broader TOP UP trial. Fall events documented in the incident report system and resident progress notes over 12 months before randomisation were extracted by two independent reviewers using a standardised Excel form. Agreement between the two data collection methods was calculated using Cohen's kappa coefficient. RESULTS: A total of 75 falls were recorded from 27 (59%) of the 46 participants who were 65% female, with an average age of 83 [SD 9] years. The incident reports captured 68 (90.7%) falls, while the progress notes captured 73 (97.3%) falls. Overall, there was a 75% agreement between falls recorded in progress notes and incident reports. Perfect agreement was identified for five facilities (n = 35), while one facility had a lower agreement rate of 29% (n = 11), which appeared to be attributable to staff shortages linked to the COVID-19 pandemic. CONCLUSIONS: There was substantial agreement between incident reports and progress records. These findings support the use of incident reports for identifying falls in research or to investigate the effectiveness of fall prevention strategies in residential aged care facilities.

Psychometric analysis of the Group Climate Inventory-Revised in adults with mild intellectual disability or borderline intellectual functioning in a secure residential facility.

BACKGROUND: In secure residential facilities, group climate perceptions of clients with mild intellectual disability or borderline intellectual functioning are systematically assessed for quality improvement. A valid and reliable measure may ensure that this process is consistent. The Group Climate Inventory-Revised (GCI-R) is a new measure to assess group climate perceptions. METHOD: Confirmatory factor analysis was conducted in 148 adult clients (79% male) with mild intellectual disability or borderline intellectual functioning in a secure facility to examine internal structure validity and internal consistency reliability of the GCI-R. RESULTS: The results indicate support for the five-factor structure of the GCI-R ('Support', 'Growth', 'Repression', 'Peer interactions', and 'Physical environment'). The internal consistency reliability of its scales ranged from acceptable to good (α: .72-.87; ω: .76-.86). CONCLUSION: The GCI-R demonstrates evidence of psychometric adequacy when applied to adult clients with mild intellectual disability or borderline intellectual functioning in secure residential facilities.

Measurement invariance of the group climate inventory across adults with and without mild intellectual disability in secure residential facilities.

BACKGROUND: The Group Climate Inventory (GCI) was tested for measurement invariance across 332 adults with and 225 adults without mild intellectual disabilities in Dutch forensic treatment, and for latent mean differences on its Support, Growth, Repression, and Atmosphere subscales. METHOD: Multigroup confirmatory factor analysis was used to evaluate the configural, threshold, and loading and threshold invariance of the GCI across both groups, and to compare group latent means on each subscale. RESULTS: Measurement invariance was found across groups. Latent mean group comparisons showed small but significant differences reflected in lower scores on Support and Atmosphere in the group with mild intellectual disabilities. CONCLUSION: The GCI allows meaningful comparisons between clients with and without mild intellectual disabilities in secure facilities. Results from the between-group comparisons suggest that consideration should be given as to whether, and why, the support and atmosphere perceptions of clients with mild intellectual disabilities might be less good.

Staff Support for Family Relationship and Life Story Work for Children at Residential Care Facilities for Children with Disabilities in Japan.

This study aimed to identify the social care support provided by life story work and children's family relationships for children with disabilities in medical-type residential care facilities for children in Japan and the challenges thereof. The participants were 12 staff from residential care facilities for children with disabilities experienced in providing ongoing support to children admitted for social care purposes. Semi-constructive interviews on the life story work and support for family relationships practiced with children admitted to a residential care facility for children with disabilities for social care were conducted with the participants. The interviews were recorded and analyzed using thematic analysis. The analysis resulted in 32 codes, 10 sub-themes, and four main themes. The main themes were family form, children's thoughts on their family, support for family relationships, and readiness for life story work. In some cases, children were not informed about their negative situation, that is, the reason for admission or their family situation. This was due to the lack of a unified view on life story work among staff and insufficient organizational readiness. The results suggest the need for a unified understanding throughout the organization, as well as the need to disseminate the methodology of life story work for children with disabilities.

Development and initial validation of the staff perception of residential care environments (SPORE) instrument.

BACKGROUND: The impact of the physical environment on healthcare staff well-being and work performance is well recognised, yet there is a lack of instruments assessing environmental features from the perspective of staff working in residential care facilities (RCFs) for older people. OBJECTIVES: To develop and provide initial validation of the instrument Staff Perceptions Of Residential care facility Environments (SPORE). DESIGN: An instrument development and psychometric evaluation study. METHODS: Based on material from a British project, items were translated and adapted for Swedish residential care facilities as SPORE. Care staff (N = 200), recruited from 20 Swedish RCFs, completed a questionnaire-based survey containing the SPORE instrument and two other instruments selected as suitable for use in the validation. In addition, an environmental assessment instrument was used for further validation. Analyses were performed at individual (staff) level and home (RCF) level. RESULTS: The SPORE subscales demonstrated good internal consistency reliability and were moderately to strongly correlated at the individual level with the subscales of measures of person-centred care, and strongly correlated with the same measures at the home level. The SPORE subscales were also highly correlated with the total score of the instrument used to assess the quality of the physical environment. CONCLUSION: The initial validation indicates that the SPORE instrument is promising for measuring care staff perceptions of environmental features in care facilities for older people. SPORE can be a valuable instrument for use in research and in practice to evaluate the environment as part of working towards high-quality care. IMPLICATIONS FOR PRACTICE: The design of the physical environment within RCFs can affect the staff's health and work performance. The instrument is useful for evaluating the environment and informing decisions about design solutions that support staff in their important work.

The experiences of family members of persons with intellectual disabilities who used residential care homes during the COVID-19 pandemic.

BACKGROUND: The global COVID-19 pandemic has shown the vulnerability of some population groups, including persons with intellectual and developmental disabilities (IDD). AIM: The present paper will provide more clarity and understanding of the experiences of family members of persons with IDD housed in residential facilities in Catalonia within the period of maximum restrictions during the COVID-19 pandemic. METHODS AND PROCEDURES: Semi-structured interviews were conducted using an interpretive phenomenological qualitative approach. Study participants consisted of 14 relatives of IDD individuals who were institutionalized in residence facilities or homes. The guiding questions emerged from group discussions with relatives of those with IDD who did not participate in the subsequent interviews. Drawing from this group, the factors that were identified to have had the greatest impact on their lives were later used to guide the interviews. Data collection was carried out in face-to-face individual interviews that were recorded together with the observations of two researchers between February and October 2022. RESULTS: Our analysis identified 4 main themes that developed into additional factors: the decision to stay at home or in the residence, fear, illness, and protocol. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. CONCLUSION: The results of this study allow for a better understanding of the experiences of families of persons with IDD in residential centres during the lockdown by identifying their needs and how to better support them in the future. OUTCOMES AND RESULTS: Knowledge and understanding of these events should allow for better management of similar situations in the future.

This study contributes to a growing body of research that examines the experiences of IDD individuals and their families during the early months of the COVID-19 pandemic. A qualitative phenomenological interpretative approach was used following the recommendations of qualitative research practices in health care. Our findings reveal that relatives of persons with IDD who lived in residential care homes felt that the residents were not adequately cared for by the staff, who applied measures for containment and contagion prevention that were disproportionate, resulting in their needs not being considered; these recommended measures had been developed for elderly care homes. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. The present findings show that residential care homes for persons with IDD require specific action protocols in crisis situations that are adapted to the needs and characteristics of each centre,thus adopting a model of care based on human rights.

[Continuation of implementation processes in residential long-term care : Sustainability of the expert standard "Relationship management in the care of people with dementia"]. / Verstetigung von Implementierungsprozessen in der stationären Langzeitpflege : Nachhaltigkeit des Expertenstandards Beziehungsgestaltung in der Pflege von Menschen mit Demenz.

BACKGROUND: Nursing institutions are facing many challenges due to evidence-based requirements. For example, they are required to introduce new interventions such as expert standards and thus adapt routine practices to new findings; however, if new interventions are continuously implemented in the facilities their sustainability is questionable. OBJECTIVE: The aim was to find out how sustainably the expert standard "Relationship management in the care of people with dementia" is implemented in residential long-term care institutions. MATERIAL AND METHODS: Qualitative, guideline-based interviews were conducted with persons from residential long-term care, oriented to the procedure of the problem-centered interview. The interviewees were involved in the model implementation of the expert standard "Relationship management in the care of people with dementia"'. The data were then analyzed using qualitative content analysis. RESULTS: The participants assessed the sustainable implementation in different ways. Some rated the sustainability of the expert standard in their institution as successful, while others see potential for improvement. According to the participants, the sustainability of continuation of implementation processes is influenced by various factors. These relate to the institution, the external context, the intervention, the implementation process, and the people involved in the implementation. CONCLUSION: On the basis of the factors identified, key needs can be derived for nursing practice, for science and research as well as for politics and legislation, so that the sustainability of expert standards and other evidence-based interventions can be ensured and, if necessary, optimized.

Practices countering resident-to-resident aggression and promoting wellness care for older adults in congregate residential facilities: results from a systematic review.

Resident-to-resident aggression (RRA) is an important issue in congregate residential facilities (CRFs) for older adults and has devastating effects. This study aimed to provide an inventory and content analysis of the practices used to counter RRA and promote wellness care for older adults in CRFs. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, original, peer-reviewed research and systematic reviews published in 14 electronic databases and two gray literature sources were examined. Of the 6196 articles identified, 28 met the inclusion criteria. Practices aimed to prevent, track or intervene in RRA, mostly in long-term care centers, but few were evidence-based and ready for widespread implementation. It emerges that continuous training of staff is necessary and that it should prioritize a person-centered approach. CRFs' managers must promote a culture of wellness care and policymakers should consider the prevention practices to improve the quality of life of older adults in CRFs.

Allied health service delivery in residential aged care and the impact of the coronavirus (COVID-19) pandemic: a survey of the allied health workforce.

Objectives Industry reports suggest that routine and essential care in Australian residential aged care (RAC), including allied health (AH) services, were disrupted during the coronavirus diseas 2019 (COVID-19) pandemic. This study aimed to explore whether AH services in RAC were paused during the pandemic, factors associated with a pause in care delivery, and qualitative details on how COVID-19 impacted AH service delivery. Methods A 26-question survey was distributed via social media, health service providers, and AH networks between February and April 2022. Participation was restricted to AH professionals and assistants with experience in RAC during the pandemic. A mix of closed and open-ended response questions was used to collect demographic data and experiences of delivering care during the pandemic. Quantitative responses were analysed with descriptive statistics and a probit model. Content analysis was performed on open-ended questions. Results One hundred and four AH professionals and assistants responded to the survey. Fifty-five percent of participants (n = 51) were contractually or casually employed. AH services were negatively impacted by the pandemic with 52% of respondents experiencing a pause in service delivery and 78% reporting poorer AH care quality. In a probit model, contracted/casually employed respondents were more likely to experience a pause in care delivery (1.03, P < 0.05) compared to permanently employed AH professionals. Conclusion Insecure work arrangements may have exacerbated inconsistent care during the pandemic (impacting residents) and may have negative implications on the RAC AH workforce. In the future, an AH inclusive workforce policy including data collection and research is required to monitor and plan the RAC workforce.

Nurses' perspectives on medication errors and prevention strategies in residential aged care facilities through a national survey.

BACKGROUND: Medication errors are common in residential aged care facilities (RACFs) due to several factors. Effective medication management is essential to prevent medication errors among older people particularly due to the complexity of co-morbidities they can experience. OBJECTIVES: This study aimed to examine and quantify the contributing factors of medication errors from nurses' perspectives and the prevention strategies to reduce medication errors among older adults living in RACFs. METHODS: A survey with 140 completed responses from registered nurses (RNs) and endorsed enrolled nurses (EENs) working in RACFs across Australia were included in the study. The survey had 24 items, related to contributing factors of medication errors, and the prevention strategies. Descriptive statistics and exploratory factor analysis were used in the data analysis process. RESULTS: The study identified medication errors are caused by contributing factors such as use of agency staffing (70.4%) and delays in receipt of laboratory results (94.3%). However, it also identified suggestions to reduce medication errors in RACFs, for example use of electronic alerts (88.3%), and efficient laboratory communication (91.8%). Our results revealed three key factors for causes (workload, interprofessional involvement and interruptions) and suggestions (medication safety alerts, medication process improvement and effective reporting). CONCLUSION: Medication errors in RACFs are a global problem being one of the leading causes of morbidity and mortality. The knowledge and awareness of the factors associated with medication errors and the prevention strategies can guide potential quality improvement plans and contribute to minimisation of risk associated with medication safety in RACFs. IMPLICATIONS FOR PRACTICE: The study recommends strategies for best practices in medication management such as interprofessional collaboration, implementing standardised policies and electronic alerts to reduce medication errors in RACFs.

Effects of Mindfulness-Based Elder Care (MBEC) on symptoms of depression and anxiety and spiritual well-being of institutionalized seniors with disabilities: a randomized controlled trial.

BACKGROUND: Despite the need to incorporate seniors from various settings into mindfulness-based empirical research, issues of geriatric frailties and non-compliance remain. This study aimed to evaluate the effects of a mindfulness-based elder care (MBEC) program on mental health and spiritual well-being among seniors with disabilities in long-term care residential settings. METHODS: This single-blind, randomized controlled trial (RCT) randomly assigned seventy-seven participants into an MBEC group or control group of an eight-week MBEC program. Participants were assessed every four weeks at baseline (T0), mid-intervention (T1), post-intervention (T2) and follow-up (T3) using the Geriatric Depression Scale Short Form (GDS-SF), the State-Trait Anxiety Inventory (STAI) and the Spiritual Well-Being Scale (SWBS), respectively. RESULTS: Linear mixed model (LMM) showed that MBEC participants' mental health improved significantly after completing the intervention; compared with controls, the MBEC group exhibited significantly lower anxiety (state-anxiety at T2; trait-anxiety at T2 and T3) and fewer depressive symptoms. Spiritual well-being was also significantly enhanced compared to that in the control group. CONCLUSIONS: MBEC has positive effects on both mental health and spiritual well-being outcomes among seniors with disabilities. In long-term care facilities, seniors with abilities have the potential to adhere to and engage in activities of a mindfulness-based intervention. This low risk, easily accessible, and effective 8-week program is recommended to be integrated into regular long-term care institutional routines. TRIAL REGISTRATION: This study was registered with Clinical Trial Registry (ClinicalTrials.gov - U.S. National Library of Medicine #NCT05123261. Retrospectively registered on 07/04/2021.). The CONSORT 2010 guidelines were used in this study for properly reporting how the randomized trial was conducted.

Who's Involved? Case Reports on Older Adults' Alcohol and Tobacco Use in Dutch Residential Care Facilities.

Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities and aim to provide person-centered care (PCC). Maintaining residents' autonomy is important to provide PCC, for example, with shared decision-making (SDM). Residents are largely dependent on multiple stakeholders, which could jeopardize their autonomy, especially regarding unhealthy behaviors, such as smoking tobacco or drinking alcohol. This case study explores the dynamics of multiple stakeholders around four RCF residents regarding their alcohol and/or tobacco use. Four RCF residents who smoke tobacco and/or drink alcohol were selected from a previous study, and their (in)formal caregivers were additionally invited to participate. A qualitative research design was chosen, and semi-structured interviews were conducted. The Ethics Review Board from the Tilburg University School of Social and Behavioral Sciences (Reference: RP39) and the executive boards of the two participating organizations granted approval. Narrative portraiture resulted in four case descriptions. Two cases focused mostly on tobacco use, and two cases focused mostly on alcohol use. Multiple stakeholders were involved on different levels: family bought alcohol or cigarettes, and team managers supported care professionals. However, little interaction was found between stakeholders. In these cases, limited interaction between the stakeholders, including the resident, jeopardizes SDM and, in this way, PCC regarding residents' alcohol and/or tobacco use. SDM on this topic could enhance interaction between all stakeholders involved, which could increase PCC. Finally, the cases indicate a constant struggle between protecting residents from adverse outcomes of alcohol and tobacco use and enhancing their autonomy.

The experience of intergenerational interactions and their influence on the mental health of older people living in residential care.

The mental health of an increasing ageing population is an important part of healthcare. Research has explored means to enrich the lives of older adults living in residential settings, including approaches like the Eden Alternative. This is a cross-sectional, qualitative study with a quantitative component. It looks at common mental health conditions (CMHCs) in residential-living older adults in South Africa and describes their experiences of intergenerational interactions with playschool children. Participants completed a questionnaire which included the Geriatric Depression Scale and Geriatric Anxiety Scale and a semi-structured interview. Anxiety and depression were common in the sample with limited awareness of non-pharmacological therapy available at the facility. The intergenerational interactions were experienced positively with emerging themes of belonging, sense of purpose, reminiscence and positive affective experiences, but influenced by participants' preconceptions of children. The study concludes that intergenerational interactions may serve as adjunctive therapy in managing CMHCs in residential-living older adults. Recommendations are made for successful implementation of such programs.

Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022.

This study surveyed US adolescent residential addiction treatment facilities to assess treatments used for adolescents younger than 18 years seeking treatment for opioid use disorder.

[Collaborative work between coordinating physicians, geriatric EMGE physicians and emergency physicians]. / Un travail collaboratif entre médecins coordonnateurs, médecins gériatres des EMGE et médecins urgentistes.

The medical summary section (VSM) was formalized in 2011 with its content defined in 2013. In residential facilities for dependent elderly people (Ehpad), the VSM is almost non-existent and is requested by the majority of doctors who have to take medical care of a resident, often in an emergency situation. Following the health crisis and under the aegis of the regional and national associations of coordinating physicians, a working group was set up in 2021 to create a unique VSM that meets the needs of the field. This document was created and tested with very favorable feedback from users. This VSM is currently being deployed in the Ehpad of the Île-de-France region.

Respuesta a la crisis sanitaria producida por la pandemia de COVID-19 en los centros residenciales sociosanitarios de Navarra / Response to the health crisis produced by the COVID-19 pandemic in the centers socio-sanitary residential homes in Navarra

Como consecuencia de la pandemia de COVID-19 que afectó a nuestra sociedad, y su especialvirulencia y gravedad entre la población residencial del ámbito sociosanitario, el Departamento de Salud del Gobierno de Navarra creó una unidad interdepartamental y multidisciplinarpara dar respuesta a esta crisis sanitaria. El objetivo general de la misma era garantizar unaatención sanitaria de calidad en los centros sociosanitarios, trabajando proactiva y preventivamente en los diferentes escenarios que se fueran generando, asentando las actuacionesprofesionales en unas bases sólidas que permitiesen el afrontamiento eficaz, eficiente y encondiciones de equidad de las diferentes necesidades a corto, medio y largo plazo. La UnidadSociosanitaria, con participación de las tres Áreas (Pamplona, Tudela y Estella), proporcionóapoyo a los centros residenciales de mayores, incluyendo también a congregaciones religiosas, centros de discapacidad física e intelectual y trastorno mental grave, y a todos los profesionales que prestaban servicio en los mismos durante la pandemia, siendo su objetivo finalconsolidar su labor para alcanzar una adecuada coordinación sociosanitaria, estableciendounos estándares asistenciales de calidad durante la pandemia. En el presente artículo se detallan todas las actuaciones realizadas desde la Unidad Sociosanitaria desde mayo del 2020, y los datos recogidos en relación a los brotes que hubo entre lasegunda y la séptima olas epidémicas. Finalmente, en las conclusiones, se valoran las dificultades encontradas y los aspectos que podrían mejorarse, pensando en el futuro, no solamente en relación a la enfermedad COVID-19, sino también a otras posibles epidemias, brotes opandemias.(AU)

Mortality in residential care facilities for people with disability: a descriptive cross-sectional analysis of statutory notifications in Ireland.

OBJECTIVES: To determine incidence of death in residential care facilities for people with disability in Ireland, primary cause of death, associations of facility characteristics and deaths, and to compare characteristics of deaths reported as expected and unexpected. DESIGN: Descriptive cross-sectional study. SETTING: All residential care facilities for people with disability operational in Ireland in 2019 and 2020 (n=1356). PARTICIPANTS: n=9483 beds. MAIN OUTCOME MEASURES: All expected and unexpected deaths notified to the social services regulator. Cause of death as reported by the facility. RESULTS: 395 death notifications were received in 2019 (n=189) and 2020 (n=206). 45% (n=178) were for unexpected deaths. Incidence of death per 1000 beds per year was 20.83 for all, 11.44 for expected and 9.39 for unexpected deaths. Respiratory disease was the most common cause of death, accounting for 38% (n=151) of all deaths. In adjusted negative binomial regression analysis, congregated settings versus non-congregated (incidence rate ratio (95% CI): 2.59 (1.80 to 3.73)) and higher bed numbers (highest vs lowest quartile) (4.02 (2.19 to 7.40)) were positively associated with mortality. There was also a positive n-shaped association with category of nursing staff-to-resident ratio when compared with zero nurses. Emergency services were contacted for 6% of expected deaths. Of the deaths reported as unexpected, 29% were receiving palliative care and 10.8% had a terminal illness. CONCLUSION: Although incidence of death was low, residents of congregated and larger settings had higher incidence of death than residents of other settings. This should be a consideration for practice and policy. Given the high contribution of respiratory diseases to deaths and the potential avoidability of these, there is a need for improved respiratory health management in this population. Nearly half of all deaths were reported as unexpected; however, overlap in the characteristics of expected and unexpected deaths highlights the need for clearer definitions.

Evaluating person-centered care in residential care facilities from the perspective of caregivers in South Korea: a survey.

BACKGROUND: As many older people spend their time in residential care facilities, the demand for person-centered care (PCC), which affects their quality of life, is increasing. Many residential care facility residents have cognitive problems, such as dementia and strokes. Providing quality care upholds their rights as human beings. Currently, the PCC tools used in South Korea are only translations of foreign tools into Korean, so it is necessary to develop tools for older adult care facilities that reflect the reality of Korean care facilities for older adults. This study aims to develop a tool for measuring PCC in residential care facilities for older people from the perspectives of care givers. METHODS: The draft of 34 questions was developed through literature reviews, interviews with LTC practitioners and researchers. This developed questionnaire was then administered to 402 direct caregivers working in the residential care facilities because many of the residents had cognitive problems. By measuring the interrater reliability, the items with high levels of agreement were selected and the validity of the construct was checked through factor analysis. To determine whether the domains adequately measured each concept, we calculated correlation coefficients and Cronbach's α. RESULTS: Four domains and 32 items concerning service conditions, resident's right to self-determination, a comfortable living environment for all residents, and resident and staff satisfaction are derived, thus explaining 24.7%, 23.6%, 14.6%, and 8.00% of the total variance, respectively. Cronbach's alphas for each domain are 0.965, 0.948, 0.652, and 0.525, respectively, thus demonstrating internal consistency. The inter-rater agreement is high (66.7%~100.0%). The correlation between service conditions and resident's right to self-determination (r = 0.643, p < 0.001), a comfortable living environment for all residents, resident and staff satisfaction (r = 0.674, p < 0.001), and resident's right to self-determination and comfortable living environment (r = 0.695, p < 0.001) is strong. CONCLUSIONS: It is important that caregivers recognize PCC and provide services. When evaluating the residential care services, measuring the degree of PCC should be made compulsory. If the facility becomes more person-centered, it will be possible to promote quality of life for older people. TRIAL REGISTRATION: Not applicable.