Integrating Community-Based Learning Into the Classroom: Students Become Long-Term Care Resident Advocates

To examine the impact of training on detection and reporting cases of elder abuse and neglect perpetrated by staff in LTC facilities and to compare staff with previous training to those with no training. A quantitative study in which questionnaires were collected from 250 multi- professional participants at a training seminar. Trainees with previous training on elder abuse reported higher perceived self-efficacy, higher intention to take action asking residents direct questions on abuse, to refer and report cases of elder abuse. They identified more cases of elder abuse in comparison to trainees without previous training. Findings indicate a positive relationship between perceived self-efficacy and intention to take action, and between perceived self-efficacy and direct questioning and referral for further inquiry. Training professionals is essential in coping effectively with elder abuse and neglect in LTC facilities.

Avoiding errors with allergy and immunology meds

The cluster randomised controlled trial OrkA (Orofaciopharyngeal and linguistic-communicative activation in older age) aims to evaluate the efficacy of a preventive group programme for older adults in long-term care (LTC) facilities. The programme objective is to support the maintenance of swallowing, speech and communication skills in later life. Group therapy and preventive services are two options that could help to counteract the current shortage of specialists and long waiting times for speech and language therapy (SLT). However, these strategies are rarely chosen to meet outpatient SLT needs in Germany. Group interventions in LTC facilities for older adults are diverse and have already been researched in various areas. Group interventions that promote language and communication in LTC facilities lead to an increase in well-being. However, group interventions delivered by speech and language therapists in LTC facilities are topics that have received little research attention to date. The present evaluation was conducted to investigate: (1) the conditions required for a successful group intervention in an LTC setting, and (2) the skillset needed by trainers. The study involved multiple stakeholders: LTC facilities (including staff and residents) and speech and language therapists (as group trainers). Seven semi-structured interviews were conducted with four group trainers following each intervention. Both the transcription and the qualitative content analysis based on Mayring's approach were carried out using MAXQDA. Categories were developed both deductively and inductively. The success of preventive intervention programmes for older adults in LTC settings is influenced by external and internal factors. External factors include the institutional conditions of the facilities, room environments and the effectiveness of communication among the different stakeholders (nursing staff, trainers, project administration, residents). Internal factors comprise group characteristics and dynamics, participants limitations and group-related challenges. This interplay necessitates a comprehensive trainers' skill-set, including: (1) disruption management, (2) manual-based programme implementation and adaptation, (3) empathic and appreciative behaviour, (4) self-reflective competencies, and (5) effective facilitation of group processes. Preventive measures concerning swallowing, speech and communication abilities among older adults in LTC facilities must consider a range of critical conditions. External and internal factors are interdependent and should not be considered in isolation. The trainer's role is pivotal, requiring attentiveness to training objectives, external support structures and the individual needs of group members. Leading a group differs markedly from conducting individual therapy, demanding a wide array of trainer competencies, encompassing methodological, interpersonal and personal skills. Thus, group-based approaches should be incorporated into SLT training programmes. What is already known on this subject Although prevention measures and group offer can counteract the growing shortage of skilled workers, such programmes are rarely used in outpatient speech and language therapy settings in Germany. In 2023, only 0.2% of speech therapy services were provided in group therapy. There are several reasons for the underuse of group offers. These relate to organisational and financial factors. Other reasons may include speech and language therapists not feeling adequately prepared. Therefore, further evaluation of group therapy settings is required. Especially in combination with prevention it is relevant to evaluate the factors that contribute to success. This may be because speech and language therapists do not feel adequately prepared. In psychology and pedagogy, group phases are known that necessitate management and supervision by group leaders. What this study adds to existing knowledge For further insight into group formats within SLT, a preventive group training aimed at maintaining swallowing, speech and communication skills for older adults in long-term care (LTC) facilities was evaluated. The present findings revealed several factors that influence the implementation of preventive group training for the target group. These factors emphasise the importance of trainers possessing specific methodological and social-communicative competencies to effectively address various internal and external influences. What are the potential or actual clinical implications of this work? Group offers are greater than the sum of their parts. As the group itself is an effective factor, its composition is also important. Trainers and therapists need a wide range of skills to handle different situations. While therapists' knowledge and skills concerning group management are highly relevant, they are not necessarily covered in the training curriculum.

To investigate the relationships between demographic characteristics of the elderly, type of long-term care (LTC) facilities, and the reasons for moving into LTC facilities. Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non-linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. The results showed that the older adults in quadrant I were characterized by being involved in the decision-making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. We believe that the results of the present study will facilitate policy-making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319-1327.

Nursing Programs Could Sharpen LTC Focus

BackgroundAdults with Alzheimer disease (AD) or Alzheimer disease and related dementias (ADRD) who require a wheelchair to accommodate disease-associated decline in mobility are at elevated risk for pressure injuries. More than half of residents in long-term care (LTC) facilities in the United States experience AD or ADRD. In LTC facilities, bed-based technologies exist to facilitate pressure injury prevention efforts, but similar technologies have not yet been widely evaluated to address sitting-related pressure injuries.ObjectiveThis study aimed to determine preliminary design inputs from care providers for technology to address sitting-related pressure injury prevention in LTC settings. Specifically, we sought to (1) understand the types and use of sitting-related equipment used in LTC for residents with AD or ADRD, (2) identify challenges faced by nurses and other caregivers when repositioning seated residents, and (3) understand care provider preferences for features of future sitting-related feedback technologies designed to facilitate effective and timely repositioning.MethodsSurveys (n=30) and semistructured interviews (n=9) of administrative and direct care providers in LTC facilities were administered. Survey results were summarized, and we used thematic qualitative analysis of interview responses to develop themes around challenges experienced by care providers and their perceptions about how technologies could facilitate the prevention of sitting-related pressure injuries.ResultsSurvey respondents endorsed using many sitting surfaces for LTC residents with memory loss, such as padded reclining chairs, bedside or dining chairs, and wheelchairs with cushions. All indicated that shared equipment is provided by the facility, and 43% of respondents reported having access to a seating specialist at their facility. Sitting time was typically up to 12 hours per day. Themes related to pressure injury prevention in the LTC context, specific to those with memory loss, included (1) barriers to repositioning seated residents vary with the degree of memory loss, (2) care providers are aware of guidelines and policies around the 2-hour repositioning schedule, and (3) care providers are interested in technologies that have relative value over added burden. Care providers expressed interest in mobile health (mHealth) technologies that provide automatic repositioning in later stages of memory loss, delivery of cues for residents with mild memory loss to encourage independent repositioning, and tools to monitor resident sitting and pressure-related outcomes.ConclusionsThese findings highlight the complexity of addressing the repositioning needs of seated LTC residents with AD or ADRD using mHealth technologies due to changes as the disease progresses. mHealth technologies should encourage more independence by residents experiencing milder memory loss, with increasing automaticity in repositioning residents in later stages. Both approaches could potentially minimize care provider burden in repositioning seated residents throughout the day. Design, development, and implementation of technologies should carefully weigh benefit versus burden to care providers and residents and continue to engage with them for feedback as development progresses.

Background: Implementing robust antimicrobial stewardship programs within long-term care facilities (LTCFs) presents unique challenges not typically seen in other healthcare settings. These facilities tend to care for older adults, rely on limited on-site clinician availability and experience higher-than-normal staff turnover. Many LTCFs lack the resources and expertise to track and analyze antibiotics usage. Through a collaborative effort between the Arizona Department of Health Services and the University of Arizona College of Pharmacy, support for carrying out stewardship activities was provided to these healthcare facilities. Our objective was to assess the viability of using pharmacy prescribing data to evaluate antibiotics usage among LTCFs throughout Arizona to assist in development of antimicrobial stewardship interventions. Methods: We invited interested LTCFs to participate in the development and enhancement of antimicrobial stewardship programs. We analyzed antibiotic prescribing data from November 2017 through November 2018 to assess the types and quantities of antibiotics prescribed. We worked with pharmacies to obtain a deidentified dataset that included unique patient identifiers, transaction (start) date, agent name, directions for use, route of administration, quantity dispensed, and stop dates. We estimated duration of treatment by assessing antibiotic starts using the number of transaction dates and unique patient identifiers for repeat prescriptions. Each agent was evaluated individually and assigned to an antibiotic category to better assess cumulative prescribing. Results: Through assistance from our community partners, we recruited 11 facilities to participate and worked with 5 servicing pharmacies to obtain a complete dataset for 6 LTCFs. For the facilities evaluated, there were a total of 4,654 antibiotic prescriptions. The most commonly prescribed antibiotic categories were fluroquinolones (24.3% of prescriptions) and oral β-lactams (17.8% of prescriptions). The third most commonly prescribed antibiotics were agents utilized against methicillin-resistant Staphylococcus aureus (MRSA) (13.7% of prescriptions). Antibiotic duration ranged from 1 to 304 days of therapy. Conclusions: Working directly with servicing pharmacies is an efficient way to obtain antibiotic prescribing data for LTCFs. During the 1-year period evaluated, antibiotic prescription rates varied between LTCFs. Despite numerous warnings, the fluroquinolone class continue to be among the most commonly prescribed antibiotics. Visualizing trends in LTCFs antibiotic data is an optimal way to develop and enhance antimicrobial stewardship programs in LTCFs. This fundamental information can help identify areas in which a facility can focus their stewardship efforts and provide a baseline for monitoring progress over time.Funding: NoneDisclosures: None

The coronavirus disease 2019 (COVID-19) outbreak increases the importance of strategies to enhance urgent medical care delivery in long-term care (LTC) facilities that could potentially reduce transfers to emergency departments. The study objective was to model resource requirements to deliver virtual urgent medical care in LTC facilities. We used data from all general medicine inpatient admissions at 7 hospitals in the Greater Toronto Area, Ontario, Canada, over a 7.5-year period (Apr. 1, 2010, to Oct. 31, 2017) to estimate historical patterns of hospital resource use by LTC residents. We estimated an upper bound of potentially avoidable transfers by combining data on short admissions (≤ 72 h) with historical data on the proportion of transfers from LTC facilities for which patients were discharged from the emergency department without admission. Regression models were used to extrapolate future resource requirements, and queuing models were used to estimate physician staffing requirements to perform virtual assessments. There were 235 375 admissions to general medicine wards, and residents of LTC facilities (age 16 yr or older) accounted for 9.3% (n = 21 948) of these admissions. Among the admissions of residents of LTC facilities, short admissions constituted 24.1% (n = 5297), and for 99.8% (n = 5284) of these admissions, the patient received laboratory testing, for 86.9% (n = 4604) the patient received plain radiography, for 41.5% (n = 2197) the patient received computed tomography and for 81.2% (n = 4300) the patient received intravenous medications. If all patients who have short admissions and are transferred from the emergency department were diverted to outpatient care, the average weekly demand for outpatient imaging per hospital would be 2.6 ultrasounds, 11.9 computed tomographic scans and 23.9 radiographs per week. The average daily volume of urgent medical virtual assessments would range from 2.0 to 5.8 per hospital. A single centralized virtual assessment centre staffed by 2 or 3 physicians would provide services similar in efficiency (measured by waiting time for physician assessment) to 7 separate centres staffed by 1 physician each. The provision of acute medical care to LTC residents at their facility would probably require rapid access to outpatient diagnostic imaging, within-facility access to laboratory services and intravenous medication and virtual consultations with physicians. The results of this study can inform efforts to deliver urgent medical care in LTC facilities in light of a potential surge in COVID-19 cases.

Monitoring COVID-19 vaccine use in Italian long term care centers: The GeroCovid VAX study

When performed correctly, performance appraisals are a valuable management tool in the development of employees. The purposes of this study were to determine the degree that evaluations are being given to foodservice employees, how they are being presented and why managers give performance appraisals. A questionnaire was mailed to foodservice directors in three types of noncommercial foodservice operations: public schools (n = 214), long-term care (LTC) facilities (n = 231), and hospitals (n = 107). Frequency of appraisal was different among the three types of facilities (p < .001). Only 53% of the school respondents reported that their foodservice employees receive an evaluation at least once a year compared to 90% and 96% of LTC and hospital foodservice employees, respectively. Both written and oral evaluations were conducted significantly more often in hospitals and LTC facilities than in schools (95%, 83% and 53%, respectively). The office was the most frequently used location for conducting evaluations. All of the respondents from hospitals, and the majority of those from LTC facilities (95%) and schools (57%), reported using evaluation forms for performance appraisals of foodservice employees. Respondents stated that their primary reason for conducting appraisals was to analyze strengths and weaknesses, in order to assist the employee in improving performance. Foodservice managers may want to examine their performance appraisal process to maximize its effectiveness.

Use of long-term care (LTC) facilities has become a necessary alternative in the health armamentarium in all developed countries. In the United States, 24% die in nursing homes (Porock et al., 2005) . Although only 5% of individuals over age 65 are living in LTC facilities at any given point in time, nearly 40% will spend at least some portion of their lives there (U.S. Census Bureau, 2002 ). Annually almost 2 million adults are admitted to one of 16,800 nursing homes in the United States (Hyer & Ragan, 2002 ; Rhoades & Krauss, 1999) . The recent growth of assisted living facilities too – now estimated at over 36,000 facilities serving about one million residents (Stefanacci, 2005) – complements these nursing homes within the spectrum of LTC settings. Nursing homes themselves are now mini-medical facilities, functioning not as “homes” but as hospitals from the perspective of the residents (Bergman-Evans, 2004) . In this regard, LTC environments present residents with many challenges, including lack of privacy, confinement to an institutional schedule, and the knowledge that the LTC setting is likely to be an individual’s final home. In this environment, the challenge of integrating mental health into the care of the aging within these varied LTC settings is enormously important. In fact, mental and medical pathologies often share a common expression and function. Physical changes, like those seen in Parkinson’s disease, have definite medical etiologies, but frequently fall into the domain of mental health, given their neuropsychological properties and high incidence of comorbid depression (Dening & Bains, 2004) . A majority of residents living in LTC facilities carry a least one psychiatric diagnosis. As many as 80% of nursing home residents will have dementia or another diagnosable psychiatric disorder (Hyer & Ragan, 2002 ; Rovner et al., 1990) . Furthermore, between 6 and 24% have a major depressive disorder diagnosis, 30% have minor depression or dysthymia, and as many as 35% manifest depressive symptoms. Minimum Data Set (MDS) reports that 14.6% of LTC residents have been diagnosed with anxiety disorder, though this rate may be deceptively low given limitations of assessment and in reporting anxiety symptoms within the MDS (Centers for Medicare and Medicaid Studies, 2004) . Despite these high rates of psychiatric disorders, most residents are not under the care of a mental health clinician. Typically, these services are provided by independent psychiatric consultants who see specific residents on an as-needed, on-call basis

Background: The demand for long-term residential care for people with dementia is, especially for those in the moderate to severe stages, increasing. However, dementia care services within long-term care (LTC) settings remain underdeveloped in low- and middle-income countries (LMICs). Objectives: This qualitative evidence synthesis aimed to explore LTC staff's experiences of taking care of people with dementia in LTC facilities in LMICs. Methods: A comprehensive literature search was conducted of six databases in January 2023 and updated in August 2024 for qualitative studies of LTC staff's experience of caring for people with dementia. Thematic synthesis was utilised for data synthesis, and NVivo facilitated this process. Results: 8,565 studies were screened, and 11 articles were included in this review. The studies included were conducted in Brazil (n = 2), China (n = 5), India (n = 1), Iran (n = 1), Malaysia (n = 1) and South Africa (n = 1) between 2012 and 2024. An overarching theme was identified: We are an island: underdeveloped dementia care within the LTC settings in LMICs, and the following categories identified as (1) the development of care provided for people living with dementia within care home settings is in its infancy; (2) the positive and effective coping strategies that may help embrace a brighter future of dementia care; (3) the deficiencies in caregiving approaches that contributed to poor-quality care for people living with dementia. Conclusions: The development of dementia care services within LTC in LMICs is still in its early stages. The main concern is the lack of available support and training for care staff and their insufficient dementia knowledge and care competencies. We hope that this review will help to increase attention to this significant issue of long-term institutional care for people with dementia in LMICs and that further research could investigate and enhance potential improvements in the practical implementation of long-term residential dementia care.

Utilization of Nurse Practitioners in Long-Term Care: Findings and Implications of a National Survey

In Canada, residents of long-term care (LTC) facilities are frequently transferred back to their residential facilities to continue recovery 1 week following hip fractures. Limited evidence is available regarding rehabilitation services in LTC facilities following hip fracture or rehabilitation practices after hip fracture for persons with dementia. We previously performed a systematic review of the impact of rehabilitation after hip fractures on persons with dementia. The purpose of this project was to augment our systematic review findings and determine current reported rehabilitation practices of rehabilitation professionals working in LTC facilities with hip-fractured patients with dementia and examine perceived barriers to the delivery of rehabilitation. We performed a survey study of rehabilitation professionals working in LTC facilities in a Canadian province, using a modified Delphi Consensus approach and a Web-based survey format. The survey was constructed on the basis of our systematic literature review and through discussions with clinical experts. A 2-round modified Delphi consensus approach was used to attain consensus among respondents. Examination of agreement and disagreement among respondents in the areas of (1) current practice and (2) perceived barriers to care was undertaken. A total of 42 respondents completed round 1 and 27 respondents completed round 2. Respondents were primarily female and working as physical therapists or occupational therapists. Most worked at facilities that employed at least 1 physical therapist and 1 occupational therapist. Treatment strategies for patients with hip fracture focused on return to independent ambulation and transfers. Although cognition was seen as a barrier to treatment, respondents implemented strategies to mitigate this barrier. Inadequate time and staffing were also seen as barriers to effective treatment. Rehabilitation professionals working in LTC facilities reported that the residents with dementia can and should participate in rehabilitation following hip fractures; however, they identified time and staffing constraints in addition to cognitive impairment as barriers. Current research in LTC facilities is very sparse and little is known about the rehabilitation care provided in these facilities. Further research is needed to determine the most effective rehabilitation interventions following hip fractures for residents of LTC facilities with dementia.

This report summarizes the descriptive data collected and analyzed as part of a larger study examining an educational intervention related to health screening practices in long-term care (LTC) facilities in a rural Midwestern state. The health screening practices examined were prostate-specific antigen testing, manual prostate examination, breast self-examination, clinical breast examination, and mammography. A review of the literature reveals health-screening practices are not being adequately provided to older adults. This includes older adults living in the community and those residing in LTC facilities. The director of nurses (DONs) in 41 LTC facilities were sent a questionnaire to ascertain the DONs' knowledge of American Cancer Society (ACS) guidelines for health screening practices, as well as written policies for, and implementation of, the screening practices in the LTC facility. The response rate was 73% (30 of 41). The major finding of this study was that health-screening practices according to ACS were not being implemented in LTC facilities in the rural state under study. This is congruent with current literature regarding health-screening practices in LTC facilities in more urban areas. These findings are not generalizable beyond the state studied, however, implications for nursing relate to increasing continuing education for nurses in LTC facilities about ACS guidelines.