"Let Them Know That They're Appreciated": The Importance of Work Culture on Direct Care Worker Retention.

Retaining direct care workers (DCWs) in all areas of long-term services and supports (LTSS) remains an unending challenge. The current study purposively selected 12 high-performing LTSS communities (e.g., nursing homes, assisted living, home care agencies) in Ohio with high family satisfaction and staff retention. Qualitative interviews were conducted in 2022 with 21 personnel in leadership positions and 16 DCWs (e.g., certified nursing assistants, personal care aides). Interviews were audio recorded, transcribed, and a team of two coders conducted the thematic analysis. Three themes of work culture emerged as important for retention: (1) Family-Like Organizational Approach, (2) Supportive Working Conditions, and (3) Worker Empowerment. DCWs valued empathic relationships with their clients and supervisors. Favorable working conditions consisted of choice, participative leadership, and effective communication. DCWs experienced empowerment through appreciation, financial incentives, and career advancement opportunities. Findings suggest practical changes for person-centered care practitioners that are feasible across any organizational work culture setting. [Journal of Gerontological Nursing, 49(8), 7-13.].

"It Hits Me Right Here at my Heart": Promoting Emotional Health of Home Care Workers.

Demand for home and community-based services continues to outpace employment of home care workers (HCWs) who provide this vital assistance. HCWs face challenges that contribute to inadequate staff retention. Of particular concern is the lack of research on HCWs' emotional health. This research describes facilitators and resources that support HCW emotional health. Qualitative descriptive interviews were conducted with a purposive sample of HCWs (n = 17) who were formally recognized for their success. Interviews were audio recorded, transcribed verbatim, and coded in Dedoose. Thematic analysis revealed three facilitators of emotional health that HCWs link to their professional success: "right state of mind," practicing self-care, and a combined sense of appreciation and support. HCWs highlight specific, practicable resources that promote their emotional health. Policy implications connects low wages and benefits to HCW emotional health, and practice implications for enhancing training and support to retain these important workers.

A North Star for Gerontology: Using the Threshold Concept Framework to Transform Ageism Education.

Threshold concepts are fundamental to the learning process and are said to transform the way we view and understand the world around us. Although a new framework to gerontology, the threshold concept framework has been utilized in many fields inside (e.g., psychology, social work) and outside (e.g., clinical and research settings) of academia. This framework facilitates understanding learning, exposing expert blind spots, and designing curricula for complex concepts that are challenging to learn. For decades gerontologists have grappled with ageism and its dire consequences including unemployment, negative health outcomes, and rationing of health care. Education is one of, if not the most, powerful tools to combat ageism. This article demonstrates the utility of the threshold concept framework for gerontologists by conceptualizing ageism as a threshold concept. The purpose of this article is to provide an innovative approach to education on complex gerontological topics in different clinical, research, and educational settings using ageism as a primary example of a threshold concept in gerontology.

"By the time she got sick it was just kind of too late": A qualitative study on advanced care planning among bereaved lesbian, gay, and bisexual older women.

BACKGROUND: Lesbian, gay, and bisexual (LGB) older women have unmet communication needs around palliative and end-of-life care. Past research has found communication differences for LGB women patients. Consequently, older LGB women may experience healthcare communication barriers around advance care planning. AIM: To explore experiences of bereaved LGB older women to understand perspectives regarding advance care planning communication between clinicians, patients, and dyads. DESIGN: Guided by queer gerontology as a theoretical framework, this qualitative descriptive study employed individual interviews with purposively recruited participants. Interviews were conducted in person using a semi structured protocol and analyzed using inductive thematic analysis. SETTING/PARTICIPANTS: Sixteen LGB women, age 60 years or older from across the United States who had lost a spouse/partner within the past 5 years. RESULTS: Four main themes emerged from the transcripts, LGB older women: (1) experience unclear advance care planning communication and end-of-life care support from clinicians, (2) often avoid advance care planning discussions with spouse or partners, (3) lack of knowledge about palliative or end-of-life care, and (4) have more positive experiences when there is consistent communication with spouse or partner and clinicians during a spouse/partner's illness and end-of-life. DISCUSSION: While certain experiences and opinions may reflect those of non-LGB older adults, novel advance care planning barriers exist for LGB older women. Greater understanding among clinicians is needed regarding advance care planning conversations with LGB dyads. We recommend four improvements in training, recognition, acceptance, and dyad-based communication interventions.

We Speak a Different Language: End-of-Life and Bereavement Experiences of Older Lesbian, Gay, and Bisexual Women Who Have Lost a Spouse or Partner.

We examine the end-of-life (EOL) experiences, communications, and grief support during and after their loved one's death of older lesbian, gay, and bisexual women (LGB) ages 60 to 85 who have lost a spouse or partner. Queer gerontology was used as a theoretical framework, and descriptive qualitative analytical methods were used to discern themes. Through semi-structured interviews with a purposive sample of 16 participants, we identified two main themes: Gathering the Women and Compassionate Care. Although older LGB women may have some similar support needs as non-LGB adults, other needs are distinct but often unmet. While our participants' interactions with health care professionals were overtly positive, there was often a lack of communication about grief resources, including lesbian and women-specific grief groups. Overall researchers, policymakers, and practitioners should be mindful of the importance of fully integrating and including populations into their care practices to avoid creating systems of superficial tolerance.

Through the Montessori Looking-Glass: Barriers to Implementing a Montessori-Based Intervention.

Montessori methods are used with individuals with dementia to create meaningful, inclusive, failure-free activities that enhance quality of life. This research qualitatively explored the barriers to implementing a Montessori-based intervention for people living with dementia in a 24-hr memory care setting. A lens comprised of key Montessori values and principles guided a content analysis of field note data to create an overall framework for understanding implementation barriers, which are rarely addressed in the literature. Interestingly, the four themes that emerged as barriers-the absence of respect, interdependence, meaningful activity, and structure-permeated implementation efforts and represent the opposite of Montessori principles. These findings confirm literature that identifies similar barriers across diverse interventions. Findings underscore the need for formal documentation of implementation barriers and extensive pre-implementation work to accomplish culture change in long-term care.