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Context: Observation is an increasingly popular method for care home research. However, there are challenges associated with the use of this method in this context. As researchers, what we bring, what we do, and what we leave behind when using this method can have a significant impact on the lives and work of people in care homes. Perspective: Drawing on the experiences of two research teams, we share real-world examples of the ethical, methodological, and practical concerns when using the non-participant observation method in a care home context. Four key areas for observational research in care homes are considered: privacy and confidentiality; managing consent; observation activities and the role and skills of the researcher; and sensitivity, reflexivity, and relational aspects of observational research. We offer examples from our work to guide researchers on: i) making a case for ethics; ii) the observational ‘gaze’ (or focus); iii) including people who lack capacity; iv) addressing concerns about care or practices; v) the role of the researcher; and vi) addressing observational sensitivities. Implications: This paper highlights the opportunities and challenges of the non-participant observation method for care home research. In particular, we highlight the unique contextual and ‘people’ factors for researchers to consider. Our paper addresses a significant gap in the existing literature. It will be of interest to researchers world-wide, generating discussions that will support the research community to undertake research that appropriately uses observational methods to address questions that matter for the sector and to generate high-quality evidence with the potential to benefit those living and working in care homes.

Abstract The COVID-19 pandemic exposed long-standing inequities in Canada’s long-term residential care (LTRC) sector with life-threatening consequences. People from marginalized groups are overrepresented among those who live in, and work in LTRC facilities, yet their voices are generally silenced in LTRC research. Concerns about these silenced voices have sparked debate around ways to change LTRC policy to better address long-standing inequities and enhance the conditions that foster dignity for those who live and work in LTRC. Weaving an analysis of historical and cultural attitudes about LTRC, and promising strategies for engaging people with lived experience, we argue that the voices of people with lived experience of life and work (paid and unpaid) in LTRC are essential for ethically and effectively shifting long-standing inequities. Lessons from a 4-year, national, multi-disciplinary research study, known as the Seniors Adding Life to Years (SALTY) project, suggest that resident-determined quality of life can be prioritized by centring the perspectives of residents, their family/friends, direct care workers, volunteers, and people living with dementia in the research process. Accordingly, we highlight strategies to include these voices so that meaningful and impactful system change can be realized.

The COVID-19 pandemic exposed long-standing inequities in Canada's long-term residential care (LTRC) sector with life-threatening consequences. People from marginalized groups are overrepresented among those who live in, and work in LTRC facilities, yet their voices are generally silenced in LTRC research. Concerns about these silenced voices have sparked debate around ways to change LTRC policy to better address long-standing inequities and enhance the conditions that foster dignity for those who live and work in LTRC. Weaving an analysis of historical and cultural attitudes about LTRC, and promising strategies for engaging people with lived experience, we argue that the voices of people with lived experience of life and work (paid and unpaid) in LTRC are essential for ethically and effectively shifting long-standing inequities. Lessons from a 4-year, national, multi-disciplinary research study, known as the Seniors Adding Life to Years (SALTY) project, suggest that resident-determined quality of life can be prioritized by centring the perspectives of residents, their family/friends, direct care workers, volunteers, and people living with dementia in the research process. Accordingly, we highlight strategies to include these voices so that meaningful and impactful system change can be realized. Plain Language Summary: This article argues that long-term residential care facilities in Canada have a long history of perpetuating social inequalities, beginning with seventeenth century poor houses and almshouses, from which long-term residential care facilities evolved in North America. We highlight that those who currently reside in long-term residential care are more likely to be people with less social power—for example women, people living with dementia, and people with low-income. These residents are rarely included in research projects as co-designers of research, co-producers of knowledge, or experts on the realities of long-term residential care. We explore strategies for addressing these underrepresented voices and inequalities in research by highlighting promising examples of resident, family, and worker-engagement emerging from a pre-pandemic to early pandemic pan-Canadian research project on quality of life in long-term residential care. We argue that long-term residential care residents, their family/friend caregivers, people living with dementia, and direct care workers have voices that are essential in residential care design and research engagement strategies. By prioritizing these voices in research, we can better amplify their critical perspectives in broader policy and decision-making processes that guide meaningful and impactful system change. [ABSTRACT FROM AUTHOR]

Context: The impacts of Covid-19 pandemic conditions in Canada’s long-term residential care (LTRC) sector have demonstrated that future pandemic preparedness necessitates not only recovery but deeper sectoral transformation of longstanding vulnerabilities. Improving workforce mental health and resilience is central to these transformative efforts. Objective: This study presents a content analysis of staff recommendations for pandemic preparedness and employee mental health in LTRC. Methods: Qualitative data were gathered through semi-structured interviews conducted with 50 LTRC staff members from 12 organizations. The interviews aimed to gain insights into supporting worker mental health in the first wave of the Covid-19 pandemic. Participant responses to a question seeking recommendations for future pandemic preparedness were extracted and analyzed using qualitative content analysis. Findings: Our findings encompass staff recommendations organized into seven categories: 1) Risk reduction and compensation, 2) Staffing reappraisal, 3) Opportunities for relief, 4) Spaces to be heard, 5) Improved communication, 6) Cultivating responsive leadership, and 7) Redefining public accountability. Limitations: The data primarily relied on interviews with LTRC workers from western Canada. Implications: Recommendations are situated within existing policy and research for worker mental health and staffing. We discuss how supporting and listening to LTRC workers can strengthen pandemic preparedness, workforce mental health, and delivery of quality person-centered care. We position the increased presence of worker voices in knowledge generation and policymaking as vital for realizing the sectoral transformations needed in LTRC.

Although emerging research links family experiences with long-term residential care (LTRC) transitions to structural features of health care systems, existing scholarship inadvertently tends to represent the transition as an individual problem to which families need to adjust. This secondary qualitative analysis of 55 interviews with 22 family members caring for an older adult engages a critical gerontological lens. A concept of cumulative, structural empowerment informs this analysis of families' experiences across a broad continuum of older adults' moves into LTRC. Leading up to transitions, families have little power over home care services, and family members have little control over their involvement in care provision. Some families respond by making choices to refuse publicly provided service options, therein both resisting and reinforcing broader relations of power. Expectations for family involvement in LTRC placement decisions were incongruent with some families' experiences, reinforcing a sense of powerlessness compounded by the speed with which these decisions needed to be made. A broad temporal analysis of transitions highlights LTRC transitions as a process of cumulative family disempowerment connected to broader formal care structures alongside emphases on aging in place and familialism that characterize LTRC as the option of last resort. [ABSTRACT FROM AUTHOR]

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.

Context: The impacts of Covid-19 pandemic conditions in Canada's long-term residential care (LTRC) sector have demonstrated that future pandemic preparedness necessitates not only recovery but deeper sectoral transformation of longstanding vulnerabilities. Improving workforce mental health and resilience is central to these transformative efforts. Objective: This study presents a content analysis of staff recommendations for pandemic preparedness and employee mental health in LTRC. Methods: Qualitative data were gathered through semi-structured interviews conducted with 50 LTRC staff members from 12 organizations. The interviews aimed to gain insights into supporting worker mental health in the first wave of the Covid-19 pandemic. Participant responses to a question seeking recommendations for future pandemic preparedness were extracted and analyzed using qualitative content analysis. Findings: Our findings encompass staff recommendations organized into seven categories: 1) Risk reduction and compensation, 2) Staffing reappraisal, 3) Opportunities for relief, 4) Spaces to be heard, 5) Improved communication, 6) Cultivating responsive leadership, and 7) Redefining public accountability. Limitations: The data primarily relied on interviews with LTRC workers from western Canada. Implications: Recommendations are situated within existing policy and research for worker mental health and staffing. We discuss how supporting and listening to LTRC workers can strengthen pandemic preparedness, workforce mental health, and delivery of quality person-centered care. We position the increased presence of worker voices in knowledge generation and policymaking as vital for realizing the sectoral transformations needed in LTRC. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Context: To slow the spread of COVID-19 within the Canadian long-term residential care (LTRC) sector, a series of pandemic management strategies were introduced, including restricted visitation and single site employment. These strategies were enacted to prevent and control infection, resulting in unknown impact on direct care staff and staff capacity to deliver quality care or service. Objective: To explore staff reports of outcomes associated with LTRC pandemic management strategies, particularly their impact on LTRC staff mental health, work behaviours and quality of care or service provision. Method: This was a case study using mixed methods including a longitudinal survey and interviews with staff from one LTRC site in British Columbia. Survey data from 68 staff who participated in both survey times were analyzed using regressions with relative weight analysis. Semi-structured interviews were conducted with 26 LTRC staff and analyzed using content analysis. Findings: Survey data demonstrated that staff perceived the sick time policy and staffing levels as the most inadequate pandemic management strategies. Survey data also showed the visitation policy, the sick time policy and the single site employment policy were most significantly associated with negative outcomes to staff mental health, work behaviours and quality of care or service delivery. Qualitative data suggested connections between these policies and inadequate staffing levels and heavy workloads. Limitations: The study design along with the low response rate and the small sample size limits the generalizability of the findings to other settings. Implications: The development and implementation of pandemic management strategies must be informed by and give consideration to working conditions of LTRC staff including long standing systemic issues such as staffing shortages and heavy workloads.

Context: To slow the spread of COVID-19 within the Canadian long-term residential care (LTRC) sector, a series of pandemic management strategies were introduced, including restricted visitation and single site employment. These strategies were enacted to prevent and control infection, resulting in unknown impact on direct care staff and staff capacity to deliver quality care or service. Objective: To explore staff reports of outcomes associated with LTRC pandemic management strategies, particularly their impact on LTRC staff mental health, work behaviours and quality of care or service provision. Method: This was a case study using mixed methods including a longitudinal survey and interviews with staff from one LTRC site in British Columbia. Survey data from 68 staff who participated in both survey times were analyzed using regressions with relative weight analysis. Semi-structured interviews were conducted with 26 LTRC staff and analyzed using content analysis. Findings: Survey data demonstrated that staff perceived the sick time policy and staffing levels as the most inadequate pandemic management strategies. Survey data also showed the visitation policy, the sick time policy and the single site employment policy were most significantly associated with negative outcomes to staff mental health, work behaviours and quality of care or service delivery. Qualitative data suggested connections between these policies and inadequate staffing levels and heavy workloads. Limitations: The study design along with the low response rate and the small sample size limits the generalizability of the findings to other settings. Implications: The development and implementation of pandemic management strategies must be informed by and give consideration to working conditions of LTRC staff including long standing systemic issues such as staffing shortages and heavy workloads. [ABSTRACT FROM AUTHOR]

Aims: To provide insight into the everyday realities facing care aides working in long‐term residential care (LTRC), and how they perceive their role in society. Design: A qualitative ethnographic case study. Methods: Data were collected over. 10 months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi‐structured interviews (70 h) with 31 care aides; and naturalistic observation (170 h). Data were analysed using reflexive thematic analysis. Results: The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections – which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC. Conclusion: Care aides remain an unsupported workforce that is essential to the provision of high‐quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role. Impact: What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings.What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care.Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings. [ABSTRACT FROM AUTHOR]

Ageism is arguably one of the least challenged forms of discrimination globally and manifests in many obvious and subtle ways. Situating our conversation within the context of COVID-19, we discuss peculiar and unchallenged forms of ageism in current times as well as the intersections with other forms of discrimination such as ableism, racism, sexism, and heterosexism. We highlight the limits of current understandings of ageism, specifically those that seek to identify positive aspects of ageism without appreciating how these forms of ageism reinforce inequalities among older adults. With regards to spatial manifestations of ageism, we explore the failure of critiques of institutionalization to include older people. Only in the context of "mass death" during COVID-19 has the public eye turned toward the problems of long-term residential care facilities as spaces of care, yet disabled, mad, and D/deaf people and allies have challenged the mass institutionalization of disabled people for decades, highlighting how physical and social segregation constitutes an obvious form of ableism. Institutions are notorious for their physical, spiritual, and emotional harms, but when it comes to residential long-term care for older people, especially older people living with dementia, responses to segregation and isolation have generally been ambivalent. Even aging studies scholars call for "transformation" but do not call for the elimination of large-scale institutions (e.g., Theurer et al.). We discuss this softer critique from aging studies, raising questions about whether institutionalized and segregated congregate living for older people is inherently discriminatory, and we consider the implications for families, health care administrators, researchers, and scholars working in the field of long-term residential care. [ABSTRACT FROM AUTHOR]

Immigrant older adults are increasingly moving into long term residential care (LTRC) homes; however, most were designed and continue to be run in accordance with Anglocentric norms and values. Participation and interest in Family Councils—through which they might collectively voice concerns—was low within our purposive sample of nine Chinese-origin residents living in LTRC homes and 11 family carers. Our study, conducted in two LTRC homes in British Columbia, Canada between January and March 2016, further explored participants’ perceptions of quality of care by staff and quality of life of residents. Our findings negate participants’ rationale that they do not attend because they have no issues to raise. Solutions must recognize that carers’ time is precious and care-work is gendered; language incongruity and failure to address it marginalizes residents and their family members. A culturally informed reticence to speak out is reinforced when attempts to do so are silenced. [ABSTRACT FROM AUTHOR]

This method study compares the results yielded by using three different methods of examining how communication strategies may facilitate person-centred care in longterm residential care. The analysis involved two quantitative coding systems, which rated language-based and person-centred communication strategies, and a qualitative analysis based on Conversation Analysis. The data consisted of a video-recorded conversation that took place between an enrolled nurse and a resident with dementia in a long-term residential care facility in western Sweden. The qualitative analysis sheds light on several shortcomings in the two quantitative coding systems. Although both coding systems revealed that the enrolled nurse used many facilitating strategies, only one of the systems captured problems in the interaction. The conclusion of this study is that context as well as paralinguistic aspects in communication should be considered in the development and use of quantitative coding systems. [ABSTRACT FROM AUTHOR]

This article explores the architecture of long-term residential care (LTRC) design in Canada. Because choosing residential care over aging in place is widely perceived as a personal, social, and familial failure, LTRC is fraught with ageist connotations. Relatedly, chronic underfunding and low prestige make many LTRC buildings nearly invisible. Like hotels, university residences, and even summer camps, LTRC buildings try to look residential, but their functional programs are wholly institutional. We examine how these contradictions are legible in Canadian LTRC architecture, drawing on a fictional example—Joan Barfoot’s Exit Lines—that demonstrates how the real LTRC buildings we discuss are popularly understood. We also draw on an extensive set of ethnographic notes from a team-based research project for which members visited sites across Canada, with a promise of anonymity. We argue here that LTRC buildings fade into our neighbourhoods and cities (and even budgets), because their gestures to institutional and to suburban architectural vernacular traditions are unremarkable, but that they require attention precisely because of this uneasy ambivalence. We highlight a handful of Canadian buildings whose architects have broken the mould of LTRC design and offered fresh alternatives to argue that home might not be the only or even the best model for designing LTRC. [ABSTRACT FROM AUTHOR]

In this article, we explore some notable differences between long-term residential care (LTRC) facilities in Canada and Norway. Through the analysis of mealtimes and activities, we show that the observed Norwegian facility follows more routinized, ritualized, and collectivistic organizational formats than the Canadian facility. As well, the medicalized nature of Norwegian LTRC contributes to a greater degree of conformity in ideas and ideals relative to Canadian facilities. We did not observe the same conformity to the patterns and demands of the nursing home organization in the Canadian facility; it appeared to be less driven by and dependent on ideas and procedures from the outside. Consequently, the Canadian facility seemed to be more apt at satisfying the varied social needs of residents. However, lower staffing levels in Canadian LTRC may limit opportunities for collective activities and communal life, while higher staffing levels and a higher level of formal competence in Norway may enhance personalized medical care. Based on observations and research experiences from other Norwegian and Canadian facilities, we think it is possible that greater differences might exist between Canadian facilities with regard to the quality and content of care. Equity for residents in general might be better maintained within and between Norwegian facilities, while services and quality of care may vary significantly in Canada. Facilities in Norway are, in short, more standardized and homogenous; the difference in content and quality tends to be relatively similar from facility to facility. [ABSTRACT FROM AUTHOR]

Compared to a decade ago, long-term care residents are likely to be older, frailer, more functionally impaired, more medically complex, and closer to the end of life. Because of this, residents are also less likely to benefit from and more likely to be harmed by the same drugs and routine medical interventions that may have worked well for them earlier in life. Family physicians are well positioned to play a key role in navigating the tensions between life extension, rehabilitation, symptom management, and palliation. Unfortunately, in many jurisdictions, despite more than a decade of primary care reform, family physicians are not attracted to working in long-term residential care (LTRC). The proportion of those working in LTRC has been declining over time, and there is no mandatory training of family physicians in LTRC work. This article reviews the influence of Canadian primary care policy related to the physician role in LTRC facilities and describes a number of promising practices across Canadian provinces to engage them in LTRC teamwork. [ABSTRACT FROM AUTHOR]

The article discusses the study conducted on the quality of long-term residential care in six different countries including U.S., England and Canada. Reporting that the countries with highest rates of privatization were having complex, standardized and regulatory approach effects whereas, the lowest rates have for profit organizations with regulated approach in managing care. Thus, the report states that market forces, logic used and structural quality holds the implications in the sector.

The article discusses the risks of privatization by the old age peoples in Canada. Stating that privatization was mainly focused on the for-profits organizations and their kind of care delivery and security for residential care. The four aspects of security were examined on the point of view of their risks involved by privatization. These includes security of physical access, security of quality, security of financial access and security of employment by the care providers.

The article discusses the professional characteristics of assistive personnel or care givers in the long-term residential care (LTRC) sectors. A comparative study was done in the countries of U.S., Norway and Canada, to get the views of societies and workers responsibilities towards the older people care. Stating that reputed nursing homes were observed with quality, organizational records and questioned LTRC members, where literacy of care givers found most important to improve the situation.

Linguistic and ethnocultural diversity in long-term residential care is a growing trend in many urban settings. When long-term care staff and residents do not share the same language or ethnocultural background, the quality of their communication and care are jeopardized. There is very little research addressing how staff and residents communicate when they experience a mismatch in their language and ethnocultural backgrounds. Thus, the goals of the present study were to 1) document the verbal and nonverbal behaviours used by staff and residents in diverse interactions, and 2) identify and account for behaviours that either promoted or detracted from positive communication by drawing on principles from 'Communication Accommodation Theory'. Two long-term care facilities in British Columbia Canada were selected due to the diverse linguistic and ethnocultural backgrounds of their staff and residents. Twenty-seven staff and 27 residents consented to being video-recorded during routine activities (e.g., mealtimes, recreational activities). The recorded observations were transcribed, translated, and coded using qualitative descriptive and interpretive analyses. A number of verbal and nonverbal behaviours were identified and interpreted in relation to whether they promoted or detracted from positive communication. The findings point to considering a variety of proactive strategies that staff and administrators could employ to effectively accommodate to language and ethnocultural diversity in long-term care practice. [ABSTRACT FROM AUTHOR]

The paper compares two films, Children of Nature (Börn náttúrunnar, Iceland, Friðrik Þór Friðriksson, 1991) and Cloudburst (Canada, Thom Fitzgerald, 2010), which share remarkable similarities, despite their difference in historical and geographical origin. In focusing on these two examples, the paper shows the extent to which a widespread fear of long-term residential care evident in popular discourse motivates larger commentaries about growing old. Each narrative presents a romance catalyzed by the threat of long-term residential care. In both stories, the couples are depicted as fugitives from the law, escaping what is perceived as a fate worse than death in order to pursue death on their own terms. The paper explores the structure and significance of how they leave and what they accomplish while they are away. The films offer examples of a broader cultural discourse that is damaging, while they are also heartening in their satisfying representation of the possibility of escape. Through that, they indicate the importance of choice and desire to transforming residential care in a manner that could also transform popular understandings of the “nursing home.” [ABSTRACT FROM AUTHOR]

Background:People with Young Onset Dementia (YOD) have specific needs for care. These people eventually require institutional care, usually delivered by institutions designed for the elderly. The Dutch network of care organizations delivering specialized YOD care offers a unique opportunity to obtain more knowledge of this special population.Methods:Our cross-sectional study collected data from 230 people with YOD in eight care homes providing YOD specialized care. Data collected: demographic data, disease duration, dementia subtype, comorbidity, dementia severity (Global Deterioration Scale – GDS), neuropsychiatric symptoms (NPS; Neuropsychiatric Inventory – NPI, Cohen Mansfield Agitation Inventory – CMAI), disease awareness (Guidelines for the Rating of Awareness Deficits – GRAD), need for assistance (hierarchic Activities of Daily Living (ADL) scale – Resident Assessment Instrument – Minimum Data Set (RAI-MDS)).Results:The mean age of the residents with YOD in care homes was 60 years and 53% of them were men. There is a large variety of etiologic diagnoses underlying the dementia. Dementia severity was very mild to mild in 18%, moderate in 25%, and severe or very severe in 58% of the participants. The prevalence of NPS was high with 90% exhibiting one or more clinically relevant NPS. Comorbidity was present in more than three quarters of the participants, most frequently psychiatric disorders.Conclusions:The institutionalized YOD population is heterogeneous. NPS occur in almost all institutionalized people with YOD, and frequency and severity of NPS are higher than in late onset dementia (LOD) and community-dwelling YOD patients. Care should be delivered in settings accommodating a mixed male and female population, with appropriate, meaningful activities for all individuals. Further research is needed on NPS in YOD, to enhance quality of life and work in specialized YOD-care. [ABSTRACT FROM AUTHOR]

Care of the older person has become more specialised in Ireland particularly since the introduction of national and international healthcare standards. In this regard, older people are receiving more evidence-based quality care when living in long-term healthcare facilities in Ireland. Assessment and management of falls is currently high on the quality agenda in terms of measuring quality outcomes. Clinical practice is being standardised using evidence-based practice and research. Residential care nurses caring for older people in Ireland are required to demonstrate clinical competence when assessing and managing falls in the residential care setting. Healthcare legislation, policy and in-service education, occurring in both the public and private sector, require a multidisciplinary-team approach. This article addresses the nursing priorities regarding falls assessment and management strategies that residential nurses should consider when caring for the older person at risk of falling. [ABSTRACT FROM AUTHOR]

Aim. In this paper, I describe my experiences as a novice researcher doing a critical ethnography in long-term residential care. I reflect upon the challenges and lessons learned in navigating trust and power relations in this complex sociopolitical field. Background. Critical ethnography is an important method of inquiry that can lead to disruptions in the status quo and empowerment of disenfranchised groups. In nursing scholarship, there is a body of literature about this method of inquiry. This paper further contributes to this scholarship by describing my experiences in the field, with particular attention to the linkages between the study's theoretical perspective, method of inquiry, and criteria for trustworthiness, and how these elements guided my actions in the field. Data sources. The study that provides the context for this paper was a critical ethnography that examined the organization of long-term residential care in British Columbia, Canada. The method of inquiry was underpinned by a theoretical perspective that wove together a postcolonial feminist approach with Foucauldian epistemology. The study's criteria for trustworthiness were: credibility, reflexivity, reciprocity, voice and praxis. Discussion. Throughout the study, I found myself navigating issues related to building trust in the researcher/participant relationship and navigating power relations. Using examples, I describe how I approached these issues using the criteria for trustworthiness and theoretical perspective as guides. Conclusion. Critical ethnography is a method of inquiry that can enrich nursing research and educational scholarship by generating greater understanding about the complex fields in which nurses practise. [ABSTRACT FROM AUTHOR]

Public health responses to COVID-19 in long-term residential care facilities (LTRCFs) have restricted family engagement with residents. These restrictions impact on quality of care and the psychosocial and emotional well-being of family caregivers. Following a national cross-sectional web-based survey, respondents were invited to provide personal reflections on visitor restrictions. This study aims to describe the consequences of these restrictions for individuals living in LTRCF and their families during the first wave of the COVID-19 pandemic. Data from open-ended questions contained within the survey were analyzed using Braun and Clarke's (2006) method of thematic analysis. Four themes were identified: 1. Altered Communication and Connection; 2. Emotional and Psychological Impact; 3. Protecting and Caring Role of Staff; 4. Family Role. Throughout the narrative accounts, it is evident that the visitor restrictions impacted on the emotional and mental well-being of families. Some respondents expressed frustration that they could not assist staff in essential care provision, reducing meaning and purpose in their own lives. COVID-19 LTRCF visitor restrictions made little distinction between those providing essential personal care and those who visit for social reasons. A partnership approach to care provision is important and should encompass strategies to maintain the psychosocial and emotional well-being of families and their relatives during times of self-isolating or restrictive measures.

Public representations of long-term residential care (LTRC) facilities have received limited focus in Canada, although literature from other countries indicates that public perceptions of LTRC tend to be negative, particularly in contexts that prioritize aging and dying in place. Using Manitoba as the study context, we investigate a question of broad relevance to the Canadian perspective; specifically, what are current public perceptions of the role and function of long-term care in the context of a changing health care system? Through critical discourse analysis, we identify four overarching discourses dominating public perceptions of LTRC: the problem of public aging, LTRC as an imperfect solution to the problem, LTRC as ambiguous social spaces, and LTRC as a last resort option. Building on prior theoretical work, we suggest that public perceptions of LTRC are informed by neoliberal discourses that privilege individual responsibility and problematize public care.

Care workers have valuable knowledge to contribute to the improvement of their work environments. Yet incorporating their perspectives into organizational decision-making within long-term care facilities (LTCFs) has been an ongoing challenge. In this article we investigate a promising practice that brought workers and management together in weekly and bimonthly facilitated reflection meetings to identify and resolve problems. Drawing on observations as well as individual and group interviews, we sought to understand whether and how this intervention worked from the perspective of participants. Our study found that one of the main achievements was creating a safe space for workers to speak honestly. They felt heard and treated with respect. In this context, they were willing to surface concerns, failures, and problems for collective deliberation and action. The inclusion of a range of occupational groups ensured that the solutions developed were sensitive to context, including organizational and occupational realities. While the outcomes of the process were impressive, this paper highlights the relational work that created trust, respect, and a spirit of collaboration. We suggest that such facilitated reflection processes may serve as an important strategy to improve the organization of work in LTCFs, one that is particularly well-suited to the dynamic and relational nature of care., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Systematic, in-depth exploration of news media coverage of aggression and older adults remains sparse, with little attention to how and why particular frames manifest in coverage across differing settings and relationships. Frame analysis was used to analyze 141 English-language Canadian news media articles published between 2008 and 2019. Existing coverage tended towards stigmatizing, fear-inducing, and biomedical framings of aggression, yet also reflected and reinforced ambiguity, most notably around key differences between settings and relations of care. Mainstream news coverage reflects tensions in public understandings of aggression and older adults (e.g., as a medical or criminal issue), reinforced in particular ways because of the nature of news reporting. More nuanced coverage would advance understanding of differences among settings, relationships, and types of actions, and of the need for multifaceted prevention and policy responses based on these differences.

Care work by family and friends is recognized as a cornerstone of community-based care for older adults; however, the role of families in institutional-based care work has been less well understood and researched. Drawing on findings from a critical ethnographic study, this article aims to examine the unique role of highly involved family members within long-term residential care. The study took place between October 2006 and April 2008 in two facilities in British Columbia, Canada. A purposive sample of 11 highly involved family members participated in in-depth interviews and participant observations. The main themes were "Hands-On," "Hands-Off," "Surveillance," and "Interlopers." These themes illuminate the ways in which highly involved family members engaged in care work, including how they positioned themselves and were positioned by staff and administrators. Implications of the study focus on the need to include families in philosophies of care and policies that shape care work in long-term residential care.