[Response to the urgent need to train family doctors in geriatrics : residency in long term care facilities]. / Réponse à l'urgence de former les médecins de famille à la gériatrie : l'assistanat en EMS.

Family doctors have to provide the geriatric cares needed by an aging population. In particular, the increased complexity of care needs in the population living in long term care facilities (LCTF) raises several challenges. One of these challenges is the adequate training of physicians working in LCTF as well as the next generation. Residency programs in LTCFs for future general practioners has demonstrated their value abroad. We describe here the creation of a residency program in LTCF for family doctors in Canton Vaud. Since its beginning in 2020, the program has not only trained young physicians but has also improved interprofessionality and strengthened the training of other healthcare professionals.

La population vieillissante requiert des soins gériatriques spécifiques auxquels le médecin de famille doit répondre. De plus, la complexification des besoins en soins de la population en établissement médicosocial (EMS) soulève de multiples défis. Un de ces défis est la formation adéquate des médecins travaillant en EMS et leur relève. A l'étranger, l'expérience de tournus des médecins de famille dans des structures similaires aux EMS a démontré sa pertinence. Nous illustrons ici le contexte et la mise en place d'une formation postgraduée en EMS pour les médecins de famille sur le canton de Vaud et présentons un aperçu des bénéfices de ce programme depuis sa mise en place en 2020 : au-delà de la formation de jeunes médecins, l'assistanat en EMS améliore la collaboration interprofessionnelle et contribue à la formation d'autres professionnels de la santé.

"Geriatric Team Health Care Pathways": An Organizational Innovation to Enhance Care Pathways of Long-Term Care Facilities' Residents in the French Region of Occitania.

Born out of the COVID crisis, an innovative disposal called "Geriatric Team Healthcare Pathways" (GTHPs) has been implemented in the Occitania area in the south of France. GTHPs can be considered as geriatric "hotlines" providing expertise and knowledge to long-term care facility (LTCF) professionals, pursuing the general objective to promote a simplified, direct, and fair access to geriatric care for residents. This article highlights the history of their creation and their current use cases and operating modes for the year 2023, which includes a "quality of care approach" on good practices at a regional level (820 LTCFs), on topics such as the prevention of malnutrition and falls.

Designing a virtual course for essential care partners (ECPs) in long-term care (LTC): a pre-implementation study.

Objectives: We describe our co-design process aimed at supporting the reintegration of essential care partners into long-term care homes during the COVID-19 pandemic.Methods: More specifically, using a co-design process, we describe the pre-design, generative, and evaluative phases of developing a virtual infection prevention and control course for essential care partners at our partnering long-term care home. For the evaluative phase, we also provide an overview of our findings from interviews conducted with essential care partners on the expected barriers and facilitators associated with this virtual course.Results: Results from these interviews indicated that the virtual course was viewed as comprehensive, detailed, engaging, refreshing, and reliable, and that its successful implementation would require appropriate resources and support to ensure its sustainability and sustainment. Findings from this study provide guidance for the post-design phase of our co-design process.Conclusion: Our careful documentation of our co-design process also facilitates its replication for other technological interventions and in different healthcare settings. Limitations of the present study and implications for co-designing in the context of emergent public health emergencies are explored in the discussion.

Leadership and Staff Perceptions on Long-term Care Staffing Challenges Related to Certified Nursing Assistant Retention.

OBJECTIVE: This study investigates practices that may help retain certified nursing assistants (CNAs) and address the staffing challenges faced in long-term care. BACKGROUND: CNAs are critical to quality care and retention has never been more challenging. To solve this staffing crisis, understanding the unique perspective of CNAs is imperative. METHODS: In semistructured interviews, 5 nursing assistants, the director of nursing, and the nursing home administrator at 59 long-term care facilities answered 4 questions, providing multiple perspectives about causes and solutions to CNA staffing challenges. RESULTS: Key responses for each stakeholder group were identified. CNAs highlighted the nature of the job as a bigger challenge than leadership recognized. Although pay is a top concern, emotional support, training, relationship-building, communication, and the work culture can be equally important in reducing turnover. CONCLUSION: When organizational leaders understand how to meet the needs and interests of CNAs, they can reduce turnover.

Effectiveness of various cleaning strategies in acute and long-term care facilities during novel corona virus 2019 disease pandemic-related staff shortages.

BACKGROUND: Cleanliness of hospital surfaces helps prevent healthcare-associated infections, but comparative evaluations of various cleaning strategies during COVID-19 pandemic surges and worker shortages are scarce. PURPOSE AND METHODS: To evaluate the effectiveness of daily, enhanced terminal, and contingency-based cleaning strategies in an acute care hospital (ACH) and a long-term care facility (LTCF), using SARS-CoV-2 RT-PCR and adenosine triphosphate (ATP) assays. Daily cleaning involved light dusting and removal of visible debris while a patient is in the room. Enhanced terminal cleaning involved wet moping and surface wiping with disinfectants after a patient is permanently moved out of a room followed by ultraviolet light (UV-C), electrostatic spraying, or room fogging. Contingency-based strategies, performed only at the LTCF, involved cleaning by a commercial environmental remediation company with proprietary chemicals and room fogging. Ambient surface contamination was also assessed randomly, without regard to cleaning times. Near-patient or high-touch stationary and non-stationary environmental surfaces were sampled with pre-moistened swabs in viral transport media. RESULTS: At the ACH, SARS-CoV-2 RNA was detected on 66% of surfaces before cleaning and on 23% of those surfaces immediately after terminal cleaning, for a 65% post-cleaning reduction (p = 0.001). UV-C enhancement resulted in an 83% reduction (p = 0.023), while enhancement with electrostatic bleach application resulted in a 50% reduction (p = 0.010). ATP levels on RNA positive surfaces were not significantly different from those of RNA negative surfaces. LTCF contamination rates differed between the dementia, rehabilitation, and residential units (p = 0.005). 67% of surfaces had RNA after room fogging without terminal-style wiping. Fogging with wiping led to a -11% change in the proportion of positive surfaces. At the LTCF, mean ATP levels were lower after terminal cleaning (p = 0.016). CONCLUSION: Ambient surface contamination varied by type of unit and outbreak conditions, but not facility type. Removal of SARS-CoV-2 RNA varied according to cleaning strategy. IMPLICATIONS: Previous reports have shown time spent cleaning by hospital employed environmental services staff did not correlate with cleaning thoroughness. However, time spent cleaning by a commercial remediation company in this study was associated with cleaning effectiveness. These findings may be useful for optimizing allocation of cleaning resources during staffing shortages.

COVID-19 Pandemic Impact on the National Health Care Surveys.

While underscoring the need for timely, nationally representative data in ambulatory, hospital, and long-term-care settings, the COVID-19 pandemic posed many challenges to traditional methods and mechanisms of data collection. To continue generating data from health care and long-term-care providers and establishments in the midst of the COVID-19 pandemic, the National Center for Health Statistics had to modify survey operations for several of its provider-based National Health Care Surveys, including quickly adding survey questions that captured the experiences of providing care during the pandemic. With the aim of providing information that may be useful to other health care data collection systems, this article presents some key challenges that affected data collection activities for these national provider surveys, as well as the measures taken to minimize the disruption in data collection and to optimize the likelihood of disseminating quality data in a timely manner. (Am J Public Health. 2021;111(12):2141-2148. https://doi.org/10.2105/AJPH.2021.306514).

Updates on Infection Control in Alternative Health Care Settings.

Patients increasingly receive care from a large spectrum of different settings, placing them at risk for exposure to pathogens by many different sources. Each health care environment has its own specific challenges, and thus infection control programs must be tailored to each specific setting. High-turnover outpatient settings may require additional considerations, such as establishing patient triage and follow-up protocols, and broadened cleaning and disinfection procedures. In nursing homes, infection control programs should focus on surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs.

How Does the Facilitation Effort of Clinical Educators Interact With Aspects of Organizational Context to Affect Research Use in Long-term Care? Evidence From CHAID Analysis.

PURPOSE: Organizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their interrelationships is often impractical. Big Data analytics can automatically detect patterns within the data. We applied the chi-squared automatic interaction detection (CHAID) algorithm and classification tree technique to explore the dynamic and interdependent relationships between the implementation science concepts-context, facilitation, and research use. DESIGN: Observational, cross-sectional study based on survey data collected from a representative sample of nursing homes in western Canada. METHODS: We assessed three major constructs: (a) Conceptual research utilization (CRU) using the CRU scale; (b) facilitation of research use measured by the frequency of contacts between the frontline staff and a clinical educator, or person who brings new ideas to the care unit; and (c) organizational context at the unit level using the Alberta Context Tool (ACT). CHAID analysis was performed to detect the interactions between facilitation and context variables. Results were illustrated in a classification tree to provide a straightforward visualization. FINDINGS: Data from 312 care units in three provinces were included in the final analysis. Results indicate significant multiway interactions between facilitation and various aspects of the organizational context, including leadership, culture, evaluation, structural resources, and organizational slack (staffing). Findings suggested the preconditions of the care settings where research use can be maximized. CONCLUSIONS: CHAID analysis helped transform data into usable knowledge. Our findings provide insight into the dynamic relationships of facilitators' efforts and organizational context, and how these factors' interplay and their interdependence together may influence research use. CLINICAL RELEVANCE: Knowledge of the combined effects of facilitators' efforts and various aspects of organizational context on research use can contribute to effective strategies to narrow the evidence-practice gap in care settings.

Epidemiology of patient safety incidents in a long-term rehabilitative hospital in KwaZulu-Natal, South Africa (April 2011 to March 2016).

BACKGROUND: Patient safety is a key priority of the National Department of Health. Despite the publication of legislation and other measures to address patient safety incidents (PSIs) there are a paucity of studies relating to patient safety at the different levels of hospitals. OBJECTIVES: To determine the epidemiology (incidence, nature and root causes) of PSIs at a long-term rehabilitative hospital between April 2011 and March 2016. METHOD: Data were collected through a review and analysis of routinely collected hospital information on patient records and from the PSI register, as well as minutes of adverse health events meetings, quality assurance reports and patient complaints register. RESULTS: A total or 4.12 PSIs per 10 000 inpatient days were reported. Approximately 52% of the adverse health events occurred in females with most of the adverse health events occurring in the 50-59 years category: 96% being reported during the day and 33% within the shift change. Pressure ulcers, falls, injury, hospital acquired infections and medication error were the most commonly reported PSIs. Patient factors were listed as the most common root cause for the PSIs. CONCLUSION: The study shows a low reporting rate of PSIs whilst showing a diverse pattern of PSIs over a period of 5 years. There is a need for active change management in order to establish a blame-free culture and learning environment to improve reporting of PSI. A comprehensive quality improvement intervention addressing patients, their families and staff is essential to minimise PSI and its consequences.

Integrated Care model: Transition from acute to chronic care.

OBJECTIVE: Description and discussion dimensions of Integrated Care Model. METHODS: A descriptive study is done that describe a technological innovation, intervention strategies for professional performance. RESULTS: Integrated Care Model (ICM) has two main categories include individual and Group-and disease-specific Model. First, is used for risky patients or with comorbidities. In second category; Chronic Care Model (CCM) is common form of Integrated Care Model to improve resultants in the patients with chronic condition, to move from acute care to integrate, regular, long-lasting, preventative and community-based nursing. FINAL CONSIDERATIONS: It is important to consider patient as an active member of the treatment team. It seems to be essential to monitor performance of care system. On the other hand, offer multidisciplinary care leads to present desirable care, tailored to the specific needs of patients regarding safety, patient-centered care and their culture.

Dementia Enlightened?! A Systematic Literature Review of the Influence of Indoor Environmental Light on the Health of Older Persons with Dementia in Long-Term Care Facilities.

Light therapy for older persons with dementia is often administered with light boxes, even though indoor ambient light may more comfortably support the diverse lighting needs of this population. Our objective is to investigate the influence of indoor daylight and lighting on the health of older adults with dementia living in long-term care facilities. A systematic literature search was performed within PubMed, CINAHL, PsycINFO, Web of Science and Scopus databases. The included articles (n=37) were published from 1991 to 2020. These articles researched the influence of existing and changed indoor light conditions on health and resulted in seven categories of health outcomes. Although no conclusive evidence was found to support the ability of indoor light to decrease challenging behaviors or improve circadian rhythms, findings of two studies indicate that exposure to (very) cool light of moderate intensity diminished agitation. Promising effects of indoor light were to reduce depressive symptoms and facilitate spatial orientation. Furthermore, there were indications that indoor light improved one's quality of life. Despite interventions with dynamic lighting having yielded little evidence of its efficacy, its potential has been insufficiently researched among this study population. This review provides a clear and comprehensive description of the impact of diverse indoor light conditions on the health of older adults with dementia living in long-term care facilities. Variation was seen in terms of research methods, (the description of) light conditions, and participants' characteristics (types and severity of dementia), thus confounding the reliability of the findings. The authors recommend further research to corroborate the beneficial effects of indoor light on depression and to clarify its role in supporting everyday activities of this population. An implication for practice in long-term care facilities is raising the awareness of the increased lighting needs of aged residents.

Reducing Hospitalizations Among Nursing Home Residents.

Full-time APRNs, supported by administrative teams, are essential for success.

[Needs, Dilemmas, and Policy Suggestions Related to Patients With Mental Health Long-Term Care].

In Taiwan, The increase in life expectancy in Taiwan has increased the incidents of age-related problems among patients with mental illness. Therefore, the needs related to long-term care in mental health are significantly important. These needs include: (1) reducing stigmatization; (2) reducing the physical and economic burden of caregivers; (3) constructing a comprehensive, long-term care service system; and (4) developing assessment tools suitable to the long-term care of patients with mental illness. Moreover, six dilemmas in meeting long-term care needs were identified. These dilemmas include: (1) lack of a model of continuous care and of a platform for integrating hospital and community resources; (2) poor / inadequate service quality provided by certain community rehabilitation institutions; (3) the needs of patient/family centered care; (4) the persistence of stigma and misunderstanding; (5) the heavy burdens borne by family members providing long-term care; and (6) the disconnect between subsequent needs and the disability assessment system. Policy suggestions provided in this article include: (1) establish an inclusive platform for mental health long-term care information and resource integration; (2) construct long-term care centers for patients with mental health conditions; (3) train adequate manpower to provide long-term care services to these patients; and (4) promote community inclusiveness for these patients. In order to enter the era of long-term mental health care, government policy should target long-term care programs to meet the needs of patients with mental health conditions. These programs should include seamlessly integrating services into the long-term mental health care system and the care resources of community mental health, developing suitable assessment tools, establishing a multidisciplinary team of long-term care professionals to provide mental health care.

An Analysis of the Long-Term Care Policy Mandates Implemented in Canada during the First Wave of the COVID-19 Pandemic.

The first wave of the COVID-19 pandemic had a catastrophic impact on Canada's long-term care system. This report compares the experiences of the five Canadian provinces that were most affected by COVID-19. This includes a comparison of the five mandates that provincial governments implemented in order to protect long-term care residents. Findings from this report indicate that the Canadian provinces whose long-term care systems were most devastated by COVID-19 failed their residents by responding too slowly compared with provinces with similar long-term care systems. This lesson should guide policy reform to safeguard residents during the second wave and beyond.

Improving Care for Older Adults in China: Development of Long-Term Care Policy and System.

This special issue covers several important topics related to long-term care (LTC) systems and policy development in China. It provides a good contextual background on the development of the LTC system in China as well as the needs and preferences of LTC from family and older adults' perspectives. In addition, this issue covers the topic of evaluation of a recently developed long-term care nursing insurance and provides an example of family caregiving for persons with dementia within the Chinese context. The authors in this special issue also provided insights into the impact of the COVID-19 pandemic on older adults' life and LTC quality, and explored potential strategies to handle the challenges during and post-pandemic.

A recommended management plan for coronavirus disease 2019-positive geriatric patients based in South African old age homes.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on elderly patients, and thus, adequate treatment plans are essential. This qualitative report provides recommendations for the supportive care and treatment of residents in long-term care facilities (LTCF) with COVID-19. A treatment protocol was developed in response to an outbreak of COVID-19 in an LTCF based in Johannesburg and was implemented over a 3-month period.