Beyond the ‘Iron Lungs of Gerontology’: Using Evidence to Shape the Future of Nursing Homes in Canada

Hirdes, John P.; Mitchell, Lori; Maxwell, Colleen J.; White, Nancy

doi:10.1017/s0714980811000304

Cited by 171 publications

(183 citation statements)

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“…The descriptive, quantitative data explore LTC service use pathways and predictors among clients living in the small but populous health region of Fraser Health (FH) (Hirdes, Mitchell, Maxwell, & White, 2011).…”

Section: Design and Methodsmentioning

confidence: 99%

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

Cloutier¹,

Penning

2016

GERONT

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Purpose of the Study: Janus, the two-faced, Roman god of beginnings and transitions, is used as a metaphor to explore our personal narratives and our quantitative research on the experiences of older women with dementia in long-term care (LTC). Two research questions are addressed: (a) How do our quantitative data map onto our mothers' experiences? (b) What lessons do our mothers' experiences offer for the care of older women with dementia? Design and Methods: Informed by a life-course perspective, we triangulate administrative data on 3,717 women with dementia receiving LTC in British Columbia, Canada, with personal narratives-the stories of our mothers who made the transition from home care into residential (nursing home) care. Results: Our quantitative data reveal that the home care to residential care transition is the most common LTC trajectory for women with dementia who are most likely to be widowed and living alone in suburban areas. On entry into residential care, they exhibit greater frailty in terms of activities of daily living, cognition, aggression, and incontinence. Our personal narrative data on our mothers reveals that the relatively straightforward pathways through LTC for women with dementia, are often considerably more complex in a real-world context. Attention is drawn to the public and private services, hospitalization patterns, and substantial communication gaps experienced by our moms and families. Implications: A life-course perspective, and qualitative and quantitative data facilitate understanding the care journeyshealth and service trajectories of older women with dementia. Writing over a decade ago about their mother's experience of nursing home care after a serious stroke, Kane and West (2005) argued that society appears uninterested in making the necessary commitment to care for frail older adults in creative, compassionate, and appropriate ways aligned with goals of quality of care and quality of life. In this special issue called, Aging-It's Personal, we explore this concern by triangulating data from our funded research program with our personal narratives describing our mothers' experiences as clients of the long-term care (LTC) system.As social gerontologists, we have spent much of our careers studying health service provision for vulnerable older adults. As adult children, we have recent personal and family-centered experience related to our mothers' care journeys as women who began their service trajectory in home care and continued on to become clients of residential (nursing home) care until their deaths. In thisThe Gerontologist cite as : Gerontologist, 2017, Vol. 57, No. 1, 68-81 doi:10.1093 Advance Access publication November 16, 2016 article, we employ the metaphor of Janus, the two-faced Roman god of beginnings and transitions, to explore how our personal and professional worlds have intertwined, affecting us indelibly as family members, sparking our research questions, and giving us a greater appreciation for the ways that care is navigated. We consider ...

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Section: Design and Methodsmentioning

confidence: 99%

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

Cloutier¹,

Penning

2016

GERONT

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“…10,22 The RAI 2.0 is administered by trained assessors who use available information from chart review and interaction with residents, their families, and the clinical staff who work with them. In Canada, it is administered within 14 days of admission to the LTC facility, on a quarterly basis thereafter, or as needed if there is a significant change in status.…”

Section: Methodsmentioning

confidence: 99%

“…In Canada, the proportion of LTC residents receiving PT in 2009-2010 ranged from 5.6% in Manitoba to 31.9% in Yukon. 10 Variation in use of rehabilitation within provinces has not previously been reported. Rates of therapy usage also vary between countries, 11 from 10% in the United Kingdom 12 to 11% in the United States, 30% in Iceland and Japan, 11 and 35%-90% in the Netherlands.…”

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confidence: 96%

“…18 These variations suggest that access to rehabilitation services may not be defined by the needs of residents, and there may be room for improving QOL, restoring function, and decreasing the rate of physical decline. 10 Our cross-sectional study had three objectives: first, to describe the proportion of residents receiving rehabilitation services (defined as PT and OT); second, to describe the demographic and clinical characteristics of residents receiving PT in LTC; and, third, to determine what factors are associated with the receipt of PT, at three frequencies and time intensities, in LTC facilities across five provinces and one territory.…”

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confidence: 99%

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Who Receives Rehabilitation in Canadian Long-Term Care Facilities? A Cross-Sectional Study

McArthur¹,

Hirdes

Berg

et al. 2015

Physiotherapy Canada

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Purpose: To describe the proportion of residents receiving occupational therapy (OT) and physical therapy (PT) and the factors associated with receiving PT in long-term care (LTC) facilities across five provinces and one territory in Canada. Methods: Using a population-based, retrospective analysis of crosssectional data, the proportion of LTC facility residents in each province or territory receiving three different amounts (time and frequency) of PT, OT, or both before July 1, 2013, was calculated according to the Resource Utilization Groups-III rehabilitation classifications. Twenty-three variables from the Resident Assessment Instrument 2.0, such as age and cognition, were examined as correlates; those significant at p < 0.01 were included in a multivariate logistic regression. Results: Between 63.7% and 88.6% of residents did not receive any PT or OT; 0.8%-12.6% received both PT and OT; 5.8%-29.5% received an unspecified amount of PT; 1.9%-7.0% received 45 minutes or more of PT 3 days or more per week; and fewer than 1% received 150 minutes or more of PT on 5 or more days per week. Province, age, cognitive status, depression, clinical status, fracture, multiple sclerosis, and self-rated potential for improvement were associated with PT irrespective of time intensity. Conclusions: The proportion of LTC residents receiving rehabilitation services varies across Canada and appears to be associated with physical impairments and the potential for improvement; older residents with cognitive impairment or mood disorders are less likely to receive rehabilitation services. Future recommendations should consider what is driving the patterns of service use, determine whether the resources available are appropriate, and address the most appropriate goals for residents in LTC.Key Words: aged; long-term care; occupational therapy; rehabilitation. RÉ SUMÉObjet: Dé crire la proportion de ré sidents qui reç oivent des soins d'ergothé rapie (ET) et de physiothé rapie (PT) ainsi que les facteurs associé s à la ré ception de soins de PT dans des é tablissements de soins de longue de cinq provinces et d'un territoire au Canada. Mé thodes: À l'aide d'une analyse ré trospective de donné s transversales fondé e sur la population, la proportion de ré sidents des é tablissements de soins de longue duré e dans chaque province ou territoire qui recevaient trois combinaisons diffé rentes (temps et fré quence) de soins de PT ou d'ET avant le 1 er juillet 2013 a é té calculé e en fonction des groupes d'utilisation des ressources-classifications de ré adaptation III. Un total de 23 variables de la mé thode d'é valuation RAI 2.0, comme l'â ge et la cognition, ont é té examiné es en tant que corré lats; les variables significatives au seuil de p < 0.01 ont é té incluses dans une ré gression logistique à variables multiples. Ré sultats: De 63,7% à 88,6% des ré sidents n'ont pas reç u de soins de PT ou d'ET; de 0,8% à 12,6% des ré sidents ont reç u les deux types de soins; de 5,8% à 29,5% des ré sidents ont reç u une quantité non pré c...

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“…Increasingly, they provide end-of-life care [3][4][5] as approximately one in five residents living in LTC homes in Canada and UK dies each year [6][7][8][9]. Yet, there exists a culture of silence surrounding dying that creates a barrier to end-of-life communications in LTC [2,10].…”

Section: Introductionmentioning

confidence: 99%

Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

Ramsbottom

Kelley

2014

International Journal of Palliative Care

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Long term care (LTC) homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP) important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide "resident-centred care"; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.

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Beyond the ‘Iron Lungs of Gerontology’: Using Evidence to Shape the Future of Nursing Homes in Canada

Cited by 171 publications

References 101 publications

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

Who Receives Rehabilitation in Canadian Long-Term Care Facilities? A Cross-Sectional Study

Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

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