Context: Population ageing and projections that more people will die in care homes demand that care home staff are prepared for advance care planning (ACP). This is an update of a prior review, published in 2021, of ACP education interventions for healthcare professionals in care homes. Objective: We sought to address the questions: (1) What ACP education interventions exist for care home staff? and (2) How effective are these interventions? Method: The review adheres to PRISMA; PROSPERO (ID: CRD42022337865). Original research evaluating ACP education for care home staff, reporting any measurable outcome of effectiveness, was included. Extensive literature searches were performed from March 2018 to June 2022. The results were reported by narrative synthesis. Findings: We identified 10 studies (310 care homes), from the UK, Belgium, Norway and Canada. Major sources of heterogeneity between studies include intervention design, target population and outcome measure. More recent interventions target the wider multi-disciplinary team. There is a trend towards the adoption of more resident/family and staff-related outcomes. There was insufficient evidence to draw conclusions about the effectiveness of ACP education interventions. Limitations: Heterogeneity of the primary studies did not allow for meta-analysis. Implications: There is still insufficient data to determine the effectiveness of ACP education interventions for care home staff. Future researchers should aim to agree on outcomes that are specific to ACP education interventions for care home staff and develop standardised, validated outcome measures. Study design should consider an intervention’s ‘theory of change’ when considering outcomes.

Context: Long-term residential care (LTRC) has been disproportionately impacted by Covid-19, with two-thirds of Covid-19 deaths occurring in LTRC homes in Ireland. Objectives: The study aims to examine the factors associated with LTRC Covid-19 outbreaks in Ireland. Methods: We merged data on Covid-19 cases and deaths in the community and LTRC homes with LTRC home characteristics across Waves 1-3 of the pandemic. Analyses examined the impact LTRC home characteristics and proximity to high community Covid-19 rates had on the likelihood of Covid-19 outbreaks and severity of outbreaks in LTRC homes. Findings: 8,502 confirmed cases of Covid-19 among LTRC home residents were recorded. Two thirds of LTRC homes had a Covid-19 outbreak across the first three waves of the pandemic. Larger LTRC homes were three times more likely to have an outbreak than smaller homes. High local community Covid-19 rates significantly increased the probability of a LTRC home outbreak. Homes in areas with the highest community Covid-19 rates were almost seven times more likely to have an outbreak than LTRC homes located in areas with the lowest community Covid-19 rates. Limitations: No centralised dataset exists in Ireland that collects information on morbidity, dementia or cognitive status of had on residents. Implications: Covid-19 had a significant impact on LTRC in Ireland with very high rates of cases and deaths. Our findings suggest that while factors such as home size may have increased the probability of an outbreak, being located in areas with high levels of community Covid-19 cases was likely the key factor explaining LTRC outbreaks.

<strong>Background and Objectives:</strong> This paper investigates the relationship between organizational culture and financial performance in under-resourced nursing homes (85% or higher Medicaid residents). <strong>Research Design and Methods: </strong>We tested whether the type of organizational culture (clan, adhocracy, market, and hierarchical) was associated with higher financial performance, measured by the operating margin. Survey data of 341 nursing home administrators were collected in 2017–2018 and merged with secondary datasets with facility and market characteristics. We used multiple regression analysis to test our hypotheses. <strong>Results:</strong> We found that a market culture was positively associated with higher operating margin. On the other hand, having a clan, hierarchical, or non-dominant culture was associated with lower financial performance, compared to a market culture. <strong>Discussion and Implications: </strong>Ensuring the financial viability of high-Medicaid nursing homes is important since they provide care to low-income residents and a high proportion of racial/ethnic minorities. Our findings suggest that having a market culture with an external orientation may be associated with better financial performance among these nursing homes.

<strong>Context:</strong> The COVID-19 pandemic hit Chile hard and affected older people the most. Through its National Service for Older Adults, the country implemented a strategy to prevent and mitigate infection and spread in long-term care facilities (LTCF), reaching regulated and registered residences and, for the first time, informal and unregistered residences. <strong>Objective:</strong> Identify the challenges and lessons from the COVID-19 response in LTCF with respect to the support received, the implementation of infection control measures, workforce challenges experienced and the measures adopted to promote residents’ wellbeing. <strong>Methods:</strong> An online questionnaire was sent to all LTCF managers (N = 385, Response Rate = 32.4%). Statistical tests compare results to identify differences across LTCF characteristics: residence size, location and management type (private, public or subsidized, or informal). <strong>Findings:</strong> Irrespective of their location, size or management, managers highlight common challenges during the crisis. They include limited personal protective equipment (PPE) availability, staff shortages, low quality of replacement staff, reduced staff mental health, and the difficulty to understand and implement protocols. Managers acknowledge receiving institutional support in the form of PPE provision and opportunities for staff training, but managers noted the need to expand this support to cover staffing surge needs, staff psychological needs, and ensure the continuity of clinical support for residents as well. Managers share a common demand for a more coordinated response from public institutions. Managers recognize that the pandemic and the measures implemented to mitigate it negatively affected staff morale and residents’ wellbeing. Many noted that peer-to-peer support was a mechanism to support staff. <strong>Limitations:</strong> Results might be subject to selection bias. Data collection covered a limited period of time at the early stage of the pandemic. <strong>Implications:</strong> Findings are relevant to assess the COVID-19 response and to better prepare for another COVID-19 wave or similar health or environmental threats in the future.

Context: As a result of changing demographics, the number of older adults living in long-term care homes (LTCHs) is expected to rise dramatically. Thus, there is a pressing need for better understanding of how the social organization of care may facilitate or hinder the quality of work-life and care in LTCHs. Objectives: This study explored how the social organization of work influences the quality of work-life and care delivery in LTCHs. Method: Institutional ethnography followed by theory building provided the conceptual underpinnings of the methodological approaches. Participants included 42 care team members who were employed by one of three participating LTCHs. Data were derived from 104 hours of participant observation and 42 interviews. Findings: The resident care aides (RCAs) were found to rely on supportive work-teams to accomplish their work successfully and safely. Reciprocity emerged as a key feature of supportive work-teams. Management practices that demonstrated respect (e.g., inclusion in residents’ admission processes), recognition, and responsiveness to the RCAs’ concerns facilitated reciprocity among the RCAs. Such reciprocity strengthened their resilience in their day-to-day work as they coped with common work-place adversities (e.g., scarce resources and grief when residents died), and was essential in shaping the quality of their work-life and provision of care. Discussion: The empowerment pyramid for person-centred care model proposes that the presence of empowered, responsive leaders exerts a significant influence on the cultivation of organizational trust and reciprocating care teams. Positive work-place relationships enable greater resilience amongst members of the care team and enhances the RCAs’ quality of work-life, which in turn influences the quality of care they provide. Limitations: Whether there were differences in the experiences, opinions, and behaviour of the people who agreed to participate and those who declined to take part could not be ascertained. Further research is required to determine and understand all of the factors that support or inhibit the development of empowered leaders in LTCHs. Implications: Cultures of caring, reciprocity and trust are created when leaders in the sector have the support and capacity to lead responsively and in ways that acknowledge and respect the contributions of all members of the team caring for some of the most vulnerable people.

Context: Survivors of acquired brain injury (ABI) experience long-term cognitive, behavioural, psychological and social consequences often overlooked by health and social care providers, as are the implications for family members. Objective: To improve understanding of 1) the long-term community rehabilitation needs of ABI survivors and their families, and 2) their experiences of community health and social care provision within the United Kingdom. Method: A mixed-method, predominantly qualitative, approach was employed using questionnaires and semi-structured interviews in a two-stage design. Stage one: Seventy-six participants (31 ABI specialist professionals, 26 family members and 19 survivors) completed an online survey analysed using conventional content analysis. Participants were invited to take part in stage two, which recruited 21 participants (12 ABI survivors, 5 family members and 4 professionals) to semi-structured interviews analysed using a mixed thematic approach. Findings: Three main themes were identified with associated sub-themes 1) consequences of ABI ( cognitive and behavioural; psychological and social consequences, impact on family) 2) types of services required (tailored, specialist and interdisciplinary care) and 3) poor access to services (associated with; lack of understanding of ABI among professionals, the hidden nature of ABI, organisational structures and a lack of available services). Limitations: The study failed to achieve a sample distributed evenly across the United Kingdom, making it difficult to draw conclusions around best practice. Implications: The study concluded that professionals need training to understand the needs of ABI survivors and their families and that services need to be provided in a long-term, integrated manner.