Safe staffing for older people wards: RCN report and recommendation

In 2012, RCN published their recommendations for appropriate staffing for older adults in acute and long-term care facilities.  This report gives evidence-based recommendations on the range of staffing levels required for safe care, the requirement for strong leadership, high levels of training and a positive-practice environment.

To access the report and learn more about safe staffing levels please visit http://bit.ly/YLv4rs.

Environment Scan on Canadian Seniors’ Transitions to Special Care Facilities

Released by the Canadian Mortgage and Housing Corporation (CMHC), the research report Environment Scan on Canadian Seniors' Transitions to Special Care Facilities provides a comprehensive picture on how and why Canadian seniors move to long-term care facilities.  To write the report, CMHC conducted a thorough literature review of best available evidence and compiled and analyzed Statistics Canada data on senior's housing transitions.

Some key points from their findings:

·         Approximately 7.9% of Canadian seniors live in a special care facility

·         Quebec had the largest proportion of seniors living a long-term care facility at 9%

·         Health concerns is the most common reason why a senior moves to a special care facility

·         The move from a private dwelling to a special care facility often takes place between the age of 80-85

·         There are three kinds of moves seniors will often make

o   The first move is undertaken right after retirement and is primarily for amenity or lifestyle reasons

o   The second move is done to be near a primary caregiver when the senior becomes moderately disabled

o   The third move is to an institution when a senior's needs are too much for the caregiver to handle

RAND Improving Dementia Long-Term Care: a policy blueprint

Improving Dementia Long-Term Care: a policy blueprint is a published report from RAND looking at potential policy options for dementia in long-term care services and supports.  The document primarily focuses on the social services and supports that are being conducted in the United States, but the document has international implications.

The policy blueprint is intended to assist government and non-profit organizations with a set of priorities to build consensus and establish policies, actions and performance metrics to improve quality of care and long-term care services.  The authors examined the current available options for long-term care services for persons with dementia and came up with 25 priorities for care that can be summarized into five objectives. 

The five objectives include:

1.       Increase public awareness of dementia to reduce stigma and promote earlier detection of signs and symptoms

2.       Improve access to and utilization of long-term care services and supports for persons with dementia

3.       Promote high quality, person and family-caregiver-centred care.

4.       Provide better support for family caregivers of people with dementia

5.       Reduce the burden of dementia LTSS costs on individuals and families

To read the full report, please visit http://bit.ly/1pp7Y23.

Long-term Care: Perceptions, Experiences, and Attitudes Among Americans 40 or Older

This report, released April, 2013, summarizes the results of a national survey conducted by Associated Press-NORC Center for Public Affairs (University of Chicago).

The research focused on understanding experiences and attitudes of older Americans as they begin to plan for their own care and interact with the long-term care system. The survey asked Americans 40 years or older what they believe about their need for long-term care, the costs of this service, and how these issues fit into their concerns about growing older.  

Market Survey of Long-Term Care Costs The 2011 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs October 2011

In 2002, the MetLife Mature Market Institute pioneered the collection of national market survey data on nursing home, assisted living, and home care costs. Since then, these market survey data have been updated and released on an annual basis. In 2007, cost information on adult day services (ADS) was included for the first time.

This market survey, conducted in conjunction with LifePlans, Inc., contains daily private-pay rates for private and semi-private rooms in licensed nursing homes, monthly base rates for assisted living communities, hourly rates for home health aides from licensed agencies and agency-provided homemaker companion services, and daily rates for adult day services across the United States. Geographic areas reported are for state Metropolitan Statistical Areas (MSA), and a randomly selected sample of service providers or facilities not already identified in the MSAs (“Rest of State” areas). Costs for this survey were calculated for each service provider in an area and were aggregated across all providers to compute a statewide average cost


http://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-market-survey-nursing-home-assisted-living-adult-day-services-costs.pdf

Young People in Nursing Homes

Published by Monash University in August, 2011, the objective of this white paper is to summarize the research and policy context related to the issue of young people in nursing homes in Australia.

This discussion paper aims to:
• summarize research regarding the social inclusion of young people in nursing homes
• provide background on the policy and practical challenges regarding young people in
nursing homes

http://www.summerfoundation.org.au/attachments/151_White%20Paper%20Young%20People%20in%20Nursing%20Homes-lo.pdf

Older People in Care Homes: Sex, sexuality and intimate relationships

Published in August, 2011 from the Royal College of Nursing (UK), this guidance has been developed to help nurses and care staff work effectively with issues of sexuality, intimate relationships and sex, particularly for older people living in care homes.

Its goal is to facilitate learning, support best practice, and serve as a resource to help nurses and care staff address the needs of older service users in a professional, sensitive, legal and practical way.

Alongside raising awareness of issues which can impact on the sexuality, intimate relationships and sexual
activity of older care home residents, the document contains:

•  legal and professional frameworks within which nursing and caring practice takes place
• considerations for policies that address sexuality and sexual health needs in care homes
• guidance on principles of good practice, including care environments, organisational systems and care
• practices
• ideas on how to identify barriers to expression of sexuality and work towards removing these in
• practice
• suggestions on how to broach issues concerning sexuality, intimate relationships and sex
• guidance on dealing with situations where sexuality is seen as a problem
• suggestions on how staff can develop their own confidence and competence in dealing with
• sexuality issuescase examples,which can be used to highlight issues for discussion.

http://www.rcn.org.uk/__data/assets/pdf_file/0011/399323/004136.pdf

Dementia among aged care residents: first information from the Aged Care Funding Instrument

The Aged Care Funding Instrument (ACFI) is a new tool to appraise the care needs of permanent residents in residential aged care facilities in Australian Government subsidized aged care.

The ACFI appraisal was used to identify more than 104,400 permanent residents in 2008-09 who had a diagnosis of dementia. This equates to 53% of all residents with an ACFI appraisal in this financial year. Seventy per cent of residents with a dementia diagnosis were female reflecting their overall proportion in residential care. Approximately 79% of all residents with dementia were aged 70 years and over.

The report analyses data extracted from the Australian Department of Health and Ageing’s Aged and Community Care Management Information System (ACCMIS). This Management System holds administrative data on approved services to care recipients and residents and payment of funding to approved providers of community and residential care. This report outlines the demographic characteristics and care requirements of permanent residents with a diagnosis of dementia and other residents in Australian Government subsidised residential aged care facilities in 2008–09, as identified by information from the Aged Care Funding Instrument (ACFI). The report is structured as follows:
• Chapter 2 describes the background and purpose of the ACFI, how it is used and the information it collects.
• Chapter 3 examines how dementia is defined and described in the ACFI and what diagnostic sources are used.
• Chapter 4 discusses the characteristics and care needs of aged care residents with a diagnosis of dementia. It also includes data on the comorbidities of residents with a diagnosis of dementia and the completed length of stay of residents with a diagnosis of dementia compared with other residents.
2
• Chapter 5 presents some characteristics of residential aged care facilities that provide care to people with a diagnosis of dementia and information on the average amount of Australian Government subsidy (excluding supplements) provided to care for these people, as compared to other residents.

The information within the report provides a resource for program planners and funders and identifying needs for residential aged care, both now and in the future.

http://www.aihw.gov.au/publication-detail/?id=10737419025&tab=2

Population Aging and the Continuum of Older Adult Care in Manitoba

Older adults (people 65+ years old) are the main users of home care services and nursing homes (called personal care homes, or PCHs, in Manitoba), and the number of older adults living in Manitoba will soon increase considerably. Most Canadian provinces have expanded their care options for older adults, and Manitoba initiated an Aging in Place program in 2004. As one part of this program, supportive housing was created as an alternate to PCH use so that some people can continue living in the community.

To date however, Manitoba has not developed a tool that differentiates supportive housing users from PCH users. This tool is important to ensure that people receive the right type of care based on their needs. Also, a new strategy is required to more clearly define PCH residents’ needs so that providers can develop better care plans for these individuals. Knowledge from this tool can also be used to help understand the capacity of supportive housing to offset PCH use, now and in the future.

This research was conducted at the Manitoba Centre for Health Policy (MCHP), Faculty of Medicine, University of Manitoba, and provides evidence about the continuum of home care, supportive housing, and PCH care in Manitoba. Using a combination of clinical data from the Winnipeg Regional Health Authority (WRHA) and health care use data from the Population Health Research Data Repository (Repository)  housed at MCHP, the objectives of this research were to:

• develop a tool for placing people into either supportive housing or PCH care and a second tool to
  more clearly describe PCH residents’ needs.
• use this new evidence to estimate the capacity for supportive housing to offset current and future
  PCH use.

Profiles of State Innnovation: Roadmap for Managing Long-Term Care Supports and Services

In November, 2010, the Center for Health Care Strategies (CHCS) published its third report in a series on innovative strategies for providing long-term services and supports to low-income people with Medicaid.
Profiles of State Innovation: Roadmap for Managing Long-Term Supports and Services identifies the best practices in the nation for delivering effective long-term services and supports under Medicaid managed-care programs. 

The SCAN Foundation, CHCS conducted an environmental scan to identify state best practices for rebalancing programs to provide innovative alternatives to nursing homes including, expanding the pool of personal care workers to increase the numbers of beneficiaries in home and community settings; take advantage of initiatives that help people move out of nursing homes and into the community; and analyze relevant data to track quality of care metrics that reflect the vision of the long-term care program .

The private cost of long-term care in Canada : where you live matters (2010)

Published in October, 2010 in the SEDAP research series, this paper explores the Canadian economic experience access to long-term care health care. The authors found that the private cost of long-term care differs greatly across the country, and within provinces, with substantial variation, depending on income level, marital status, and, in Quebec alone, on assets owned. A non-married person with average income would pay more than twice as much in the Atlantic provinces as in Quebec, while a couple with one in care would pay almost four times as much in Newfoundland as in Alberta


The Program for Research on Social and Economic Dimensions of an Aging Population (SEDAP) is an
interdisciplinary research program centred at McMaster University with co-investigators at seventeen other
universities in Canada and abroad. The SEDAP Research Paper series provides a vehicle for distributing
the results of studies undertaken by those associated with the program.

http://socserv.mcmaster.ca/sedap/p/sedap277.pdf

Measuring the Quality of Long-Term Care

At at least 70% of the over 65s will require some long-term care (LTC) services during their lives, and pojections suggest that over the next twenty years the total cost of LTC will rise by 110%. Ensuring the quality of the long term care services and learning from current experience will continue to be of great importance.

The current issue of Eurohealth (v. 16(2), 2010 published by LSE Health, London School of Economics and Political Science, examines approaches to measuring quality in seven countries:

US: Vincent Mor discusses the advancement of public reporting of provider performance as a means of introducing quality based competition.

Germany: Andreas Büscher describes Germany's program of  publishing overall quality scores for LTC facilities for the general public, and in order to develop expert standards and quality indicators.

Finland: Harriet Finne-Soveri and colleagues review nine years experience using the US originated Resident Assessment Instrument benchmarking system.

Austria: Birgit Trukeschitz describes the introduction, not only of a national quality certificate for care homes, but also a tool to be used in respect of quality of home-based care provided by nursing staff.

England:  Juliette Malley takes a critical look at the impact of quality measures, and their usefulness as independent, reliable measures of quality.

Fact Sheets on Critical Issues in Long-Term Care

The SCAN Foundation presents six fact sheets that draw attention to national figures on long-term care that provide an introduction to some of the field’s most significant topics.

Each document presents a critical long-term care issue, highlights main points in bullet format and provides a comprehensive list of citations.

Click on the following links to read each themed fact sheet:

• Demographic & Economic Characteristics of an Aging Population
• Who Needs and Who Uses Long-Term Care?
• Who Pays for Long-Term Care?
• Growing Demand for Long-Term Care
• Who Provides Long-Term Care?
• Where is Long-Term Care Provided?

Commonwealth Fund Survey of Long-Term Care Specialists

From The Commonwealth Fund: Publications, these eight articles appearing in the August 2010 issue of Medical Care Research and Review explore the survey findings and analysis, revealing the opinions of those in the long-term care field on the state of the industry, the nature of its problems, its dissatisfaction with past efforts at repair, and its preferences for future strategies for improvement

Publications include:

• The Commonwealth Fund Survey of Long-Term Care Specialists
• Weighing Public and Private Options for Reforming Long-Term Care Financing: Findings from a National Survey of Specialists
• The Taste for Regulation in Long-Term Care
• Nursing Home Organizational Change: The "Culture Change" Movement as Viewed by Long-Term Care Specialists
• Supporting Home- and Community-Based Care: Views of Long-Term Care Specialists
• Opinion Networks Among Long-Term Care Specialists
• Improving Quality in Long-Term Care
• Long-Term Care: Getting on the Agenda and Knowing What to Propose

RGPc Education and Best Practice Database

The Regional Geriatric Program central has launched a new Education and Best Practice database.

They have taken all of the resources and educational materials that were posted across their website and brought them together in a new easy to use online, searchable database, including:
Best Practice guidelines, assessment tools and resources on the geriatric giants

• LTC Best Practice resources, including the Best Practice Blogger newsletter
• Presentations by geriatric experts
• Monthly RGPc Breaking News e-newsletter

Visit www.rgpc.ca and click on “Resources” in the left navigation bar. Search by keyword or subject area. You can also quickly check out the newest resources added to the database from the “New Resources” window on our homepage.

If you have educational tools or resources to add to the database, send an email to sagel@hhsc.ca.

Residential Care Facilities (Statistics Canada)

Released in May, 2010, this annual statistical report from Statistics Canada focuses on homes for the aged, facilities for persons with mental disorders and other facilities which provide health or social care. Facilities for the aged include homes for the aged, nursing homes, lodges for senior citizens and rest homes.

http://dsp-psd.pwgsc.gc.ca/collections/collection_2010/statcan/83-237-X/83-237-x2010001-eng.pdf

Programs to Manage Aggressive Behaviour in Long-Term Care Patients: A Review of Clinical-Effectiveness, Cost-Effectiveness, and Guidelines

In response to concerns from nursing staff in LTC facilities about physical aggression, and the wish to minimize the use of physical and pharmacological restraints, some LTC facilities want to train their nursing staff to deal with potentially aggressive patients in a manner which decreases or averts the physical aggressiveness without use of restraints.

This report from the Canadian Agency for Drugs and Technology in Health summarizes and appraises the evidence for programs to reduce aggression.

http://www.cadth.ca/media/pdf/L0089_Programs_Manage_Aggressive_Behaviour_in_Long-Term_Care_Patients_final.pdf

OANHSS Submission to the Standing Committee on Finance and Economic Affairs: Building a Seniors' Care Continuum

The Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) represents not-for-profit providers of long-term care, community services, and housing for seniors.

This paper, published in January 2010, identifies the existing gaps that need to be filled in order to ensure that the health care system evolves to meet the needs of Ontario seniors, as envisioned by health care providers and the government of Ontario.

http://www.oanhss.org/AM/TemplateRedirect.cfm?Template=/CM/ContentDisplay.cfm&ContentID=6005

"Current Perspectives" Update

Pressure Ulcers, Transitioning to Long Term Care, Family, and Continence in the J. W. Crane Memorial Library’s “Current Perspectives” series have been newly updated.

The "Current Perspectives Series" from the J. W. Crane Memorial Library, highlights current articles, books and Internet resources on specific topics of interest to long-term care professionals.

To access these and other topics in the series, go to: http://umanitoba.ca/libraries/units/health/links/aging.html#currentpers

Older People's Vision of Long Term Care

Commissioned by the Joseph Rowntreee Foundations Independent Living Committee, the Older People’s Programme (OPP1) and the Centre for Policy on Ageing (CPA) in the UK, this report explores older people’s experiences of living with high support needs. This work focused on those moving to and living in care homes now, and those using other kinds of supported accommodation or living arrangements (e.g. extra care and adult placement schemes).

The report which was published in November 2009:

• presents the results of a scoping study exploring the current role of long-term care and sets out the policy context;
• summarises key messages from older people with high support needs and presents their vision for a good life;
• highlights the need for radical change in long-term care policy and services to achieve this vision;
• recommends a multifaceted change programme to enable this vision to be achieved for individuals and their families; for local populations; and at a national policy and societal level.

http://www.jrf.org.uk/sites/files/jrf/older-people-vision-for-care-full.pdf