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Demand for home and community-based services continues to outpace employment of home care workers (HCWs) who provide this vital assistance. HCWs face challenges that contribute to inadequate staff retention. Of particular concern is the lack of research on HCWs' emotional health. This research describes facilitators and resources that support HCW emotional health. Qualitative descriptive interviews were conducted with a purposive sample of HCWs (n = 17) who were formally recognized for their success. Interviews were audio recorded, transcribed verbatim, and coded in Dedoose. Thematic analysis revealed three facilitators of emotional health that HCWs link to their professional success: "right state of mind," practicing self-care, and a combined sense of appreciation and support. HCWs highlight specific, practicable resources that promote their emotional health. Policy implications connects low wages and benefits to HCW emotional health, and practice implications for enhancing training and support to retain these important workers. [ABSTRACT FROM AUTHOR]

Threshold concepts are fundamental to the learning process and are said to transform the way we view and understand the world around us. Although a new framework to gerontology, the threshold concept framework has been utilized in many fields inside (e.g. psychology, social work) and outside (e.g. clinical and research settings) of academia. This framework facilitates understanding learning, exposing expert blind spots, and designing curricula for complex concepts that are challenging to learn. For decades gerontologists have grappled with ageism and its dire consequences including unemployment, negative health outcomes, and rationing of health care. Education is one of, if not the most, powerful tools to combat ageism. This article demonstrates the utility of the threshold concept framework for gerontologists by conceptualizing ageism as a threshold concept. The purpose of this article is to provide an innovative approach to education on complex gerontological topics in different clinical, research, and educational settings using ageism as a primary example of a threshold concept in gerontology. [ABSTRACT FROM AUTHOR]

Background: Lesbian, gay, and bisexual (LGB) older women have unmet communication needs around palliative and end-of-life care. Past research has found communication differences for LGB women patients. Consequently, older LGB women may experience healthcare communication barriers around advance care planning. Aim: To explore experiences of bereaved LGB older women to understand perspectives regarding advance care planning communication between clinicians, patients, and dyads. Design: Guided by queer gerontology as a theoretical framework, this qualitative descriptive study employed individual interviews with purposively recruited participants. Interviews were conducted in person using a semi structured protocol and analyzed using inductive thematic analysis. Setting/participants: Sixteen LGB women, age 60 years or older from across the United States who had lost a spouse/partner within the past 5 years. Results: Four main themes emerged from the transcripts, LGB older women: (1) experience unclear advance care planning communication and end-of-life care support from clinicians, (2) often avoid advance care planning discussions with spouse or partners, (3) lack of knowledge about palliative or end-of-life care, and (4) have more positive experiences when there is consistent communication with spouse or partner and clinicians during a spouse/partner's illness and end-of-life. Discussion: While certain experiences and opinions may reflect those of non-LGB older adults, novel advance care planning barriers exist for LGB older women. Greater understanding among clinicians is needed regarding advance care planning conversations with LGB dyads. We recommend four improvements in training, recognition, acceptance, and dyad-based communication interventions. [ABSTRACT FROM AUTHOR]

Montessori methods are used with individuals with dementia to create meaningful, inclusive, failure-free activities that enhance quality of life. This research qualitatively explored the barriers to implementing a Montessori-based intervention for people living with dementia in a 24-hr memory care setting. A lens comprised of key Montessori values and principles guided a content analysis of field note data to create an overall framework for understanding implementation barriers, which are rarely addressed in the literature. Interestingly, the four themes that emerged as barriers—the absence of respect, interdependence, meaningful activity, and structure—permeated implementation efforts and represent the opposite of Montessori principles. These findings confirm literature that identifies similar barriers across diverse interventions. Findings underscore the need for formal documentation of implementation barriers and extensive pre-implementation work to accomplish culture change in long-term care. [ABSTRACT FROM AUTHOR]

Most older Americans do not financially qualify for Medicaid and support provided through the Older Americans Act is quite limited. In response, Ohio has generated funds for services for older adults through the use of local county tax levy programs. Ohio currently leads the nation in the utilization and support of local levy funding, generating more than US$200 million annually. This study conducted qualitative descriptive interviews with 15 locally funded programs across the state. Thematic analysis revealed that local programs encounter an array of implementation barriers, including increased state and federal eligibility requirements, staffing issues, lack of access to services in rural locations, and low reimbursement rates. These barriers are coupled with added pressure from county officials to move individuals onto state-funded programs, rather than locally funded programs. This paper also provides recommendations for how these programs can be better supported to ensure their sustainability for the future., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Objectives: Montessori-based interventions (MBIs) promote quality of life among older adults living with dementia. We used Dementia Care Mapping (DCM) to evaluate the impact of a small-scale MBI. DCM is a systematic observation tool that records the behavior and mood/engagement of individuals living with dementia and can be used to improve quality of care and well-being., Research Design and Methods: Pre- and post-intervention data from 15 care community residents compared: 1) residents' range and types of behaviors, 2) their mood/engagement and 3) staff behaviors that facilitated and impeded residents' personhood. In this mixed-methods study, deductive qualitative content analysis of DCM field notes further explored staff behaviors., Results: Post-intervention, a significantly higher proportion of residents' behaviors had the potential to promote their well-being, although there was little change in mood/engagement while engaging in those behaviors. Post-intervention, there was also a significant increase in staff behaviors that facilitated, and a decrease in staff behaviors that impeded, residents' personhood. Further, post-intervention, staff interactions with residents were more open-ended and inclusive. Although some staff behaviors still excluded residents, the exclusion was more benign than pre-intervention., Discussion and Implications: DCM documented incremental changes toward person-centered care, and DCM field notes provided insight into missed opportunities for effective staff interactions with residents. Taken together, findings provide additional support for the use of MBIs and highlights the usefulness of DCM, especially its associated field notes, to help researchers and practitioners create environments that promote the personhood that individuals living with dementia deserve., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Threshold concepts are fundamental to the learning process and are said to transform the way we view and understand the world around us. Although a new framework to gerontology, the threshold concept framework has been utilized in many fields inside (e.g., psychology, social work) and outside (e.g., clinical and research settings) of academia. This framework facilitates understanding learning, exposing expert blind spots, and designing curricula for complex concepts that are challenging to learn. For decades gerontologists have grappled with ageism and its dire consequences including unemployment, negative health outcomes, and rationing of health care. Education is one of, if not the most, powerful tools to combat ageism. This article demonstrates the utility of the threshold concept framework for gerontologists by conceptualizing ageism as a threshold concept. The purpose of this article is to provide an innovative approach to education on complex gerontological topics in different clinical, research, and educational settings using ageism as a primary example of a threshold concept in gerontology., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)