Improving long-term care provision: towards demand-based care by means of modularity

<p>Abstract</p> <p>Background</p> <p>As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes.</p> <p>Methods</p> <p>Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software.</p> <p>Results</p> <p>Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services.</p> <p>Conclusion</p> <p>The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further enable demand-based provision of long-term care by means of modularity.</p

Protocol for a participatory study for developing qualitative instruments measuring the quality of long-term care relationships

Introduction  In long-term care (LTC), it is unclear which qualitative instruments are most effective and useful for monitoring the quality of the care relationship from the client's perspective. In this paper, we describe the research design for a study aimed at finding and optimising the most suitable and useful qualitative instruments for monitoring the care relationship in LTC. Methods and analysis  The study will be performed in three organisations providing care to the following client groups: physically or mentally frail elderly, people with mental health problems and people with intellectual disabilities. Using a participatory research method, we will determine which determinants influence the quality of a care relationship and we will evaluate up to six instruments in cooperation with client-researchers. We will also determine whether the instruments (or parts thereof) can be applied across different LTC settings. Ethics and dissemination  This study protocol describes a participatory research design for evaluating the quality of the care relationship in LTC. The Medical Ethics Committee of the Radboud University Nijmegen Medical Centre decided that formal approval was not needed under the Dutch Medical Research Involving Human Subjects Act. This research project will result in a toolbox and implementation plan, which can be used by clients and care professionals to measure and improve the care relationship from the client's perspective. The results will also be published in international peer-reviewed journals

How staff act and what they experience in relation to the autonomy of older adults with physical impairments living in nursing homes

Autonomy is important for people, even when they have physical impairments and are living in nursing homes. The way staff respond to residents is important for the realisation of autonomy. In order to gain knowledge about what nursing home staff, registered and assistant nurses, occupational therapists and nutritional assistants do and experience in relation to the autonomy of residents, a qualitative study design was chosen. Shadowing, a non-participatory observation method, was used. A total of 15 staff members of a care unit from two different nursing homes participated. Short interviews followed these observations to reflect on intentions of observed activities. The COREQ guidelines were used to report on the study. Four activities to enhance autonomy were identified: getting to know each older adult as a person and responding to his/her needs; encouraging an older adult to perform self-care; stimulating an older adult to make choices; and being aware of interactions. The exploration showed that staff considered it important to strengthen autonomy of older adults living in nursing homes and that they used different activities related to autonomy. However, activities could both enhance as well as hinder autonomy

Facilitators and barriers to autonomy:A systematic literature review for older adults with physical impairments, living in residential care facilities

Autonomy is important in every stage of life. However, little is known about how autonomy is enhanced for older adults living in residential care facilities (RCFs). This leads to the research question: which facilitators and barriers to autonomy of older adults with physical impairments due to ageing and chronic health conditions living in RCFs are known? The results will be organised according to the framework of person-centred practice, because this is related to autonomy enhancement. To answer the research question, a systematic literature search and review was performed in the electronic databases CINAHL, PsycINFO, PubMed, Social Services Abstracts and Sociological Abstracts. Inclusion and exclusion criteria were derived from the research question. Selected articles were analysed and assessed on quality using the Mixed Methods Appraisal Tool. Facilitators and barriers for autonomy were found and arranged in four themes: characteristics of residents, prerequisites of professional care-givers, care processes between resident and care-giver, and environment of care. The established facilitators and barriers are relational and dynamic. For a better understanding of the facilitators and barriers to autonomy for older adults with physical impairments living in RCFs, a description is based on the 35 included articles. Autonomy is a capacity to influence the environment and make decisions irrespective of having executional autonomy, to live the kind of life someone desires to live in the face of diminishing social, physical and/or cognitive resources and dependency, and it develops in relationships. The results provide an actual overview and lead to a better understanding of barriers and facilitators for the autonomy of older adults with physical impairments in RCFs. For both residents and care-givers, results offer possibilities to sustain and reinforce autonomy. Scientifically, the study creates new knowledge on factors that influence autonomy, which can be used to enhance autonomy

Influence of freedom of movement on the health of people with demnetia:A systematic review

Background and Objectives To protect residents with dementia from harm, nursing homes (NHs) often have closed-door policies. However, current research suggests a positive influence of freedom of movement, that is, the right to (decide to) independently move from one place to another, on the health of NH residents with dementia. This systematic review aims to collate, summarize, and synthesize the scientific evidence published to date on the influence of freedom of movement on health among NH residents with dementia. Research Design and Methods Multiple databases were searched up until March 2021. Peer-reviewed qualitative, quantitative, and mixed methods studies were included. Health was operationalized using the Positive Health framework, encompassing 6 dimensions: bodily functions, mental functions and perception, existential dimension, quality of life, social and societal participation, and daily functioning. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Results Sixteen studies were included of good to excellent quality. Compared to closed NHs, freedom of movement in semiopen and open NHs may have a positive influence on bodily functions, mental functions and perception, quality of life, and social and societal participation. The influence on daily functioning and on the existential dimension remains unclear. Discussion and Implications Freedom of movement of NH residents with dementia is often studied as part of a larger context in which other factors may contribute to health benefits. More research is therefore needed to unravel the underlying mechanisms of the positive influence of freedom of movement on health

Development of a self-scan to evaluate and improve person-centered care in nursing homes:A Delphi study

Background and objective: Person centered care (PCC) has become the gold standard for providing care in nursing homes (NHs). Therefore, it is important for healthcare professionals in NHs to learn PCC-skills and to be supported to learn about- and improve the quality of PCC they provide. At this moment an instrument to support healthcare professionals in NHs to monitor and evaluate PCC is limited. The aim of the study was to develop a self-evaluation tool that provides healthcare professionals in NHs insight into the extent to which they provide PCC to residents, so that they can learn and further improve their current ways of working in a person-centered way. Methods: A three-round Delphi study with an expert panel (n = 25) in the domains of PCC, quality of NH care and education of caring staff. Findings were validated by residents and relatives during semi-structured interviews. Thematic analysis and descriptive statistics were used to analyze the data. Results: In the first round the experts did not provide measuring instruments, but we identified 18 key aspects of PCC. In the second round, three clusters were identified, and a scale was added, to enable assessment. In the third round, we deduplicated, restructured and used more clear language. This led to 14 key aspects of PCC, 24 measures, grouped into five clusters: knowing the resident, establishing relationship, a respectful approach, making decisions jointly and personal development. The result is a PCC self-scan for healthcare professionals in NHs. Residents and relatives, agreed with all aspects and stated that no aspects were missing. Conclusions: In this study we developed an accessible self-report learning tool for healthcare professionals that makes it possible to evaluate and improve their PCC-skills and improve the quality of PCC in NHs