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Omniprésente dans les soins de santé, particulièrement ceux s’adressant à des personnes très dépendantes et impliquant une importante intrusion dans leur intimité, la pudeur est cependant encore peu discutée en éthique des soins. Cet article présente une exploration conceptuelle de la notion de pudeur et de ses manifestations dans les soins de santé, plus précisément de leur dimension morale et des défis qu’elles posent pour les institutions de soins. Puisque la pudeur invite à la protection de l’intégrité, de la dignité et à l’atténuation de la vulnérabilité de la personne soignée, elle nous semble porteuse d’une visée morale, et donc mériter non seulement plus d’attention de la part de l’éthique des soins, mais peut-être même d’y être introduite à titre de vertu.

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]

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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]

Copyright of Economics & Statistics / Economie et Statistique is the property of Ministere de l'Economie, des Finances et de la Relance and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Contexte : Les résidents de centres d’hébergement et de soins de longue durée (CHSLD) et de résidences privées pour aînés (RPA) ont été vaccinés en priorité contre la maladie à coronavirus 2019 (COVID-19). Vu la pénurie de vaccins de l’hiver 2021, le Comité sur l’immunisation du Québec a recommandé le report de l’administration des deuxièmes doses pour augmenter plus rapidement la couverture vaccinale avec une dose. L’objectif de cette étude est de mesurer l’impact de la vaccination avec une première dose sur 1) l’incidence des cas et des complications en CHSLD et en RPA ainsi que 2) sur la fréquence des éclosions en CHSLD. Méthodes : Dans cette étude écologique, le taux d’incidence et de complications de la COVID-19 chez les résidents de CHSLD et de RPA du Québec, ont été comparés à la population générale à un moment où l’éligibilité à la vaccination était encore limitée. Résultats : Après la vaccination en CHSLD, le taux d’incidence de la COVID-19 a diminué de 92 %, contre 49 % dans la communauté, et le nombre de décès a diminué de 95 %. À six semaines post-vaccination, presqu’aucune installation ne rapportait cinq cas ou plus par 100 lits par semaine. En RPA, le taux d’incidence a diminué de 91 %, contre 2 % dans la communauté durant la même période. Les hospitalisations et les décès ont diminué de 94 % et 90 %, respectivement. Conclusion : Suite à 1) la vaccination avec une dose des résidents 2) l’immunité naturelle déjà acquise en CHSLD et en RPA, 3) la vaccination des travailleurs de la santé ainsi que 4) d’autres mesures de prévention non-pharmaceutiques mises en place, la circulation du coronavirus dans ces milieux de vie a été largement interrompue.

Contexte : En mars 2021, une éclosion de maladie à coronavirus 2019 (COVID-19) a été déclarée dans un grand établissement de soins de longue durée et de séjour de courte durée en Colombie-Britannique, au Canada, bien après l’introduction du programme de vaccination dans les établissements de soins de longue durée qui a entraîné une baisse spectaculaire du nombre d’éclosions dans ce type d’établissement. L’objectif de cette étude est de fournir l’épidémiologie descriptive de cette éclosion, dans le contexte de l’immunisation partielle des résidents et du personnel de l’établissement. Méthodes : Les renseignements sur les cas ont été extraits d’un système de renseignements provincial (Panorama). L’analyse descriptive a été réalisée à l’aide de Microsoft Excel et de SAS. Les contrôles de gestion de l’éclosion comprenaient, sans s’y limiter, des tests asymptomatiques et des efforts pour augmenter la vaccination. Résultats : Vingt-six cas parmi les 241 résidents et trois cas parmi les 418 membres du personnel (correspondant à des taux d’attaque de 10 % et moins de 1 %, respectivement) ont été trouvés. Le taux d’attaque chez les résidents était considérablement plus faible que le taux d’attaque moyen pour les éclosions de COVID-19 dans les établissements de soins de longue durée avant le déploiement du vaccin. Dix-sept cas résidents étaient partiellement ou totalement immunisés. Quatre des huit cas hospitalisés et deux des trois cas décédés étaient partiellement immunisés. Dix-sept cas étaient des résidents en séjour temporaire. Les trois cas du personnel n’ont pas été vaccinés. Dix cas ont été trouvés avec des tests asymptomatiques. Conclusion : L’introduction de la vaccination dans les établissements a contribué à la baisse des taux d’attaque et à l’augmentation du nombre de cas asymptomatiques dans cette éclosion. Le dépistage des personnes asymptomatiques a permis de trouver des cas supplémentaires parmi les résidents vaccinés. Les résultats soulignent l’importance d’atteindre une couverture vaccinale élevée, y compris chez les résidents en séjour temporaire, afin de prévenir l’introduction du virus et les possibilités de transmission ultérieures non reconnues.

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]

Introduction : Depuis mars 2020, le Québec (Canada), comme le reste du monde, vit une crise sanitaire majeure résultant de la pandémie de COVID-19. En plus des nombreux décès occasionnés par le virus, des personnes vivront leur fin de vie dans ces temps mouvementés où les mesures d’urgence sanitaire forcent leur isolement et modifient en profondeur l’organisation et la pratique des soins de fin de vie. Au Québec, 64 % des personnes qui sont décédées étaient des résidents de Centre d’hébergement et de soins de longue durée (CHSLD), une population considérée hautement vulnérable. Cependant, le risque de mourir de la COVID-19 est inégal entre les régions sociosanitaires du Québec, suggérant, par le fait même, la possibilité que des mesures organisationnelles et cliniques différentes aient été mises en place dans divers milieux. Objectif : L’article présente le protocole d’une étude visant à mieux comprendre les effets de la COVID-19 sur les soins de fin de vie en CHSLD par l’identification de transformations organisationnelles et cliniques ainsi que le contraste de deux régions différemment affectées, soit Montréal et l’Estrie. Méthodes : Un devis descriptif-explicatif est utilisé. Des entrevues sont réalisées avec les coordonnateurs de site et les soignants ayant travaillé en CHSLD durant la première vague de COVID-19 afin d’identifier les transformations vécues et leurs effets sur les soins offerts aux résidents en fin de vie, ainsi que sur le personnel soignant. Discussion et conclusion : Les conclusions de ce projet mèneront à des recommandations sur le plan organisationnel, clinique, politique et scientifique.

Copyright of Leisure/Loisir: Journal of the Canadian Association for Leisure Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La stabilisation de la résistance émergente aux antibiotiques dépend de notre capacité à mettre en place une gestion responsable des antimicrobiens (GRA). Plus de 90 % des antibiotiques délivrés en médecine humaine sont prescrits dans des établissements de soins de santé communautaires plutôt que dans des hôpitaux, les principaux prescripteurs étant des médecins de famille, des dentistes, des pharmaciens et des infirmiers praticiens travaillant au sein d’un vaste éventail de cabinets privés, d’équipes de médecine familiale, de cliniques de soins d’urgence, de services des urgences et d’établissements de soins de longue durée. Pour améliorer le rayonnement de la GRA dans les établissements de soins de santé communautaires, l’Agence de la santé publique du Canada s’est associée avec Choisir avec soin en 2017 pour mettre au point une campagne ciblée intitulée Utilisation judicieuse des antibiotiques. Cette campagne est dirigée par les prescripteurs d’antibiotiques eux-mêmes, qui travaillent dans des établissements de soins de santé communautaires et qui savent mieux identifier les modifications spécifiques qui iraient dans le sens d’une utilisation plus responsable des antibiotiques. Le présent article décrit ces changements de pratiques, les points forts et les défis de la campagne Utilisation judicieuse des antibiotiques et les futures occasions de promouvoir la GRA dans les établissements de soins de santé communautaires.

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

There is paucity of data assessing levels of food/beverage waste in long-term care (LTC) facilities, especially in Ontario. Observations in the Veteran's Centre (VC) at Sunnybrook Health Sciences Centre (Sunnybrook) indicated food/beverage waste may be high, potentially impacting sustainability efforts within our institution. Before proceeding with waste reduction efforts, we conducted a comprehensive 3-day waste-audit of food/beverage items provided to VC residents with the goal of understanding the extent of food/beverage waste at VC, items wasted, and any other factors that may inform future changes. Our results indicate that 28% of items served to residents were wasted. Lunch was the meal with greatest waste at 31% and waste of solid items was 12% higher than that of liquids. We observed a large variability in waste between residents and within each resident, with 15% of residents wasting >50% of items provided. This study provides a deeper insight into the magnitude of food/beverage waste in a LTC population and highlights the importance of considering individualized strategies to address waste to avoid negative impact on residents.

Most older adults prefer to age in place, which for many will require home and community care (HCC) support. Unfortunately, HCC capacity is insufficient to meet demand due in part to low wages, particularly for personal support workers (PSWs) who provide the majority of paid care. Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in HCC and institutional long-term care (ILTC). Specifically, we consider the cost of increased HCC PSW wages versus expected savings from avoiding unnecessary ILTC placement for those accommodated by HCC capacity growth. The expected increase in HCC PSW retention would create HCC capacity for approximately 160,000 people, reduce annual health system costs by approximately $7 billion, and provide an 88 per cent return on investment. Updating wage structures to reduce turnover and enable HCC capacity growth is a cost-efficient option for expanding health system capacity.

Purpose: To assess care home and staff characteristics associated with task-focused (TF) and relationship-centred care (RCC) mealtime practices prior to the COVID-19 pandemic. Methods: Staff working in Canadian and American care homes were invited to complete a 23-item online survey assessing their perceptions of mealtime care, with one item assessing 26 potential care practices from the Mealtime Relational Care Checklist (relationship-centred = 15; task-focused = 11) reported to occur in the home prior to the pandemic. Multivariate linear regression evaluated staff and care home characteristics associated with mealtime practices. Results: Six hundred and eighty-six respondents completed all questions used in this analysis. Mean TF and RCC mealtime practices were 4.89 ± 1.99 and 9.69 ± 2.96, respectively. Staff age was associated with TF and RCC practices with those 40-55 years reporting fewer TF and those 18-39 years reporting fewer RCC practices. Those providing direct care were more likely to report TF practices. Dissatisfaction with mealtimes was associated with more TF and fewer RCC practices. Homes that were not making changes to promote RCC pre-pandemic had more TF and fewer RCC practices. Newer care homes were associated with more RCC, while small homes (≤49 beds) had more TF practices. Conclusions: Mealtime practices are associated with staff and home factors. These factors should be considered in efforts to improve RCC practices in Canadian homes.

This cross-sectional study investigated staff's attitudes towards the use of mobile telepresence robots in long-term care (LTC) homes in western Canada. We drew on a Health Technology Assessment Core Model 3.0 to design a survey examining attitudes towards nine domains of mobile telepresence robots. Staff, including nurses, care staff, and managers, from two LTC homes were invited to participate. Statistical analysis of survey data from 181 participants revealed that overall, participants showed positive attitudes towards features and characteristics, self-efficacy on technology use, organizational aspects, clinical effectiveness, and residents and social aspects; neutral attitudes towards residents' ability to use technology, and costs; and negative attitudes towards safety and privacy. Participants who disclosed their demographic backgrounds tended to exhibit more positive attitudes than participants who did not. Content analysis of textual data identified specific concerns and benefits of using the robots. We discuss options for implementing mobile telepresence robots in LTC.

Within long-term care homes (LTCHs), conflicts occur between residents' desires, LTCH constraints, and healthcare providers' concerns about risks of harm. Due to the high prevalence of dysphagia and malnutrition in these settings, decisions regarding food choices are a common source of such tensions. Existing biomedical ethical models fail to capture the complexity of the interprofessional chronic care environment. This article proposes an alternative ethical lens, the relational ethics model. We describe a case illustrating the application of a decision-making framework with a relational ethics lens for a resident with severe dysphagia and malnutrition. We highlight how the bioethics model excludes important actors from ethical decision making. We encourage registered dietitians working in LTCH to incorporate a relational ethics model into their practice to help identify resident's values and bring attention to the interconnectedness of caring relationships and contextual factors. This approach can inform difficult decisions regarding the food and nutrition choices of residents and may facilitate meaningful outcomes for both individuals and the long-term care community.

Baby boomers were at the forefront of profound social changes in sexual attitudes and many have expressed a desire to remain sexually active throughout their life course. The purpose of this survey study was to assess the perceived preparedness of Ontario's long-term care (LTC) homes to meet the changing sexuality needs and expectations of LTC residents. We examined sexuality-related attitudes, including in the context of dementia, among 150 LTC administrators. Participants also completed a questionnaire assessing their experiences and perceptions regarding existing and anticipated supports, barriers, and priorities. Most participants demonstrated positive sexual attitudes; however, multiple challenges to meeting residents' sexuality needs were noted, including assessing capacity to consent, limited privacy, staff training, conflicting attitudes, and a lack of adequate policy and guidelines. Challenges are broad and significant and considerable attention is required to meet the expectations of the next generation of LTC residents, including gender and sexual minority elders.

Background: The COVID-19 pandemic highlighted the importance of the care provided by family members and close friends to older people living in long-term care (LTC) homes. Our implementation science team helped three Ontario LTC homes to implement an intervention to allow family members to enter the homes during pandemic lockdowns., Objective: We used a variety of methods to support the implementation, and this paper reports results from an Ontario-wide survey intended to help us understand the nature of the care provided by family caregivers., Methods: We administered a survey of essential caregivers in Ontario, and a single open-ended question yielded a substantial qualitative data set that we analysed with a coding and theming procedure that yielded 13 themes., Findings: The 13 themes reveal deficiencies in Ontario's LTC sector, attempts to cope with the deficiencies, and efforts to influence change and improvement., Discussion: Our findings indicate that essential caregivers find it necessary to take on vital roles in order to shore up two significant gaps in the current system: they provide psychosocial and emotional (and sometimes even basic) care to residents, and they play a monitoring and advocacy role to compensate for the failings of the current regulatory compliance regime.

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Older adults, 65 years of age and older, living in long-term care (LTC) commonly experience anxiety. This study aimed to understand care providers' perspectives on the barriers to and facilitators of managing anxiety in residents of LTC. Ten semi-structured interviews with care providers in LTC were completed. Framework analysis methods were used to code, thematically analyze, designate codes as barriers or facilitators, and map the codes to the Theoretical Domains Framework. Themes were categorized as acting at the resident, provider, or system level, and were labelled as either barriers to or facilitators of anxiety care. Key barriers to anxiety care at each level were resident cognitive impairment or co-morbidities; lack of staff education, staff treatment uptake and implementation; as well as the care delivery environment and access to resources. There is a need to prioritize measurement-based care for anxiety, have increased access to non-pharmacological treatments, and have a care delivery environment that supports anxiety management to improve the care for anxiety that is delivered to residents.

The coronavirus disease (COVID-19) pandemic and resulting restrictions on physical access to long-term care homes culminated in health declines for older adults living there and their families. Knowledge gaps exist regarding maintaining social connectedness when physically separated. The study aimed to explore family members' perceptions of the impact that restrictions on physical access to long-term care homes had on the experience of social connectedness between family members and older adults living in long-term care. The method used was a qualitative description, using in-depth semi-structured interviews. Themes arising from inductive qualitative content analysis of 21 interviews with family members included: (a) lack of connection threatening mental, emotional health, and physical health; (b) navigating trust in the unknown; (c) feelings of stress and anxiety for family members; and (d) technology - an asset, but not for everyone. Study findings suggest more emphasis should be placed on supporting social connections between older adults and their families in the context of long-term care beyond COVID-19.

Waitlists for long-term care (LTC) continue to grow, and it is anticipated aging populations will generate additional demand. While literature focuses on individual-level factors, little is known about system-level factors contributing to LTC waitlists. We considered these factors through a scoping review. Inclusion/exclusion included publication year (2000-2022), language, paper focus, and document type. A total of 815 abstracts were identified, only 17 studies were included. Through qualitative content analysis, 10 key factors were identified: (1) waitlist management styles, (2) inconsistent standards of admission, (3) personnel shortage, (4) insufficient community-based care, (5) inequitable distribution of services, (6) lack of system integration, (7) unintended consequences of insurance plans, (8) ranking preferences, (9) the debate of supply and demand, and (10) financial incentives. Targeting interventions to address waitlist management, community-based care capacity, and demographic trends could improve access. More research is needed to address system-level barriers to timely LTC access.

In Canada, long-term care and retirement home residents have experienced high rates of COVID-19 infection and death. Early efforts to protect residents included restricting all visitors as well as movement inside homes. These restrictions, however, had significant implications for residents' health and well-being. Engaging with those most affected by such restrictions can help us to better understand their experiences and address their needs. In this qualitative study, 43 residents of long-term care or retirement homes, family members and staff were interviewed and offered recommendations related to infection control, communication, social contact and connection, care needs, and policy and planning. The recommendations were examined using an ethical framework, providing potential relevance in policy development for public health crises. Our results highlight the harms of movement and visiting restrictions and call for effective, equitable, and transparent measures. The design of long-term care and retirement policies requires ongoing, meaningful engagement with those most affected.

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]