Knowing and being known: the qualities that make a long-term care facility a home

There has been consistent pressure to transform long-term care (LTC) facilities into more homelike settings. The concept of home within institutionalized care-based living environments is not well understood. For this study, a supplementary analysis was conducted to address two questions: (1) What factors contribute to a sense of home for people living and working in rural LTC homes, and (2) What organizational structures enable or impede a rural LTC home’s ability to actualize the factors that help them feel homelike? Findings indicate that the physical environment should prioritize accessibility and personalization; the social environment should prioritize relationships and opportunities for connection; and psychological considerations should prioritize supporting choice, autonomy, and flexibility. Additionally, a sense of home in LTC is dependent upon leadership that empowers staff and enables a flexible and relational approach to care, which results in residents being truly ‘known’ by their care providers

Nonpharmacological management of behavioral and psychological symptoms of dementia: what works, in what circumstances, and why?

Sherpa Romeo yellow journal. Open access article. Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0) appliesObjective: Behavioral and psychological symptoms of dementia (BPSD) refer to the often distressing, noncognitive symptoms of dementia. BPSD appear in up to 90% of persons with dementia and can cause serious complications. Reducing the use of antipsychotic medications to treat BPSD is an international priority. This review addresses the following questions: What nonpharmacological interventions work to manage BPSD? And, in what circumstances do they work and why? Method: A realist review was conducted to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases for empirical studies that reported a formal evaluation of nonpharmacological interventions to decrease BPSD. Results: Seventy-four articles met the inclusion criteria. Three mechanisms emerged as necessary for sustained effective outcomes: the caring environment, care skill development and maintenance, and individualization of care. We offer hypotheses about how different contexts account for the success, failure, or partial success of these mechanisms within the interventions. Discussion: Nonpharmacological interventions for BPSD should include consideration of both the physical and the social environment, ongoing education/training and support for care providers, and individualized approaches that promote self-determination and continued opportunities for meaning and purpose for persons with dementia