The social organization of a sedentary life for residents in long‐term care

Abstract

Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.

Influencing everyday activities in a nursing home setting: A call for ethical and responsive engagement

“…This dilemma could be seen, for example, by the nurse assistant of not doing ‘ what we are here for’ in the sense of providing responsive care to the residents. Lack of time and short staffing (Benjamin et al., 2016; Gustavsson, et al., 2015; Salzmann‐Erikson, 2016; Stabell, Eide, Solheim, Solberg, & Rustøen, 2004) are examples of organizational conditions hindering influence enactment in everyday activities. These dilemmas can be seen as being understood and accepted to different degrees by all parties involved as follows: management staff, significant others, and even the residents.…”

“…This knowledge about activities meaning for older adults is important, but limited because these tasks constitute just a small part of everyday activities in a NH. Moreover, they emerge mostly from institutional needs and are not necessarily grounded on the residents' interests (Benjamin, Rankin, Edwards, Ploeg, & Legault, 2016;Boelsma, Baur, Woelders, & Abma, 2014), which puts person-centered practices at stake. Spontaneous, unplanned, and unprompted activities that emerge through a relational and person-centered understanding of care are less often addressed in this research field (Harnett, 2010(Harnett, , 2014.…”

Exergaming Platform for Older Adults Residing in Long-Term Care Homes: User-Centered Design, Development, and Usability Study

“…However, it is difficult for OAs who reside in LTC homes (herein referred to as residents) to engage in adequate amounts of PA because of multiple comorbidities, including frailty and severe cognitive impairments [1,7]. The sedentary nature of living in LTC homes is well documented [8], and this level of physical inactivity significantly increases the likelihood of further declines in cognitive and functional abilities, especially in the first few months after OAs are admitted to LTC homes [9]. The high prevalence of physical and cognitive impairments among LTC residents also compounds social isolation [10,11], a risk factor that negatively influences cognitive [12] and mental health.…”

Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence

“…A mechanism that this approach lacks is one that connects new knowledge (the management of constipation) with the benefits for the resident, did they feel better and were they continent, as well as the wider concerns and activities of the care home. A doctoral thesis on care staff and care home working 154 highlighted how a focus on one activity (in this case personcentred care at meal times to support resident choice and participation) had unintended consequences for the rest of the care home staff's workload. The result was that they rushed other aspects of care in order to meet the expectations of what should happen at meal times:…”

“…133 154 There were two small care home studies that tested the feasibility of novel interventions for addressing constipation using transcutaneous posterior tibial nerve stimulation 155 and mechanical vibration to provide abdominal massage. 156 Neither included PLWD and it was unclear who, apart from the research team, were involved and how the interventions could be implemented by care home staff for PLWD.…”