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Locked doors and secure units are often used as a solution in long-term residential care (LTRC) for residents with moderate to severe dementia who are at risk for wandering and potentially harming themselves or others. This practice creates important quality of life implications for residents as well as for employees. In this paper we explore broader assumptions, connotations and possibilities of LTRC built environments by comparing and contrasting the use of and philosophies regarding the locking of doors and entire units in facilities that maintain this practice to those that have open doors, open units and other accessible physical spaces. This sub-study is part of a larger international, interdisciplinary study that uses rapid site-switching ethnography within a feminist political economy framework to investigate promising practices in LTRC. Field observations and interviews with management, health providers, support staff, informal care providers, union representatives, residents and family members were conducted in 27 sites, 10 of which we elected to include for the purpose of this paper, located in Nova Scotia, Ontario, Manitoba, and British Columbia (BC), Canada, as well as Norway, Germany and the United Kingdom (UK). Locked doors and units, and inaccessible physical spaces affect the balance between “home” and “institution” in LTRC facilities in numerous ways including privacy, mobility and autonomy of residents, the ability to remain socially connected within the home, possibilities of integration with the larger community and overall quality of life and care. [ABSTRACT FROM AUTHOR]

Cleaning and cleaners make three main contributions to long-term residential care. While cleaning in hospitals has received considerable research attention, much less attention has been paid to connecting cleaning and cleaners with the specific nature of long-term care and resident needs. In this article we explore three critical contributions cleaning and cleaners make to the quality of care in nursing homes. This work is central to infection control. It is also important in maintaining the appearance of the home; in making it home-like, welcoming, and safe. Much less visible is the significant part cleaners play in supporting relational care. Based on ethnographic studies in six countries, we argue that the extent to which cleaners and cleaning promote quality care and worker health is related to the division of labour, team work, training, equipment, and some autonomy. [ABSTRACT FROM AUTHOR]

Objective: To explore the social organization of food provision and dietary intake in seriously mentally ill people with diabetes who reside in a for-profit group home., Methods: Institutional ethnography was used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were conducted with residents with diabetes, care providers, field workers, and health professionals. Observations and document analysis were also used to understand the lack of congruence between diabetes guidelines and the possibilities for diabetes management within the confines of group home care., Results: Although it was mandated in group home guidelines that "Health Canada's Eating Well with Canada's Food Guide" (2007) be followed, menus were planned within the context of a limited food budget of approximately $1.91 per day per resident. Group home policies regulated systems of safety, reporting, and financial accountability, but not health promotion. Inspections carried out by the Public Health Department focused primarily on food safety during handling, preparation, and storage, and compliance to regulations regarding environmental cleanliness and infection control., Conclusion: Resource rationing found in group home care exacerbates illness in an already marginalized group. Financial support is required to enable provision of healthy food choices, including dairy products, fresh fruits, and vegetables. Additional support is required for care of co-morbid conditions such as diabetes for associated food costs and education to improve outcomes. Group home policies must take into consideration health threats to this population and give primacy to health promotion and illness prevention.