Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

Poor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. We aimed to understand the mealtime experience in long-term residential care by exploring (missed) opportunities for person-centred care in different settings.; As part of the TRANS-SENIOR research network, rapid ethnographies, were conducted across multiple sites (including interviews, observations and informal conversations), in a long-term residential care home in the UK, Switzerland and the Netherlands between October 2020 and December 2021. RESULTS: Following analysis and interpretation of observations, interviews and informal conversations, the following themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed: 1) considering the setting, 2) listening to and implementing resident choice, 3) enabling residents to help/care for themselves and others, 4) providing individualised care in a communal setting, and 5) knowing the person in the past and present. Residents experienced moments of participatory choice, interaction, independence and dignity, but opportunities for these were often missed due to organisational or policy constraints.; There are opportunities for person-centred moments during the mealtime, some of which are taken and some missed. This largely depended on the setting observed, which includes the overall environment (size of dining area, seating arrangements etc.) and allocation of staff resources, and the level of resident involvement in mealtimes, from preparation to the actual activity

Sparse Suffix and LCP Array:Simple, Direct, Small, and Fast

Sparse suffix sorting is the problem of sorting b = o(n) suffixes of a string of length n. Efficient sparse suffix sorting algorithms have existed for more than a decade. Despite the multitude of works and their justified claims for applications in text indexing, the existing algorithms have not been employed by practitioners. Arguably this is because there are no simple, direct, and efficient algorithms for sparse suffix array construction. We provide two new algorithms for constructing the sparse suffix and LCP arrays that are simultaneously simple, direct, small, and fast. In particular, our algorithms are: simple in the sense that they can be implemented using only basic data structures; direct in the sense that the output arrays are not a byproduct of constructing the sparse suffix tree or an LCE data structure; fast in the sense that they run in O(n log b) time, in the worst case, or in O(n) time, when the total number of suffixes with an LCP value greater than 2⌊log n/b⌋+1− 1 is in O(b/ log b), matching the time of optimal yet much more complicated algorithms [Gawrychowski and Kociumaka, SODA 2017; Birenzwige et al., SODA 2020]; and small in the sense that they can be implemented using only 8b + o(b) machine words. We also show that our second algorithm can be trivially amended to work in O(n) time for any uniformly random string. Our algorithms are non-trivial space-efficient adaptations of the Monte Carlo algorithm by I et al. for constructing the sparse suffix tree in O(n log b) time [STACS 2014]

Sparse Suffix and LCP Array: Simple, Direct, Small, and Fast

Sparse suffix sorting is the problem of sorting $b=o(n)$ suffixes of a string of length $n$. Efficient sparse suffix sorting algorithms have existed for more than a decade. Despite the multitude of works and their justified claims for applications in text indexing, the existing algorithms have not been employed by practitioners. Arguably this is because there are no simple, direct, and efficient algorithms for sparse suffix array construction. We provide two new algorithms for constructing the sparse suffix and LCP arrays that are simultaneously simple, direct, small, and fast. In particular, our algorithms are: simple in the sense that they can be implemented using only basic data structures; direct in the sense that the output arrays are not a byproduct of constructing the sparse suffix tree or an LCE data structure; fast in the sense that they run in $\mathcal{O}(n\log b)$ time, in the worst case, or in $\mathcal{O}(n)$ time, when the total number of suffixes with an LCP value greater than $2^{\lfloor \log \frac{n}{b} \rfloor + 1}-1$ is in $\mathcal{O}(b/\log b)$, matching the time of the optimal yet much more complicated algorithms [Gawrychowski and Kociumaka, SODA 2017; Birenzwige et al., SODA 2020]; and small in the sense that they can be implemented using only $8b+o(b)$ machine words. Our algorithms are simplified, yet non-trivial, space-efficient adaptations of the Monte Carlo algorithm by I et al. for constructing the sparse suffix tree in $\mathcal{O}(n\log b)$ time [STACS 2014]. We also provide proof-of-concept experiments to justify our claims on simplicity and efficiency.Comment: 16 pages, 1 figur

How the interrelated physical, social and organizational environment impacts daily life of residents with dementia on a Green Care Farm

Green Care Farms (GCF) are innovative long-term care environments and an alternative to regular nursing homes in the Netherlands. Following a culture change movement, GCFs have radically altered the care environment. Research suggests positive effects on residents. However, knowledge is limited regarding their physical, social and organizational environment. This article explores the care environment of 24-h GCFs for people with dementia and its impact on residents and their daily life. An ethnographic study using mixed methods was carried out at a GCF in the Netherlands between June and October 2021. Researchers lived on the GCF and completed 28 days of participatory observations in three groups. During the day, informal conversations were held with residents (; n; = 48), staff and family members. Twenty four semi-structured interviews were conducted with residents, their family members, staff and the managers, complemented by a focus group with staff. The physical environment was additionally assessed with the OAZIS-dementia tool. Data collection methods informed each other. Qualitative data was thematically analyzed, quantitative data descriptively. Four themes were identified as crucial during daily life on the GCF: stimulating the senses, engaging in purposeful activities, sharing responsibilities and creating a community in a new home. Realizing these topics in practice, physical, social and organizational environmental components were highly interrelated. The physical environment encouraged and facilitated meaningful in-/outdoor activities and social encounters. The organizational environment supported the use of the physical environment by aligning processes and transporting the vision. The social environment focused on collaboration and creating a home-like atmosphere by including residents in household- and farm chores. This community-building led to more meaningful activities and social interaction. In conclusion, this study revealed the central influence of the management in paving the way for a new form of care delivery. As leaders shape the three environments, the organization influences the design of the physical environment and the actions taking place within it. By creating a community, the care home benefits residents, their families and staff equally. The conscious interrelation and harmonization of the physical, social and organizational components of a long-term care environment has the potential to improve the daily life of residents

What makes extra care housing an appropriate setting for people with dementia? An exploration of staff decision-making.

Extra care housing facilities in the UK are intended to offer a community-based alternative to care home placement. However, little is known about staff’s views of the appropriateness of extra care housing for people with dementia. This paper describes a mixed-methods study which explored this issue using statistical modelling of frontline staff’s recommendations of the best care setting for care home entrants; thematic analysis of transcripts from a simulated Resource Allocation Management Panel meeting; and content analysis of care coordinators’ reasons for not considering extra care housing in actual care home applications. Frontline practitioners saw extra care housing as a valuable alternative for a significant minority of care home entrants. However, extra care housing was not recommended if people needed care at night. Social care managers expressed general support for the idea of extra care housing, but appeared overwhelmingly focused on maintaining people at home and unsure where in the care pathway extra care housing sat. More evidence is needed on whether extra care housing can be an alternative to care homes and how services should be arranged to meet the needs of people living in extra care housing

Factsheet Betekenis van zorgboerderijen voor verschillende doelgroepen

Zowel het aantal zorgboerderijen als het aantal mensen dat er gebruik van maakt, is de afgelopen decennia sterk toegenomen. Er is steeds meer kennis beschikbaar over de waarde van dagbesteding en 24-uurs zorg op zorgboerderijen. Uit de verschillende onderzoeken blijkt dat zorgboerderijen een waardevolle voorziening kunnen zijn voor verschillende doelgroepen, waaronder jeugd, mensen met een verstandelijke beperking, mensen met een psychiatrische achtergrond en mensen met dementie. Deze kennis is echter nog onvoldoende bekend bij gemeenten, zorgverzekeraars en zorg- en onderwijsinstellingen. De verwachting is dat deze kennis relevant kan zijn voor de beleidsvorming van deze partijen en het vormgeven van lokale samenwerkingen

Allowing Visitors Back in the Nursing Home During the COVID-19 Crisis:A Dutch National Study Into First Experiences and Impact on Well-Being

Objectives: To prevent and control COVID-19 infections, nursing homes across the world have taken very restrictive measures, including a ban for visitors. These restrictive measures have an enormous impact on residents' well-being and pose dilemmas for staff, although primary data are lacking. A Dutch guideline was developed to cautiously open nursing homes for visitors during the COVID-19 pandemic. This study reports the first findings on how the guideline was applied in the local context; the compliance to local protocols; and the impact on well-being of residents, their family caregivers, and staff.Design: A mixed-methods cross-sectional study was conducted.Setting and Participants: In total, 26 nursing homes were permitted to enlarge their possibilities for allowing visitors in their facility. These nursing homes were proportionally representative of the Netherlands as they were selected by their local Area Health Authority for participation. At each nursing home, a contact person was selected for participation in the current study.Methods: A mixed-methods cross-sectional study was conducted, consisting of questionnaire, telephone interviews, analyses of documentation (ie, local visiting protocols), and a WhatsApp group.Results: Variation in local protocols was observed, for example, related to the use of personal protective equipment, location, and supervision of visits. In general, experiences were very positive. All nursing homes recognized the added value of real and personal contact between residents and their loved ones and indicated a positive impact on well-being. Compliance with local guidelines was sufficient to good. No new COVID-19 infections were reported during this time.Conclusions and Implications: These results indicate the value of family visitation in nursing homes and positive impact of visits. Based on these results, the Dutch government has decided to allow all nursing homes in the Netherlands to cautiously open their homes using the guidelines. More research is needed on impact and long-term compliance. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.</p