Implementation of the single site order in long-term care:: what we can learn from using the consolidated framework for implementation research

Context: To mitigate the risk of spread of COVID-19 in long-term care (LTC), the Public Health Agency of Canada instituted several rapid redesign and resource redeployment practices, including single-site policies. Objective: This study aims to understand factors that influence implementation of the Single Site Order (SSO). Methods: Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Ten leadership team members and 18 staff were interviewed across 4 LTC homes in British Columbia (BC), Canada. In NVivo 12, a deductive framework analysis was used. Findings: Seven notable CFIR constructs (intervention source, evidence strength and quality, costs, culture, networks and communication, readiness for implementation, and patient needs and resources) were found to be most influential in the implementation of the SSO. We present these constructs and the factors within. Limitations: Our study was limited to the BC context. However, we believe that the findings offer useful insights into the complexity of policy implementation in LTC. Implications: In a system already facing staffing concerns and a highly dependent and increasingly frail resident population, implementation of the SSO further taxed already stretched resources

Snow and Rain Modify Neighbourhood Walkability for Older Adults

RÉSUMÉ La littérature a documenté une relation positive entre la mobilité à l’extérieur chez les personnes âgées et les environnements bâtisables et marchables. Cependant, étonnamment, toute considération de la façon dont le temps modifie l’accessibilité piétonnière à travers les quartiers est absente. À Vancouver, au Canada, on a utilisé des données météorologiques archivées liées à des données recueillies auprès d’un échantillon d’aînés. On a constaté que, lorsqu’il neige, les quartiers où l’on dépend d’automobiles (comportant des blocs plus longs, moins d’intersections et une plus grande distance aux commodités) sont devenus inaccessibles. Même les adultes plus âgés qui vivaient dans les quartiers qui étaient très bien adaptés au traffic pietonnier marchait à 25 pour cent moins de destinations pendant la neige. Il est essentiel de tenir compte de l’impact des conditions météorologiques dans la relation entre la marchabilité des quartiers et la mobilité des personnes âgées

Policy and practices in primary care that supported the provision and receipt of care for older persons during the COVID-19 pandemic: a qualitative case study in three Canadian provinces

Abstract Background The effects of the COVID-19 pandemic on older adults were felt throughout the health care system, from intensive care units through to long-term care homes. Although much attention has been paid to hospitals and long-term care homes throughout the pandemic, less attention has been paid to the impact on primary care clinics, which had to rapidly change their approach to deliver timely and effective care to older adult patients. This study examines how primary care clinics, in three Canadian provinces, cared for their older adult patients during the pandemic, while also navigating the rapidly changing health policy landscape. Methods A qualitative case study approach was used to gather information from nine primary care clinics, across three Canadian provinces. Interviews were conducted with primary care providers (n = 17) and older adult patients (n = 47) from October 2020 to September 2021. Analyses of the interviews were completed in the language of data collection (English or French), and then summarized in English using a coding framework. All responses that related to COVID-19 policies at any level were also examined. Results Two main themes emerged from the data: (1) navigating the noise: understanding and responding to public health orders and policies affecting health and health care, and (2) receiving and delivering care to older persons during the pandemic: policy-driven challenges & responses. Providers discussed their experiences wading through the health policy directives, while trying to provide good quality care. Older adults found the public health information overwhelming, but appreciated the approaches adapted by primary care clinics to continue providing care, even if it looked different. Conclusions COVID-19 policy and guideline complexities obliged primary care providers to take an important role in understanding, implementing and adapting to them, and in explaining them, especially to older adults and their care partners

Family caregiving or caregiving alone : who helps the helper?

This investigation advances the understanding of family caregiving by examining the relationship between adult children caregivers and their helpers, as well as the intersections between helping, gender and kinship. Specifically, it focuses on examining "who helps whom" and extends analyses beyond the dyadic focus of caregiving in later life. The focus on helping and caregiving addresses the variety of contributions and responsibilities involving not only the ’caregiver’ who was the ’target’ respondent in this research, but also others identified as ’helpers’ in the provision of care. The data for this dissertation are derived from the Work and Eldercare Research group of CARNET: The Canadian Aging Research Network. Secondary analysis of CARNET data focuses on quantitative and verbatim data collected from 250 individuals with significant caregiving responsibilities to at least one older person. The dissertation is comprised of three scholarly papers each focusing on a dimension of helping and caregiving by adult children. Study One examines the multiple relationships and contributions involved in providing care to an older relative. The research extends Kahn & Antonucci’s convoys of social support model (1981) and Cantor’s model of social care (1991) by disentangling some of the dimensions of helping and caregiving such as the distinction between direct and assistive help. Direct help is defined as the help given by caregivers and helpers to an older person. Assistive help is the help given to a caregiver or helper. Study Two examines the characteristics and composition of helping and caregiving families with specific attention to the intersection of gender and kinship. Findings underscore the presence and coordination of direct and assistive help, the predominance of women and kin, the importance of adult siblings and the participation of men in helping and caregiving. Study Two also advances understandings of caregiving/helping as a family-level concept. Study Three through the analysis of three case vignettes explores several themes in helping. Themes include, the presence and importance of absent caregivers/helpers, the presence of multiple care recipients, the participation of men in helping/caregiving and the contributions of paid helpers. Conclusions highlight implications for professional practice, policy and research.Graduate and Postdoctoral StudiesGraduat

“I’m New to This”: Navigating Digitally Mediated Photovoice Methods to Enhance Research With Older Adults

The COVID-19 pandemic forced a shift in long established participatory visual qualitative methods. Some researchers adapted photovoice— which traditionally happens in-person—and used technology to connect with participants referred to as “digitally mediated photovoice”. Collective knowledge about best practices for digitally mediated photovoice to support and enhance research with older adults is in its infancy. Thus, to advance the field, we describe our approach to digitally mediated photovoice with older adults for a study in Vancouver, Canada. We explore participant and researcher reflections with data generated during three sessions over two-and-a-half years during the COVID-19 pandemic. The first two virtual interview sessions used photo elicitation, and the third session was an in-person interactive photography exhibition. We identified three central benefits to using digitally mediated photovoice. This approach 1. built rapport through the shared experience of navigating technology; 2. allowed a rich exchange of information despite physical distancing; and 3. facilitated opportunity for participants to exercise their agency. As we consider constraints for in-person data collection, digitally mediated photovoice may offer an avenue to establish mutually beneficial researcher-participant relationships with older adults. We add to the growing body of literature that addresses how qualitative researchers incorporate technology into the research process to reshape how we understand intimacy and access

Ethno-cultural diversity in home care work in Canada: issues confronted, strategies employed

Worldwide, immigrant workers are responsible for much of the care provided to elderly people who require assistance with personal care and with activities of daily living. This article examines the characteristics of immigrant home care workers, and the ways in which they differ from non-migrant care workers in Canada. It considers circumstances wherein the labor of care is framed by ethno-cultural diversity between client and worker, interactions that reflect the character of this ethno-cultural diversity, and the strategies employed by workers to address issues related to this diversity. Findings from a mixed methods study of 118 workers in the metropolitan area of Vancouver, British Columbia, Canada, indicate that while the discriminatory context surrounding migrant home care workers persists, issues of ethno-cultural diversity in relationships are complex, and can also involve non-foreign born workers. Multi-cultural home care is not always framed in a negative context, and there often are positive aspects

Canada’s Complex and Fractionalized Home Care Context: Perspectives of Workers, Elderly Clients, Family Carers, and Home Care Managers

In Canada, home care provides health and social services to an estimated one million people, most of them older adults. In the absence of national policy directives, services vary considerably from one jurisdiction to the next, in what has been called a “checkerboard” of policy and practice. This paper examines policy-relevant issues in the provision of home care services, focusing specifically on “home support” services delivered by unregulated workers. We examine findings from our six-year program of research, and highlight three policy issues that emerged from our study of workers, older clients, family carers, and managers. These are: scope of services, scheduling of services, and the presumption of availability of family/friend carers. For each issue, we give examples of policy or practice initiatives being undertaken and current challenges. We then examine these issues in relation to guiding principles for services, as identified by the Canadian Home Care Association. Au Canada, des services de santé et des services sociaux à domicile sont fournis à environ un million de personnes, pour la plupart des personnes âgées. En l'absence de directives politiques nationales, les services varient considérablement d'un territoire à l'autre, dans ce qui a été appelé une « mosaïque » de politiques et de pratiques. Ce document examine les questions liées aux orientations politiques en matière de prestation de services de soins à domicile, et plus particulièrement les services de « soutien à domicile » proposés par des travailleurs non réglementés. Nous analysons les conclusions de notre programme de recherche mené à bien sur six années, et mettons en avant trois problèmes de politique qui ont émergé de notre étude sur les travailleurs, les clients âgés, les aidants familiaux et les gestionnaires. Ces trois problèmes sont : la portée des services, les horaires des services et la disponibilité présumée des aidants familiaux ou amicaux. Pour chaque point, nous présentons des exemples d'initiatives entreprises en matière d'orientation politique ou de pratiques, ainsi que les défis rencontrés. Nous considérons ensuite ces questions à la lumière des principes directeurs de ces services, identifiés par l'Association canadienne de soins et services à domicile

“Think positive and don’t die alone” - Foreign-born, South Asian older adults’ perceptions on healthy aging

South Asians are the largest and fastest-growing racialized group in Canada, yet there are limited data on various aspects of health and well-being within this population. This includes the South Asian older adults’ ethnoculturally informed perceptions of ageing. The study aimed to understand how social and cultural forces impact the meaning assigned to healthy ageing amongst older South Asians in Canada. We recruited with purposeful and snowball sampling strategies in Southern Ontario. We conducted in-depth focus group and individual interviews (n = 19) in five South Asian languages, employing a multilingual and cross-cultural qualitative approach. In our analysis, we identified three central themes: (a) taking care of body (b) taking care of mind and heart and (c) healthy ageing through the integration of mind and body. Our study demonstrates that older immigrants are a diverse and heterogeneous population and that their conception of healthy ageing is strongly influenced by their country of origin. This study also demonstrates how racialized foreign-born older adults might provide distinctive perspectives on the ageing process and on social theories of ageing due to their simultaneous immersion in and belonging to global majority and global minority cultures. This research also adds to the limited body of literature on the theories of ageing, despite migration trends, still has a white-centric lens