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Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.
To examine whether previously established associations between experiences of meaning in life on the one hand and life satisfaction and depressive symptoms on the other hand are transferable to a population of older residential care residents with Alzheimer’s disease (AD).
Cross-sectional study using questionnaires administered in a structured interview format.
Nine residential care settings in Flanders, Belgium.
Convenience sample of 138 older adults (+65) living in residential care with a diagnosis of AD.
Meaning in life was measured using the Presence of Meaning (PoM) subscale of the Meaning in Life Questionnaire-Short Form, life satisfaction was measured using the Satisfaction With Life Scale (SWLS), depressive symptoms were measured using a five-item short form of the Geriatric Depression Scale (GDS), and general cognitive status was measured using the Mini-Mental State Examination (MMSE).
Controlling for demographic variables (age, sex, and marital status) and cognitive status, meaning in life scores were positively predictive of life satisfaction scores and negatively predictive of depressive symptoms. Post-hoc analyses suggested a possible interaction between meaning in life and cognitive status in predicting both outcomes of psychological functioning (GDS and SWLS).
The presence of meaning in life is related to important well-being outcomes for older adults with AD living in residential care. More awareness for the importance of existential themes and interventions fostering meaning might be warranted for this population.
This qualitative study explores the experiences of older adults participating in a creative visual arts program at a residential care facility in Victoria, British Columbia. A narrative inquiry approach was used to conduct face-to-face interviews with 10 residents and three program staff in addition to the systematic observations of program activities and an arts exhibit. The findings reveal the program fostered a sense of community among participants and enhanced their sense of self-worth as artists. A public art exhibition at a community centre underlined the value of residents’ artwork and gave meaning and purpose to their involvement in the program. Findings show the importance of arts programs in fostering creativity in later life and illustrate how people living in institutions can experience multiple dimensions of the self through artistic forms of expression. This study highlights the need to increase access to arts programs for individuals living in residential care.
Observation of long-term trends within countries is needed to increase insight into how policy initiatives are reflected in the use of care over time in addition to individual determinants of care use. In the past decades, Dutch care policies have favoured homecare and reduced the availability of institutional care which extended the care responsibilities of formal and informal care-givers at home. This study investigates the changes in the use of informal and formal homecare, community services and residential care among cognitively impaired older adults over time in the Netherlands. In addition, of special interest here are the associations of the presence of a spouse, other family members or social network with care use, and the interdependency between the use of different types of care. The study employs the Longitudinal Aging Study Amsterdam (LASA) covering the years 1992–2012, analysed with generalised estimating equations. The data consisted of 1,022 observations gathered from 813 respondents aged 65–85. The respondents were cognitively impaired according to the age- and education-standardised Mini-Mental State Examination score. The analyses took into account several individual determinants of care use. The use of informal care and residential care decreased while the use of formal homecare and community services remained the same. Simultaneously, the proportion of those who did not use the studied care types increased. The contribution of partners in informal care decreased. Informal care and formal homecare use increasingly became complementary services. The findings suggest that the decreases in informal care and residential care have not been replaced by other types of care, as reflected in the increased number of persons receiving no care. Care policies should not rely excessively on the availability of informal help and should guarantee adequate formal help, especially for those in high need.
Research on young people transitioning out of the childcare system and into young adulthood is inevitably reductionist in that it is unable to take into account the many complex forces that play a role in the development of a child from birth, into and through the care system and on to adulthood. Consequently, studies on the outcomes of care-leavers need to be interpreted with care and thought. This paper serves to illustrate these challenges in research and the various ways that research results can be interpreted by drawing on data from a study being conducted in a residential care programme in South Africa. Demographic, pre-care and in-care variables of a sample of care-leavers are compared with a set of independent living outcome variables a year after aging out of care. Unanticipated results are contrasted with those that were anticipated, and multiple interpretations of the same results are provided. Because of this, the author calls for judicious and humble use of research results when making judgements about the outcomes of care-leavers and the effectiveness of child welfare interventions.
Therapeutic residential care is currently seen as an answer to managing the increasing disruption experienced by many young people in care. Yet the history of residential care in Australia is problematic and the international evidence for the efficacy of therapeutic approaches is very poor. The author's own agency's experience of providing residential care also indicates that caution is needed before increasing the numbers of residential ‘beds’. Problems include young people's dislike of residential options and the stressfulness of an environment that involves shift workers and multiple transient relationships. Further, residential care can be a financial drain on child welfare budgets (being tendered to non-government agencies at over seven times the cost of community care), and has the potential danger – when beds are empty – of being used for young people who do not need this level of care. Residential care may appear to be the only option for a handful of adolescents no longer suited to foster care; but before developing therapeutic residential care further, government must be able to guarantee, at a minimum: a safe environment, a nurturing and healing environment, continuity of care, and the capacity to meet young people's developmental and permanency needs. These standards must be met, not just now, but over the long term.
Touchscreen technology (TT) is a resource that can improve the quality of life of residents with dementia, and care staff, in residential aged care facilities (RACF) through a person-centered care approach. To enable the use of TTs to engage and benefit people with dementia in RACFs, education is needed to explore how these devices may be used, what facilitates use, and how to address barriers. We sought to provide education and explore RACF staff views and barriers on using TT to engage their residents with dementia. An educational session on using TT with residents with dementia was given to staff from three long-term RACFs in Melbourne, Australia. A cross-sectional convenience sample of 17 staff members (personal care attendants, registered nurses, enrolled nurses, allied health clinicians, and domestic staff) who attended were administered questionnaires pre- and post-sessions. As a result of the education seminar, they were significantly more confident in their ability to use TT devices with residents. TT, and education to staff about its use with residents with dementia, is a useful strategy to enhance RACF staff knowledge and confidence, thereby enhancing the use of technology in RACFs in order to improve care standards in people with dementia.
Older people living in long-term facilities (nursing and residential homes providing 24-hour care) spend the majority of their time inactive, despite the known health and wellbeing benefits of physical activity and reduced time spent sedentary. In order to successfully embed interventions that aim to increase physical activity or reduce sedentary behaviour, it is necessary to understand the features of the care environment that influence residents’ routine patterns of movement. Drawing on an organisational perspective, this paper explores the structures and mechanisms that shaped different care practices concerning residents’ movement in two contrasting care homes in the north of England. This study adopted an ethnographic approach, using a combination of qualitative observations, informal conversations and interviews. A grounded theory approach to data analysis was adopted. The findings illustrate the importance of translating espoused values of care into tangible and acceptable care practices, systems of management, staff training and development, and the use of care planning in residents’ routine patterns of movement. Understanding how organisational factors shape routine movement among care home residents will help inform the development of embedded and sustainable interventions that enhance physical activity and reduce sedentary behaviour. This study is part of a wider programme of research developing and testing a complex intervention, embedded within routine care, to reduce sedentary behaviour among care home residents.
Complex developmental trauma impacts on neurobiological development through the creation of a frightening and unpredictable environment in which the brain develops. This early experience results in an under-developed limbic system and pre-frontal cortex. For some children and young people, their experiences of early trauma lead them into the residential Out-of-Home Care (OOHC) system. Neurodevelopmental delays that occur as a result of early trauma and abuse often become particularly pronounced during adolescence, including limited impulse control, poor emotional regulation and attachment impairments. These same delays contribute to offending behaviour and subsequent contact with the justice system. Complex developmental trauma has serious repercussions both for the individual and the society in which he or she lives. These repercussions may take the form of offending behaviour and contact with the justice system, drug and alcohol abuse, and continuing cycles of abuse and violence within families or victimisation.
This study compared how older people use quality information to choose residential care providers in England, the Netherlands and Spain (Catalonia). The availability of information varies between each country, from detailed inspection and survey information in the Netherlands, through to a lack of publicly available information in Catalonia. We used semi-structured interviews and group workshops with older people, families and professionals to compare experiences of the decision-making process and quality information, and also to explore what quality information might be used in the future. We found that most aspects of the decision-making experience and preferences for future indicators were similar across the three countries. The use of quality information was minimal across all three, even in England and the Netherlands where information was widely available. Differences arose mainly from factors with the supply of care. Older people were most interested in the subjective experiences of other residents and relatives, rather than ‘hard’ objective indicators of aspects such as clinical care. We find that the amount of publicly available quality information does not in itself influence the decisions or the decision-making processes of older people and their carers. To improve the quality of decisions, more effort needs to be taken to increase awareness and to communicate quality in more accessible ways, including significant support from professionals and better design of quality information.
The distinct needs of lesbian, gay, bisexual and trans (LGBT) residents in care homes accommodating older people have been neglected in scholarship. On the basis of a survey of 187 individuals, including service managers and direct care staff, we propose three related arguments. First, whilst employees’ attitudes generally indicate a positive disposition towards LGBT residents, this appears unmatched by the ability to recognise such individuals and knowledge of the issues and policies affecting LGBT people. Statements such as, ‘We don't have any [LGBT residents] at the moment’ and ‘I/we treat them all the same’ were common refrains in responses to open-ended questions. They suggest the working of heteronormativity which could deny sexual and identity difference. Second, failure to recognise the distinct health and social care needs of LGBT residents means that they could be subject to a uniform service, which presumes a heterosexual past and cisgender status (compliance with ascribed gender), which risks compounding inequality and invisibility. Third, LGBT residents could be obliged to depend largely on the goodwill, knowledge and reflexivity of individual staff (including people of faith) to meet care and personal needs, though such qualities were necessary but not sufficient conditions for inclusion and no substitute for collective practices (involving commitment to learn about LGBT issues) that become integral to care homes’ everyday functioning. A collective approach is key to advancing inclusion, implementation of legal rights to self-expression and securing equality through differentiated provision.
Up to 90% of people with dementia living in residential aged care facilities (RACFs) display behavioral and psychological symptoms of dementia (BPSD), and these are associated with poorer quality of life and increased morbidity and mortality. In order to implement appropriate interventions, it is important to understand the symptoms in more detail. Despite the availability of BPSD assessment tools, it is unknown what the current practice of monitoring of BPSD in RACFs. We sought to investigate the current BPSD assessment tools being used in RACFs and explore different stakeholders’ views on current practices. A cross-sectional convenience sample of 21 clinicians were identified and administered a questionnaire.
Old age psychiatrists, aged psychiatry clinicians, behavior management teams and RACF staff completed the questionnaires. Clinicians reported that objective consistent information about BPSD were important for recommending and implementing pharmacological and non-pharmacological strategies for BPSD; however, the use of validated BPSD assessments in RACFs was not a usual part of clinical practice. RACF staff stated the major barrier to assessment of BPSD was lack of time. Alternate methods of assessing BPSD which consider preferences from clinicians and RACF staff should be further investigated. Modern technology which can allow “real time” assessment may be a solution.
Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.
Over the past three decades, there has been a notable increase in studies of practice change interventions in long-term care (LTC) settings. This review, based on a modified realist approach, addresses the following questions: What practice change intervention characteristics work? And, in what circumstances do they work and why? A modified realist approach was applied to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases and published literature for empirical studies of practice change interventions that (a) were conducted in LTC settings, (b) involved formal care staff members, and (c) reported a formal evaluation. Ninety-four articles met the inclusion criteria. Interventions that included only predisposing factors were least likely to be effective. Interventions that included reinforcing factors were most likely to produce sustained outcomes. We concluded that interventions aimed at practice change in LTC settings should include feasible and effective enabling and reinforcing factors.
In the light of Dave Vicary's review of 40 years of publications addressing out-of-home care (OOHC) issues and current concerns about both the systemic context of child protection and the comparatively narrow range of options for the delivery of care in the sector, a range of people from Australia and beyond were asked for their responses to the question: Where do you see OOHC going in the next 40 years and what do you think our priorities need to be?
This paper explores the debates surrounding out-of-home care for children who are unable to live with their birth parents and become looked after by the state in England. The historical context for the provision of out-of-home care is considered. Themes, including the use of residential care, foster care, adoption and placements of children from Black and minority ethnic children, are identified. These themes are re-examined in light of the current political and policy context, including the impact of globalisation. The paper concludes some reflections on future trends.
This study aims to present the development of a scale focused on youth’s perceptions about their group in residential care and to offer evidences of validity and reliability. This work is part of a national study involving 59 institutions and 360 adolescents (55% males) from 11 to 18 years old (M = 14.72; SD = 1.81). Evidences of validity were tested, as well as the reliability data and the relationship between group perceptions, individual characteristics and placement length. A structure with three components was found explaining 62% of variance: Deviant behavior, Positive Attributes and Oppositional Behavior. The CFA revealed good values of fit: CFI = .95, GFI = .90 and RMSEA = .050. Furthermore, a positive and significant correlation was found between positive attributes and life satisfaction (p < .001), and negative ones with deviant behavior (p < .01) and oppositional behavior (p < .01). Finally, a positive and significant correlation was found between Deviant behavior and youth’s age (p < .05), and significant gender differences were found in this dimension (i.e., p < .001; d = .38, 95% CI [–9.97, 2.94]; males reported higher scores than females). No significant correlations were found regarding the length of placement. These results suggest that this tool reveals satisfactory psychometric properties to be used in further studies with youth in residential care.
This paper examines the ways in which older people's residential and nursing homes can constitute heteronormative environments – social spaces in which the same-sex attractions and desires of residents are disregarded in the provision of everyday care. The aim of this discussion is to examine the synergies and differences between older lesbian, gay and bisexual (LGB) adults' expectations for future care home provision and the expectations of care staff and managers in providing residential services to older people with diverse sexual backgrounds. We present qualitative evidence from research into the provision of care environments in Wales. In this paper, we present findings from two cohorts: first, from five focus groups with care and nursing staff and managers; and second, from 29 semi-structured interviews with older LGB adults (50–76 years) residing in urban and rural locations across Wales. We argue that residential care environments can constitute heterosexualised spaces in which LGB identities are neglected in comparison to the needs and preferences of other residents. To this extent, we discuss how care staff and managers can be more attentive and responsive to the sexual biographies of all residents and argue against the separation of care and sexual orientation in practice.
Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the ‘right’ leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.
This paper describes the collaboration between an Aboriginal community and Western Australia's (WA) Department for Child Protection (DCP) in designing and operating a residential child care facility in a predominantly Aboriginal community. Research literature has established that the effective operation of child protection systems in remote Aboriginal communities requires practitioners and policy-makers to have awareness of local and extra-local cultural, historical and contemporary social factors in nurturing children. This ethnographic case study describes how a newspaper campaign heightened public and professional awareness of child abuse in the town of Halls Creek, in WA's Kimberley region. With its largely Aboriginal population, Halls Creek lacked the infrastructure to accommodate an inflow of regional people. Homelessness, neglect and poverty were widespread. Within a broader government and local response, DCP joined with community leaders to plan out of home care for children. Detailed are the importance and complexities of negotiating between universal standardised models of care and local input. Strategies for building positive relationships with children's family while strengthening both parenting capacity and community acceptance, and use of the facility are identified. Key to success was the development of a collaborative ‘third-space’ for threading together local and professional child protection knowledge.