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Background and Purpose: Although nursing home culture change models (e.g., Green House, The Pioneer Network) in the U.S. have been proven to improve the quality of life of the residents by providing person-centered care and home-like environment, limited efforts have been made to implement a model in Korea. The purpose of this study was to examine whether the adapted culture change model would improve the quality of life of the residents and strengthen the person-centered climate. Methods: Employing a quasi-experimental design, the PI developed and implemented a 12-session culture change enhancement program to 32 staff in four nursing homes. Data were collected from 109 nursing home residents before and after the intervention, and key measures included the quality of life scale and the person-centered climate. The paired t-test analyses were performed with SPSS 26.0. Results: Paired samples t-tests showed that the culture change intervention significantly improved the quality of life of the residents. There were significant differences in the scores for privacy at pretest (M=2.63) and posttest (M=3.21); autonomy at pretest (M= 3.20) and posttest (M= 3.43); relationships at pretest (M= 2.88) and posttest (M= 3.36); individuality at pretest (M=3.26) and posttest (M=3.61). An average score for person-centered climate (M=6.25) were significantly higher than that of pretest (M=5.96) (p

Low retention of certified nursing assistants (CNAs) and direct care workers (DCWs) continues to be an unresolved problem for nursing homes (NH) and assisted living (AL) settings. While numerous studies have examined predictors of CNA retention in NHs, little attention has been paid to differences between settings of long-term care. To inform practice and policy related to growth in the AL industry, this study compares the predictors of CNA and DCW retention rates. The 2017 Ohio Biennial Survey of Long-Term Care Facilities provides facility-level information from 968 NHs (91% response rate) and 708 ALs (88% response rate). Using regression analysis, we compare the factors that predict retention rates among providers with complete data on retention and controls. The same covariates relating to structural and financial characteristics, as well as staffing, management, and a number of retention best practices are used. Average DCW and CNA retention rates were 66% and 61% in ALs and NHs, respectively, with some settings reporting very low (and even 0%) retention over a year. AL and NH providers rated the problem’s severity highest (6 out of 10) compared to retaining other licensed nurses. Similar and different predictors were found across financial, environmental, and managerial practices supporting retention. CNA and DCW retention strategies may not be equivalently meaningful between settings, given differing working environments, resources, and regulations. Aging services managers should be attuned to practices supporting retention in their industry.

Mealtime difficulties are common in residents with dementia, leading to negative outcomes. Interaction with staff are critical to engage residents in eating. This study characterized dyadic verbal interactions (descriptive statistics), and relationships among verbal behaviors and between verbal behaviors and individual characteristics (bivariate analyses). This secondary analysis of 110 videotaped mealtime observations involved 25 residents and 29 staff (42 unique dyads) in 9 nursing homes (NH). Verbal behaviors (utterances) were coded using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing 8 positive behaviors and 4 negative behaviors. Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%). 85.1% of residents’ utterances were positive and 14.9% negative. Staff positive utterances were associated with staff negative utterances (p=.02), and resident positive (p

Understanding residents’ satisfaction with assisted living (AL) is essential for creating supportive environments that are focused on residents’ needs and preferences. Nearly half of AL residents experience some level of cognitive impairment, although limited research has examined residents’ satisfaction with AL particularly among those with cognitive impairment. The purpose of this study was to compare satisfaction with AL between residents with and without dementia. Baseline data from the Dissemination and Implementation of Function Focused Care in AL study was used in this analysis. A total of 481 AL residents were included in the sample. Measures included demographic information, Saint Louis University Mental Status Exam (SLUMS), and the Resident Satisfaction Index. Controlling for age, gender, and comorbidities, multivariate analyses of variance was performed to consider the impact of cognitive status on residents’ satisfaction with health care services, physical environment, relationships with staff, and social activities. The majority of participants were female (71%), White (97%), mean age was 89 years old (SD=7.43), and mean SLUMS score was 15.90 (SD=4.74). On average, residents were highly satisfied with AL reporting a mean score of 19.17 (SD=3.15). There were no significant differences in residents’ satisfaction scores (p>.05) between residents with dementia and without dementia across all subdomains of satisfaction: health care services, physical environment, relationships with staff, and social activities. There may have been some bias in results due to social desirability. Further research should explore additional aspects of residents’ satisfaction with staff such as whether or not person-centered care is provided.

In recent decades, assisted living facilities (ALFs) have grown dramatically as an alternative to nursing homes. Research in nursing homes has shed light on the nature of the relationships that exist between family members and staff. However, little is known about family-staff relations within ALFs. We present data from the first study to describe the prevalence of conflict and positive and negative family-staff interactions in ALFs and to examine whether positive and negative aspects of the relationship contribute to salient staff and family outcomes. We use data collected from 252 family members and 472 staff members across 20 ALFs from the Partners in Care in Assisted Living (PICAL) study. Participants completed measures including interpersonal conflict, depression, perception of treatment, and stress-related to caregiving. Results showed that conflict among family and staff members is relatively low in ALFs. For staff, interpersonal conflict and treatment by family members significantly predicted burnout and depression. For families, only gender significantly predicted burden. Subgroup analyses, however, indicated that the effect of interpersonal conflict was significantly associated with perceived caregiver burden among family members whose relative has dementia. Despite the relatively harmonious relationships identified among family members and staff in ALFs, sources of conflict and negative interactions were identified, revealing the influence these relationships have on both family and staff outcomes. These findings can inform intervention efforts targeting family-staff interactions within ALFs.

This study aimed to elicit psychosocial reactions to relocation to nursing homes from older adults’ perspectives with a qualitative interview design. Narratives from 23 Chinese nursing home residents from Fuzhou, China in a life review program were recorded, transcribed into sentences, and analyzed with the qualitative content analysis. It revealed five stages of psychosocial reactions to relocation to nursing homes as fear, struggle, compromise, acceptance, and contribution. The first stage resulted from negative labels attached to nursing homes, disconnection to the society, difficulties in establishing new relationships, and being abandoned by their families. The second stage described the behaviors of struggle: complain about family members, think of going back home, pray to have a change, and take action to leave. The third stage described the keys to compromise: choices between maintaining the harmony in family relation and companionship of relatives, choices between professional care and family care, and choices between costs and effects of family care and nursing home care. The fourth stage described how they accept nursing home life: accept the life and yet with worries, affirm benefits of living in nursing homes, and embrace the nursing home life. The last stage resulted from sense of ownership and giving full play to self-worth. This study generated new insights into the knowledge on psychosocial reactions to relocation to nursing homes and provided both family members and nursing home staff with a direction for how to promote a smoother relocation process.

Residence in a long-term care (LTC) facility poses numerous challenges to psychological well-being and rates of depression are high. Sense of belonging (SoB) has been linked with measures of well-being in all age groups and interventions focused on improving SoB have been successful with college-age adults. It is unclear if SoB improves in LTC residents as they adjust to living in this environment or what factors predict poor SoB in this population. As part of a larger study of care preferences in LTC residents, participants (n= 76) completed measures of SoB, well-being, religious activity, and demographic information. SoB did not vary significantly based on duration of stay, age, gender, ethnicity, marital status, number of children, education, facility, cognitive functioning, or physical health. SoB was found to be significantly and positively correlated with participation in religious activities (r= .388, N=76, p=.001), private religious practices (r= .275, N=71, p=.020), and spirituality (r= .263, N=70, p=.028). There was also a significant positive correlation between SoB and positive affect (r= .450, N=74, p

Life review therapy, used as part of a comprehensive therapy plan for increasing the quality of life of the elderly, helps them to resolve their past conflicts, and accept their present conditions. This study tested the effectiveness of a structured life review therapy protocol on the life satisfaction of institutionalized older adults. A quasi-experimental design was adopted in this study. Fifty older adults aged 65 or above were recruited from nursing homes in southern Taiwan through convenience sampling. The participants in the intervention group carried out life review therapy for eight weeks in addition to their daily activities. The participants in the comparison group maintained their daily activities. Both groups were evaluated using a life-satisfaction scale including two aspects of life worries and situations in weeks 1 and 8. Data were collected at baseline (T1), immediately post-intervention (T2). Generalized estimating equations were used to examine the effect of the intervention on the outcomes. The overall life satisfaction increased significantly over time for the intervention group compared to the comparison group from week 1 to week 8. The life review therapy programs showed promising effects in improving the life satisfaction of older adults living in nursing homes.

Prior research has demonstrated that ageism, specifically negative attitudes and behaviors about growing old, can be barriers to delivering high-quality long-term care (LTC), but little is known about how ageism may be related to job satisfaction – an important driver of workforce retention in LTC. Hence, the purpose of this study was to examine the role of ageism in job satisfaction in LTC. Our cross-sectional study used data collected from 265 staff members of aging services organizations (e.g. nursing homes, assisted living) representing the continuum of job types in LTC. The study examined the relationship between ageist attitudes (i.e. internalized and relational aging anxiety; affinity for older persons) and ageist behaviors, and job satisfaction when controlling for socio-demographic (i.e. age; gender; ethnicity) and employment-related variables (i.e. years of employment; advanced training in gerontology; direct care vs. managerial position). Results of a regression analysis showed that lower internalized aging anxiety and higher affinity for older people were significantly associated with higher levels of job satisfaction. Findings suggest addressing ageism to improve job satisfaction in LTC and provide some evidence for incorporating ageism screening and training into recruitment and onboarding of staff to enhance job satisfaction and to mitigate turnover.

Older adults in assisted living (AL) tend to be highly sedentary, which increases their risk of functional decline and frailty. Reducing sedentary behavior (SB) and replacing it with light physical activity (LPA) could have important implications for maintenance of functional abilities. The purpose of this qualitative study was to gather feedback from AL residents on a proposed exercise-specific self-efficacy enhancing intervention designed to promote LPA and reduce SB. We conducted one-on-one semi-structured interviews at four AL facilities with 20 residents ages 65-99 (mean age 83.1; 60% women). They were presented with the proposed intervention and were asked questions to inform the development and modification of the intervention. Data were analyzed with a thematic analysis approach. Specific recommendations included short intervention sessions of one hour and scheduled in the morning. Many residents thought a 16 week intervention was too long. We identified broader themes, including concerns about how the intervention would work for residents with a wide range of abilities and concerns about safety. They suggested that exercises will need to be highly modifiable. Most residents recommended framing the intervention message as increasing LPA rather than decreasing SB, because it would be more positive. All except one said they would want to participate in the intervention, but they were unsure how many other residents would want to be more active. The resident feedback and suggestions will guide development of the intervention and are important for increasing the probability that a future feasibility and acceptability trial of the intervention will be successful.

Long-term care residents with and without cognitive impairment may experience undertreatment of persistent pain (Fain et. al, 2017). Certified nursing assistants (CNAs) are important sources of information about resident pain as they provide the majority of residents’ hands-on care. Therefore, assessing the accuracy of CNAs’ pain assessments and potential influencing factors may provide insight regarding the undertreatment of pain. Informed by prior research, this study examined resident pain catastrophizing and cognitive status as predictors of CNAs’ pain assessment accuracy. CNA empathy was examined as a moderating variable. Analyses confirmed a relationship between pain catastrophizing and CNA pain rating accuracy (R^2 = .205, p < .01), reflecting lower accuracy of ratings for residents higher in catastrophizing. Hypotheses predicting a relationship between resident cognitive status and CNA pain rating accuracy and moderating effects of empathy were disconfirmed. Challenges of conducting research in long-term care are discussed.

Background Recent systematic reviews suggest the effectiveness of complex psychosocial interventions to reduce sleep disturbances in people with dementia (PwD) living in nursing homes. However, it is unclear how and under which circumstances these interventions work and which components and processes are crucial determinants for effectiveness. Objectives To develop a Theory of Change (ToC) that describes a causal chain for the reduction of sleep disturbances. Design and Methods The ToC approach is a participatory method in intervention development to generate knowledge about how, why, and under which circumstances interventions are effective. We conducted two expert workshops, a subsequent expert survey (n=12), a systematic literature review, and expert interviews (day and night nurses). Results Necessary preconditions for the reduction of sleep disturbances were identified on staff, management and cultural levels of nursing homes. Intermediate goals like “individual knowledge on PwD is available”, “a specific institutional concept to promote sleep is implemented”, “person-centred care is implemented” and “sleep preferences of PwD are fulfilled” were defined. The intermediate goals, interventions, promoting and inhibiting factors as well as rationales were sorted into a causal chain. All intermediate goals were rated as relevant or highly relevant based on the expert survey. Conclusions The ToC model displays how a complex psychosocial intervention is likely to be effective in reducing sleep disturbances and meeting sleep preferences of PwD in nursing homes. The model is the basis for the development and evaluation of a planned complex psychosocial intervention to prevent and reduce sleep disturbances in PwD.

This study adds to the growing literature on attitudes toward aging in older adulthood by using a multidimensional measure to assess heterogeneous profiles of expectations regarding aging (ERA) in a sample of assisted living (AL) residents. The author analyzed secondary data from a cross-sectional quantitative study consisting of 202 residents of 21 ALs. Participants were mostly female (72%), white (90%), and widowed (59%); ages ranged from 51 to 100 (M = 83.05, SD = 10.32). Hierarchical Cluster Analysis identified four subgroups: (1) “healthy agers”, n = 54, 27%, characterized by high physical, emotional, and cognitive ERA; (2) “cognitively intact”, n = 41, 20%, characterized by low physical, low emotional, and high cognitive ERA; (3) “coping with decline”, n = 56, 28%, characterized by moderate physical, high emotional, and low cognitive ERA; and (4) “unhealthy agers”, n = 51, 25%, characterized by low physical, emotional, and cognitive ERA. Subgroups varied by mental health (healthy agers > unhealthy agers), cognitive ability (cognitively intact > coping with decline), and activity participation (coping with decline > unhealthy agers). Surprisingly, groups did not differ based on social support from co-residents, staff, or family. Results demonstrate that distinct subgroups of ERA exist among AL residents, supporting the utility of assessing ERA as a multidimensional construct in this setting. In addition, findings suggest that expecting to retain health and ability in at least one domain may protect against behavioral consequences of negative ERA. The author also discusses implications for future research and clinical practice in AL.

In the past, urinary tract infections (UTIs) have been attributed to poor hygiene, the natural course of aging, an unfortunate corollary of nursing home (NH) residence, and a condition routinely treated empirically with antibiotics. Recent UTI management consensus statements foretell a very different future and support the need to consider all UTIs in the NH as complex infections. Improving assessment capabilities of the NH nurse workforce is essential for improving quality of care. This study aimed to determine how, using simulation, licensed vocational nurses (LVNs) integrated a mobile decision-support app (MDS-app) into assessment of a NH resident with a potential UTI. The MDS-app directed the LVN to examine or question the resident (mannequin) to identify signs and symptoms developed as part of a simulated clinical scenario. MDS-app items were based on UTI practice guidelines. A descriptive, participant observation design (video-taped) was used with ten practicing LVNs. An observation checklist was used to examine audiovisual recordings and included frequency of verbal interaction (17.9+/-7.2), and eye contact (10.6+/-4.1). Participants (47%) were “glued to” the MDS-app without making resident eye contact or touching residents during the assessment. 60% of participants deviated from the app to ascertain urine odor and color; irrelevant symptoms for UTI diagnosis. Assessments required 11.20 (+/-4.67) minutes to complete. The MDS-app provided LVNs with needed focus on data driven by guidelines and not individual LVN preferences. Training LVNs should focus on integration of communication, assessment skills, and MDS-app use for evidence-based data collection as a basis for UTI treatment decisions.

Moving to a continuing care retirement community (CCRC) and living apart together (LAT) as a repartnering form, represent new late-life beginnings. A larger qualitative study on LAT relationships constructed in the CCRC identified envy and jealousy yet they were not examined in-depth. Envy is wanting something we lack whereas jealousy is fear of losing something that is ours to another. These emotions are rarely explored in the context of older adults’ relationships. Our aim is to examine experiences of envy and jealousy from perspectives of residents aged 79 to 96 and staff, heuristically using Goffman’s framework on (semi)-totalitarian institutions. 30 semi structured qualitative interviews were conducted in three CCRCs in Israel with 10 LAT residents, 10 residents not LAT, and 10 CCRC staff members including social workers. Analysis was conducted based on principles of thematic analysis and triangulation. Findings refer to kinds of envy, ignoring envy, and the development and consequences of jealousy and/or envy related to LAT in the CCRC. Conclusions address how semi-totalitarian CCRC features influence envy and jealousy experiences including implications for assisting social workers, older adults and their family members to adjust to life in the CCRC and assist CCRC management and staff to address possible consequences of envy and jealousy.

‘Unbefriended’ adults are those who lack decision-making capacity and have no surrogates or advance care plans. Little data exist on nursing homes (NHs)’ healthcare decision-making practices for unbefriended residents. This study aimed to describe NH staff’s perceptions of healthcare decision making on behalf of unbefriended residents. Sixty-six staff including administrators, physicians, nurses, and social workers from three NHs in one geographic area of Georgia, USA participated in a 31-item survey. Their responses were analyzed using descriptive statistics and conventional content analysis. Of 66 participants, eleven had been involved in healthcare decision-making for unbefriended residents. The most common decision was do-not-resuscitate orders. Decisions primarily were made by relying on the resident’s primary care physician and/or discussing within a facility interdisciplinary team. Key considerations in the decision-making process included “evidence that the resident would not have wanted further treatment” and the perception that “further treatment would not be in the resident’s best interest”. Compared with decision making for residents with surrogates, participants perceived decision making for unbefriended residents to be equally-more difficult. Key barriers to making decisions included uncertainty regarding what the resident would have wanted in the given situation and concerns regarding the ethically and legally right course of action. Facilitators (reported by 52 participants) included some information/knowledge about the resident, an understanding regarding decision-making-related law/policy, and facility-level support. The findings highlight the complexity and difficulty of healthcare decision making for unbefriended residents and suggest more discussions among all key stakeholders to develop practical strategies to support decision-making practices in NHs.