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By late May 2020, COVID-19 cases among long-term care (LTC) residents in Ontario constituted 5,157 of the province's 28,499 cases. In British Columbia (B.C.), there were 339 cases among LTC residents compared with a provincial total of 2,562 cases. While the LTC sectors in these two provinces have some differences, this article reviews their pre-pandemic LTC staffing policies and compares their staffing-related COVID-19 prevention measures in 2020. Ontario's policies before 2020 corresponded with lower staff-to-patient ratios than B.C., which may have constrained Ontario's pandemic responses. Implementation of standards or guidelines and changes to funding could help achieve LTC sector staffing resiliency. [ABSTRACT FROM AUTHOR]

Claims of high turnover, reflecting worker dissatisfaction, in the long-term-care home (LTCH) sector have been common during the coronavirus disease 2019 pandemic. Using a census of registered nurses (RNs) and registered practical nurses (RPNs) in Ontario from 2014 to 2020, we compare LTCHs and other health care sectors in terms of (a) worker and job characteristics and (b) job turnover (distinct from occupational turnover). RNs in LTCHs are older, have lower levels of education, and are more likely to be trained outside of Canada compared with the provincial average, whereas RPNs are more similar to that norm. LTCH jobs are more likely to be rural and to involve casual contracts and irregular hours than those in most, but not all, sectors. Pre-pandemic, RNs in LTCHs were in the middle of the sectoral turnover distribution, whereas RPNs were lower than all sectors except hospitals. Among nurses who changed jobs, LTCH sectoral retention was similar to that in other sectors. Overall, turnover measures do not suggest lower job satisfaction in LTCHs than other sectors. During the first year of the pandemic, small changes in turnover were observed, but it is difficult to disentangle pandemic restrictions on holding multiple jobs from other causes. [ABSTRACT FROM AUTHOR]

After a decade of unprecedented austerity, Greece abruptly changed the course of pension consolidation in 2022 and implemented the controversial carve‐out pension funding approach, whereby a portion of existing pay‐as‐you‐go (PAYG) contributions are diverted to fund individual pension savings, thus undermining the financing of existing PAYG pensions. Although inspired by the World Bank's 1994 pension privatization blueprint, the Greek 2022 reform features a major policy shift by entrusting the management of individual pension savings to a dedicated government body, ostensibly to try to remedy inherent market failures in private pension provision. Like earlier reforms in Eastern Europe, the multi‐decade transition costs of carve‐out funding have been vastly underestimated in Greece, which will give rise to fiscal distress in the coming years when annual transition costs become sizeable and favourable international financing terms start to change. Unless firm political commitment is established to implement the measures necessary to finance the transition costs, Greece may have to resort to reform reversals similar to those already implemented across Eastern Europe. [ABSTRACT FROM AUTHOR]

Long‐term care provision and financing are becoming increasingly important matters in all ageing economies. Therefore, a major challenge for policy makers is to strike a balance between adequate care and sustainable financing. In this study, we evaluate the proposal of a so‐called sustainability factor in German long‐term care insurance. Considering changes in the beneficiary‐contributor ratio, it aims for a rule‐based consideration of demographic dynamics to alleviate pressure on long‐term care financing. Using the framework of generational accounting, we demonstrate that this proposal could have a relieving effect on finances, depending on the share of involvement of current and future generations. It may offer an option for pay‐as‐you‐go long‐term care insurance systems worldwide that need to curb the impact of ageing societies. Therefore, this article addresses policy makers tasked with designing a sustainable financing model for long‐term care insurance. It demonstrates that the sustainability factor represents a step towards sustainable finances and, thus, it might be one component of a more comprehensive reform package. [ABSTRACT FROM AUTHOR]

Modesty is omnipresent in health care, particularly in the care of highly dependent persons and which involves a significant intrusion into their intimacy. However, it is still little discussed in health care ethics. This article presents a conceptual exploration of the notion of modesty and its manifestations in healthcare, more specifically their moral dimension and the challenges they pose for health care institutions. Since modesty calls for the protection of the integrity, dignity and vulnerability of the person being cared for, it seems to us to have a moral purpose, and therefore deserves not only more attention from the ethics of care, but perhaps even to be introduced as a virtue. [ABSTRACT FROM AUTHOR]

This study examines worker voice in the development and implementation of safety plans or protocols for covid -19 prevention among hospital workers, long-term care workers, and education workers in the Canadian province of Ontario. Although Ontario occupational health and safety law and official public health policy appear to recognize the need for active consultation with workers and labour unions, there were limited – and in some cases no – efforts by employers to meaningfully involve workers, worker representatives (reps), or union officials in assessing covid -19 risks and planning protection and prevention measures. The political and legal efforts of workers and unions to assert their right to participate and the outcomes of those efforts are also documented through archival evidence and interviews with worker reps and union officials. The article concludes with an assessment of weaknesses in the government promotion and protection of worker health and safety rights and calls for greater labour attention to the critical importance of worker health and safety representation. Cette étude examine la voix des travailleurs dans l'élaboration et la mise en œuvre de plans ou de protocoles de sécurité pour la prévention du covid-19 chez les travailleurs hospitaliers, les travailleurs de soins de longue durée et les travailleurs de l'éducation dans la province canadienne de l'Ontario. Bien que la loi ontarienne sur la santé et la sécurité au travail et la politique officielle de la santé publique semblent reconnaître la nécessité d'une consultation active avec les travailleurs et les syndicats, il y a eu des efforts limités – et dans certains cas aucuns efforts – deployés par les employeurs pour impliquer de manière significative les travailleurs, les représentants des travailleurs (délégués), ou des responsables syndicaux pour évaluer les risques liés au covid-19 et planifier les mesures de protection et de prévention. Les efforts politiques et juridiques des travailleurs et des syndicats pour affirmer leur droit de participer et les résultats de ces efforts sont également documentés par des preuves d'archives et des entretiens avec des délégués et des responsables syndicaux. L'article se termine par une évaluation des faiblesses de la promotion et de la protection par le gouvernement des droits des travailleurs en matière de santé et de sécurité et appelle à une plus grande attention des travailleurs à l'importance cruciale de la représentation en matière de santé et de sécurité des travailleurs. [ABSTRACT FROM AUTHOR]

Older people and their care workers have been disproportionately affected by the COVID‐19 pandemic. Many OECD Member countries have taken measures to contain the spread of the infection and improve the care workforce. Yet the health crisis is highlighting and exacerbating pre‐existing structural problems in the long‐term care (LTC) sector. In many OECD Member countries, recruiting enough workers in LTC remains a challenge and care workers experience difficult working conditions. Skills mismatch and poor integration with the rest of health care lie at the root of preventable hospital admissions even in normal times. Such challenges are likely to become ever more acute if no further action is taken given the speed of population ageing. Policies to improve recruitment and which also address retention through training, improvements in coordination and productivity, leveraging the effect of digital technologies, are needed. [ABSTRACT FROM AUTHOR]

The article sets out key elements of the policy agenda for enhanced integration between health and social care for older people in high‐income countries and demonstrates its wider relevance to low‐ and middle‐income countries (LMICs). The article then explores the context for this agenda in Brazil, including growing demand for long‐term care (LTC) and current institutional arrangements. It goes on to discuss a case study project of partnering for LTC between local social assistance and health agencies in the Brazilian city of Belo Horizonte. It identifies challenges and potential benefits of this partnership model, offering policy insights for LTC policy in Brazil and other countries. [ABSTRACT FROM AUTHOR]

In this article, we provide an overview of the current long‐term care (LTC) landscape across low‐ and middle‐income countries (LMICs), based on an analysis and synthesis of literature review findings. We begin with a brief assessment of LTC needs on the demand side, followed by a supply side assessment of the available mix of formal LTC services vis‐à‐vis informal care provision. Next, we describe and discuss the role of government policies in LTC provision and governance. We conclude by discussing and offering practical LTC policy considerations for LMICs, drawing on experiences, best practices and lessons learned from high‐income countries. [ABSTRACT FROM AUTHOR]

First published in April 1948 as the Bulletin of the International Social Security Association, this year marks the 75th anniversary of what, since January 1967, we have all come to know as the International Social Security Review. To mark this important anniversary, this special double issue, "The human right to long‐term care for the elderly: Extending the role of social security programmes", talks to current debates on social security coverage extension in a context of population ageing. There is a case to be made for revising the international social security standards to formally recognize long‐term care for the elderly, possibly as a distinct branch of social security. At the heart of this discussion, the questions to be addressed by all countries are the roles that social security systems can and should play in helping to meet the long‐term medical and social care needs of elders. [ABSTRACT FROM AUTHOR]

This article investigates the challenges of ageing for long‐term care. The analysis proceeds in three steps. In the first step, we estimate the prospective care demand for 30 developed countries based on projected ageing and disabilities among the elderly. In the second step, we outline challenges for care systems with respect to shortages of care workers, increasing skill requirements for care workers, barriers to universal and equitable access to care, and cost containment subject to adequate care quality. In the third step, we identify solutions for these challenges by comparing the care systems of Germany, Israel, Japan, the Republic of Korea and the Netherlands. [ABSTRACT FROM AUTHOR]

With the acceleration of population ageing, healthy ageing is becoming an imperative for all. Social protection systems have an important role to play in this endeavour. Through a life cycle approach, social protection systems can support i) the prevention of disability in old age (i.e. by addressing the social determinants of health and rehabilitation), ii) effective access to long‐term care without hardship for those who need it, and iii) decent work in the care economy. To do so will require adopting a gender‐transformative approach. Indeed, women are disproportionately represented among both older persons and long‐term care providers in their diversity. Further, to adequately contribute to healthy ageing and effective access to long‐term care without hardship as a rights‐based entitlement, social protection systems will need to build strong coordination between health care, social care and other social policies. This article highlights the key entry points for social protection systems to contribute to the United Nations Decade of Healthy Ageing, building on the rights‐based approach of human rights and international social security standards. [ABSTRACT FROM AUTHOR]

We introduce evidence that for-profit long-term-care providers are associated with less successful outcomes in coronavirus disease 2019 outbreak management. We introduce two sets of theoretical arguments that predict variation in service quality by provider type: those that deal with the institution of contracting (innovative competition vs. erosive competition) and those that address organizational features of for-profit, non-profit, and government actors (profit seeking, cross-subsidization, and future investment). We contextualize these arguments through a discussion of how contracting operates in Ontario long-term care. That discussion leads us to exclude the institutional arguments while retaining the arguments about organizational features as our three hypotheses. Using outbreak data as of February 2021, we find that government-run long-term-care homes surpassed for-profit and non-profit homes in outbreak management, consistent with an earlier finding from Stall et al. (2020). Non-profit homes outperform for-profit homes but are outperformed by government-run homes. These results are consistent with the expectations derived from two theoretical arguments—profit seeking and cross-subsidization—and inconsistent with a third—capacity for future investment. [ABSTRACT FROM AUTHOR]

Résumé: Chez les patients âgés dépendants, la douleur procédurale peut être favorisée par les soins quotidiens. La prise en charge antalgique est bien définie, cependant celle de l'anxiété associée est moins codifiée. Au sein de notre établissement, les médecins gériatres utilisent le midazolam injectable per os à faible posologie 30 minutes avant les soins douloureux. Objectif. Valider l'utilisation du midazolam per os en prémédication anxiolytique avant des soins quotidiens (soins d'hygiène, réfection de pansement...) en unités de soins de longue durée gériatriques. Matériel et méthode. Nous avons effectué une recherche documentaire en privilégiant les sources tertiaires d'information. Nous avons également étudié la faisabilité d'une préparation magistrale de midazolam administrable per os et proposé un protocole de prise en charge correspondant. Résultats. Deux méta-analyses ont démontré l'efficacité du midazolam – y compris per os – en prémédication anxiolytique d'actes douloureux anxiogènes. La faisabilité d'une suspension buvable de midazolam concentrée à 1 mg/mL a également été confirmée. Notre protocole d'utilisation prévoit que le midazolam per os soit utilisé 30 minutes avant le soin. La posologie doit être titrée (posologie initiale : 1 mg puis augmentation par pallier de 0,5 à 1 mg) et ne doit pas dépasser 5 mg. Ces éléments ont été intégrés dans une planche d'information. Conclusion. Ce premier retour d'expérience montre que l'utilisation de midazolam per os en prémédication anxiolytique avant des soins quotidiens est pertinente. Procedural pain in care homes is common and can be caused by daily care. Pain management is well defined but associated anxiety is less. Geriatricians of our care homes prescribe oral intravenous midazolam in this situation. Objective. Determine the appropriateness of oral midazolam as an anxiolytic premedication before daily care (personal hygiene, wound dressing) in care homes. Material and method. We performed a literature review, favoring tertiary information sources. We also studied the feasibility of a midazolam oral suspension and proposed a management protocol. Results. Two meta-analysis provide evidence that oral midazolam is effective in different kind of painful and anxious procedures. A stability study also confirmed the feasibility of a 1 mg/mL oral suspension. According to our management protocol, oral midazolam should be administered 30 minutes before the care. Doses should be established gradually (beginning from 1 mg, increasing by 0.5-1 mg) and should not exceed 5 mg. This information is compiled in a leaflet. Conclusion. This first feedback confirmed the relevance of oral midazolam in preventing anxiety associated with daily care. [ABSTRACT FROM AUTHOR]

The Chinese social security system has been the subject of numerous publications, which have made policy developments more accessible to researchers and administrators from all countries. However, the steps introduced in response to growing demands for intervention by the authorities in favour of dependent persons have remained poorly documented in the international literature. The purpose of this article is to take stock of pilot experiments in this field since the beginning of the 13th Five‐Year Plan (2016–2020) with regard to their policy objective, operating mode and financing modalities. [ABSTRACT FROM AUTHOR]

The purpose of this commentary is to present and respond to the gap that currently exists in providing culturally inclusive residential long-term care options for Indigenous peoples in Ontario. After presenting statistics regarding the Indigenous population and long-term care options, we argue that we have an ethical responsibility to offer more culturally inclusive longterm care. [ABSTRACT FROM AUTHOR]

Across Canada the demand for continuing care services is increasing. However, little is known about the implications this has for rural communities. This scoping review identifies several key themes in the literature related to continuing care in Alberta. These include contextual factors, quality assurance and improvement, and workforce issues. We identify the ways in which rural dynamics are included in, or omitted from, this literature and recommend areas for future research on rural continuing care provision. Further research on residential care services in rural communities should work towards bridging the rural health, academic, and organizational literature on continuing care. This synthesis will help to position rurality as a determinant of health and to situate continuing care services in specific rural settings. Key Messages: The literature on continuing care in Alberta primarily focuses on quality assurance and improvement and the changing structure of the continuing care workforce.Little is known about the continuing care needs of rural Albertans.Future research ought to explore rural assets and challenges related to continuing care provision. [ABSTRACT FROM AUTHOR]

Neuropsychiatric symptoms (NPS) of dementia present some of the most challenging aspects of dementia care in the long-term care setting. Music therapy was introduced in two long-term care facilities in Nova Scotia, Canada as a non-pharmacological intervention to treat the NPS of dementia. Using an observational, within-subject, control design, the impact of half-time music therapy on residents was evaluated in 16 residents with NPS of dementia as measured on the Cohen-Mansfield Agitation Inventory (CMAI) over a 12-month period, and resident quality of life was measured on the Cornell-Brown Scale for Quality of Life in Dementia (CB-QoLD). The 16 participants ranged from age 76 to 92, with moderate to severe dementia (average MMSE 9.53). Monthly CB-QoLD scores demonstrated significant improvement in 7 out of 12 months relative to a pre-intervention baseline, and low levels of agitation were seen in residents during active treatment. Staff perception of the impact of music therapy on the overall long-term care environment was assessed using a quality assurance survey, and showed a perceived improvement in both morale and resident behaviours. The results support the inclusion of music therapy in long-term care for dementia even at the level of one half-time position. [ABSTRACT FROM AUTHOR]

Shifts from professionals to volunteers are observed across national contexts and in various types of public services, particularly in long-term care and social work. This article examines how professionals and volunteers in the Netherlands perform boundary work to construct, maintain and dissolve boundaries between them in the context of social service reform. Two types of boundary work were found: demarcation work and welcoming work. Demarcation work relates to a situation where differences in knowledge, authority and reliability between professionals and volunteers are emphasised. Welcoming work involves the efforts of professionals to welcome specific volunteers to their professional domain. This study examines the implications of the second type of boundary work for structural characteristics of the social service sector. It concludes that although welcoming work can lead to deprofessionalisation, it can also promote the professionalisation of nurses and social workers. [ABSTRACT FROM AUTHOR]

The unpaid care work undertaken by family members and friends often continues when relatives move to long-term residential care (LTRC). Using a feminist political economy approach, this paper explores the labour and skills of family/friend carers—most of whom are women—in LTRC. Data were gathered using the rapid site-switching ethnography method, which involved document analysis, qualitative interviews with 25 family members, and observations in eight LTRC facilities across Canada. We present five themes, developed through a thematic analysis of interviews and observations, to give insight into the labour and skills of these unpaid carers in LTRC: maintaining relationships, navigating the system to assert residents’ needs, supplementing care, assisting other residents, and working for change. In our analysis, we tease out complexities between family/friend care work in practice and the descriptions of their involvement in resident and family handbooks—guiding documents that serve as touchstones for communication between LTRC facilities and families. We note discrepancies between the impoverished descriptions of family engagement in handbooks and the complex labour undertaken by many family/friend carers in LTRC. These discrepancies reinforce the invisibility of unpaid care and an undervaluing of the skills involved in this labour. To conclude, we suggest an addition to handbooks that could serve to better recognize the involvement of family members and friends in LTRC. [ABSTRACT FROM AUTHOR]

Based on a qualitative rapid ethnography study, this article analyzes everyday care work in nursing homes in Ontario and Sweden. The comparison is linked to the broader socio-political and organizational contexts in the two jurisdictions. Policy documents in both locations stress that care services should be of high quality and individually adapted. The organizational preconditions to provide such care were better in the Swedish care homes because of higher staffing ratios, fewer routines, and more time for collegial support. The workers therefore had more opportunities to adapt their efforts to meet residents’ different and changing needs. In both jurisdictions, however, the care workers’ own needs were often disregarded, and their health and well-being were at risk. [ABSTRACT FROM AUTHOR]

Although the culture change movement has sought to transform residential care facilities from warehouses of death into homes for living, there is growing recognition of the need to address dying within these settings. Drawing on data from an international and interdisciplinary study, this paper explores the state of end-of-life care in residential care facilities, identifying barriers to the provision of compassionate care for the dying, as well as promising practices and areas for future inquiry. Interviews with staff and researcher observations at 20 nursing homes in Canada, Germany, Norway, Sweden, the United States, and the United Kingdom were analyzed. Six themes were identified: the growing need for end-of-life care; the challenge of identifying a dying phase; the importance of open communication about death; the need to address bereavement of both families and staff; the need for additional training and resources; and the inadequacy of current models of care. Taken together, these findings suggest that dying intensifies the need for relational care, a type of care residential care facilities have been struggling to provide. However, while demands increase, there are also opportunities. We conclude with a reflection on the potential that the blurred boundaries between living and dying hold for experimentation in long-term residential care with visions of life and health that can include death. [ABSTRACT FROM AUTHOR]

In this article, we compare current Canadian nursing home workers’ experiences and conditions of care to past work and care conditions to determine changes and similarities over the period from 1970 to the present. Employing a feminist political economy framework and a team-based rapid ethnography approach, our study involved observations of and in-depth interviews with management, health providers, support staff, informal care providers, union officials, and residents between 2012 and 2015. The historical substudy drew on interviews of past and present workers of one large long-term residential care home in Ontario. While improvements have been made in training and in the physical safety of staff and residents in these gendered spaces of work, there has been a persistence, if not intensification, in job precarity; inadequate staffing levels coupled with heavy workloads; routinized, assembly-line types of work; and cost-cutting on supplies. [ABSTRACT FROM AUTHOR]

Vitamin B12 (B12) deficiency, although treatable, impacts up to 43% of community-living older adults; long-term care (LTC) residents may be at greater risk. Recommendations for screening require further evidence on prevalence and incidence in LTC. Small, ungeneralizable samples provide a limited perspective on these issues. The purposes of this study were to report prevalence of B12 deficiency at admission to LTC, incidence 1 year post-admission, and identify subgroups with differential risk. This multi-site (8), retrospective prevalence study used random proportionate sampling of resident charts ( n = 412). Data at admission extracted included demographics, B12 status, B12 supplementation, medications, diagnoses, functional independence, cognitive performance, and nutrition. Prevalence at admission of B12 deficiency (<156 pmol/L) was 13.8%; 47.6% had normal B12 (>300 pmol/L). One year post-admission incidence was 4%. Better B12 status was significantly associated with supplementation use prior to LTC admission. Other characteristics were not associated with status. This work provides a better estimate of B12 deficiency prevalence than previously available for LTC, upon which to base protocols and policy. Prospective studies are needed to establish treatment efficacy and effect on health related outcomes. [ABSTRACT FROM AUTHOR]

Vitamin-mineral supplementation may offer older adults health and cognition-related benefits but overuse may contribute to polypharmacy. We examined the prevalence of supplement usage in long-term care facility (LTC) residents (≥65 years of age). As cognition may be affected by nutrition, we also examined use in those with diagnosis of dementia and those with no dementia diagnosis. The prevalence of supplement usage and overall 'pill count' from pharmaceutical use was assessed in 189 LTC residents and a subsample of 56 older adults with dementia diagnosis, respectively. Participants were residing in an LTC facility of a mid-size metropolitan area during 2009. The average use of supplements was 1.0 per day for all residents, with 35% taking vitamin D supplements, 20% multivitamins, and 26% calcium. Supplement use was similar ( p ≥ 0.05) for those with dementia diagnosis (53%, average 2.0 per day) and for those without such diagnosis (45%, average 2.2 per day). Usage ranged between 1-6 supplements per day. In both of these groups, ∼73% of users were taking vitamin D. The number of prescribed medications ranged from 4 to 24 (average 10.2) in a subsample of residents whose supplement intake was 0 to 6 (average 2). These findings suggest an overall low rate of supplement use, with no significant differences ( p ≥ 0.05) in use between residents with and without dementia diagnosis. However, some residents were at risk for supplement overuse. [ABSTRACT FROM AUTHOR]

A randomized controlled trial was conducted to evaluate the effect of music therapy on stress, anxiety, and depression levels of a group of the elderly who resided in a nursing home, The intervention group received 10 weeks of daily music-based sessions (each 90 minutes) including listening to music, singing and playing percussion instruments, while the control group (no music) received daily regular activities. The 21- item Depression Anxiety Stress Scale was used as a pre-and post-intervention measure in each group. Differences in pre- and post-intervention scores indicated significant reductions in mean scores of anxiety (P = .004), stress (P = .001), and depression (P < .001) in the intervention group as compared with the control group (no music). [ABSTRACT FROM AUTHOR]