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Sample records for residential care establishments

  1. Residential Care

    Science.gov (United States)

    ... Kids For Teens For Parents & Teachers Resolving Family Conflicts The Holidays and Alzheimer's Glossary Virtual Library Online ... longer an option Costs Choosing a care setting Types of residential care A good long-term care ...

  2. Can a web-based community of practice be established and operated to lead falls prevention activity in residential care?

    Science.gov (United States)

    Francis-Coad, Jacqueline; Etherton-Beer, Christopher; Bulsara, Caroline; Nobre, Debbie; Hill, Anne-Marie

    The aims of this study were to evaluate establishing and operating a web-based community of practice (CoP) to lead falls prevention in a residential aged care (RAC) setting. A mixed methods evaluation was conducted in two phases using a survey and transcripts from interactive electronic sources. Nurses and allied health staff (n = 20) with an interest in falls prevention representing 13 sites of an RAC organization participated. In Phase 1, the CoP was developed, and the establishment of its structure and composition was evaluated using determinants of success reported in the literature. In Phase 2, all participants interacted using the web, but frequency of engagement by any participant was low. Participatory barriers, including competing demands from other tasks and low levels of knowledge about information communication technology (ICT) applications, were identified by CoP members. A web-based CoP can be established and operated across multiple RAC sites if RAC management support dedicated time for web-based participation and staff are given web-based training. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Energy, protein, calcium, vitamin D and fibre intakes from meals in residential care establishments in Australia.

    Science.gov (United States)

    Nowson, Caryl A; Sherwin, Alice J; McPhee, Joan G; Wark, John D; Flicker, Leon

    2003-01-01

    Residents from high level (nursing homes) and low-level care facilities (hostel) being served the three common diet texture modifications (full diet, soft-minced diet and pureed diet) were assessed. Individual plate waste was estimated at three meals on one day. Fifty-six males and 156 females, mean age 82.9+/-9.5 (SD) years, of which 139 lived in nursing homes (NH) and 76 in hostels (H) were included. Mean total energy served from meals was 5.3 MJ/day, 5.1 to 5.6 MJ/day, 95% confidence intervals (CI), in NH which was less than in H, 5.9 MJ/day (CI 5.6 to 6.2 MJ/day) (P=0.007). Protein and calcium intakes were lower in NH, 44.5g (CI 41.5 to 47.5g), 359.0mg (CI 333.2 to 384.8mg), versus 50.5g (CI 46.6 to 54.3g), 480.5mg (CI 444.3 to 516.7mg) in H (P=0.017, Phostels, except for protein. Strategies to effectively monitor nutrient intakes and to identify those with eating impairment are required in order to ensure adequate nutrition of residents in nursing homes and hostels.

  4. Residential care : Dutch and Italian residents of residential care facilities compared

    NARCIS (Netherlands)

    de Heer-Wunderink, Charlotte; Caro-Nienhuis, Annemarie D.; Sytema, Sjoerd; Wiersma, Durk

    2008-01-01

    Aims - Characteristics of patients living in residential care facilities and the availability of mental hospital- and residential beds in Italy and The Netherlands were compared to assess whether differences in the process of deinstitutionalisation have influenced the composition of their

  5. Therapeutic Residential Care for Children and Youth:

    DEFF Research Database (Denmark)

    Whittaker, James K.; Holmes, Lisa; del Valle, Jorge F.

    2016-01-01

    so in closer collaboration with their families and in closer proximity to their home communities; and, (3) with the hope of reducing the high costs often associated with group residential provision. In some jurisdictions, efforts to reduce residential care resources in the absence of sufficient...... alternatives to serve high-resource needing youth has had unintended and negative consequences. It is within this context that a working group international experts representing research, policy, service delivery and families (International Work Group for Therapeutic Residential Care) convened at the Centre...... for Child and Family Research, Loughborough University in the U.K. for a Summit meeting on therapeutic residential care for children and youth funded by the Sir Halley Stewart Trust (UK). The focus centered on what is known about therapeutic residential care and what key questions should inform a priority...

  6. Measuring Group Care Worker Interventions in Residential Youth Care

    NARCIS (Netherlands)

    Bastiaanssen, I.L.W.; Kroes, G.; Nijhof, K.S.; Delsing, M.J.M.H.; Engels, R.C.M.E.; Veerman, J.W.

    2012-01-01

    Background By interacting with children, group care workers shape daily living environments to influence treatment. Current literature provides little knowledge about the content of youth residential care. Objective In this study, a questionnaire called the Group care worker Intervention

  7. Expressions of Prayer in Residential Care Homes.

    Science.gov (United States)

    Reimer-Kirkham, Sheryl; Sharma, Sonya; Smith, Brenda; Schutt, Kelly; Janzen, Kyla

    2018-01-01

    Although the value of spiritual care in the care of older adults is supported by research, few studies have focused specifically on prayer in residential care settings. This ethnographic study with fifteen chaplains and administrators in eleven residential care homes involved analyses of walking interviews and research diaries. Findings revealed the spaces in which prayer happens and the forms it takes. The identities of chaplains-their own spiritual practices, religious beliefs, and positioning within the facility-shaped their dis/comfort with prayer and how they located prayer within public and private spaces. Where organizational leadership endorsed the legitimacy of chaplaincy services, prayer was more likely to be offered. Even in these circumstances, however, religious diversity and questions about secularism left chaplains ambivalent about the appropriateness of prayer. The results demonstrate the relevance of religion and spirituality to residential care, and illustrate how prayer functions as an opportunity for connection and understanding.

  8. Employee influenza vaccination in residential care facilities.

    Science.gov (United States)

    Apenteng, Bettye A; Opoku, Samuel T

    2014-03-01

    The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities. The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study's objectives. Facility size, director's educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates. Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  9. Adjustment problems and residential care environment

    OpenAIRE

    Jan Sebastian Novotný

    2015-01-01

    Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently g...

  10. Adjustment problems and residential care environment

    Directory of Open Access Journals (Sweden)

    Jan Sebastian Novotný

    2015-01-01

    Full Text Available Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently growing up in an residential care environment, aged 13 to 21 (M = 16.23, SD = 1.643. The second group consisted of 214 adolescents growing up in a family, aged 15 to 20 (M = 17.07, SD = 1.070. We used a questionnaire Youth Self Report. Data were analyzed using descriptive statistics and MANOVA. Results: Results showed that adolescents in residential care exhibit higher average values in all adjustment problems. Also, in the context of diagnostic categories are the residential care adolescents more frequently in non-normal range (borderline and clinical, primarily in the border range. The greatest differences were reflected in the Thought problems and Rule-breaking behavior. MANOVA showed a significant multivariate effect between groups of adolescents, Hotelling's T = .803, F(8, 490 = 49.202, p <.001, d = .445 (large effect. Univariate analysis further showed a significant effect for Withdrawn/depressed (p = .044, d = .089, small effect, Somatic complaints (p = .002, d = .139, medium effect, Social problems (p = 004, d = .127, a small effect, Thought problems (p <.001, d = .633, strong effect, Attention problems (p <.001, d = .320,strong effect, Rule-breaking behavior (p <.001 , d = .383, strong effect, and Aggressive behavior (p = 015, d = .110, small effect. Results for the dimension of Anxious/depressed were not significant (p = .159. Discussion: The results didn’t confirmed the assumption that more than 30% of residential care adolescents have adjustment

  11. Bullying in Adolescent Residential Care: The Influence of the Physical and Social Residential Care Environment

    Science.gov (United States)

    Sekol, Ivana

    2016-01-01

    Background: To date, no study examined possible contributions of environmental factors to bullying and victimization in adolescent residential care facilities. Objective: By testing one part of the Multifactor Model of Bullying in Secure Setting (MMBSS; Ireland in "Int J Adolesc Med Health" 24(1):63-68, 2012), this research examined the…

  12. Positive and Negative Peer Influence in Residential Care.

    Science.gov (United States)

    Huefner, Jonathan C; Smith, Gail L; Stevens, Amy L

    2017-10-13

    The potential for negative peer influence has been well established in research, and there is a growing interest in how positive peer influence also impacts youth. No research, however, has concurrently examined positive and negative peer influence in the context of residential care. Clinical records for 886 residential care youth were used in a Hierarchical Linear Model analysis to examine the impact of negative and positive peer influence on naturally occurring patterns of serious problem behavior over time. Negative peer influence, where the majority of youth in a home manifested above the average number of serious behavior problems, occurred 13.7% of the time. Positive peer influence, where the majority of youth manifested no serious problem behaviors for the month, occurred 47.7% of the time. Overall, youth problem behavior improved over time. There were significantly lower rates of serious problem behavior in target youth during positive peer influence months. Conversely, there were significantly higher rates of serious problem behaviors in target youth during negative peer influence months. Negative peer influence had a relatively greater impact on target peers' serious behavior problems than did positive peer influence. Caregiver experience significantly reduced the impact of negative peer influence, but did not significantly augment positive peer influence. Months where negative peer influence was combined with inexperienced caregivers produced the highest rates of serious problem behavior. Our results support the view that residential programs for troubled youth need to create circumstances that promote positive and control for negative peer influence.

  13. Examination of Negative Peer Contagion in a Residential Care Setting

    Science.gov (United States)

    Huefner, Jonathan C.; Ringle, Jay L.

    2012-01-01

    There has been ongoing concern about the negative impact of residential treatment on youth in care. Research examining the impact of negative peer influence in juvenile justice, education, and residential care settings is reviewed. A study was conducted to examine the impact of negative peer contagion on the level of problem behavior in a…

  14. Family-centred residential care : the new reality?

    NARCIS (Netherlands)

    Geurts, Esther M. W.; Boddy, Janet; Noom, Marc J.; Knorth, Erik J.

    This paper considers therapeutic approaches to residential care with specific attention to the question of family involvement. It builds on a body of literature indicating the potential of residential care as a positive intervention for young people, and examines the contention that even when family

  15. Demand of elderly people for residential care: an exploratory study

    NARCIS (Netherlands)

    van Bilsen, P.; Hamers, J.; Groot, W.; Spreeuwenberg, C.

    2006-01-01

    Background: Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources) that

  16. Older Men's Experiences of Moving Into Residential Care

    OpenAIRE

    Weighell, Simon

    2015-01-01

    Research examining the transition into residential aged care suggests that it can have a significant psychological and physiological impact upon older adults. There is a dearth of research examining the specific experiences of older men moving into and living in residential aged care. Older men may be at a significant disadvantage in managing the transition into care, particularly in context to; institutional living often characterised by increased dependency and a loss of control; physical d...

  17. Use of Electronic Health Records in Residential Care Communities

    Science.gov (United States)

    ... The 2010 NSRCF used a stratified two-stage probability sampling design. The first stage was the selection ... 3,605 residential care communities were sampled with probability proportional to size. Interviews were completed with 2, ...

  18. Residents Living in Residential Care Facilities: United States, 2010

    Science.gov (United States)

    ... analyses, the 12% of residents chair-ridden or bedridden were defined as receiving assistance in the transferring ... MD: National Center for Health Statistics. 2011. Mollica R, Sims-Kastelein K, O'Keeffe J. Residential care ...

  19. Social Inclusion and Residential Child Care

    DEFF Research Database (Denmark)

    Schwartz, Ida

    to an inclusion perspective, the focal point of this presentation will be on how professionals – with focus on relations and networks – work with the expansion of social opportunities of participation for children and young people in out-of-home care. This paper is based on a Danish practice-research project Børn...... in relation to social inclusion in out-of-home care. How can we conceptualise the cooperative development of professional practices in order to establish flexible alignments of actions relative to problems within complex issues?...

  20. Invisible Elderly in Danish and Swedish Residential Care Home Architecture

    DEFF Research Database (Denmark)

    E Andersson, Jonas; Grangaard, Sidse

    2015-01-01

    This study of two architectural competitions suggests that the fit between architectural design and older users, who depend on regular caregiving due to cognitive or functional disabilities, requires a particular consideration when designing new residential care homes.......This study of two architectural competitions suggests that the fit between architectural design and older users, who depend on regular caregiving due to cognitive or functional disabilities, requires a particular consideration when designing new residential care homes....

  1. Hospitals and health care establishments

    International Nuclear Information System (INIS)

    1999-01-01

    These guidelines have been drown up to assist all those involved in the management and maintenance of hospitals and health care establishments. Compliance with this guidance should minimise the risk of pollution occurring. The guidelines are jointly produced by the Environment Agency for England and Wales, the Scottish Environment Protection Agency and the Environment and Heritage Service for Northern Ireland, referred to as the Agency or Agencies. It includes guidelines on site drainage, sewage and waste water disposal, treatment of surface water drainage and waste management

  2. Resident Satisfaction and Its Components in Residential Aged Care

    Science.gov (United States)

    Chou, Shu-Chiung; Boldy, Duncan P.; Lee, Andy H.

    2002-01-01

    Purpose: The purpose of this study was to assess the direction and magnitude of the effects among the components of resident satisfaction in residential aged care and to examine if the relationships among satisfaction components vary according to facility type (i.e., nursing home and hostel). Briefly, a hostel is a low-care facility in which…

  3. End-of-life care for advanced dementia patients in residential care home-a Hong Kong perspective.

    Science.gov (United States)

    Luk, James K H; Chan, Felix H W

    2017-08-28

    Dementia will become more common as the population ages. Advanced dementia should be considered as a terminal illnesses and end-of-life (EOL) care is very much needed for this disease group. Currently, the EOL services provided to this vulnerable group in Hong Kong, especially those living in residential care homes, is limited. The usual practice of residential care homes is to send older residents with advanced dementia to acute hospitals when they are sick, irrespective of their wish, premorbid status, diagnoses and prognosis. This may not accord with what the patients perceive to be a "good death". There are many barriers for older people to die in place, both at home and at the residential care home. In the community, to enhance EOL care to residential care home for the elderly (RCHE) residents, pilot EOL program had been carried out by some Community Geriatric Assessment Teams. Since 2015, the Hospital Authority funded program "Enhance Community Geriatric Assessment Team Support to End-of-life Patients in Residential Care Homes for the Elderly" has been started. In the program, advance care planning (ACP), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) (non-hospitalized) order will be established and the program will be expected to cover all clusters in Hong Kong by 2018/2019. In hospital setting, EOL clinical plan and EOL ward in geriatric step-down hospitals may be able to improve the quality of death of older patients. In Sep 2015, the Hospital Authority Guidelines on Life-Sustaining Treatment in the Terminally Ill was updated. Amongst other key EOL issues, careful (comfort) hand feeding was mentioned in the guideline. Other new developments include the possible establishment of enduring power of attorney for health care decision and enhancement of careful hand feeding amongst advanced dementia patients in RCHEs.

  4. Therapeutic Residential Care for Children and Youth : A Consensus Statement of the International Work Group on Therapeutic Residential Care

    NARCIS (Netherlands)

    Whittaker, James K.; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James P.; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laura; Daly, Daniel L.; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek T.; Holden, Martha J.; James, Sigrid; Kendrick, Andrew; Knorth, Erik J.; Lausten, Mette; Lyons, John S.; Martin, Eduardo; McDermid, Samantha; McNamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari M.; Small, Richard W.; Thoburn, June; Thompson, Ronald; Zeira, Anat

    While the focus of this consensus statement and the review volume that preceded it (Whittaker, Del Valle, & Holmes, 2014) is on therapeutic residential care (TRC), a specialized form of group care, we view our work as supportive of a much wider effort internationally concerned with the quality of

  5. Communication Supports in Congregate Residential Care Settings in Ohio

    Science.gov (United States)

    Mitchell, Pamela R.

    2009-01-01

    Background: Communication skills are important to the pursuit of increased self-determination in individuals with disabilities. The aim of this investigation was to gather information about communication supports in state-run residential care facilities in Ohio, and to compare findings with a previous investigation on this topic examining such…

  6. Risk Profiles of Children Entering Residential Care: A Cluster Analysis

    Science.gov (United States)

    Hagaman, Jessica L.; Trout, Alexandra L.; Chmelka, M. Beth; Thompson, Ronald W.; Reid, Robert

    2010-01-01

    Children in residential care are a heterogeneous population, presenting various combinations of risks. Existing studies on these children suggest high variability across multiple domains (e.g., academics, behavior). Given this heterogeneity, it is important to begin to identify the combinations and patterns of multiple risks, or risk profiles,…

  7. Sexual abuse of children in residential care : an international review

    NARCIS (Netherlands)

    Timmerman, Margaretha; Schreuder, Pauline

    2014-01-01

    This paper reports the results of an international review of academic literature on sexual abuse in residential child and youth care, 1945-2011. The review focusses on questions related to the nature and scope of sexual abuse, on personal and institutional factors providing either protection or

  8. 38 CFR 17.65 - Approvals and provisional approvals of community residential care facilities.

    Science.gov (United States)

    2010-07-01

    ... approvals of community residential care facilities. 17.65 Section 17.65 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Community Residential Care § 17.65 Approvals and provisional approvals of community residential care facilities. (a) An approval of a facility meeting all of...

  9. Integrated working between residential care homes and primary care: a survey of care homes in England

    Directory of Open Access Journals (Sweden)

    Gage Heather

    2012-11-01

    Full Text Available Abstract Background Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. Methods A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621 in England in 2009. Responses were analysed using quantitative and qualitative methods. Results The survey achieved an overall response rate of 15.8%. Most care homes (78.7% worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs had visited the care homes in the last six months (SD 5.11, median 14; a mean of .39 (SD.163 professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60% managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low

  10. Staff satisfaction and its components in residential aged care.

    Science.gov (United States)

    Chou, Shu-Chiung; Boldy, Duncan P; Lee, Andy H

    2002-06-01

    The purpose of this study was to assess the direction and magnitude of the effects among the components of staff satisfaction in residential aged care and to examine whether the relationships among satisfaction components vary according to facility type (i.e. nursing homes and hostels). A hostel is a low care facility in which residents are more independent, have a lower level of care needs, and receive personal but not nursing care. A cross-sectional survey design was adopted to collect the required information, and a stratified random sampling approach was utilized to select facilities. Structural equation modeling was used to examine relationships among satisfaction components. Seventy residential aged care facilities in Western Australia. The sample includes 610 nursing home and 373 hostel care staff. The relationships among satisfaction components are different for nursing home and hostel staff. Professional support is found to have a strong and positive effect on all other aspects of staff satisfaction. The findings lead to an improved understanding of the interrelationship among staff satisfaction components, which has important implications through enhancing professional support. This needs to be recognized and emphasized by managers, care providers, and policy makers so as to maintain stable personnel and continuity of care.

  11. Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

    Science.gov (United States)

    Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

    2018-04-23

    This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  12. Is psychotropic medication use related to organisational and treatment culture in residential care.

    Science.gov (United States)

    Peri, Kathryn; Kerse, Ngaire; Moyes, Simon; Scahill, Shane; Chen, Charlotte; Hong, Jae Beom; Hughes, Carmel M

    2015-01-01

    The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care. Cross-sectional analyses of staff and resident's record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers). In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants' assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98). Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture

  13. A narrative exploration of older people's transitions into residential care.

    Science.gov (United States)

    Lee, Victoria S P; Simpson, Jane; Froggatt, Katherine

    2013-01-01

    Moving into residential care has been argued to be a significant life transition for older people, often resulting in stress and anxiety. This research aimed to explore qualitatively older people's experiences of this transition, including how relocation is reflected upon and incorporated into their personal narratives. Eight older adults (65-97 years) living in a residential facility for between three and 12 months participated in interviews focussed on their experiences of relocating to a residential care home. Narrative analysis revealed that rather than depicting time bound stages of transition, participants' experiences reflected key plots of 'control', 'power', 'identity' and 'uncertainty' interwoven throughout their narratives. Participants experienced some difficulties in incorporating this transition into their life stories. Furthermore, participants discussed not feeling confident in their decision to move, living in constant fear of losing their memory, and limited expectations for their future. Professionals should move away from considering transition as a stage-based process ending in acceptance, instead focussing on how residents perceive relocation in relation to previous life experiences, unspoken fears evoked by moving and how the environment and relationships with staff may be altered to assist residents in maintaining their identity and sense of control.

  14. [Regulation of sexual expression in residential aged care facilities: A professional point of view].

    Science.gov (United States)

    Villar, Feliciano; Fabà, Josep; Celdrán, Montserrat; Serrat, Rodrigo

    2014-01-01

    The purpose of this study is to determine the opinion of professionals working in residential aged care facilities on the regulation of sexuality in these settings. Fifty-three professionals from five residential aged care facilities located in the metropolitan area of Barcelona answered several questions regarding the advisability of establishing measures for the regulation of sexuality in RACFs, the elements that could contribute to this, and the aspects that such regulations should consider. Around 50% of the participants recognized the advisability of having some type of measures for sexuality regulation in residential aged care facilities. According to their responses this should be developed taking into account professional opinions, but also the points of view of the residents and their relatives. The most frequently mentioned regulations were those that ensured that any kind of sexually charged situation occurred in a private environment. The development of strategies are suggested to distinguish those people with dementia that are competent to consent to sexual acts from those who are not. The opinion of professionals working in RACFs regarding the advisability of establishing measures for sexuality regulation seems to be considerably divided. Thus, whilst around 50% of them recognize their potential usefulness, the other half consider them unnecessary or even counterproductive for the sexual freedom of residents. Associating regulation with prohibition and sexuality with sexual activity was not uncommon among the responses of the participants. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  15. Older adults’ home- and community-based care service use and residential transitions: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Chen Ya-Mei

    2012-08-01

    Full Text Available Abstract Background As Home-and Community-Based Services (HCBS, such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions. Methods The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1 Community-Community-Community (CCC: Resided in community during the entire study period; (2 Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3; (3 Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3; (4 Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.. Results Older adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other

  16. Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care.

    Science.gov (United States)

    Lindley, Lisa C

    2017-01-01

    Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.

  17. Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities

    OpenAIRE

    Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.

    2015-01-01

    Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with simila...

  18. A challenging job: Physical and sexual violence towards group workers in youth residential care.

    NARCIS (Netherlands)

    Alink, L.R.A.; Euser, S.; Bakermans-Kranenburg, M.J.; van IJzendoorn, M.H.

    2014-01-01

    Background: Residential or group care social workers appear to be at increased risk for experiencing physical violence at work. However, little is known about sexual harassment in addition to physical victimization of social workers in youth residential or group care. Objective: We investigated the

  19. A Challenging Job: Physical and Sexual Violence towards Group Workers in Youth Residential Care

    Science.gov (United States)

    Alink, Lenneke R. A.; Euser, Saskia; Bakermans-Kranenburg, Marian J.; van IJzendoorn, Marinus H.

    2014-01-01

    Background: Residential or group care social workers appear to be at increased risk for experiencing physical violence at work. However, little is known about "sexual harassment" in addition to physical victimization of social workers in "youth" residential or group care. Objective We investigated the prevalence of physical and…

  20. Homesick: residential and care patterns in patients with severe mental illness

    NARCIS (Netherlands)

    de Mooij, Liselotte D.; Kikkert, Martijn; Lommerse, Nick M.; Theunissen, Jan; de Koning, Mariken B.; de Haan, Lieuwe; Beekman, Aartjan T. F.; Duurkoop, Pim W. R. A.; Dekker, Jack J. M.

    2016-01-01

    Changes in the residential and care settings of patients with severe mental illness (SMI) are a concern because of the large variety of possible negative consequences. This study describes patterns of changes in the residential and care settings of SMI patients and explores associations between

  1. Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial.

    Science.gov (United States)

    Llewellyn-Jones, R H; Baikie, K A; Smithers, H; Cohen, J; Snowdon, J; Tennant, C C

    1999-09-11

    To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care. Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months. Population of residential facility in Sydney living in self care units and hostels. 220 depressed residents aged >/=65 without severe cognitive impairment. The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care. Geriatric depression scale. Intention to treat analysis was used. There was significantly more movement to "less depressed" levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011). The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.

  2. Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care.

    Science.gov (United States)

    Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

    2016-06-01

    Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities. © 2015 AJA Inc.

  3. Psychotropic medication in a randomly selected group of citizens receiving residential or home care

    DEFF Research Database (Denmark)

    Futtrup, Tina Bergmann; Schultz, Hanne; Jensen, Margit Bak

    2014-01-01

    INTRODUCTION: Treatment with one or more psychotropic medications (PMs), especially in the elderly, is associated with risk, and the effects of treatment are poorly validated. The aim of this article was to describe the use of PM in a population of citizens receiving either residential care or home...... care with focus on the prevalence of drug use, the combination of different PMs and doses in relation to current recommendations. METHODS: The medication lists of 214 citizens receiving residential care (122) and home care (92) were collected together with information on age, gender and residential...

  4. Exploring Environmental Variation in Residential Care Facilities for Older People.

    Science.gov (United States)

    Nordin, Susanna; McKee, Kevin; Wijk, Helle; Elf, Marie

    2017-01-01

    The aim of this study was to explore variation in environmental quality in Swedish residential care facilities (RCFs) using the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). Well-designed physical environments can positively impact on health and well-being among older persons with frail health living in RCFs and are essential for supporting person-centered care. However, the evidence base for informing the design of RCFs is weak, partly due to a lack of valid and reliable instruments that could provide important information on the environmental quality. Twenty RCFs were purposively sampled from several regions, varying in their building design, year of construction, size, and geographic location. The RCFs were assessed using S-SCEAM and the data were analyzed to examine variation in environmental quality between and within facilities. There was substantial variation in the quality of the physical environment between and within RCFs, reflected in S-SCEAM scores related to specific facility locations and with regard to domains reflecting residents' needs. In general, private apartments and dining areas had high S-SCEAM scores, while gardens had lower scores. Scores on the safety domain were high in the majority of RCFs, whereas scores for cognitive support and privacy were relatively low. Despite high building standard requirements, the substantial variations regarding environmental quality between and within RCFs indicate the potential for improvements to support the needs of older persons. We conclude that S-SCEAM is a sensitive and unique instrument representing a valuable contribution to evidence-based design that can support person-centered care.

  5. Needs and preferences of parents of adolescents with multiple and complex needs in residential care

    OpenAIRE

    Steene, Van den, Helena; West, Van, Dirk; Glazemakers, Inge

    2018-01-01

    Abstract: The perspective of parents whose children are in residential care, has received only minor attention in the literature, despite evidence pointing out the value of parental involvement in care delivery for their child. Drawing upon in‐depth interviews with 12 parents of adolescent girls with multiple and complex needs in residential child welfare, this exploratory study describes parents' own needs and preferences with regard to care delivery. Parents wish: (a) to have a true partner...

  6. What Do They Do at Home? The Literacies of Children Living in Residential Care in Malaysia

    Science.gov (United States)

    Tan, Jennifer

    2015-01-01

    This paper presents an ethnographic study of the out of school literacy practices of children living in residential care in Malaysia. Although residential homes generate much publicity, especially during the festive seasons, not much is known about the children living within the confines of these homes. Even more lacking is research on their…

  7. Refining the COPES to Measure Social Climate in Therapeutic Residential Youth Care

    Science.gov (United States)

    Leipoldt, Jonathan D.; Kayed, Nanna S.; Harder, Annemiek T.; Grietens, Hans; Rimehaug, Tormod

    2018-01-01

    Background: Previous studies have shown that social climate in therapeutic residential youth care (TRC) is important to the welfare of residents, staff, and assessing treatment outcomes. The most influential theory on social climate in residential settings is the theory of Moos. The measurement of the concepts and aspects of this theory using the…

  8. Association between Residential Proximity to PERC Dry Cleaning Establishments and Kidney Cancer in New York City

    Directory of Open Access Journals (Sweden)

    Jing Ma

    2009-01-01

    Full Text Available Perchloroethylene (PERC is commonly used as a dry cleaning solvent and is believed to be a human carcinogen, with occupational exposure resulting in elevated rates of kidney cancer. Living near a dry cleaning facility using PERC has been demonstrated to increase the risk of PERC exposure throughout the building where the dry cleaning is conducted, and in nearby buildings. We designed this study to test the hypothesis that living in an area where there are many PERC dry cleaners increases PERC exposure and the risk of kidney cancer. We matched the diagnosis of kidney cancer from hospitalization discharge data in New York City for the years 1994–2004 by zip code of patient residence to the zip code density of dry cleaners using PERC, as a surrogate for residential exposure. We controlled for age, race, gender, and median household income. We found a significant association between the density of PERC dry cleaning establishments and the rate of hospital discharges that include a diagnosis of kidney cancer among persons 45 years of age and older living in New York City. The rate ratio increased by 10 to 27% for the populations in zip codes with higher density of PERC dry cleaners. Because our exposure assessment is inexact, we are likely underestimating the real association between exposure to PERC and rates of kidney cancer. Our results support the hypothesis that living near a dry cleaning facility using PERC increases the risk of PERC exposure and of developing kidney cancer. To our knowledge, this study is the first to demonstrate an association between residential PERC exposure and cancer risk.

  9. Association between Residential Proximity to PERC Dry Cleaning Establishments and Kidney Cancer in New York City

    International Nuclear Information System (INIS)

    Ma, J.; Lessner, L.; Lessner, L.; Carpenter, D.O.; Schreiber, J.

    2010-01-01

    Perchloroethylene (PERC) is commonly used as a dry cleaning solvent and is believed to be a human carcinogen, with occupational exposure resulting in elevated rates of kidney cancer. Living near a dry cleaning facility using PERC has been demonstrated to increase the risk of PERC exposure throughout the building where the dry cleaning is conducted, and in nearby buildings. We designed this study to test the hypothesis that living in an area where there are many PERC dry cleaners increases PERC exposure and the risk of kidney cancer. We matched the diagnosis of kidney cancer from hospitalization discharge data in New York City for the years 1994-2004 by zip code of patient residence to the zip code density of dry cleaners using PERC, as a surrogate for residential exposure. We controlled for age, race, gender, and median household income. We found a significant association between the density of PERC dry cleaning establishments and the rate of hospital discharges that include a diagnosis of kidney cancer among persons 45 years of age and older living in New York City. The rate ratio increased by 10 to 27% for the populations in zip codes with higher density of PERC dry cleaners. Because our exposure assessment is inexact, we are likely underestimating the real association between exposure to PERC and rates of kidney cancer. Our results support the hypothesis that living near a dry cleaning facility using PERC increases the risk of PERC exposure and of developing kidney cancer. To our knowledge, this study is the first to demonstrate an association between residential PERC exposure and cancer risk.

  10. Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

    NARCIS (Netherlands)

    Bastiaanssen, I.L.W.; Delsing, M.J.M.H.; Geijsen, L.; Kroes, G.; Veerman, J.W.; Engels, R.C.M.E.

    2014-01-01

    The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. The aim of the current study was to observe the pedagogical interventions of group care

  11. Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

    Science.gov (United States)

    Bastiaanssen, Inge L. W.; Delsing, Marc J. M. H.; Geijsen, Luuk; Kroes, Gert; Veerman, Jan W.; Engels, Rutger C. M. E.

    2014-01-01

    Background: The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. Objective: The aim of the current study was to observe the pedagogical interventions of group care workers within residential…

  12. Love, intimacy and sexuality in residential dementia care: A spousal perspective.

    Science.gov (United States)

    Roelofs, Tineke Sm; Luijkx, Katrien G; Embregts, Petri Jcm

    2017-01-01

    The experiences and needs of spouses of residential care facility residents with dementia, regarding friendship, love, intimacy, and sexuality were explored. Understanding of how spouses make sense of their experiences was pursued. Semi-structured interviews were held with nine spouses of people with dementia, living in high intensive 24-hour care units within residential care facilities. The results show that friendship, love, intimacy, and sexuality were still embedded in the couples' marital lives, but all in their own way. Changing roles and a shift in purpose of the relationship recurred. Although intimacy was found to be still important in the lives of spouses, emotional, and practical residential care facility barriers were experienced by the spouses, of which the absence of communication were most important. Our findings on the experiences of spouses with regard to intimacy and sexuality can help residential care facility staff and policymakers to recognize the needs of couples and take these into account.

  13. A culture of education: Enhancing school performance of youth living in residential group care in Ontario.

    Science.gov (United States)

    Gharabaghi, Kiaras

    2011-01-01

    This article presents a synthesis of what is known about the educational experiences of youth living in residential group care based on a literature review that highlights both the experiences of the youth themselves and the operational context of residential group care in Ontario as it pertains to educational performance. The author argues that there is little emphasis on education within the residential group care sector in Ontario that could translate into more productive educational experiences for youth. The article then provides a framework for developing a culture of education for residential group care that can be acted upon expeditiously. Enhancing the educational performance of young people living in group care will require a cultural approach that provides for daily and pervasive education supports and encouragement, and aims to enhance the lived experience of young people pursuant to their education.

  14. Daily activities and living at a Therapeutic Residential Care Center

    Directory of Open Access Journals (Sweden)

    Luciane Prado Kantorki

    2014-12-01

    Full Text Available This study describes and analyzes day-to-day issues in a Therapeutic Residential Care Center and the daily life characteristics of its residents. This case study was conducted in Caxias do Sul, based on an evaluation of the fourth generation together with a Methodology for Analyzing Everyday Life Networks. The following categories emerged: possibilities in the territory, participation and flexibility in household tasks, situations that mark living, employees who are mediators in conflict resolution, staff committed to the resident, freedom as a therapeutic tool, difficulties in daily life, and building of alliances. This study helped to get to know the structure of everyday life experienced by the residents, identifying some difficulties they face and the mechanisms used to overcome them, in addition to noticing that the professionals can be instrumental in strengthening a daily living that can be pluralized, busy, and enriched, while still respecting the uniqueness of each resident. doi: 10.5216/ree.v16i4.22923.

  15. Job satisfaction and intention to stay within community and residential aged care employees.

    Science.gov (United States)

    Radford, Katrina; Meissner, Ellen

    2017-09-01

    This study investigated the different facets of job satisfaction that influence community care and residential care employees' intention to stay in the aged care workforce. A survey of four organisations in Australia was undertaken. t-Tests were conducted to analyse differences between groups. Regression analyses were performed to examine the factors influencing intentions to stay in the workforce. Community care workers were more satisfied with various facets of job satisfaction including work on their present job, supervision, people in their present job and the job in general. There was a difference between how the various facets of job satisfaction influenced intentions to stay for residential care compared to community care workers. Both workers were satisfied with their work conditions and work to different extents. There is an opportunity for residential care to look to the practices within the community care sector to improve employees' intentions to stay. © 2017 AJA Inc.

  16. Substance use among adolescents in special education and residential youth care : Prevalence, onset and risk factors

    NARCIS (Netherlands)

    Kepper, A.S.

    2013-01-01

    Adolescents attending special education for learning disabilities (SEL), special education for behavioural problems (SEB) and adolescents living in a residential youth care (RYC) institution present a complex risk profile including severe behavioural and emotional problems, deviant peer networks,

  17. Well-being, the Decision making process in residential care facilities and accommodation in Denmark

    DEFF Research Database (Denmark)

    Knudstrup, Mary-Ann; Harder, Henrik

    process. 3. Alternatives to "the living environments”. In general a discussion about “the living environments” as the only and right solution for organising the residential care facilities and accommodation in Denmark is recommended. Maybe there should be a possibility given to create more private...... for assisted living residential care facilities and accommodation for senior citizens selected from different parts of Denmark. The case study will provide important knowledge on municipal activities in the area of residential care facilities, as well as discuss the different actors’ roles in the decision......-based knowledge is needed: There is a need for research-based knowledge manuals among the actors involved in the planning and project design process which describe systematically the importance of working with the different aspects on well-being in residential care facilities and accommodation in Denmark. 2. More...

  18. Medication management policy, practice and research in Australian residential aged care: Current and future directions.

    Science.gov (United States)

    Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

    2017-02-01

    Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. WHERE HAS THE COMPASSION GONE FROM THE RESIDENTIAL AGED CARE ENVIRONMENT?

    Science.gov (United States)

    Oliver, Kim

    2017-02-01

    Would working in residential aged care be your dream job as a newly qualified nurse, probably not, but why not? Montayre (2015) suggests that although nurses don't like to talk about it, or even less, what the real problem is perceived to be with this practice area, residential aged care nursing is thought to be less exciting, monotonous, and requiring less skill than other areas such as emergency nursing, or medical nursing.

  20. Small children´s movements across residential care and day-care

    DEFF Research Database (Denmark)

    Schwartz, Ida

    2018-01-01

    is then seen as closely connected with the ways in which their caregivers coordinate and involve one another across different locations. Viewed from the children's perspectives, their parental support also plays a major role, but due to the conflicts in inter-professional cooperation, parents may find...... in very different ways. Parents, child-welfare workers in residential care and day-care teachers in kindergartens may assess problems in children's everyday lives differently. These different perspectives on the common work of childcare are analysed and the challenges and conflicts inherently hidden...

  1. Homesick: residential and care patterns in patients with severe mental illness.

    Science.gov (United States)

    de Mooij, Liselotte D; Kikkert, Martijn; Lommerse, Nick M; Theunissen, Jan; de Koning, Mariken B; de Haan, Lieuwe; Beekman, Aartjan T F; Duurkoop, Pim W R A; Dekker, Jack J M

    2016-12-03

    Changes in the residential and care settings of patients with severe mental illness (SMI) are a concern because of the large variety of possible negative consequences. This study describes patterns of changes in the residential and care settings of SMI patients and explores associations between these changes, sociodemographics, and clinical characteristics. From January 2006 to January 2012, all data relating to changes in residential and/or care setting by SMI patients (N = 262) were collected from electronic case files. Data covering psychopathology, substance use, and medication adherence were assessed in 2006. There were more changes in the residential than in the care setting. In 6 years, only 22% of our sample did not move, 23% changed residence once, 19% twice, 10% three times, and 26% four or more times. Substance use predicted changes of care and/or residential setting and rehospitalisation. The severity of negative symptoms predicted rehospitalisation and duration of hospitalisation. Disorganisation symptoms predicted the duration of hospitalisation. A majority of patients with SMI changed residential and/or care settings several times in 6 years. Patients with substance use or severe negative and disorganisation symptoms may need more intensive and customised treatment. Further research is needed to investigate prevention programmes for highly-frequent movers.

  2. New faces in new spaces in new places: Residential attainment among newly legalized immigrants in established, new, and minor destinations.

    Science.gov (United States)

    Frank, Reanne; Akresh, Ilana Redstone

    2016-05-01

    Immigrants at the beginning of the twenty-first century are located in a more diverse set of metropolitan areas than at any point in U.S. Whether immigrants' residential prospects are helped or hindered in new versus established immigrant-receiving areas has been the subject of debate. Using multilevel models and data from the New Immigrant Survey (NIS), a nationally representative sample of newly legalized immigrants to the U.S., we move beyond aggregate-level analyses of residential segregation to specify the influence of destination type on individual-level immigrant residential outcomes. The findings indicate that immigrants in new and minor destinations are significantly more likely to live in tracts with relatively more non-Hispanic whites and relatively fewer immigrants and poor residents. These residential advantages persist net of individual-level controls but are largely accounted for by place-to-place differences in metropolitan composition and structure. Our exclusive focus on newly legalized immigrants means that our findings do not necessarily contradict the possibility of worse residential prospects in new areas of settlement, but rather qualifies it as not extending to the newly authorized population. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Cost-analysis of teledentistry in residential aged care facilities.

    Science.gov (United States)

    Mariño, Rodrigo; Tonmukayakul, Utsana; Manton, David; Stranieri, Andrew; Clarke, Ken

    2016-09-01

    The purpose of this research was to conduct a cost-analysis, from a public healthcare perspective, comparing the cost and benefits of face-to-face patient examination assessments conducted by a dentist at a residential aged care facility (RACF) situated in rural areas of the Australian state of Victoria, with two teledentistry approaches utilizing virtual oral examination. The costs associated with implementing and operating the teledentistry approach were identified and measured using 2014 prices in Australian dollars. Costs were measured as direct intervention costs and programme costs. A population of 100 RACF residents was used as a basis to estimate the cost of oral examination and treatment plan development for the traditional face-to-face model vs. two teledentistry models: an asynchronous review and treatment plan preparation; and real-time communication with a remotely located oral health professional. It was estimated that if 100 residents received an asynchronous oral health assessment and treatment plan, the net cost from a healthcare perspective would be AU$32.35 (AU$27.19-AU$38.49) per resident. The total cost of the conventional face-to-face examinations by a dentist would be AU$36.59 ($30.67-AU$42.98) per resident using realistic assumptions. Meanwhile, the total cost of real-time remote oral examination would be AU$41.28 (AU$34.30-AU$48.87) per resident. Teledental asynchronous patient assessments were the lowest cost service model. Access to oral health professionals is generally low in RACFs; however, the real-time consultation could potentially achieve better outcomes due to two-way communication between the nurse and a remote oral health professional via health promotion/disease prevention delivered in conjunction with the oral examination. © The Author(s) 2015.

  4. Emergency residential care settings: A model for service assessment and design.

    Science.gov (United States)

    Graça, João; Calheiros, Maria Manuela; Patrício, Joana Nunes; Magalhães, Eunice Vieira

    2018-02-01

    There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study.

    Science.gov (United States)

    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

    2017-01-01

    Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents ( n  = 1460) and staff ( n  = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents . Descriptive and comparative statistics, independent samples t-test, Chi 2 test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  6. 25 CFR 20.508 - What must the social services agency do when a child is placed in foster care, residential care...

    Science.gov (United States)

    2010-04-01

    ... PROGRAMS Child Assistance Foster Care § 20.508 What must the social services agency do when a child is placed in foster care, residential care or guardianship home? The social services agency must make... placed in foster care, residential care or guardianship home? 20.508 Section 20.508 Indians BUREAU OF...

  7. Integrated Payment And Delivery Models Offer Opportunities And Challenges For Residential Care Facilities.

    Science.gov (United States)

    Grabowski, David C; Caudry, Daryl J; Dean, Katie M; Stevenson, David G

    2015-10-01

    Under health care reform, new financing and delivery models are being piloted to integrate health and long-term care services for older adults. Programs using these models generally have not included residential care facilities. Instead, most of them have focused on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with matched individuals in the community and nursing home, and rates of functional dependency that fall between those of their counterparts in the other two settings. These results suggest that the residential care facility population could benefit greatly from models that coordinated health and long-term care services. However, few providers have invested in the infrastructure needed to support integrated delivery models. Challenges to greater care integration include the private-pay basis for residential care facility services, which precludes shared savings from reduced Medicare costs, and residents' preference for living in a home-like, noninstitutional environment. Project HOPE—The People-to-People Health Foundation, Inc.

  8. The Transition Status of Youth Departing Residential Care

    Science.gov (United States)

    Casey, Kathryn J.; Reid, Robert; Trout, Alexandra L.; Hurley, Kristin Duppong; Chmelka, M. Beth; Thompson, Ronald

    2010-01-01

    This study evaluated the characteristics related to a successful reintegration among youth from a residential facility. Specifically, this study describes the transition skills of youth at departure in five areas: (a) education and employment goals, (b) self-determination skills, (c) social support, (d) life skills, and (e) hopefulness. Further,…

  9. The bottom line: an ethnography of for-profit elderly residential care

    OpenAIRE

    Greener, Joe

    2011-01-01

    In the last 20 years the UK’s elderly residential care system has become progressively more privatised with an increase in the number of for-profit organisations delivering these services. This study is a participant observation of care work in one privatised elderly residential care home (‘Meadowvale’), owned and operated by a large provider of such services (‘Moonlight Care’). It provides a rich ethnographic depiction of life at Meadowvale both from the point of view of the workers and the ...

  10. A qualitative study exploring issues related to medication management in residential aged care facilities

    Directory of Open Access Journals (Sweden)

    Ahmad Nizaruddin M

    2017-11-01

    Full Text Available Mariani Ahmad Nizaruddin, Marhanis-Salihah Omar, Adliah Mhd-Ali, Mohd Makmor-Bakry Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Background: Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs.Participants and methods: A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner.Results and discussion: Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents’ medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes.Conclusion: There are important issues

  11. A qualitative study exploring issues related to medication management in residential aged care facilities.

    Science.gov (United States)

    Ahmad Nizaruddin, Mariani; Omar, Marhanis-Salihah; Mhd-Ali, Adliah; Makmor-Bakry, Mohd

    2017-01-01

    Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs). A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner. Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents' medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes. There are important issues related to medication management in RACFs which require a need to establish policy and guidelines.

  12. Nitrogen input from residential lawn care practices in suburban watersheds in Baltimore county, MD

    Science.gov (United States)

    Neely L. Law; Lawrence E. Band; J. Morgan. Grove

    2004-01-01

    A residential lawn care survey was conducted as part of the Baltimore Ecosystem Study, a Long-term Ecological Research project funded by the National Science Foundation and collaborating agencies, to estimate the nitrogen input to urban watersheds from lawn care practices. The variability in the fertilizer N application rates and the factors affecting the application...

  13. Stress and Coping among Owners and Managers of Residential Care Facilities.

    Science.gov (United States)

    Walker, Hollie; And Others

    Stress and burnout are common in the caregiving professions. Stress negatively affects both the caregivers and patients. In order to help caregivers deal with stress effectively and to improve the care in residential care facilities, it is essential to learn more about the particular stressors that managers of such facilities experience. In this…

  14. Medical Service Utilization among Youth with School-Identified Disabilities in Residential Care

    Science.gov (United States)

    Lambert, Matthew C.; Trout, Alexandra L.; Nelson, Timothy D.; Epstein, Michael H.; W. Thompson, Ronald

    2016-01-01

    Background: Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with…

  15. Prevalence of Weight Problems among Youth with High-Incidence Disabilities in Residential Care

    Science.gov (United States)

    Trout, Alexandra L.; Lambert, Matthew C.; Nelson, Timothy D.; Thompson, Ronald W.

    2014-01-01

    The prevalence of weight problems among youth in general and youth in out-of-home care has been well documented; however, the prevalence of obesity/overweight among youth with high-incidence disabilities in more restrictive settings, such as residential care, has not been assessed. The purpose of the present study was to evaluate the prevalence of…

  16. Transition secured? A follow-up study of adolescents who have left secure residential care

    NARCIS (Netherlands)

    Harder, Annemiek; Knorth, Erik J.; Kalverboer, Margrite E.

    2011-01-01

    Many adolescents who make the transition to adulthood experience problems after their departure from secure residential care. Research suggests that these young people are often in need of support after they have left secure care. Little is known about the experiences and perceptions of adolescents

  17. Education secured? The school performance of adolescents in secure residential youth care

    NARCIS (Netherlands)

    Harder, Annemiek T.; Huyghen, Anne-Marie N.; Knot-Dickscheit, Jana; Kalverboer, Margrite E.; Köngeter, Stefan; Zeller, Maren; Knorth, Erik J.

    Despite poor school performance by adolescents in secure residential care and the potential importance of education during care, little is known about how to achieve academic success with these adolescents. Therefore, the aim of the present study is to assess adolescents' academic achievement during

  18. 25 CFR 20.509 - What must the social services worker do when a child is placed in foster care or residential care...

    Science.gov (United States)

    2010-04-01

    ... home or residential care facility to law enforcement and protective services in accordance with tribal... Assistance Foster Care § 20.509 What must the social services worker do when a child is placed in foster care... tribal or state licensed foster home or residential care facility evaluating how the home has fulfilled...

  19. Determinants of establishment survival for residential trees in Sacramento County, CA

    Science.gov (United States)

    Lara A. Roman; John J. Battles; Joe R. McBride

    2014-01-01

    Urban forests can provide ecosystem services that motivate tree planting campaigns, and tree survival is a key element of program success and projected benefits. We studied survival in a shade tree give-away program in Sacramento, CA, monitoring a cohort of young trees for five years on single-family residential properties. We used conditional inference trees to...

  20. Residential aged care residents and components of end of life care in an Australian hospital.

    Science.gov (United States)

    Leong, Laurence Jee Peng; Crawford, Gregory Brian

    2018-06-09

    With ageing of Australians, the numbers of residential aged care (RAC) residents is rising. This places a spotlight on decisions about appropriate care for this population, including hospitalisation and end-of-life (EOL) care. The aim was to study a sample of RAC residents who attended and died in hospital, to quantify measurable components of EOL care so as to describe the extent of palliative care required. A retrospective case-note review of hospital records was conducted in Adelaide, Australia. Participants were 109 RAC residents who attended from July 2013 to June 2014 and died in hospital. Measurements were advance care planning, health care input from the RAC facilities to hospital and components of EOL care. Residents with and without advanced dementia were compared. Advance care directives (ACDs) were present from 11 to 50%, and advance care plans (ACPs) at 60%. There were more ACPs, resuscitation orders (for/against) and do-not-hospitalise orders in residents with advanced dementia than those without. General practitioner (GP) and extended care paramedic (ECP) input on decisions for hospital transfer were 30% and 1 %. Mean hospital stay to death was 5.2 days. For residents admitted under non-palliative care teams, specialist palliative care (SPC) was needed for phone advice in 5%, consultation in 45%, transfer to palliative care unit in 37%, and takeover by SPC team in 19%. Mean number of documented goals-of-care discussions with family/caregiver was 1.7. In the last 3 days of life, the mean daily number of doses of EOL medications was 4.2. Continuous subcutaneous infusion was commenced in 35%. Staff in RAC need to be adequately resourced to make complex decisions about whether to transfer to hospital. RAC nurses are mainly making these decisions as GP and ECP input were suboptimal. Ways to support nurses and optimise decision-making are needed. Advance care planning can be improved, especially documentation of EOL wishes and hospitalisation orders. By

  1. Valuing narrative in the care of older people: a framework of narrative practice for older adult residential care settings.

    Science.gov (United States)

    Buckley, Catherine; McCormack, Brendan; Ryan, Assumpta

    2014-09-01

    To report on the development of a framework of narrative practice, in residential care settings for older people. Residential care settings for older people provide care for people who are no longer able to live in their own home. To date, the impact and structure of nursing practice on care provision in these settings has proved difficult to conceptualise within a specific nursing theory framework. A hermeneutic approach incorporating narrative methods was used. Forty-six narrative interviews with older people in residential care were secondary-analysed for key themes through a three-stage process: by the first author, four focus groups of 12 clinical nurse managers and two independent experts. Themes were also derived from a focus group of eight residents who explored person-centredness and narrative. Finally, the combined findings were used to derive a single set of themes. The secondary data analysis process led to the development of a framework of narrative practice for the care of older people in residential settings. The framework is influenced by narrative enquiry, person-centred practice and practice development. It has four pillars, prerequisites, care processes, care environment and narrative aspects of care. To operationalise the framework of narrative practice, three narrative elements, narrative knowing, narrative being and narrative doing, need to be considered. Working with the foundational pillars and the narrative elements would enable staff to 'work in a storied way' and provide person-centred outcomes and a narrative informed philosophy of care for older adults in residential care. This framework provides nurses with a template that confirms the identity of the older person taking account of their biography. The framework outlines an approach that provides staff with a template on how to provide person-centred care in a narrative way. © 2013 John Wiley & Sons Ltd.

  2. Methodological advances in unit cost calculation of psychiatric residential care in Spain.

    Science.gov (United States)

    Moreno, Karen; Sanchez, Eduardo; Salvador-Carulla, Luis

    2008-06-01

    The care of the severe mentally ill who need intensive support for their daily living (dependent persons), accounts for an increasingly large proportion of public expenditure in many European countries. The main aim of this study was the design and implementation of solid methodology to calculate unit costs of different types of care. To date, methodologies used in Spain have produced inaccurate figures, suggesting few variations in patient consumption of the same service. An adaptation of the Activity-Based-Costing methodology was applied in Navarre, a region in the North of Spain, as a pilot project for the public mental health services. A unit cost per care process was obtained for all levels of care considered in each service during 2005. The European Service Mapping Schedule (ESMS) codes were used to classify the services for later comparisons. Finally, in order to avoid problems of asymmetric cost distribution, a simple Bayesian model was used. As an illustration, we report the results obtained for long-term residential care and note that there are important variations between unit costs when considering different levels of care. Considering three levels of care (Level 1-low, Level 2-medium and Level 3-intensive), the cost per bed in Level 3 was 10% higher than that of Level 2. The results obtained using the cost methodology described provide more useful information than those using conventional methods, although its implementation requires much time to compile the necessary information during the initial stages and the collaboration of staff and managers working in the services. However, in some services, if no important variations exist in patient care, another method would be advisable, although our system provides very useful information about patterns of care from a clinical point of view. Detailed work is required at the beginning of the implementation in order to avoid the calculation of distorted figures and to improve the levels of decision making

  3. Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens' jury.

    Science.gov (United States)

    Laver, Kate; Gnanamanickam, Emmanuel; Whitehead, Craig; Kurrle, Susan; Corlis, Megan; Ratcliffe, Julie; Shulver, Wendy; Crotty, Maria

    2018-01-01

    Objectives Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens' jury to elicit views of members of the public regarding consumer directed care in residential care. Methods A citizens' jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person's funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable

  4. Needs of Aboriginal and Torres Strait Islander clients residing in Australian residential aged-care facilities.

    Science.gov (United States)

    Brooke, Nicole J

    2011-08-01

    This review was undertaken to identify evidence-based practice guidelines to support the care needs of Aboriginal and Torres Strait Islander clients residing in residential aged-care facilities. A systematic literature review was undertaken. An electronic search of online databases and subsequent manual retrieval process was undertaken to identify relevant reports and studies that explored interventions for care of an Aboriginal and Torres Strait Islander person. Very limited published material identified strategies necessary within residential aged care. Sixty-seven articles were considered for inclusion, and a subsequent review resulted in 34 being included due to direct alignment with the study aim. Strategies recommended within the review cover areas such as care, communication, palliative care, activities and the environment. Care for an Aboriginal and Torres Strait Islander person in an Australian residential aged-care facility requires a collaborative and individual approach. Cultural safety principles should be maintained across a culturally competent workforce. Aboriginal and Torres Strait Islander persons in care is a significant experience that should not be considered 'routine' as there is much to consider in the care of this person and their community. © 2011 The Author. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  5. Organisational culture in residential aged care facilities: a cross-sectional observational study.

    Science.gov (United States)

    Etherton-Beer, Christopher; Venturato, Lorraine; Horner, Barbara

    2013-01-01

    Organisational culture is increasingly recognised as important for provision of high-quality long-term care. We undertook this study to measure organisational culture in residential aged care facilities in two Australian states. Cross-sectional observational study in 21 residential aged care facilities in Western Australia (n = 14) and Queensland (n = 7), Australia. Staff and next-of-kin of residents participated. Measurement comprised surveys of facility staff and residents' next-of-kin, and structured observation of indicators of care quality. Staff tended to rate organisational culture positively. Some qualitative feedback from staff emphasised negative perceptions of communication, leadership and teamwork. Staffing levels were perceived as a dominant challenge, threatening care quality. Direct observation revealed variability within and between facilities but suggested that most facilities (n = 12) were in the typical range, or were quality facilities (n = 8). There was scope to strengthen organisational culture in participating aged care facilities.

  6. The perceived stress and turnover intention of direct-care staff of community residential facilities

    OpenAIRE

    Lightle, Kevin Eugene

    1990-01-01

    This study examines turnover among direct-care staff of community residential facilities. Turnover is of concern as the projected rate indicated by direct-care staff is 34%. A review of personnel records project an annual turnover rate of 40%. Stress is examined for its relationship to turnover. The Maslach Burnout Inventory is used to measure the perceived stress level of staff. Results indicate direct-care staff are not stressed to the point of burnout in two of ...

  7. Use of in-patient hospital beds by people living in residential care.

    Science.gov (United States)

    Finucane, P; Wundke, R; Whitehead, C; Williamson, L; Baggoley, C

    2000-01-01

    There is concern that people living in residential care in Australia make significant and often inappropriate use of acute in-patient hospital services. To date, no factual information has been collected in Australia and its absence may allow myths and negative stereotypes to proliferate. To determine how and why people living in residential care in Australia use in-patient hospital beds. To determine the outcome of hospitalisation and functional status at 3 months following discharge. Prospective study of 184 consecutive admissions to hospital following Emergency Department (ED) attendance involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Information was obtained from the facilities' transfer letters, and where these were inadequate or absent, telephone interviews were held with residential care staff. 153 people accounted for the 184 admissions. They had a mean age of 84 years and 69% were female. 61% came from hostels and 35% from nursing homes. They had a wide range of clinical problems and twice as many were admitted to medical than to surgical units. Their mean length of hospital stay was 7.9 days, 2.3 days higher than for non-same-day patients and was higher for hostel than for nursing home residents. All but two admissions were considered unavoidable though the provision of specialised care within residential care could have prevented a further 19 (10%) admissions. 96% of admissions resulted in survival to leave hospital and in 74%, people returned directly to their place of origin. At 3 months follow-up, a further 20% of the group had died while 5% were in hospital. In all, 14% of the original group were in a different long-term care facility while 56% were living at their former residence. People living in residential care are often hospitalised because of acute illness. In the vast majority of cases hospitalisation is both appropriate and unavoidable. Most did not require prolonged hospitalisation

  8. Assisted Living Facilities - CARE_LONG_TERM_FACILITIES_ISDH_IN: Residential Care Facilities, Nursing Homes, and Hospices in Indiana in 2007 (Indiana State Department of Health, Point Shapefile)

    Data.gov (United States)

    NSGIC State | GIS Inventory — CARE_LONG_TERM_FACILITIES_ISDH_IN is a point shapefile showing the locations of 86 residential care facilities, 525 long-term care facilities (nursing homes), and 81...

  9. A social pedagogy approach to residential care: balancing education and placement in the development of an innovative child welfare residential program in Ontario, Canada.

    Science.gov (United States)

    Gharabaghi, Kiaras; Groskleg, Ron

    2010-01-01

    This paper chronicles the exploration and development of a residential program of the child welfare authority of Renfrew County in Ontario, Canada. Recognizing that virtually its entire population of youth in care was failing to achieve positive outcomes in education, Renfrew County Family and Children Services embarked on a program development process that included many unique elements within the Ontario child welfare context. This process introduced the theoretical framework of social pedagogy to the provision of residential care, and it replaced the idea of psychotherapy as the primary agent of change for youth with the concept of living and learning. The result is a template for the Ottawa River Academy, a living and learning program for youth in care that exemplifies the possibilities embedded in creative thought, attention to research and evidence, and a preparedness to transcend traditional assumptions with respect to service designs and business models for residential care in child welfare.

  10. Diabetes care and mental illness: the social organization of food in a residential care facility.

    Science.gov (United States)

    Lowndes, Ruth H; Angus, Jan E; Peter, Elizabeth

    2013-06-21

    To explore the social organization of food provision and dietary intake in seriously mentally ill people with diabetes who reside in a for-profit group home. Institutional ethnography was used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were conducted with residents with diabetes, care providers, field workers, and health professionals. Observations and document analysis were also used to understand the lack of congruence between diabetes guidelines and the possibilities for diabetes management within the confines of group home care. Although it was mandated in group home guidelines that "Health Canada's Eating Well with Canada's Food Guide" (2007) be followed, menus were planned within the context of a limited food budget of approximately $1.91 per day per resident. Group home policies regulated systems of safety, reporting, and financial accountability, but not health promotion. Inspections carried out by the Public Health Department focused primarily on food safety during handling, preparation, and storage, and compliance to regulations regarding environmental cleanliness and infection control. Resource rationing found in group home care exacerbates illness in an already marginalized group. Financial support is required to enable provision of healthy food choices, including dairy products, fresh fruits, and vegetables. Additional support is required for care of co-morbid conditions such as diabetes for associated food costs and education to improve outcomes. Group home policies must take into consideration health threats to this population and give primacy to health promotion and illness prevention.

  11. Girls in residential care: From child maltreatment to trauma-related symptoms in emerging adulthood

    NARCIS (Netherlands)

    van Vugt, E.; Lanctôt, N.; Paquette, G.; Collin-Vezina, D.; Lemieux, A.

    2014-01-01

    The current study examined the association between child maltreatment and trauma-related symptoms in emerging adulthood - over and above the incidence of such symptoms and conduct problems during adolescence - among a sample of female adolescents in residential care. This study used data from a

  12. Invited Review: Challenges of Residential and Community Care--"The Times They Are a-Changin"

    Science.gov (United States)

    Jackson, R.

    2011-01-01

    This paper seeks to examine a number of issues which relate to the provision of appropriate and high-quality residential and community care for people with an intellectual disability. A number of key themes emerging from this Special Issue of the "Journal of Intellectual Disability Research" are identified and explored: (1) normalisation; (2)…

  13. Increasing Emotional Regulation for Youths in Residential Care: Phases of Change

    Science.gov (United States)

    Cimmarusti, Rocco A.

    2011-01-01

    Youths in residential care have likely experienced trauma as they have had atypical and disruptive events occur in their lives that has contributed to their out-of-home placement. For people who have been traumatized, the regulation of emotions is an important feature of their recovery. This article presents a model that traces phases from…

  14. Validation of a Job Satisfaction Instrument for Residential-Care Employees.

    Science.gov (United States)

    Sluyter, Gary V.; Mukherjee, Ajit K.

    1986-01-01

    A new job satisfaction instrument for employees of a residential care facility for mentally retarded persons effectively measures the employees' satisfaction with 12 work related variables: salary, company policies, supervision, working conditions, interpersonal relations, security, advancement, recognition, achievement, work responsibility, and…

  15. School adjustment of children in residential care: a multi-source analysis.

    Science.gov (United States)

    Martín, Eduardo; Muñoz de Bustillo, María del Carmen

    2009-11-01

    School adjustment is one the greatest challenges in residential child care programs. This study has two aims: to analyze school adjustment compared to a normative population, and to carry out a multi-source analysis (child, classmates, and teacher) of this adjustment. A total of 50 classrooms containing 60 children from residential care units were studied. The "Método de asignación de atributos perceptivos" (Allocation of perceptive attributes; Díaz-Aguado, 2006), the "Test Autoevaluativo Multifactorial de Adaptación Infantil" (TAMAI [Multifactor Self-assessment Test of Child Adjustment]; Hernández, 1996) and the "Protocolo de valoración para el profesorado (Evaluation Protocol for Teachers; Fernández del Valle, 1998) were applied. The main results indicate that, compared with their classmates, children in residential care are perceived as more controversial and less integrated at school, although no differences were observed in problems of isolation. The multi-source analysis shows that there is agreement among the different sources when the externalized and visible aspects are evaluated. These results are discussed in connection with the practices that are being developed in residential child care programs.

  16. Enhancing adolescents' motivation for treatment in compulsory residential care: A clinical review

    NARCIS (Netherlands)

    Brauers, Malou; Kroneman, Leoniek; Otten, Rene; Lindauer, Ramon; Popma, Arne

    2016-01-01

    Youths in compulsory residential care show a high prevalence of various mental health problems but often lack motivation to engage in therapeutic treatment. Although the self-determination-theory (SDT) and the transtheoretical model of change (TTM) offer a useful framework for treatment motivation,

  17. Insomnia, Sleepiness, and Depression in Adolescents Living in Residential Care Facilities

    Science.gov (United States)

    Moreau, Vincent; Belanger, Lynda; Begin, Gilles; Morin, Charles M.

    2009-01-01

    The main objective of this study was to document sleep patterns and disturbances reported by youths temporarily living in residential care facilities. A secondary objective was to examine the relationships between sleep disturbances and mood and daytime sleepiness. A self-reported questionnaire on sleep patterns and habits assessing duration,…

  18. Care staff training in detection of depression in residential homes for the elderly - Randomised trial

    NARCIS (Netherlands)

    Eisses, AMH; Kluiter, H; Jongenelis, K; Beekman, ATF; Ormel, J

    Background. Many people with depression in residential care homes for the elderly do not receive treatment because their depression remains undetected. Aims. To determine the effects of staff training on the detection, treatment and outcome of depression in residents often homes. Method. We

  19. The incidence of depression and its risk factors in Dutch nursing homes and residential care homes

    NARCIS (Netherlands)

    Boorsma, M.; Joling, K.J.; Dussel, M.; Ribbe, M.W.; Frijters, D.H.M.; van Marwijk, H.W.J.; Nijpels, G.; van Hout, H.P.J.

    2012-01-01

    Objective: Although it is known that depression is highly prevalent in institutionalized older adults, little is known about its incidence and risk factors in nursing homes and residential care homes. The aim of this study was to investigate and compare the incidence and associated risk factors for

  20. Love, intimacy and sexuality in residential dementia care : A spousal perspective

    NARCIS (Netherlands)

    Roelofs, T.S.M.; Luijkx, K.G.; Embregts, P.J.C.M.

    2018-01-01

    The experiences and needs of spouses of residential care facility residents with dementia, regarding friendship, love, intimacy, and sexuality were explored. Understanding of how spouses make sense of their experiences was pursued. Semi-structured interviews were held with nine spouses of people

  1. The experiences of people with dementia and intellectual disabilities with surveillance technologies in residential care

    NARCIS (Netherlands)

    Niemeijer, A.R.; Depla, M.F.I.A.; Frederiks, B.J.M.; Hertogh, C.M.P.M.

    2015-01-01

    Background: Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy. Objective: To explore

  2. Setting-related influences on physical inactivity of older adults in residential care settings : a review

    NARCIS (Netherlands)

    Douma, Johanna G.; Volkers, Karin M.; Engels, Gwenda; Sonneveld, Marieke H.; Goossens, Richard H. M.; Scherder, Erik J. A.

    2017-01-01

    Background: Despite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors

  3. Care staff training in detection of depression in residential homes for the elderly: randomised trial

    NARCIS (Netherlands)

    Eisses, A.M.H.; Kluiter, H.; Jongenelis, K.; Pot, A.M.; Beekman, A.T.F.; Ormel, J.

    2005-01-01

    Background: Many people with depression in residential care homes for the elderly do not receive treatment because their depression remains undetected. Aims: To determine the effects of staff training on the detection, treatment and outcome of depression in residents of ten homes. Method: We

  4. Determinants and outcomes of social climate in therapeutic residential care : A systematic review

    NARCIS (Netherlands)

    Leipoldt, Jonathan David; Harder, Annemiek T.; Rimehaug, Tormod; Kayed, Nanna S.; Grietens, Hans

    2017-01-01

    Objectives: Residential Youth Care (RYC) is still considered a “black box”. Research continues to focus on the results that are achieved, but more insight is necessary to show how these results are achieved for different groups of residents. We refer to this principle as the “what works for whom”

  5. What's the diagnosis? Organisational culture and palliative care delivery in residential aged care in New Zealand.

    Science.gov (United States)

    Frey, Rosemary; Boyd, Michal; Foster, Sue; Robinson, Jackie; Gott, Merryn

    2016-07-01

    Organisational culture has been shown to impact on resident outcomes in residential aged care (RAC). This is particularly important given the growing number of residents with high palliative care needs. The study described herein (conducted from January 2013 to March 2014) examined survey results from a convenience sample of 46 managers, alongside interviews with a purposively selected sample of 23 bereaved family members in order to explore the perceptions of organisational culture within New Zealand RAC facilities in one large urban District Health Board. Results of the Organisational Culture Assessment Instrument (OCAI) completed by managers indicated a preference for a 'Clan' and the structured 'Hierarchy' culture. Bereaved family interviews emphasised both positive and negative aspects of communication, leadership and teamwork, and relationship with residents. Study results from both managers' OCAI survey scores and next of kin interviews indicate that while the RAC facilities are culturally oriented towards providing quality care for residents, they may face barriers to adopting organisational processes supportive of this goal. © 2015 John Wiley & Sons Ltd.

  6. Do social networks affect the use of residential aged care among older Australians?

    Directory of Open Access Journals (Sweden)

    Glonek Gary FV

    2007-10-01

    Full Text Available Abstract Background Older people's social networks with family and friends can affect residential aged care use. It remains unclear if there are differences in the effects of specific (with children, other relatives, friends and confidants and total social networks upon use of low-level residential care and nursing homes. Methods Data were drawn from the Australian Longitudinal Study of Ageing. Six waves of data from 1477 people aged ≥ 70 collected over nine years of follow-up were used. Multinomial logistic regressions of the effects of specific and total social networks on residential care use were carried out. Propensity scores were used in the analyses to adjust for differences in participant's health, demographic and lifestyle characteristics with respect to social networks. Results Higher scores for confidant networks were protective against nursing home use (odds ratio [OR] upper versus lower tertile of confidant networks = 0.50; 95%CI 0.33–0.75. Similarly, a significant effect of upper versus lower total network tertile on nursing home use was observed (OR = 0.62; 95%CI 0.43–0.90. Evidence of an effect of children networks on nursing home use was equivocal. Nursing home use was not predicted by other relatives or friends social networks. Use of lower-level residential care was unrelated to social networks of any type. Social networks of any type did not have a significant effect upon low-level residential care use. Discussion Better confidant and total social networks predict nursing home use in a large cohort of older Australians. Policy needs to reflect the importance of these particular relationships in considering where older people want to live in the later years of life.

  7. Productivity Commission Submission to the Review of Pricing Arrangements in Residential Aged Care

    OpenAIRE

    Productivity Commission

    2003-01-01

    The Commission’s submission to the Review of Pricing Arrangements for Residential Aged Care draws on earlier work, including its inquiry into Nursing Home Subsidies and a major conference on Policy Implications of the Ageing of Australia’s Population. The submission provides an assessment of the current funding and service delivery arrangements for aged care services; an analysis of the implications of ageing, trends in disability rates and other key influences on the future demand for and co...

  8. Live a life in residential care : The importance of social climate for the well-being of adolescents in care

    NARCIS (Netherlands)

    Leipoldt, Jonathan David; Rimehaug, Tormod; Harder, A.T.; Kayed, Nanna; Grietens, Hans

    2015-01-01

    Troubled youngsters in residential youth care (RYC) institutions live their daily life in and around the institutions with other disturbed youngsters and different staff members. The effect that this emerging social climate has on residents in RYC institutions is not very clear and sometimes

  9. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.

    Science.gov (United States)

    Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren

    2017-01-13

    Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care

  10. How architectural design affords experiences of freedom in residential care for older people.

    Science.gov (United States)

    Van Steenwinkel, Iris; Dierckx de Casterlé, Bernadette; Heylighen, Ann

    2017-04-01

    Human values and social issues shape visions on dwelling and care for older people, a growing number of whom live in residential care facilities. These facilities' architectural design is considered to play an important role in realizing care visions. This role, however, has received little attention in research. This article presents a case study of a residential care facility for which the architects made considerable effort to match the design with the care vision. The study offers insights into residents' and caregivers' experiences of, respectively, living and working in this facility, and the role of architectural features therein. A single qualitative case study design was used to provide in-depth, contextual insights. The methods include semi-structured interviews with residents and caregivers, and participant observation. Data concerning design intentions, assumptions and strategies were obtained from design documents, through a semi-structured interview with the architects, and observations on site. Our analysis underlines the importance of freedom (and especially freedom of movement), and the balance between experiencing freedom and being bound to a social and physical framework. It shows the architecture features that can have a role therein: small-scaleness in terms of number of residents per dwelling unit, size and compactness; spatial generosity in terms of surface area, room to maneuver and variety of places; and physical accessibility. Our study challenges the idea of family-like group living. Since we found limited sense of group belonging amongst residents, our findings suggest to rethink residential care facilities in terms of private or collective living in order to address residents' social freedom of movement. Caregivers associated 'hominess' with freedom of movement, action and choice, with favorable social dynamics and with the building's residential character. Being perceived as homey, the facility's architectural design matches caregivers

  11. Dental Care Utilization and Satisfaction of Residential University Students

    Directory of Open Access Journals (Sweden)

    Bamise CT

    2008-01-01

    Full Text Available Aim: The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. Volunteers and Material: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals, and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers. Results: Forty seven students (7.8% indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally, and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment, high dental charges, long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services. Conclusion: Dental service utilization among the students was found to be low. Oral health awareness campaigns, improving the quality of the services, and shortening the waiting time are expected to increase service utilization and satisfaction.

  12. The incidence of depression and its risk factors in Dutch nursing homes and residential care homes.

    Science.gov (United States)

    Boorsma, Marijke; Joling, Karlijn; Dussel, Martine; Ribbe, Miel; Frijters, Dinnus; van Marwijk, Harm W J; Nijpels, Giel; van Hout, Hein

    2012-11-01

    Although it is known that depression is highly prevalent in institutionalized older adults, little is known about its incidence and risk factors in nursing homes and residential care homes. The aim of this study was to investigate and compare the incidence and associated risk factors for depression in Dutch nursing homes and residential care homes. Data on depression were extracted from the Vrije Universiteit naturalistic cohort on routine care monitoring with the Minimum Data Set of the Resident Assessment Instrument. A total of 1,324 residents in six nursing homes and 1,723 residents in 23 residential care homes with an average follow-up of 1.2 years. Depression was defined as a clinical diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and the use of antidepressants. Residents with prevalent depression at baseline were excluded. The incidence rate was 13.6 per 100 person years in the nursing homes and 10.2 per 100 person years in the residential care homes. The independent risk factors for in-home depression for residents in nursing homes included dementia (OR: 1.7; 95% CI: 1.02-2.95) and a score of 3 or more on the Depression Rating Scale (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.23-3.70). A protective effect was seen on the use of a hearing aid (OR: 0.3; 95% CI: 0.12-0.80). In the residential care homes, being male (OR: 2.1; 95% CI: 1.27-3.30), having cancer (OR: 2.9; 95% CI: 1.64-4.95), and a score of 2 or higher on the Cognitive Performance Scale (OR: 1.5; 95% CI: 1.05-2.22) increased the risk to develop depression. Age greater than 85 years (OR: 0.5; 95% CI: 0.31-0.67) and hearing impairment (OR: 0.8; 95% CI: 0.60-1.00) appeared to be protective. The incidence rate for depression in residents of Dutch nursing homes and residential care homes was high and the associated risk factors found may have important implications for staff. 2012 American Association for Geriatric Psychiatry

  13. Psychometric properties of the Portuguese version of place attachment scale for youth in residential care.

    Science.gov (United States)

    Magalhães, Eunice; Calheiros, María M

    2015-01-01

    Although the significant scientific advances on place attachment literature, no instruments exist specifically developed or adapted to residential care. 410 adolescents (11 - 18 years old) participated in this study. The place attachment scale evaluates five dimensions: Place identity, Place dependence, Institutional bonding, Caregivers bonding and Friend bonding. Data analysis included descriptive statistics, content validity, construct validity (Confirmatory Factor Analysis), concurrent validity with correlations with satisfaction with life and with institution, and reliability evidences. The relationship with individual characteristics and placement length was also verified. Content validity analysis revealed that more than half of the panellists perceive all the items as relevant to assess the construct in residential care. The structure with five dimensions revealed good fit statistics and concurrent validity evidences were found, with significant correlations with satisfaction with life and with the institution. Acceptable values of internal consistence and specific gender differences were found. The preliminary psychometric properties of this scale suggest it potential to be used with youth in care.

  14. Development of a model of situational leadership in residential care for older people.

    Science.gov (United States)

    Lynch, Brighide M; McCormack, Brendan; McCance, Tanya

    2011-11-01

    The aim of the present study was to present the process used to develop a composite model of situational leadership enacted within a person-centred nursing framework in residential care. Transforming the culture of the residential unit from a restrictive institution to a vibrant community of older adults requires transformational leadership. Situational leadership is one form of transformational leadership, which claims that there is not one leadership style that works in all situations. A model of situational leadership in residential care was developed through a series of systematic steps that identified direct linkages between situational leadership and the main constructs of the Person-Centred Nursing Framework. The process included reviewing the evidence, undertaking a comparative analysis, identifying key concepts, connecting the concepts and developing a model. A conceptual model is presented which integrates person-centredness with leadership thinking in order to effectively impact on the follower's performance in managing the care environment and delivering person-centred care. Currently the model is being utilized in an action research study to evaluate the role of leaders in the practice setting of long-term care. While some of the connecting concepts have been identified in the present study, more work needs to be done to unravel these connections in further study of leaders in practice. © 2011 Blackwell Publishing Ltd.

  15. Aquatic exercise for residential aged care adults with dementia: benefits and barriers to participation.

    Science.gov (United States)

    Henwood, Timothy; Neville, Christine; Baguley, Chantelle; Beattie, Elizabeth

    2017-09-01

    Pilot work by our group has demonstrated that aquatic exercise has valuable functional and psychosocial benefits for adults living in the residential aged care setting with dementia. The aim of the currents study was to advance this work by delivering the Watermemories Swimming Club aquatic exercise program to a more representative population of older, institutionalized adults with dementia. The benefits of 12 weeks of twice weekly participation in the Watermemories Swimming Club aquatic exercise program were assessed among an exercise and usual care control group of residential aged care adults with advanced dementia. A battery of physical and psychosocial measures were collected before and after the intervention period, and program implementation was also investigated. Seven residential aged care facilities of 24 approached, agreed to participate and 56 residents were purposefully allocated to exercise or control. Twenty-three participants per group were included in the final analysis. Both groups experienced decreases in skeletal muscle index and lean mass (p exercise stifled losses in muscle strength and transition into sarcopenic. Behavioral and psychological symptoms of dementia and activities of daily living approached significance (p = 0.06) with positive trends observed across other psychosocial measures. This study demonstrates the value of exercise participation, and specifically aquatic exercise in comparison to usual care for older, institutionalized adults with advanced dementia. However, it also highlights a number of barriers to participation. To overcome these barriers and ensure opportunity to residents increased provider and sector support is required.

  16. The development of a healing model of care for an Indigenous drug and alcohol residential rehabilitation service: a community-based participatory research approach.

    Science.gov (United States)

    Munro, Alice; Shakeshaft, Anthony; Clifford, Anton

    2017-12-04

    Given the well-established evidence of disproportionately high rates of substance-related morbidity and mortality after release from incarceration for Indigenous Australians, access to comprehensive, effective and culturally safe residential rehabilitation treatment will likely assist in reducing recidivism to both prison and substance dependence for this population. In the absence of methodologically rigorous evidence, the delivery of Indigenous drug and alcohol residential rehabilitation services vary widely, and divergent views exist regarding the appropriateness and efficacy of different potential treatment components. One way to increase the methodological quality of evaluations of Indigenous residential rehabilitation services is to develop partnerships with researchers to better align models of care with the client's, and the community's, needs. An emerging research paradigm to guide the development of high quality evidence through a number of sequential steps that equitably involves services, stakeholders and researchers is community-based participatory research (CBPR). The purpose of this study is to articulate an Indigenous drug and alcohol residential rehabilitation service model of care, developed in collaboration between clients, service providers and researchers using a CBPR approach. This research adopted a mixed methods CBPR approach to triangulate collected data to inform the development of a model of care for a remote Indigenous drug and alcohol residential rehabilitation service. Four iterative CBPR steps of research activity were recorded during the 3-year research partnership. As a direct outcome of the CBPR framework, the service and researchers co-designed a Healing Model of Care that comprises six core treatment components, three core organisational components and is articulated in two program logics. The program logics were designed to specifically align each component and outcome with the mechanism of change for the client or organisation

  17. Development and validation of fall risk screening tools for use in residential aged care facilities.

    Science.gov (United States)

    Delbaere, Kim; Close, Jacqueline C T; Menz, Hylton B; Cumming, Robert G; Cameron, Ian D; Sambrook, Philip N; March, Lyn M; Lord, Stephen R

    2008-08-18

    To develop screening tools for predicting falls in nursing home and intermediate-care hostel residents who can and cannot stand unaided. Prospective cohort study in residential aged care facilities in northern Sydney, New South Wales, June 1999-June 2003. 2005 people aged 65-104 years (mean +/- SD, 85.7+/-7.1 years). Demographic, health, and physical function assessment measures; number of falls over a 6-month period; validity of the screening models. Ability to stand unaided was identified as a significant event modifier for falls. In people who could stand unaided, having either poor balance or two of three other risk factors (previous falls, nursing home residence, and urinary incontinence) increased the risk of falling in the next 6 months threefold (sensitivity, 73%; specificity, 55%). In people who could not stand unaided, having any one of three risk factors (previous falls, hostel residence, and using nine or more medications) increased the risk of falling twofold (sensitivity, 87%; specificity, 29%). These two screening models are useful for identifying older people living in residential aged care facilities who are at increased risk of falls. The screens are easy to administer and contain items that are routinely collected in residential aged care facilities in Australia.

  18. Work-related change in residential elderly care: Trust, space and connectedness.

    Science.gov (United States)

    van der Borg, Wieke E; Verdonk, Petra; Dauwerse, Linda; Abma, Tineke A

    2017-07-01

    Increasing care needs and a declining workforce put pressure on the quality and continuity of long-term elderly care. The need to attract and retain a solid workforce is increasingly acknowledged. This study reports about a change initiative that aimed to improve the quality of care and working life in residential elderly care. The research focus is on understanding the process of workforce change and development, by retrospectively exploring the experiences of care professionals. A responsive evaluation was conducted at a nursing home department in the Netherlands one year after participating in the change program. Data were gathered by participant observations, interviews and a focus and dialogue group. A thematic analysis was conducted. Care professionals reported changes in workplace climate and interpersonal interactions. We identified trust, space and connectedness as important concepts to understand perceived change. Findings suggest that the interplay between trust and space fostered interpersonal connectedness. Connectedness improved the quality of relationships, contributing to the well-being of the workforce. We consider the nature and contradictions within the process of change, and discuss how gained insights help to improve quality of working life in residential elderly care and how this may reflect in the quality of care provision.

  19. Safeguarding children and youth in residential and foster care: Supporting healthy sexual development

    DEFF Research Database (Denmark)

    Hansen, Gitte Riis; Grandal*, Niels

    (in 2012) to report on sexual and physical violence, that raised awareness on the subject. The investigations showed that professionals perceive very few of the cases of sexual abuse in residential and foster care and in many cases the perpetrators turn out to be peers. This drew attention......In The Netherlands, Denmark and Scotland special awareness on the subject of sexual abuse and sexual exploitation was raised by national investigations on the prevalence and content of sexual abuse in residential and foster care. In Flanders (Belgium) it was the start of the so called Helpline 1712...... to a central issue: the incapability of professionals to support a healthy sexual development and discuss sexual behaviour with children and young people, their (foster) parents and other professionals. Sex is a subject that is not easily talked about and most professionals feel insecure about. Moreover...

  20. Validation of CARE-Q in residential aged-care: rating of importance of caring behaviours from an e-cohort sub-study.

    Science.gov (United States)

    Tuckett, Anthony G; Hughes, Karen; Schluter, Philip J; Turner, Cathy

    2009-05-01

    To validate the Caring Assessment Report Evaluation Q-sort questionnaire in the residential aged-care setting. Based on this determination, to conclude with what degree of confidence the questionnaire can be used to determine the ranking of the importance of caring behaviours amongst aged-care nurses and residents in residential aged-care. Perceptions of caring may be context specific. Caring in residential aged-care may stand in contrast to the sense of caring understood and practiced in other settings. Self-administered survey. Residents from three not-for-profit aged-care facilities, across both high-care (nursing-home) and low-care (hostel care) were surveyed relying on the Caring Assessment Report Evaluation Q-sort questionnaire. A sub-sample of registered and enrolled nurses working in residential aged-care and registered with the Nurses & Midwives e-cohort study completed the same survey. Although the Caring Assessment Report Evaluation Q-sort questionnaire showed good internal consistency for the sample of nurses, the results for the residents were more erratic. Both groups displayed large ranges for the inter-item correlations. The results of the Mann-Whitney U-test indicated that the nurses rated the Comforts, Anticipates and Trusting relationship as significantly more important than the residents. Both groups rated the Explains and facilitates subscale as least important. All subscales, however, received median scores greater than, or equal to, six (seven-point, Likert scale) indicating that all were considered important overall. Based on poor Cronbach's alpha coefficients, negative inter-item correlations and qualitative observations, without further development within the residential aged-care facility the free response format version of the Caring Assessment Report Evaluation Q-sort may not be an appropriate measure to use with residential aged-care residents. More research needs to be conducted into how residents and nurses are interpreting the items

  1. A Cluster-Randomised Trial of Staff Education to Improve the Quality of Life of People with Dementia Living in Residential Care: The DIRECT Study

    OpenAIRE

    Beer, Christopher; Horner, Barbara; Flicker, Leon; Scherer, Samuel; Lautenschlager, Nicola T.; Bretland, Nick; Flett, Penelope; Schaper, Frank; Almeida, Osvaldo P.

    2011-01-01

    BACKGROUND: The Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care. METHODOLOGY/PRINCIPAL FINDINGS: This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 ...

  2. Leisure, functional disability and depression among older Chinese living in residential care homes.

    Science.gov (United States)

    Ouyang, Zheng; Chong, Alice M L; Ng, Ting Kin; Liu, Susu

    2015-01-01

    Previous research has rarely examined the intervening and buffering effects of leisure on the relationship between age-related stress and health among institutionalized elders, especially in the Chinese context. This study thus examines the extent to which participation in leisure activities mediates and moderates the impact of functional disability on depression among older adults living in residential care homes in China. A total of 1429 participants (858 men) aged over 60 living in residential care homes, of which 46.1% experienced depression using a cut-off score ≥ 5 on the 15-item Geriatric Depression Scale, were selected from a national survey across China by using the probability proportional to size sampling method. The findings showed that depression was positively predicted by functional disability and negatively predicted by participation in leisure activities. The results of the mediation analysis showed that participation in leisure activities partially mediated the relationship between functional disability and depression. Functional disability predicted depression both directly and indirectly through its negative influence on participation in leisure activities. Participation in leisure activities also significantly buffered the relationship between functional disability and depression such that the impact of functional disability was weaker for those who participated in leisure activities more frequently. These results provide support for the mediating and moderating roles of leisure in the stress-health relationship among institutionalized elders. To enhance residents' psychological health, residential care homes are recommended to organize more leisure activities.

  3. Mooncoin Residential Care Centre, Polerone Road, Mooncoin, via Waterford, Kilkenny.

    LENUS (Irish Health Repository)

    Allen, Finbarr

    2011-03-14

    Population trends suggest that the Irish population is ageing, and that this population will have substantial treatment needs. These patients will be better informed than previous generations, and will demand treatment aimed at preserving a natural dentition. This will impact upon delivery of oral healthcare and manpower planning needs to consider how to address the increased demand for dental care. Poor oral health is associated with systemic health problems, including cardiovascular disease, respiratory disease and diabetes mellitus. It also has a negative impact upon quality of life, and the World Health Organisation has encouraged public healthcare administrators and decision makers to design effective and affordable strategies for better oral health and quality of life of older adults, which, in turn, are integrated into general health management programmes. Treatment concepts such as minimally invasive dentistry and the shortened dental arch concept are discussed in the context of these demographic changes and recommendations.

  4. Setting-related influences on physical inactivity of older adults in residential care settings: a review.

    Science.gov (United States)

    Douma, Johanna G; Volkers, Karin M; Engels, Gwenda; Sonneveld, Marieke H; Goossens, Richard H M; Scherder, Erik J A

    2017-04-28

    Despite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors that influence the amount of inactivity. The aim of this review was to review setting-related factors (including the social and physical environment) that may contribute to the amount of older adults' physical inactivity in a wide range of residential care settings (e.g., nursing homes, assisted care facilities). Five databases were systematically searched for eligible studies, using the key words 'inactivity', 'care facilities', and 'older adults', including their synonyms and MeSH terms. Additional studies were selected from references used in articles included from the search. Based on specific eligibility criteria, a total of 12 studies were included. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Based on studies using different methodologies (e.g., interviews and observations), and of different quality (assessed quality range: 25-100%), we report several aspects related to the physical environment and caregivers. Factors of the physical environment that may be related to physical inactivity included, among others, the environment's compatibility with the abilities of a resident, the presence of equipment, the accessibility, security, comfort, and aesthetics of the environment/corridors, and possibly the presence of some specific areas. Caregiver-related factors included staffing levels, the available time, and the amount and type of care being provided. Inactivity levels in residential care settings may be reduced by improving several features of the physical environment and with the help of caregivers. Intervention studies could be performed in order to gain more insight into causal effects of improving setting-related factors on

  5. Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation.

    Science.gov (United States)

    Tariq, A; Lehnbom, E; Oliver, K; Georgiou, A; Rowe, C; Osmond, T; Westbrook, J

    2014-01-01

    Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues. We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

  6. From home to 'home': Mapping the caregiver journey in the transition from home care into residential care.

    Science.gov (United States)

    Hainstock, Taylor; Cloutier, Denise; Penning, Margaret

    2017-12-01

    Family caregivers play a pivotal role in supporting the functional independence and quality of life of older relatives, often taking on a wide variety of care-related activities over the course of their caregiving journey. These activities help family members to remain in the community and age-in-place for as long as possible. However, when needs exceed family capacities to provide care, the older family member may need to transition from one care environment to another (e.g., home care to nursing home care), or one level of care to another (from less intense to more intensive services). Drawing upon qualitative interview data collected in a populous health region in British Columbia, Canada, this study explores the roles and responsibilities of family caregivers for family members making the care transition from home care to residential care. A thematic analysis of the interview transcripts resulted in the development of a conceptual framework to characterize the "Caregiver Journey" as a process that could be divided into at least three phases: 1) Precursors to transition - recognizing frailty in family members and caregivers prior to transition; 2) Preparing to transition into residential nursing home care (RC) and 3) Post-transition: Finding a new balance - where caregivers adjust and adapt to new caregiving responsibilities. Our analyses revealed that the second phase is the most complex involving a consideration of the various activities, and roles that family caregivers take on to prepare for the care transition including: information gathering, advocacy and system navigation. We conclude that there is a need for family caregivers to be better supported during care transitions; notably through ongoing and enhanced investments in strategies to support caregiver communication and education. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  7. [The Relationship Between Burnout Symptoms and Work Satisfaction Among Child Welfare Workers in Residential Care].

    Science.gov (United States)

    Steinlin, Célia; Dölitzsch, Claudia; Fischer, Sophia; Schmeck, Klaus; Fegert, Jörg M; Schmid, Marc

    2016-01-01

    Working in residential care is associated with high demands and high stress. As a result, employees may develop symptoms of burnout. These symptoms lead to absence from work and have a negative effect on the continuity and quality of the residential care. Until now, little is known about burnout risks in child welfare workers, although children and adolescents are especially dependent on continuous relationships and healthy caregivers. A better understanding of the relationship between burnout symptoms and work satisfaction may help to identify starting points for prevention and intervention. The present study assessed symptoms of burnout in a sample of 319 social education workers in residential care in Switzerland using the burnout-screening-scales (BOSS). Work satisfaction was assessed with a newly developed questionnaire based on concepts of trauma-sensitive care. The questionnaire was tested for reliability and factorial validity in the present study. In order to estimate the relationship between burnout symptoms and work satisfaction, correlations and relative risks were calculated. Almost one fifth (18 %) of the sample showed a risk of burnout. The principal component analysis of the questionnaire on work satisfaction revealed four factors: support by superiors, participation and transparency; communication and support within the team; gratification in the work; and institutional structures and resources. All four factors as well as the total score showed significant correlations with burnout symptoms. Among employees with a comparably lower work satisfaction, the risk of burnout was 5.4 times higher than among employees with a comparably higher work satisfaction. It is discussed how work satisfaction could be promoted and how, as a result, the quality and continuity of care for the children and adolescents could be improved.

  8. Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults.

    Science.gov (United States)

    Chapman, Michael; Johnston, Nikki; Lovell, Clare; Forbat, Liz; Liu, Wai-Man

    2018-03-01

    Specialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths. A quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading 'Palliative Care Needs Rounds' to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants' hospitalisation in the past 3 months of life and the location of death. The data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (pcare service delivery in residential facilities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Making Sense of Varying Standards of Care: The Experiences of Staff Working in Residential Care Environments for Adults with Learning Disabilities

    Science.gov (United States)

    Hutchison, Andrew; Kroese, Biza Stenfert

    2016-01-01

    Research evidence reveals that adults with learning disabilities who live in residential care facilities are being exposed to considerable variation in the standards of care they receive. High profile cases of substandard care have also raised concerns regarding the appropriateness of existing care provisions and practices. While attempts have…

  10. Establishment and preliminary outcomes of a palliative care research network.

    Science.gov (United States)

    Hudson, Peter; Street, Annette; Graham, Suzanne; Aranda, Sanchia; O'Connor, Margaret; Thomas, Kristina; Jackson, Kate; Spruyt, Odette; Ugalde, Anna; Philip, Jennifer

    2016-02-01

    The difficulties in conducting palliative care research have been widely acknowledged. In order to generate the evidence needed to underpin palliative care provision, collaborative research is considered essential. Prior to formalizing the development of a research network for the state of Victoria, Australia, a preliminary study was undertaken to ascertain interest and recommendations for the design of such a collaboration. Three data-collection strategies were used: a cross-sectional questionnaire, interviews, and workshops. The questionnaire was completed by multidisciplinary palliative care specialists from across the state (n = 61); interviews were conducted with senior clinicians and academics (n = 21) followed by two stakeholder workshops (n = 29). The questionnaire was constructed specifically for this study, measuring involvement of and perceptions of palliative care research. Both the interview and the questionnaire data demonstrated strong support for a palliative care research network and aided in establishing a research agenda. The stakeholder workshops assisted with strategies for the formation of the Palliative Care Research Network Victoria (PCRNV) and guided the development of the mission and strategic plan. The research and efforts to date to establish the PCRNV are encouraging and provide optimism for the evolution of palliative care research in Australia. The international implications are highlighted.

  11. Residential respite care is associated with family carers experiencing financial strain.

    Science.gov (United States)

    Aggar, Christina; Ronaldson, Susan; Cameron, Ian D

    2014-06-01

    Care services for older people are provided with the expectation of supporting carers in their caregiving role. The aim of the study is to investigate the association between the utilisation of care services by older people and the caregiving experience. Cross-sectional design, involving a cohort of family carers (n = 119) of frail older people (≥70 years) enrolled in a clinical trial of frailty treatment in metropolitan Sydney from 2008 to 2011. The caregiving experience was measured in five domains: health, daily schedule, finance, family support and self-esteem (Caregiver Reaction Assessment tool). Multivariate regression analysis demonstrated an association between the utilisation of residential respite care and financial strain (β = -0.613, P = 0.049), after controlling for functional ability, co-residence and age. There is a need to consider carers' financial barriers and concerns in regards to the utilisation of respite care services. © 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.

  12. Mortality and health services utilisation among older people with advanced cognitive impairment living in residential care homes.

    Science.gov (United States)

    Luk, James K H; Chan, W K; Ng, W C; Chiu, Patrick K C; Ho, Celina; Chan, T C; Chan, Felix H W

    2013-12-01

    To study the demography, clinical characteristics, service utilisation, mortality, and predictors of mortality in older residential care home residents with advanced cognitive impairment. Cohort longitudinal study. Residential care homes for the elderly in Hong Kong West. Residents of such homes aged 65 years or more with advanced cognitive impairment. In all, 312 such residential care home residents (71 men and 241 women) were studied. Their mean age was 88 (standard deviation, 8) years and their mean Barthel Index 20 score was 1.5 (standard deviation, 2.0). In all, 164 (53%) were receiving enteral feeding. Nearly all of them had urinary and bowel incontinence. Apart from Community Geriatric Assessment Team clinics, 119 (38%) of the residents attended other clinics outside their residential care homes. In all, 107 (34%) died within 1 year; those who died within 1 year used significantly more emergency and hospital services (P<0.001), and utilised more services from community care nurses for wound care (P=0.001), enteral feeding tube care (P=0.018), and urinary catheter care (P<0.001). Independent risk factors for 1-year mortality were active pressure sores (P=0.0037), enteral feeding (P=0.008), having a urinary catheter (P=0.0036), and suffering from chronic obstructive pulmonary disease (P=0.011). A history of pneumococcal vaccination was protective with respect to 1-year mortality (P=0.004). Residents of residential care homes for the elderly with advanced cognitive impairment were frail, exhibited multiple co-morbidities and high mortality. They were frequent users of out-patient, emergency, and in-patient services. The development of end-of-life care services in residential care homes for the elderly is an important need for this group of elderly.

  13. School Functioning of a Particularly Vulnerable Group: Children and Young People in Residential Child Care

    Directory of Open Access Journals (Sweden)

    Carla González-García

    2017-07-01

    Full Text Available A large proportion of the children and young people in residential child care in Spain are there as a consequence of abuse and neglect in their birth families. Research has shown that these types of adverse circumstances in childhood are risk factors for emotional and behavioral problems, as well as difficulties in adapting to different contexts. School achievement is related to this and represents one of the most affected areas. Children in residential child care exhibit extremely poor performance and difficulties in school functioning which affects their transition to adulthood and into the labor market. The main aim of this study is to describe the school functioning of a sample of 1,216 children aged between 8 and 18 living in residential child care in Spain. The specific needs of children with intellectual disability and unaccompanied migrant children were also analyzed. Relationships with other variables such as gender, age, mental health needs, and other risk factors were also explored. In order to analyze school functioning in this vulnerable group, the sample was divided into different groups depending on school level and educational needs. In the vast majority of cases, children were in primary or compulsory secondary education (up to age 16, this group included a significant proportion of cases in special education centers. The rest of the sample were in vocational training or post-compulsory secondary school. Results have important implications for the design of socio-educative intervention strategies in both education and child care systems in order to promote better school achievement and better educational qualifications in this vulnerable group.

  14. [Disclosure of Adolescents in Residential Care Institutions and Boarding Schools after Exposure to Sexual Violence].

    Science.gov (United States)

    Rau, Thea; Ohlert, Jeannine; Fegert, Jörg M; Allroggen, Marc

    2016-11-01

    Disclosure of Adolescents in Residential Care Institutions and Boarding Schools after Exposure to Sexual Violence In international research, many papers exist about the issue of disclosure after having experienced sexual violence. However, specific research regarding disclosure processes of children and adolescents in institutional care are missing, even though those are particularly often affected by sexual violence. In the Germany-wide study "Sprich mit!", adolescents from the age of 15 up (n = 322; average age 16,69 (SD = 1,3); 57,1 % males) who live in residential care or boarding schools were asked for experiences of sexual violence and their consequences by means of a self-report questionnaire. Results showed that the majority of the adolescents (82 %) entrusted themselves to someone, mostly towards peers (56 %) and less frequent towards adults (24 %). Boys and girls opened up equally often, regardless of the severity of the experienced violence. Adolescents who entrusted themselves towards their peers indicated retrospectively more satisfaction than those entrusting themselves towards adults, even if there were no consequences following the disclosure. Considering that the disclosure towards peers did not initiate a process of help, adolescents in institutional care should be better informed about relevant possibilities to entrust themselves and receive support.

  15. Use of information technology for medication management in residential care facilities: correlates of facility characteristics.

    Science.gov (United States)

    Bhuyan, Soumitra S; Chandak, Aastha; Powell, M Paige; Kim, Jungyoon; Shiyanbola, Olayinka; Zhu, He; Shiyanbola, Oyewale

    2015-06-01

    The effectiveness of information technology in resolving medication problems has been well documented. Long-term care settings such as residential care facilities (RCFs) may see the benefits of using such technologies in addressing the problem of medication errors among their resident population, who are usually older and have numerous chronic conditions. The aim of this study was two-fold: to examine the extent of use of Electronic Medication Management (EMM) in RCFs and to analyze the organizational factors associated with the use of EMM functionalities in RCFs. Data on RCFs were obtained from the 2010 National Survey of Residential Care Facilities. The association between facility, director and staff, and resident characteristics of RCFs and adoption of four EMM functionalities was assessed through multivariate logistic regression. The four EMM functionalities included were maintaining lists of medications, ordering for prescriptions, maintaining active medication allergy lists, and warning of drug interactions or contraindications. About 12% of the RCFs adopted all four EMM functionalities. Additionally, maintaining lists of medications had the highest adoption rate (34.5%), followed by maintaining active medication allergy lists (31.6%), ordering for prescriptions (19.7%), and warning of drug interactions or contraindications (17.9%). Facility size and ownership status were significantly associated with adoption of all four EMM functionalities. Medicaid certification status, facility director's age, education and license status, and the use of personal care aides in the RCF were significantly associated with the adoption of some of the EMM functionalities. EMM is expected to improve the quality of care and patient safety in long-term care facilities including RCFs. The extent of adoption of the four EMM functionalities is relatively low in RCFs. Some RCFs may strategize to use these functionalities to cater to the increasing demands from the market and also to

  16. Health care aides use of time in a residential long-term care unit: a time and motion study.

    Science.gov (United States)

    Mallidou, Anastasia A; Cummings, Greta G; Schalm, Corinne; Estabrooks, Carole A

    2013-09-01

    Organizational resources such as caregiver time use with older adults in residential long-term care facilities (nursing homes) have not been extensively studied, while levels of nurse staffing and staffing-mix are the focus of many publications on all types of healthcare organizations. Evidence shows that front-line caregivers' sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes (e.g., reductions in pressure ulcers, urinary tract infections, and falls), quality of life, cost savings, and may be affiliated with transformation of organizational culture. To explore organizational resources in a long-term care unit within a multilevel residential facility, to measure healthcare aides' use of time with residents, and to describe working environment and unit culture. An observational pilot study was conducted in a Canadian urban 52-bed long-term care unit within a faith-based residential multilevel care facility. A convenience sample of seven healthcare aides consented to participate. To collect the data, we used an observational sheet (to monitor caregiver time use on certain activities such as personal care, assisting with eating, socializing, helping residents to be involved in therapeutic activities, paperwork, networking, personal time, and others), semi-structured interview (to assess caregiver perceptions of their working environment), and field notes (to illustrate the unit culture). Three hundred and eighty seven hours of observation were completed. The findings indicate that healthcare aides spent most of their working time (on an eight-hour day-shift) in "personal care" (52%) and in "other" activities (23%). One-to-three minute activities consumed about 35% of the time spent in personal care and 20% of time spent in assisting with eating. Overall, caregivers' time spent socializing was less than 1%, about 6% in networking, and less than 4% in paperwork. Re-organizing healthcare aides

  17. Development of an Internet Security Policy for health care establishments.

    Science.gov (United States)

    Ilioudis, C; Pangalos, G

    2000-01-01

    The Internet provides unprecedented opportunities for interaction and data sharing among health care providers, patients and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality and integrity of information. This paper defines the basic security requirements that must be addressed in order to use the Internet to safely transmit patient and/or other sensitive Health Care information. It describes a suitable Internet Security Policy for Health Care Establishments and provides the set of technical measures that are needed for its implementation. The proposed security policy and technical approaches have been based on an extensive study of the related recommendations from the security and standard groups both in EU amid USA and our related work and experience. The results have been utilized in the framework of the Intranet Health Clinic project, where the use of the Internet for the transmission of sensitive Health Care information is of vital importance.

  18. Physical and psychosocial function in residential aged-care elders: effect of Nintendo Wii Sports games.

    Science.gov (United States)

    Keogh, Justin W L; Power, Nicola; Wooller, Leslie; Lucas, Patricia; Whatman, Chris

    2014-04-01

    This mixed-methods, quasi-experimental pilot study examined whether the Nintendo Wii Sports (NWS) active video game (exergame) system could significantly improve the functional ability, physical activity levels, and quality of life of 34 older adults (4 men and 30 women, 83 ± 8 yr) living in 2 residential aged-care (RAC) centers. Change score analyses indicated the intervention group had significantly greater increases in bicep curl muscular endurance, physical activity levels, and psychological quality of life than the control group (p games were fun and provided an avenue for greater socialization. These results add some further support to the utilization of NWS exergames in the RAC context.

  19. Free choice in residential care for older people - A philosophical reflection.

    Science.gov (United States)

    Nord, Catharina

    2016-04-01

    Free choice in elderly care services is a debated issue. Using the theoretical support of philosophers of free will, this paper explores free choice in relocation to residential care. The three dominant perspectives within this field of philosophy, libertarianism, determinism and compatibilism, are applied from the perspective of the older individual to the process of moving. Empirical data were collected through qualitative interviews with 13 older individuals who had recently moved into residential care. These individuals had made the choice to move following either a health emergency or incremental health problems. In a deterministic perspective they had no alternative to moving, which was the inevitable solution to their various personal problems. A network of people important to them assisted in the move, making the choice possible. However, post-move the interviewees' perspective had changed to a libertarian or compatibilist interpretation, whereby although the circumstances had conferred little freedom regarding the move. The interviewees reported a high degree of self-determination in the process. It appeared that in order to restore self-respect and personal agency, the older individuals had transformed their restricted choice into a choice made of free will or freer will. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Experiences of registered nurses as managers and leaders in residential aged care facilities: a systematic review.

    Science.gov (United States)

    Dwyer, Drew

    2011-12-01

    The phenomenon of an ageing population is being experienced globally, as countries struggle to change and improve residential models of care and provide services to the elderly. The role of the registered nurse (RN) is considered crucial to the clinical governance and management of care given. To date, however, no systematic review has examined the RN's experience in leadership and management. The objective of this review is to critically appraise, synthesise and present best available evidence on the experiences of RNs as clinical leaders and managers in residential aged care facilities. This review considered qualitative research papers that addressed the experiences of RNs as clinical leaders and managers in residential aged care facilities. Participants of interest were RNs, nurse leaders, nurses holding registration and or regulation under a board of nursing, nurses working in residential aged care and long-term care facilities. The diversity and use of language to describe nurses' roles and models of care for the elderly care environment were considered in the review. The search strategy sought to find both published studies and papers, limited to the English language and published between January 1997 and February 2011. An initial limited search was done in Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature databases to identify the key words contained in the title or abstract and index terms used to describe the relevant terms in the article. A second extensive search was undertaken and extended to other relevant databases using all identified keywords and index terms. The third step involved searching reference lists and bibliographies of chosen articles for additional studies. Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appropriate critical appraisal instrument from the System for the Unified Management

  1. Organizational factors associated with readiness for change in residential aged care settings.

    Science.gov (United States)

    von Treuer, Kathryn; Karantzas, Gery; McCabe, Marita; Mellor, David; Konis, Anastasia; Davison, Tanya E; O'Connor, Daniel

    2018-02-01

    Organizational change is inevitable in any workplace. Previous research has shown that leadership and a number of organizational climate and contextual variables can affect the adoption of change initiatives. The effect of these workplace variables is particularly important in stressful work sectors such as aged care where employees work with challenging older clients who frequently exhibit dementia and depression. This study sought to examine the effect of organizational climate and leadership variables on organizational readiness for change across 21 residential aged care facilities. Staff from each facility (N = 255) completed a self-report measure assessing organizational factors including organizational climate, leadership and readiness for change. A hierarchical regression model revealed that the organizational climate variables of work pressure, innovation, and transformational leadership were predictive of employee perceptions of organizational readiness for change. These findings suggest that within aged care facilities an organization's capacity to change their organizational climate and leadership practices may enhance an organization's readiness for change.

  2. Improving and ensuring best practice continence management in residential aged care.

    Science.gov (United States)

    Heckenberg, Gayle

    2008-06-01

    Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness

  3. The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?

    Science.gov (United States)

    Barron, David N; West, Elizabeth

    2017-04-01

    There has been a radical transformation in the provision of adult residential and nursing home care in England over the past four decades. Up to the 1980s, over 80% of adult residential care was provided by the public sector, but today public sector facilities account for only 8% of the available places, with the rest being provided by a mixture of for-profit firms (74%) and non-profit charities (18%). The public sector's role is often now that of purchaser (paying the fees of people unable to afford them) and regulator. While the idea that private companies may play a bigger role in the future provision of health care is highly contentious in the UK, the transformation of the residential and nursing home care has attracted little comment. Concerns about the quality of care do emerge from time to time, often stimulated by high profile media investigations, scandals or criminal prosecutions, but there is little or no evidence about whether or not the transformation of the sector from largely public to private provision has had a beneficial effect on those who need the service. This study asks whether there are differences in the quality of care provided by public, non-profit or for-profit facilities in England. We use data on care quality for over 15,000 homes that are provided by the industry regulator in England: the Care Quality Commission (CQC). These data are the results of inspections carried out between April 2011 and October 2015. Controlling for a range of facility characteristics such as age and size, proportional odds logistic regression showed that for-profit facilities have lower CQC quality ratings than public and non-profit providers over a range of measures, including safety, effectiveness, respect, meeting needs and leadership. We discuss the implications of these results for the ongoing debates about the role of for-profit providers of health and social care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Policy options to improve leadership of middle managers in the Australian residential aged care setting: a narrative synthesis

    Science.gov (United States)

    2010-01-01

    Background The prevalence of both chronic diseases and multi-morbidity increases with longer life spans. As Australia's population ages, the aged care sector is under increasing pressure to ensure that quality aged care is available. Key to responding to this pressure is leadership and management capability within the aged care workforce. A systematic literature review was conducted to inform the policy development necessary for the enhancement of clinical and managerial leadership skills of middle managers within residential aged care. Methods Using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts, 4,484 papers were found. After a seven-tiered culling process, we conducted a detailed review (narrative synthesis) of 153 papers relevant to leadership and management development in aged care, incorporating expert and key stakeholder consultations. Results • Positive staff experiences of a manager's leadership are critical to ensure job satisfaction and workforce retention, the provision of quality care and the well-being of care recipients, and potentially a reduction of associated costs. • The essential attributes of good leadership for aged care middle management are a hands-on accessibility and professional expertise in nurturing respect, recognition and team building, along with effective communication and flexibility. However, successful leadership and management outcomes depend on coherent and good organisational leadership (structural and psychological empowerment). • There is inadequate preparation for middle management leadership roles in the aged care sector and a lack of clear guidelines and key performance indicators to assess leadership and management skills. • Theory development in aged care leadership and management research is limited. A few effective generic clinical leadership programs targeting both clinical and managerial leaders exist. However, little is known regarding

  5. Duty periods for establishing eligibility for health care. Final rule.

    Science.gov (United States)

    2013-12-26

    The Department of Veterans Affairs (VA) is amending its medical regulations concerning eligibility for health care to re-establish the definitions of "active military, naval, or air service,'' "active duty,'' and "active duty for training.'' These definitions were deleted in 1996; however, we believe that all duty periods should be defined in part 17 of the Code of Federal Regulations (CFR) to ensure proper determination of eligibility for VA health care. We are also providing a more complete definition of "inactive duty training.''

  6. Using a videogame intervention to reduce anxiety and externalizing problems among youths in residential care: An initial randomized controlled trial

    NARCIS (Netherlands)

    Schuurmans, A.T.; Nijhof, K.S.; Engels, R.C.M.E.; Granic, I.

    2018-01-01

    Residential care is among the most intensive forms of treatment in youth care. It serves youths with severe behavioral problems and is primarily focused on targeting externalizing problems. Despite best efforts, effect sizes remain moderate, which may be due to the disregarding of internalizing

  7. Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study.

    Science.gov (United States)

    Lea, Emma J; Goldberg, Lynette R; Price, Andrea D; Tierney, Laura T; McInerney, Fran

    2017-12-01

    To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia. Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved. Qualitative, interview-based study. Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically. Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers. Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices. Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change. © 2017 John Wiley & Sons Ltd.

  8. Mindfulness-based cognitive therapy for anxiety symptoms in older adults in residential care.

    Science.gov (United States)

    Helmes, Edward; Ward, Bradley G

    2017-03-01

    Anxiety in older people is under-diagnosed and poorly treated despite significant impairments that arise from anxiety. Mindfulness-based cognitive therapy (MBCT) has been shown to be a promising treatment for anxiety. The aim of this study was to determine the effect of an MBCT program on anxiety symptoms in older people living in residential care. Fifty-two participants (34 females) were randomly allocated into therapy and control groups using a 2 × 3 mixed design. The average age of participants was 83 years. The group effect showed significant improvements on all measures at the end of the seven-week program in the therapy group, while the control group did not show significant changes. This study represents one of the first studies of the effectiveness of an MBCT program on anxiety symptoms for older people using a randomized controlled trial. The study has implications for future research that include the effectiveness of MBCT for the treatment of anxiety symptoms in older people, the utility of group therapy programs in residential care and the benefits of using specialized instruments for older populations.

  9. The efficacy of a multifactorial memory training in older adults living in residential care settings.

    Science.gov (United States)

    Vranić, Andrea; Španić, Ana Marija; Carretti, Barbara; Borella, Erika

    2013-11-01

    Several studies have shown an increase in memory performance after teaching mnemonic techniques to older participants. However, transfer effects to non-trained tasks are generally either very small, or not found. The present study investigates the efficacy of a multifactorial memory training program for older adults living in a residential care center. The program combines teaching of memory strategies with activities based on metacognitive (metamemory) and motivational aspects. Specific training-related gains in the Immediate list recall task (criterion task), as well as transfer effects on measures of short-term memory, long-term memory, working memory, motivational (need for cognition), and metacognitive aspects (subjective measure of one's memory) were examined. Maintenance of training benefits was assessed after seven months. Fifty-one older adults living in a residential care center, with no cognitive impairments, participated in the study. Participants were randomly assigned to two programs: the experimental group attended the training program, while the active control group was involved in a program in which different psychological issues were discussed. A benefit in the criterion task and substantial general transfer effects were found for the trained group, but not for the active control, and they were maintained at the seven months follow-up. Our results suggest that training procedures, which combine teaching of strategies with metacognitive-motivational aspects, can improve cognitive functioning and attitude toward cognitive activities in older adults.

  10. Privacy and senior willingness to adopt smart home information technology in residential care facilities.

    Science.gov (United States)

    Courtney, K L

    2008-01-01

    With large predicted increases of the older adult (65 years and older) population, researchers have been exploring the use of smart home information technologies (IT) in residential care (RC) facilities to enhance resident quality of life and safety. Older adults' perceptions of privacy can inhibit their acceptance and subsequent adoption of smart home IT. This qualitative study, guided by principles of grounded theory research, investigated the relationship between privacy, living environment and willingness of older adults living in residential care facilities to adopt smart home IT through focus groups and individual interviews. The findings from this study indicate that privacy can be a barrier for older adults' adoption of smart home IT; however their own perception of their need for the technology may override their privacy concerns. Privacy concerns, as a barrier to technology adoption, can be influenced by both individual-level and community-level factors. Further exploration of the factors influencing older adults' perceptions of smart home IT need is necessary.

  11. How much do residential aged care staff members know about the nutritional needs of residents?

    Science.gov (United States)

    Beattie, Elizabeth; O'Reilly, Maria; Strange, Elise; Franklin, Sara; Isenring, Elisabeth

    2014-03-01

    Undernutrition, weight loss and dehydration are major clinical issues for people with dementia in residential care, with excessive weight loss contributing to increased risk of frailty, immobility, illness and premature morbidity. This paper discusses a nutritional knowledge and attitudes survey conducted as part of a larger project focused on improving nutritional intake of people with dementia within a residential care facility in Brisbane, Australia. The specific aims of the survey were to identify (i) knowledge of the nutritional needs of aged care facility residents; (ii) mealtime practices; and (iii) attitudes towards mealtime practices and organisation. A survey based on those used in other healthcare settings was completed by 76 staff members. The survey included questions about nutritional knowledge, opinions of the food service, frequency of feeding assistance provided and feeding assessment practices. Nutritional knowledge scores ranged from 1 to 9 of a possible 10, with a mean score of 4.67. While 76% of respondents correctly identified risk factors associated with malnutrition in nursing home residents, only 38% of participants correctly identified the need for increased protein and energy in residents with pressure ulcers, and just 15% exhibited correct knowledge of fluid requirements. Further, while nutritional assessment was considered an important part of practice by 83% of respondents, just 53% indicated that they actually carried out such assessments. Identified barriers to promoting optimal nutrition included insufficient time to observe residents (56%); being unaware of residents' feeding issues (46%); poor knowledge of nutritional assessments (44%); and unappetising appearance of food served (57%). An important step towards improving health and quality of life for residents of aged care facilities would be to enhance staff nutritional awareness and assessment skills. This should be carried out through increased attention to both preservice

  12. The effectiveness of environment assessment tools to guide refurbishment of Australian residential aged care facilities: A systematic review.

    Science.gov (United States)

    Neylon, Samantha; Bulsara, Caroline; Hill, Anne-Marie

    2017-06-01

    To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities. Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen. Forty-three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing. There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited. © 2017 AJA Inc.

  13. Multidimensional Treatment Foster Care: An Alternative to Residential Treatment for High Risk Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Philip A. Fisher

    2012-07-01

    Full Text Available This paper describes the Multidimensional Treatment Foster Care program (MTFC, an evidence based approach for providing psychotherapeutic treatment for very troubled children and adolescents that is an alternative to residential care. Versions of the MTFC program have been developed and validated for young children with a history of maltreatment as well as for older children and adolescents who are involved with the youth justice system. In the paper we describe the development of the MTFC program and its foundations in the social learning model that originated at the Oregon Social Learning Center in the 1960's and 70's. We present information about program elements. We then review the research that has been conducted on MTFC.

  14. Older adults' views and experiences of doll therapy in residential care homes.

    Science.gov (United States)

    Alander, Heidi; Prescott, Tim; James, Ian A

    2015-09-01

    The mechanisms underlying the success of doll therapy are poorly understood. The aims of this study were to explore how people in care, doll users and non-users, make sense of doll use in their settings. A grounded theory approach was used, recruiting participants from three residential care homes involving four male and 12 female residents. Data collection occurred in two phases; five participants took part in a focus group and later 11 participants were interviewed individually. Eight of the 11 participants had dementia, and four participants were actively using dolls. The results are presented as themes, and sub-themes, consisting of four main categories (intrapersonal features, interpersonal features, behavioural benefits, ethical and moderating factors). This thematic analysis shows that residents generally support the use of dolls, believing that dolls can have a positive impact on some users. The mechanisms by which this impact is achieved are discussed together with the ethical concerns. © The Author(s) 2013.

  15. Texture-modified food and fluids in dementia and residential aged care facilities

    Directory of Open Access Journals (Sweden)

    Painter V

    2017-08-01

    Full Text Available Virginia Painter,1 David G Le Couteur,1–3 Louise M Waite1–3 1Aged and Chronic Care Department, Concord Repatriation General Hospital, Concord, NSW, Australia; 2Ageing and Alzheimer’s Institute, Concord Repatriation General Hospital, Concord, NSW, Australia; 3Centre for Education and Research on Ageing, University of Sydney, Concord, NSW, Australia Introduction: Dysphagia is common in people living with dementia and associated with increased risk of aspiration pneumonia, dehydration, malnutrition, and death. Treatment options are limited and the use of texture-modified food and fluids (TMF is a widespread clinical practice. This review aimed to evaluate the evidence for TMF in dementia.Methods: A literature search using terms “dysphagia,” “texture-modified food and fluids,” “dementia,” and “aged care” was performed by using three electronic databases from 1990 to March 2017. Studies were assessed for suitability, then reviewed with data extracted, and grouped by categories of outcome measures.Results: A total of 3,722 publications were identified, and 22 studies met the inclusion criteria. Studies were heterogeneous in design and methodology. There were no publications examining dementia exclusively; however, many subjects with dementia were included in studies of residential aged care facilities. TMF reduced the risk of aspiration seen on videofluoroscopy but not clinical aspiration and pneumonia. TMF was associated with lower daily energy and fluid intake and variable adherence.Conclusion: There is a lack of evidence for people living with dementia and in residential care facilities that TMF improves clinical outcomes such as aspiration pneumonia, nutrition, hydration, morbidity, and mortality. Adverse effects including poorer energy and fluid intake were identified. Keywords: modified diet, dysphagia, aspiration, aged care, nursing homes, dehydration, nutrition

  16. Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data.

    Science.gov (United States)

    Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna

    2018-02-01

    To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  17. Establishing an ISO 10001-based promise in inpatients care.

    Science.gov (United States)

    Khan, Mohammad Ashiqur Rahman; Karapetrovic, Stanislav

    2015-01-01

    The purpose of this paper is to explore ISO 10001:2007 in planning, designing and developing a customer satisfaction promise (CSP) intended for inpatients care. Through meetings and interviews with research participants, who included a program manager, unit managers and registered nurses, information about potential promises and their implementation was obtained and analyzed. A number of promises were drafted and one was finally selected to be developed as a CSP. Applying the standard required adaptation and novel interpretation. Additionally, ISO 10002:2004 (Clause 7) was used to design the feedback handling activities. A promise initially chosen for development turned out to be difficult to implement, experience that helped in selecting and developing the final promise. Research participants found the ISO 10001-based method useful and comprehensible. This paper presents a specific health care example of how to adapt a standard's guideline in establishing customer promises. The authors show how a promise can be used in alleviating an existing issue (i.e. communication between carers and patients). The learning can be beneficial in various health care settings. To the knowledge, this paper shows the first example of applying ISO 10001:2007 in a health care case. A few activities suggested by the standard are further detailed, and a new activity is introduced. The integrated use of ISO 10001:2007 and 10002:2004 is presented and how one can be "augmented" by the other is demonstrated.

  18. An evaluation of the benefits and challenges of video consulting between general practitioners and residential aged care facilities.

    Science.gov (United States)

    Wade, Victoria; Whittaker, Frank; Hamlyn, Jeremy

    2015-12-01

    This research evaluated a project that provided video consultations between general practitioners (GPs) and residential aged care facilities (RACFs), with the aim of enabling faster access to medical care and avoidance of unnecessary hospital transfers. GPs were paid for video consultations at a rate equivalent to existing insurance reimbursement for supporting telehealth services. Evaluation data were gathered by direct observation at the project sites, semi-structured interviews and video call data from the technical network. Three pairs of general practices and RACFs were recruited to the project. 40 video consultations eligible for payment occurred over a 6 month period, three of which were judged to have avoided hospital attendance. The process development and change management aspects of the project required substantially more effort than was anticipated. This was due to problems with RACF technical infrastructure, the need for repeated training and awareness raising in RACFs, the challenge of establishing new clinical procedures, the short length of the project and broader difficulties in the relationships between GPs and RACFs. Video consulting between GPs and RACFs was clinically useful and avoided hospital attendance on a small scale, but further focus on process development is needed to embed this as a routine method of service delivery. © The Author(s) 2015.

  19. Dementia Special Care Units in Residential Care Communities: United States, 2010

    Science.gov (United States)

    ... on Vital and Health Statistics Annual Reports Health Survey Research Methods Conference Reports from the National Medical Care Utilization ... dementia special care units, or in a more traditional setting where these residents are integrated with residents ...

  20. Role of information and communication technology in promoting oral health at residential aged care facilities.

    Science.gov (United States)

    Adebayo, Bola; Durey, Angela; Slack-Smith, Linda M

    2017-07-01

    Information and communication technology (ICT) can provide knowledge and clinical support to those working in residential aged care facilities (RACFs). This paper aims to: (1) review literature on ICT targeted at residents, staff and external providers in RACFs including general practitioners, dental and allied health professionals on improving residents' oral health; (2) identify barriers and enablers to using ICT in promoting oral health at RACFs; and (3) investigate evidence of effectiveness of these approaches in promoting oral health. Findings from this narrative literature review indicate that ICT is not widely used in RACFs, with barriers to usage identified as limited training for staff, difficulties accessing the Internet, limited computer literacy particularly in older staff, cost and competing work demands. Residents also faced barriers including impaired cognitive and psychosocial functioning, limited computer literacy and Internet use. Findings suggest that more education and training in ICT to upskill staff and residents is needed to effectively promote oral health through this medium.

  1. Residents' perceptions and experiences of social interaction and participation in leisure activities in residential aged care.

    Science.gov (United States)

    Thomas, Jessica E; O'Connell, Beverly; Gaskin, Cadeyrn J

    2013-10-01

    Social interaction and participation in leisure activities are positively related to the health and well-being of elderly people. The main focus of this exploratory study was to investigate elderly peoples' perceptions and experiences of social interaction and leisure activities living in a residential aged care (RAC) facility. Six residents were interviewed. Themes emerging from discussions about their social interactions included: importance of family, fostering friendships with fellow residents, placement at dining room tables, multiple communication methods, and minimal social isolation and boredom. Excursions away from the RAC facility were favourite activities. Participants commonly were involved in leisure activities to be socially connected. Poor health, family, the RAC facility, staffing, transportation, and geography influenced their social interaction and participation in leisure activities. The use of new technologies and creative problem solving with staff are ways in which residents could enhance their social lives and remain engaged in leisure activities.

  2. Vitamin B12 Deficiency in Persons with Intellectual Disability in a Vegetarian Residential Care Community

    Directory of Open Access Journals (Sweden)

    Mohammed Morad

    2005-01-01

    Full Text Available The goal of this study was to determine the prevalence of vitamin B12 deficiency among intellectually disabled persons in a vegetarian remedial community in Israel. In this community, 47 individuals with intellectual disability (ID live in 7 enlarged families in a kibbutz style agricultural setting. These 47 individuals and 17 of their caregivers were screened for vitamin B12 deficiency. There were 25.5% of the disabled vs. 11.8% of the caregivers found to have levels of vitamin B12 lower than 157 pg/ml. It is concluded that persons with ID in this vegetarian residential care community seemed to be at a higher risk for vitamin B12 deficiency.

  3. A modification of the token economy for nonresponsive youth in family-style residential care.

    Science.gov (United States)

    Field, Clinton E; Nash, Heather M; Handwerk, Michael L; Friman, Patrick C

    2004-05-01

    Out-of-home treatment for youth with conduct problems is increasing rapidly in this country. Most programs for these youth deliver treatment in a group format and commonly employ some version of a token economy. Despite widespread evidence of effectiveness, a substantial minority of treated youth fail to respond. Participants for this study were 3 youth who were nonresponsive to treatment provided in a family-style residential care program with a comprehensive token economy. Our approach to the "nonresponse" of these youth involved modifications of the frequency and immediacy of their access to the backup rewards earned with tokens. We evaluated the effects of the modifications with a treatment-withdrawal experimental design. Dependent measures included two indices of youth response to treatment: intense behavioral episodes and backup rewards earned. Results showed substantial improvement among these indices during treatment conditions.

  4. Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators.

    Science.gov (United States)

    Vlaeyen, Ellen; Stas, Joke; Leysens, Greet; Van der Elst, Elisa; Janssens, Elise; Dejaeger, Eddy; Dobbels, Fabienne; Milisen, Koen

    2017-05-01

    To identify the barriers and facilitators for fall prevention implementation in residential care facilities. Systematic review. Review registration number on PROSPERO: CRD42013004655. Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles. This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified. We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers. Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills

  5. Dietary supply of selenium for adolescents in three residential care orphanages in Southern Ghana

    International Nuclear Information System (INIS)

    Adotey, Dennis K.; Stibilj, Vekoslava; Serfor-Armah, Yaw; Nyarko, Benjamin J.B.; Jaćimović, Radojko

    2011-01-01

    Adolescents require optimum dietary supply of the essential trace mineral selenium (Se); however the absence of reliable and accurate data on the dietary supply of selenium for the adolescent population in Ghanaian residential care orphanages have made it difficult for public health nutritionists to assess the adequacy of the dietary supply. The dietary supply of selenium for adolescents (12–15 years) in three residential care orphanages, (Osu, Tutu-Akwapim and Teshie), in Southern Ghana have been evaluated by sampling their 24-h duplicate diets (including water) for 7-consecutive days using the duplicate diet sampling technique. The mass fraction of selenium in the blended lyophilized homogenates of duplicate diets was determined by radiochemical neutron activation analysis (RNAA). The validity of the RNAA method for selenium determination was checked by analyses of NIST SRM 1548a (Typical diet). The chemical yield of the radiochemical separation was determined by spectrophotometry. The average mass fractions of selenium in the blended lyophilized 24-hour duplicate diets for Osu, Tutu-Akwapim and Teshie were; 165 ± 61 [117.2–285.2], 203 ± 68 [110.5–304.9] and 250 ± 92 [128.8–408.0] ng Se g −1 lyophilized matter respectively. The average dietary supply of Se were, 57.6 ± 17.3 [42.2–88.4], 82.0 ± 30.7 [44.3–136.2] and 91.7 ± 44.2 [46.0–153.4] μg Se day −1 for Osu, Tutu-Akwapim and Teshie orphanages respectively. The data generated will help public health nutritionists in the provision of dietary advice and nutritional support for the studied orphanages, as well as other orphanages. The data will also help in the planning of institutional diets.

  6. Has the income of the residential area impact on the use of intensive care?

    Science.gov (United States)

    Liisanantti, J H; Käkelä, R; Raatiniemi, L V; Ohtonen, P; Hietanen, S; Ala-Kokko, T I

    2017-08-01

    The socioeconomic factors have an impact on case mix and outcome in critical illness, but how these factors affect the use of intensive care is not studied. The aim of this study was to evaluate the incidence of intensive care unit (ICU) admissions in patients from residential areas with different annual incomes. Single-center, retrospective study in Northern Finland. All the non-trauma-related emergency admissions from the hospital district area were included. The postal codes were used to categorize the residential areas according to each area's annual median income: the low-income area, €18,979 to €28,841 per year; the middle-income area, €28,879 to €33,856 per year; and the high-income area, €34,221 to €53,864 per year. A total of 735 non-trauma-related admissions were included. The unemployment or retirement, psychiatric comorbidities and chronic alcohol abuse were common in this population. The highest incidence, 5.5 (4.6-6.7)/1000/year, was in population aged more than 65 years living in high-income areas. In working-aged population, the incidence was lowest in high-income areas (1.5 (1.3-1.8/1000/year) compared to middle-income areas (2.2 (1.9-2.6)/1000/year, P = 0.001) and low-income areas (2.0 (1.7-2.4)/1000/, P = 0.009). Poisonings were more common in low-income areas. There were no differences in outcome. The incidence of ICU admission in working-aged population was 25% higher in those areas where the annual median income was below the median annual income of €38,775 per inhabitant per year in Finland. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  7. Measuring social climate in Norwegian residential youth care : A revision of the community oriented programs environment scale

    NARCIS (Netherlands)

    Leipoldt, Jonathan David; Rimehaug, Tormod; Harder, A.T.; Kayed, Nanna; Grietens, Hans

    2016-01-01

    Introduction and objectives: Social climate is an understudied factor in residential youth care (RYC) institutions. Already in the 1950’s, the World Health Organization stated that “atmosphere” is an important factor in psychiatric treatment, but a very difficult element to measure. Assessing the

  8. [Childhood Experiences of Adolescents in Boarding Schools. A Comparison with Adolescents in Residential Care and with the General Population].

    Science.gov (United States)

    Rau, Thea; Ohlert, Jeannine; Fegert, Jörg M; Andresen, Sabine; Pohling, Andrea; Allroggen, Marc

    2018-01-01

    Childhood Experiences of Adolescents in Boarding Schools. A Comparison with Adolescents in Residential Care and with the General Population Various studies indicate that students in boarding schools experience a lot of violence during their accommodation. However, it is not proved whether adolescents in boarding schools are also a burdensome group regarding early childhood experiences such as neglect and abuse. The aim of the study was to find out more about the experiences of adolescents in boarding schools and to determine whether there are differences between adolescents in residential care and between the general population. Furthermore, it should be examined whether boys and girls differ in their experiences. In the study, adolescents of boarding schools and of residential care all over Germany, starting at the age of 15 (n = 322), were asked regarding physical and emotional neglect/abuse, light/severe parent violence, negative/positive educational behavior of the parents. The results show that students in boarding schools were less likely to be affected by childhood maltreatment and more likely to have experienced positive parental behavior compared to children in residential care. Compared to the general population, students in boarding schools were more often and more severely affected by parental violence. Moreover, girls had experienced parental violence more often than boys. The results indicate that in boarding schools there is a need for support offers for adolescents with a history of violent experiences and that the risk group should be identified directly at the admission to the school.

  9. The Impact of Child Sexual Abuse on the Education of Boys in Residential Care between 1950 and 1975

    Science.gov (United States)

    Bode, Andrew; Goldman, Juliette D. G.

    2012-01-01

    Children's education may be adversely impacted by external factors during their childhood. For example, learning to learn, critical reflection, experiential learning and self-direction may be permanently impaired. Many children in out-of-home residential care during the last century suffered ongoing child abuse and neglect, including sexual abuse,…

  10. A Long-Term Leisure Program for Individuals with Intellectual Disability in Residential Care Settings: Research to Practice

    Science.gov (United States)

    Fox, Robert A.; Burke, Amie M.; Fung, Michael P.

    2013-01-01

    We studied the effectiveness of an individually-tailored leisure program implemented by direct care staff in a residential program for 28 adults with severe to profound intellectual disability using a multiple baseline design across two homes over a 1.5 year baseline and treatment period followed by another nearly 1.5 year maintenance phase. The…

  11. "It's Different, but It's the Same": Perspectives of Young Adults with Siblings with Intellectual Disabilities in Residential Care

    Science.gov (United States)

    Jacobs, Paula; MacMahon, Ken

    2017-01-01

    Background: Siblings often play significant roles in the lives of people with intellectual disabilities. This study aimed to give voice to young adults whose siblings have an intellectual disability and are in residential care. Materials and Methods: Six participants were interviewed, with interpretative phenomenological analysis methodology…

  12. The environmental design of residential care facilities: A sense of home through the eyes of nursing home residents.

    NARCIS (Netherlands)

    J. van Hoof; B.M Janssen; MD E.J.M. Wouters; C.J.M.L. van Dijck-Heinen

    2014-01-01

    C.J.M.L. van Dijck-Heinen, E.J.M. Wouters, B.M. Janssen, J. van Hoof (2014) The environmental design of residential care facilities: A sense of home through the eyes of nursing home residents. International Journal for Innovative Research in Science & Technology 1(4): 57-69

  13. 25 CFR 20.502 - Can Child Assistance funds be used to place Indian children in residential care facilities?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Can Child Assistance funds be used to place Indian children in residential care facilities? 20.502 Section 20.502 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance How...

  14. Can money buy green? Demographic and socioeconomic predictors of lawn-care expenditures and lawn greenness in urban residential areas

    Science.gov (United States)

    Weiqi Zhou; Austin Troy; J. Morgan Grove; Jennifer C. Jenkins

    2009-01-01

    It is increasingly important to understand how household characteristics influence lawn characteristics, as lawns play an important ecological role in human-dominated landscapes. This article investigates household and neighborhood socioeconomic characteristics as predictors of residential lawn-care expenditures and lawn greenness. The study area is the Gwynns Falls...

  15. The care of Filipino juvenile offenders in residential facilities evaluated using the risk-need-responsivity model

    NARCIS (Netherlands)

    Spruit, A.; Wissink, I.B.; Stams, G.J.J.M.

    According to the risk-need-responsivity model of offender, assessment and rehabilitation treatment should target specific factors that are related to re-offending. This study evaluates the residential care of Filipino juvenile offenders using the risk-need-responsivity model. Risk analyses and

  16. Organizational capacities for 'residential care homes for the elderly' to provide culturally appropriate end-of-life care for Chinese elders and their families.

    Science.gov (United States)

    Kong, Sui-Ting; Fang, Christine Meng-Sang; Lou, Vivian Weiqun

    2017-01-01

    Developing culturally appropriate end-of-life care for Chinese elderly and families is not an endemic challenge for Hong Kong, but that of the Western countries with a noticeable trend of rising Chinese population. The particular development of Hong Kong healthcare system, which is currently the major provider of end-of-life care, makes Hong Kong a fruitful case for understanding the confluence of the West and the East cultures in end-of-life care practices. This study therefore aims at building our best practice to enhance the capacity of residential care homes in providing culturally appropriate end-of-life care. We conducted two phases of research, a questionnaire survey and a qualitative study, which respectively aims at (1) understanding the EoL care service demand and provision in RCHEs, including death facts and perceived barriers and challenges in providing quality end-of-life care in care homes, and (2) identifying the necessary organizational capacities for the 'relational personhood' to be sustained in the process of ageing and dying in residential care homes. Findings shed light on how to empower residential care homes with necessary environmental, structural and cultural-resource-related capacity for providing quality end-of-life care for Chinese elders and their families. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities.

    Science.gov (United States)

    Beer, Christopher; Horner, Barbara; Almeida, Osvaldo P; Scherer, Samuel; Lautenschlager, Nicola T; Bretland, Nick; Flett, Penelope; Schaper, Frank; Flicker, Leon

    2009-08-12

    Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF) staff and General Practitioners (GPs) relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey) and 202 GPs (19% of metropolitan GPs). Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern, communication, knowledge regarding dementia, aspects of

  18. Nurses' experiences providing palliative care to individuals living in rural communities: aspects of the physical residential setting.

    Science.gov (United States)

    Kaasalainen, S; Brazil, K; Williams, A; Wilson, D; Willison, K; Marshall, D; Taniguchi, A; Phillips, C

    2014-01-01

    Efforts are needed to improve palliative care in rural communities, given the unique characteristics and inherent challenges with respect to working within the physical aspects of residential settings. Nurses who work in rural communities play a key role in the delivery of palliative care services. Hence, the purpose of this study was to explore nurses' experiences of providing palliative care in rural communities, with a particular focus on the impact of the physical residential setting. This study was grounded in a qualitative approach utilizing an exploratory descriptive design. Individual telephone interviews were conducted with 21 community nurses. Data were analyzed by thematic content analysis. Nurses described the characteristics of working in a rural community and how it influences their perception of their role, highlighting the strong sense of community that exists but how system changes over the past decade have changed the way they provide care. They also described the key role that they play, which was often termed a 'jack of all trades', but focused on providing emotional, physical, and spiritual care while trying to manage many challenges related to transitioning and working with other healthcare providers. Finally, nurses described how the challenges of working within the physical constraints of a rural residential setting impeded their care provision to clients who are dying in the community, specifically related to the long distances that they travel while dealing with bad weather. These study findings contribute to our understanding of the experiences of nurses working in rural communities in terms of the provision of palliative care and the influence of the physical residential setting that surrounds them. These findings are important since nurses play a major role in caring for community-dwelling clients who are dying, but they are confronted with many obstacles. As such, these results may help inform future decisions about how to best improve

  19. ïSCOPE: Safer care for older persons (in residential environments: A study protocol

    Directory of Open Access Journals (Sweden)

    Barnard Debbie

    2011-07-01

    Full Text Available Abstract Background The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. High resident acuity can result in increased staff workload and decreased quality of work life. Aims Safer Care for Older Persons [in residential] Environments is a two year (2010 to 2012 proof-of-principle pilot study conducted in seven nursing homes in western Canada. The purpose of the study is to evaluate the feasibility of engaging front line staff to use quality improvement methods to integrate best practices into resident care. The goals of the study are to improve the quality of work life for staff, in particular healthcare aides, and to improve residents' quality of life. Methods/design The study has parallel research and quality improvement intervention arms. It includes an education and support intervention for direct caregivers to improve the safety and quality of their care delivery. We hypothesize that this intervention will improve not only the care provided to residents but also the quality of work life for healthcare aides. The study employs tools adapted from the Institute for Healthcare Improvement's Breakthrough Series: Collaborative Model and Canada's Safer Healthcare Now! improvement campaign. Local improvement teams in each nursing home (1 to 2 per facility are led by healthcare aides (non-regulated caregivers and focus on the management of specific areas of resident care. Critical elements of the program include local measurement, virtual and face-to-face learning sessions involving change management, quality improvement methods and clinical expertise, ongoing virtual and in person support, and networking. Discussion There are two sustainability challenges in this study: ongoing staff and leadership engagement, and organizational infrastructure. Addressing these challenges will require strategic planning with input from key stakeholders for sustaining quality improvement

  20. Staff members' perceived training needs regarding sexuality in residential aged care facilities.

    Science.gov (United States)

    Villar, Feliciano; Celdrán, Montserrat; Fabà, Josep; Serrat, Rodrigo

    2017-01-01

    The purpose of the article is to ascertain if staff members of residential aged care facilities (RACF) perceive the need for training regarding residents' sexuality, and what, if any, benefits from the training were perceived, and to compare perceived benefits of training between care assistants and professional/managerial staff. Interviews were conducted with 53 staff members of five different RACF in Spain. Their responses to two semistructured questions were transcribed verbatim and submitted to content analysis. Results show that most interviewees said they lacked training about sexuality and aging. Two potential highlighted benefits of the training are knowledge/attitudinal (countering negative attitudes regarding sexuality) and procedural (developing common protocols and tools to manage situations related to sexuality). Care assistants and professional staff agreed on the need for training, though the former emphasized the procedural impact and the latter the knowledge/attitudinal benefits. The results suggest that RACF staff should have an opportunity to receive training on residents' sexuality, as sexual interest and behavior is a key dimension of residents' lives.

  1. Education and process change to improve skin health in a residential aged care facility.

    Science.gov (United States)

    Price, Kay; Kennedy, Kate J; Rando, Tabatha L; Dyer, Anthony R; Boylan, Jo

    2017-12-01

    We report on an intervention and evaluation in relation to changes in staff knowledge, time spent on healing and wound prevention and proportion of wounds in the facilities before and after. A rapid review of recent peer-reviewed literature (2006-2016) found 14 education-based intervention articles and provided the background and context for this intervention. A cohort of 164 nurses and personal care workers and 261 residents at two aged care-approved facilities contributed to this intervention on the effect of education, mentoring and practice change on staff knowledge and wound prevalence between 2015 and 2016. There was a significant decrease in pressure injury prevalence and an increase in the early identification of potential wounds between phase 1 and 3 across the two facilities. Overall, registered nurses and enrolled nurses showed significant increase in mean knowledge scores. There was a reorganisation of time spent on various wound care and prevention strategies that better represented education and knowledge. Wound management or prevention education alone is not enough; this study, using an educational intervention in conjunction with resident engagement, practice change, mentorship, onsite champions for healthy skin and product choice suggestions, supported by an organisation that focuses on a healthy ageing approach, showed improvement across two residential sites. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  2. Economic evaluation of pharmacist-led medication reviews in residential aged care facilities.

    Science.gov (United States)

    Hasan, Syed Shahzad; Thiruchelvam, Kaeshaelya; Kow, Chia Siang; Ghori, Muhammad Usman; Babar, Zaheer-Ud-Din

    2017-10-01

    Medication reviews is a widely accepted approach known to have a substantial impact on patients' pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities.

  3. Learning to deal constructively with troubled conscience related to care providers' perceptions of deficient teamwork in residential care of older people--a participatory action research study.

    Science.gov (United States)

    Ericson-Lidman, Eva; Strandberg, Gunilla

    2015-06-01

    Conscience can be perceived as an asset that helps care providers to provide good care, but it can also be a burden that generates stress of conscience (stress related to a troubled conscience). Participatory action research (PAR) has been shown to be successful in supporting care providers in residential care of older people to learn to deal with their troubled conscience in challenging and demanding care situations. The aim of the study was to describe an intervention process to assist care providers in residential care of older people to constructively deal with their troubled conscience related to perceptions of deficient teamwork. The study design was grounded in PAR. Nine enrolled nurses (ENs), two nursing aids (NAs), one Registered Nurse (RN) and their manager participated in 12 PAR sessions. All sessions were tape-recorded, and a domain analysis of the transcriptions was performed. Findings show that a PAR-based intervention can support care providers to understand, handle and take measures against deficient teamwork. Using troubled conscience as a driving force can increase the opportunities to improve quality of care in residential care for older people. During the PAR process, participants raised their awareness of the need to view the team in a wider sense and that the manager and the Registered Nurse should also be members of the team to improve team outcome. To improve clinical practice, we suggest that teams in residential care of older people should be enabled to share and reflect on challenging situations that generate troubled conscience. However, as shown in this study, care providers might need support in order to facilitate and promote sharing and reflecting on what their conscience tells them. © 2014 Nordic College of Caring Science.

  4. Disability, residential environment and social participation: factors influencing daily mobility of persons living in residential care facilities in two regions of France.

    Science.gov (United States)

    Rapegno, Noémie; Ravaud, Jean-François

    2017-09-29

    Despite the context of individualization of public policies and promotion of independent living, residential care facilities (RCFs) (called "établissements medico-sociaux" in France) still represent the main system used by disabled people. Through a study of their daily mobility, this article proposes a geographical approach to the examination of factors influencing the social participation of disabled persons with motor impairments who live in residential care facilities. The data were collected in three stages from several sources. We first carried out 24 semi-directive interviews among supervisory staff in all the institutions in two regions of France (Greater Paris and Upper Normandy) to better understand the nature of services offered by medico-social facilities. We next did field work in greater detail in 10 of these institutions. We selected residents by random sampling. These first stages then allowed us to study the mobility of residents and record their perceptions. We conducted participant observation and interviews with 81 disabled residents within the 10 RCF. Data analysis enabled consideration not only of the role of the residential environment in people's daily mobility, but the role of the institutions as well. We identified three typical profiles of mobility practices depending on the facilities: "the islanders", living in isolated facilities far from public transportation, or in so-called "difficult" neighborhoods; people who alternate individual and group mobility in a more or less large area; and "the navigators" who have high mobility over a very large area, often living in facilities located in urban areas. The study also enabled an analysis of the obstacles and facilitators inside and outside the residential facilities. These place restrictions on social participation by disabled adults. However, possibilities for individual negotiation may enable bypassing some obstacles. The three ideal-type profiles of mobility analyzed constitute

  5. Job Satisfaction among Care Aides in Residential Long-Term Care: A Systematic Review of Contributing Factors, Both Individual and Organizational

    Science.gov (United States)

    Squires, Janet E.; Hoben, Matthias; Linklater, Stefanie; Carleton, Heather L.; Graham, Nicole; Estabrooks, Carole A.

    2015-01-01

    Despite an increasing literature on professional nurses' job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational) are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care. PMID:26345545

  6. Job Satisfaction among Care Aides in Residential Long-Term Care: A Systematic Review of Contributing Factors, Both Individual and Organizational.

    Science.gov (United States)

    Squires, Janet E; Hoben, Matthias; Linklater, Stefanie; Carleton, Heather L; Graham, Nicole; Estabrooks, Carole A

    2015-01-01

    Despite an increasing literature on professional nurses' job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational) are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care.

  7. Job Satisfaction among Care Aides in Residential Long-Term Care: A Systematic Review of Contributing Factors, Both Individual and Organizational

    Directory of Open Access Journals (Sweden)

    Janet E. Squires

    2015-01-01

    Full Text Available Despite an increasing literature on professional nurses’ job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care.

  8. Mental and physical performance of dementia patients in long-term residential care

    Directory of Open Access Journals (Sweden)

    Zbigniew Śliwiński

    2013-10-01

    Full Text Available Introduction: Dementia syndromes are an increasing medical and social problem in today’s world. Preservation of the best possible quality of life in dementia patients relies on prolonging their independence in daily life for as long as possible. Dementia patients require increasing support as the disease progresses and will ultimately become dependent on the help of others. Aim of the research: To assess the level of mental and physical performance and nutritional status in patients with dementia syndromes in long-term residential care. Material and methods : The study group comprised 62 patients with dementia syndromes resident in a Medical and Nursing Care Facility in Pustków. Selected aspects of quality of life were investigated with the Barthel scale, GDS scale according to Reissberg, Abbreviated Mental Test Score (AMTS and Mini-Nutritional Assessment (MNA scale. Results: In our study men performed better than women on the Barthel scale, 58% of all patients were rated moderately severe on that scale, 36% were severe and 7% were mild. Assessment of the current severity of dementia on the GDS scale showed that 28% of the patients had very severe dementia, 27% had mild deficits, 27% had moderate deficits, 11% had moderately severe dementia and 6% had borderline dementia. In a mental state assessment according to the AMTS scale, men scored higher than women. This difference indicates less memory deficit and better psychological and physical status among men. With regard to nutritional status, our study revealed a risk of malnutrition in 65% of the patient and actual malnutrition in 7%. Conclusions : The Barthel scale, rating the performance of dementia patients with regard to activities of daily life, classified more than half of the patients as „moderately severe”. Women had lower mean scores than men in the Barthel scale, AMTS scale and GDS scale, indicating that dementia is more prevalent among women than among men. The findings of the

  9. Residential aged care in Auckland, New Zealand 1988-2008: do real trends over time match predictions?

    Science.gov (United States)

    Broad, Joanna B; Boyd, Michal; Kerse, Ngaire; Whitehead, Noeline; Chelimo, Carol; Lay-Yee, Roy; von Randow, Martin; Foster, Susan; Connolly, Martin J

    2011-07-01

    in Auckland, New Zealand in 1988, 7.7% of those aged over 65 years lived in licenced residential aged care. Age-specific rates approximately doubled for each 5-year age group after the age of 65 years. Even with changes in policies and market forces since 1988, population increases are forecast to drive large growth in demand. This study shows previously unrecognised 20-year trends in rates of care in a geographically defined population. four cross-sectional surveys of all facilities (rest homes and hospitals) licenced for long-term care of older people were conducted in Auckland, New Zealand in 1988, 1993, 1998 and 2008. Facility staff completed survey forms for each resident. Numbers of licenced and occupied beds and trends in age-specific and age-standardised rates in residential aged care are reported. over the 20-year period, Auckland's population aged over 65 years increased by 43% (from 91,000 to 130,000) but actual numbers in care reduced slightly. Among those aged over 65 years, the proportion living in care facilities reduced from 1 in 13 to 1 in 18. Age-standardised rates in rest-home level care reduced from 65 to 33 per thousand, and in hospital level care, from 29 to 23 per thousand. Had rates remained stable, over 13,200 people, 74% more than observed, would have been in care in 2008. growth predicted in the residential aged care sector is not yet evident. The introduction of standardised needs assessments before entry, increased availability of home-based services, and growth in retirement villages may have led to reduced utilisation.

  10. Unintended adverse consequences of introducing electronic health records in residential aged care homes.

    Science.gov (United States)

    Yu, Ping; Zhang, Yiting; Gong, Yang; Zhang, Jiajie

    2013-09-01

    The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences. A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals. Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members. Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation

  11. Stories of change: the text analysis of handovers in an Italian psychiatric residential care home.

    Science.gov (United States)

    Accordini, M; Saita, E; Irtelli, F; Buratti, M; Savuto, G

    2017-05-01

    WHAT IS KNOWN ON THE SUBJECT?: There is a growing emphasis on communication as a result of the move towards the more inclusive approach associated with the community-based rehabilitation model. Therefore, more importance is attached to handovers. Besides ensuring transfer of information, handovers enhance group cohesion, socialize staff members to the practices of the service and capture its organizational culture. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: While handovers are mainly used for information transfer and to manage the services' daily routine, this paper offers an insight on how handovers can be conceived as valuable instruments to document cultural and organizational change. Only a limited amount of studies has focused on handovers in mental healthcare settings, and most of them only consider the perspectives of psychiatric nurses, while embracing a broader perspective, this paper provides valuable insights into the perspectives of various service providers. The overcoming of the dichotomy deficit-based vs. recovery-oriented model is possible if professionals use handovers to reflect upon their practice and the ways in which their cultural models are affected by the environmental context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Handovers are valuable instruments to document organizational change. It would be important for psychiatric and rehabilitation facilities to keep track of the handover records over time as they may provide insightful information about cultural change and the transformations in the core values and beliefs held by professionals. Handovers assure a timely and correct information transfer while socializing workers to the service's culture; however, no study describes them as instruments to document organizational change and only a few have focused on psychiatric settings. Aim To investigate the change in the culture of an Italian psychiatric residential care home as perceived by its mental health workers (MHWs) over the course of

  12. Evaluation of a hybrid paper-electronic medication management system at a residential aged care facility.

    Science.gov (United States)

    Elliott, Rohan A; Lee, Cik Yin; Hussainy, Safeera Y

    2016-06-01

    Objectives The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18min to 98h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers' orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care

  13. Residential Waste

    DEFF Research Database (Denmark)

    Christensen, Thomas Højlund; Fruergaard, Thilde; Matsufuji, Y.

    2011-01-01

    are discussed in this chapter. Characterizing residential waste is faced with the problem that many residences already divert some waste away from the official collection systems, for example performing home composting of vegetable waste and garden waste, having their bundled newspaper picked up by the scouts...... twice a year or bringing their used furniture to the flea markets organized by charity clubs. Thus, much of the data available on residential waste represents collected waste and not necessarily all generated waste. The latter can only be characterized by careful studies directly at the source......, but such studies are very expensive if fair representation of both spatial and temporal variations should be obtained. In addition, onsite studies may affect the waste generation in the residence because of the increased focus on the issue. Residential waste is defined in different ways in different countries...

  14. Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

    Directory of Open Access Journals (Sweden)

    Tariq Amina

    2012-11-01

    Full Text Available Abstract Background Medication incident reporting (MIR is a key safety critical care process in residential aged care facilities (RACFs. Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a design MIR artefacts that facilitate identification of the root causes of medication incidents, b integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

  15. Death wishes among older people assessed for home support and long-term aged residential care.

    Science.gov (United States)

    Cheung, Gary; Edwards, Siobhan; Sundram, Frederick

    2017-12-01

    Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long-term aged residential care. Data were collected from 35 734 people aged over 65 during 2012-2014. Chi-squared analyses were used to determine significant relationships between the presence of death wishes and demographic factors, health and functional status, and emotional and psychosocial well-being. A three-step hierarchical logistic regression model was used to determine the predictive variables of death wishes, and odds ratios were calculated. Death wishes were present in 9.5% of the sample. The following factors were significantly associated with death wishes: physical health (poor self-reported health, recurrent falls, severe fatigue and inadequate pain control), psychological factors (depression, major stressors and anxiety), social factors (loneliness and decline in social activities) and impaired cognition. Depression (odds ratio = 2.54, 95% confidence interval = 2.29-2.81), loneliness (odds ratio = 2.40, 95% confidence interval = 2.20-2.63) and poor self-reported health (odds ratio = 2.34, 95% confidence interval = 1.78-3.07) had the greatest odds ratios in the full model. Clinically significant depression alone cannot fully account for the development of death wishes in the elderly, and several factors are independently associated with death wishes. This knowledge can help clinicians caring for older persons to identify people who are most at risk of developing death wishes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

    Science.gov (United States)

    2012-01-01

    Background Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes. PMID:23122411

  17. Adolescents' reports of physical violence by peers in residential care settings: an ecological examination.

    Science.gov (United States)

    Khoury-Kassabri, Mona; Attar-Schwartz, Shalhevet

    2014-03-01

    Physical victimization by peers was examined among 1,324 Jewish and Arab adolescents, aged 11 to 19, residing in 32 residential care settings (RCS) for children at-risk in Israel. Hierarchical Linear Modeling (HLM) was used to examine the relationships between physical victimization and adolescents' characteristics (age, gender, self-efficacy, adjustment difficulties, maltreatment by staff, and perceived social climate) as well as institution-level characteristics (care setting type, size, structure, and ethnic affiliation). For this study, we define physical violence as being grabbed, shoved, kicked, punched, hit with a hand, or hit with an object. Over 50% (56%) of the adolescents surveyed reported having experienced at least one form of physical violence by peers. Boys and younger adolescents were more likely to be victimized than girls and older adolescents. The results show that adolescents with adjustment difficulties or low social self-efficacy, and adolescents who perceive an institution's staff as strict and/or had experienced maltreatment by staff, are vulnerable groups for peer victimization. Lower levels of victimization were found in RCS with a familial element than in traditional group settings. Institutions with high concentrations of young people with adjustment difficulties and violent staff behaviors had higher levels of violence among residents. Applying an ecological perspective to an investigation of peer victimization in RCS enables the identification of risk factors at adolescent and institution levels. This type of examination has implications for child welfare practice and policy that can help in the development of prevention and intervention methods designed to tackle the involvement in violence of youth in care.

  18. The prevention and management of constipation in older adults in a residential aged care facility.

    Science.gov (United States)

    Grieve, Jennifer

    2006-03-01

    The need to implement programs for developing leadership and practice improvement skills using an evidence-based practice approach to practice change is becoming more apparent in the health and aged care services. This is no more apparent than in high care residential health and aged care services, where health professionals are increasingly required to provide care for older people with multifocal and complex healthcare needs. This paper describes one of the projects undertaken as part of the Joanna Briggs Institute Commonwealth Department of Health and Ageing Clinical Aged Care Fellowship program from February 2005 to June 2005. This purpose of this particular project was twofold. First it sought to improve the local practice in the prevention and management of constipation and that this practice was performed according to the best available evidence. Second to use the Joanna Briggs Institute Practical Application of Clinical Guidance (PACES) program to implement a process of audit and feedback as a strategy to improve practice. The project was designed to link in with the facility's existing quality improvement program and better practice continence management project. The project was conducted over 6 months and was divided into six stages involving the identification of evidence-based standards of care, an initial audit to determine appropriate sample size, a clinical audit across the facility, planning of the implementation process, implementation of the action plan and re-audit to assess practice change. Overall, the results were extremely positive and demonstrated a real improvement in practice relating to constipation in the project facility. This success, however, needs to be seen in the context of the benefits of having the support of senior management, an existing quality improvement and continence management better practice project, and a culture of clinical review. Although there will always be more work to be done, the success of this project can be

  19. Evidence for the Treatment of Osteoporosis with Vitamin D in Residential Care and in the Community Dwelling Elderly

    Directory of Open Access Journals (Sweden)

    John A. A. Geddes

    2013-01-01

    Full Text Available Introduction. Vitamin D is common treatment for osteoporosis. Both age >70 years and living in residential care are associated with increased fracture risk. Community dwelling elderly are a heterogeneous group who may have more similatiry with residential care groups than younger community dwelling counterparts. Aims. To review the evidence for cholecalciferol or ergocalciferol tretment of osteoporosis in either community dwelling patients aged ≥70 years of age, or redidential care patients. Secondly endpoints were changes in bone mineral denisty, and in bone turnover markers. Methods. We performed a literature search using search terms for osteoporosis and vitamin D. Treatment for at least one year was required. Results. Only one residential care study using cholecalciferol, showed non-vertebral and hip fracture reduction in vitamin D deficient subjects. In the community setting one quasi randomised study using ergocalciferol showed reduction in total but not hip or non-vertebral fracture, and a second randomised study showed increased hip fracture risk. Three studies reported increases in hip bone mineral denisty. Discussion. A minority of studies demonstrated a fracture benefit form vitamin D and one suggested possible harm in a community setting. Current practice should be to only offer this treatment to subjects identified as deficient.

  20. [A pilot study on pain assessment among elderly with severe dementiain residential aged care facilities of Reggio Emilia district].

    Science.gov (United States)

    Bargellini, Annalisa; Mastrangelo, Stefano; Cervi, Monica; Bagnasco, Michele; Reghizzi, Jlenia; Coriani, Sandra

    2017-01-01

    . A pilot study on pain assessment among elderly with severe dementia in residential aged care facilities of Reggio Emilia district. Despite the availability of pain assessment tools and best practice recommendations for the assessment and management of pain in people with severe dementia, pain in residential aged care facilities is still undetected or misinterpreted. To assess pain prevalence and analgesic load medication in people with severe cognitive impairment admitted to residential aged care facilities of Reggio Emilia (Italy) province. A pilot cross-sectional study was conducted on 84 elderly patients affected by severe dementia and resident in aged care facilities. Pain was assessed with the PAINAD observational scale, both at rest and during routine procedures: positioning in bed, from bed to standing position, from bed to chair or during the medication of a pressure sore (under challenge). 33.4% of patients had pain at rest, mainly mild, and 86.9 % under challenge. During routine interventions, in 64 patients (76.2%) pain increased compared to at rest condition (for 39, 2/3, moderate-severe); although 46 of them were prescribed as-required analgesic medication, none had received the drug. Also patients with analgesics on regular basis experienced more pain during routine procedures. Many patients experienced pain during routine procedures. The regular use of pain assessment tools and adequate training of all healthcare professionals are essential requirements for an effective pain control.

  1. How to help depressed older people living in residential care: a multifaceted shared-care intervention for late-life depression.

    Science.gov (United States)

    Llewellyn-Jones, R H; Baikie, K A; Castell, S; Andrews, C L; Baikie, A; Pond, C D; Willcock, S M; Snowdon, J; Tennant, C C

    2001-12-01

    To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents whowere eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. INTERVENTION DESCRIPTION: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) training for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed residents are substantial.

  2. Promoting psychosocial adaptation of youths in residential care through animal-assisted psychotherapy.

    Science.gov (United States)

    Balluerka, Nekane; Muela, Alexander; Amiano, Nora; Caldentey, Miguel A

    2015-12-01

    The goal of this study was to examine the influence of animal-assisted psychotherapy (AAP) on the psychosocial adaptation of a group of adolescents in residential care who had suffered traumatic childhood experiences and who presented with mental health problems. This study recruited 63 youths (mean age=15.27, SD=1.63) who were divided into two groups: a treatment group of 39 youths (19 female and 20 male; mean age=15.03, SD=0.51) and a control group of 24 (five female and 19 male; mean age=15.67, SD=1.63). The youths who underwent the AAP program had higher school adjustment in comparison to their peers who did not receive treatment. Their hyperactive behavior decreased, and they showed better social skills, more leadership, and fewer attention problems. They also showed a more positive attitude toward their teachers in comparison to controls. No differences were observed in other variables associated with clinical symptoms or personal adjustment. These results suggest that AAP can be effective with teenagers who have suffered childhood traumas and who present with problems of psychosocial adaptation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention

    Science.gov (United States)

    Duque, Gustavo; Lord, Stephen R.; Mak, Jenson; Ganda, Kirtan; Close, Jacqueline J.T.; Ebeling, Peter; Papaioannou, Alexandra; Inderjeeth, Charles A.

    2016-01-01

    Background Older people living in residential aged care facilities (RACFs) are at a higher risk of suffering fractures than the community-dwelling older population. The first Consensus Conference on Treatment of Osteoporosis in RACFs in Australia, held in Sydney in July 2009, aimed to address some of the issues relating to the treatment of older residents with osteoporosis in RACFs. Considering that the field of osteoporosis diagnosis and management has significantly advanced in the last 5 years and that new evidence has been generated from studies performed within RACFs, a Second Consensus Conference was held in Sydney in November 2014. Methods An expert panel met in November 2014 in Penrith, NSW, Australia in an attempt to reach a consensus on diverse issues related to the treatment of osteoporosis at RACFs. Participants were selected by the scientific committee on the basis of their practice in an RACF and/or major published articles. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short, evidence-based presentation, when possible. Results This article provides an update on the most relevant evidence on osteoporosis in older people living in RACFs graded according to its level, quality, and relevance. Conclusion As with the first consensus, it is hoped that this statement will constitute an important guide to aid physicians in their decision making while practicing at RACFs. PMID:27349626

  4. Professionals' perspectives towards health promotion in residential aged care: an explorative study in Austria.

    Science.gov (United States)

    Marent, Benjamin; Wieczorek, Christina C; Krajic, Karl

    2018-04-01

    Following the trend in most developed countries, in Austria the oldest old are the fastest growing population group. Among this group, there is a high prevalence of multimorbidity, functional impairment, dementia and psychiatric conditions. While health promotion (HP) has been considered relevant in coping with the challenges of an aging population, it has so far been viewed as a foreign concept in relation to the oldest old, especially those living in residential aged care (RAC) facilities. Although there is an acknowledgement that HP should be integrated into routine nursing, there has been little research on how professionals working with RAC interpret and implement HP. In this study, 13 semi-structured interviews were carried out with professionals from four major Austrian RAC providers. The data were analysed using thematic analysis. The findings show that, typically, professionals understand HP as a concept that is oriented towards maintaining potentials and resources, thereby promoting self-determination, autonomy and social integration, including frail and functionally impaired elderly residents. However, data analysis also revealed a gap between the conceptual understanding and positive attitudes towards HP and its implementation in practice. Implementation of HP seems to occur in isolated cases, related to specific health issues. It seems that more complex HP approaches, especially the 'settings approach', are hardly practiced. To implement more comprehensive and systematic HP in Austrian RAC, support from external HP agencies as well as changes in financial incentives are needed.

  5. Participatory arts programs in residential dementia care: Playing with language differences.

    Science.gov (United States)

    Swinnen, Aagje; de Medeiros, Kate

    2017-01-01

    This article examines connections between language, identity, and cultural difference in the context of participatory arts in residential dementia care. Specifically, it looks at how language differences become instruments for the language play that characterizes the participatory arts programs, TimeSlips and the Alzheimer's Poetry Project. These are two approaches that are predominantly spoken-word driven. Although people living with dementia experience cognitive decline that affects language, they are linguistic agents capable of participating in ongoing negotiation processes of connection, belonging, and in- and exclusion through language use. The analysis of two ethnographic vignettes, based on extensive fieldwork in the closed wards of two Dutch nursing homes, illustrates how TimeSlips and the Alzheimer's Poetry Project support them in this agency. The theoretical framework of the analysis consists of literature on the linguistic agency of people living with dementia, the notions of the homo ludens (or man the player) and ludic language, as well as linguistic strategies of belonging in relation to place.

  6. Influence of aromatherapy on medication administration to residential-care residents with dementia and behavioral challenges.

    Science.gov (United States)

    Gray, Suzanne G; Clair, Alicia Ann

    2002-01-01

    Thirteen older persons (seven men and six women) in residential care participated as subjects in this study. All participants had histories of confusion due to dementia and were identified by staff as being consistently resistant to medication administration as indicated by vocal outbursts, moving away, or physical combativeness. Subjects were exposed to four aroma interventions during medication administration: 1) lavender vera (lavendula officinalis); 2) sweet orange (citrus aurantium); 3) tea tree (malaleuca alternifolia); and 4) no aroma (control). All medication administrations were videotaped for later data collection. Observers were trained to record frequency and duration of resistive behaviors during medication administration in allfour interventions for each subject. Reliability between two observers was extremely high. Results showed no statistically significant differences across all aroma conditions for either resistive behavior or duration of administration. Also, there were no statistically significant differences based on gender. This study indicates that aromatherapy does not reduce combative, resistive behaviors in individuals with dementia. Research with a larger sample in future studies may yield other results.

  7. Perceptions of conscience, stress of conscience and burnout among nursing staff in residential elder care.

    Science.gov (United States)

    Juthberg, Christina; Eriksson, Sture; Norberg, Astrid; Sundin, Karin

    2010-08-01

    This paper is a report of a study of patterns of perceptions of conscience, stress of conscience and burnout in relation to occupational belonging among Registered Nurses and nursing assistants in municipal residential care of older people. Stress and burnout among healthcare personnel and experiences of ethical difficulties are associated with troubled conscience. In elder care the experience of a troubled conscience seems to be connected to occupational role, but little is known about how Registered Nurses and nursing assistants perceive their conscience, stress of conscience and burnout. Results of previous analyses of data collected in 2003, where 50 Registered Nurses and 96 nursing assistants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire and Maslach Burnout Inventory, led to a request for further analysis. In this study Partial Least Square Regression was used to detect statistical predictive patterns. Perceptions of conscience and stress of conscience explained 41.9% of the variance in occupational belonging. A statistical predictive pattern for Registered Nurses was stress of conscience in relation to falling short of expectations and demands and to perception of conscience as demanding sensitivity. A statistical predictive pattern for nursing assistants was perceptions that conscience is an authority and an asset in their work. Burnout did not contribute to the explained variance in occupational belonging. Both occupational groups viewed conscience as an asset and not a burden. Registered Nurses seemed to exhibit sensitivity to expectations and demands and nursing assistants used their conscience as a source of guidance in their work. Structured group supervision with personnel from different occupations is needed so that staff can gain better understanding about their own occupational situation as well as the situation of other occupational groups.

  8. Assessing the homogenization of urban land management with an application to US residential lawn care

    Science.gov (United States)

    Polsky, Colin; Grove, J. Morgan; Knudson, Chris; Groffman, Peter M.; Bettez, Neil; Cavender-Bares, Jeannine; Hall, Sharon J.; Heffernan, James B.; Hobbie, Sarah E.; Larson, Kelli L.; Morse, Jennifer L.; Neill, Christopher; Nelson, Kristen C.; Ogden, Laura A.; O’Neil-Dunne, Jarlath; Pataki, Diane E.; Roy Chowdhury, Rinku; Steele, Meredith K.

    2014-01-01

    Changes in land use, land cover, and land management present some of the greatest potential global environmental challenges of the 21st century. Urbanization, one of the principal drivers of these transformations, is commonly thought to be generating land changes that are increasingly similar. An implication of this multiscale homogenization hypothesis is that the ecosystem structure and function and human behaviors associated with urbanization should be more similar in certain kinds of urbanized locations across biogeophysical gradients than across urbanization gradients in places with similar biogeophysical characteristics. This paper introduces an analytical framework for testing this hypothesis, and applies the framework to the case of residential lawn care. This set of land management behaviors are often assumed—not demonstrated—to exhibit homogeneity. Multivariate analyses are conducted on telephone survey responses from a geographically stratified random sample of homeowners (n = 9,480), equally distributed across six US metropolitan areas. Two behaviors are examined: lawn fertilizing and irrigating. Limited support for strong homogenization is found at two scales (i.e., multi- and single-city; 2 of 36 cases), but significant support is found for homogenization at only one scale (22 cases) or at neither scale (12 cases). These results suggest that US lawn care behaviors are more differentiated in practice than in theory. Thus, even if the biophysical outcomes of urbanization are homogenizing, managing the associated sustainability implications may require a multiscale, differentiated approach because the underlying social practices appear relatively varied. The analytical approach introduced here should also be productive for other facets of urban-ecological homogenization. PMID:24616515

  9. Modelling the cost-effectiveness of impact-absorbing flooring in Swedish residential care facilities.

    Science.gov (United States)

    Ryen, Linda; Svensson, Mikael

    2016-06-01

    Fall-related injuries among the elderly, specifically hip fractures, cause significant morbidity and mortality as well as imposing a substantial financial cost on the health care system. Impact-absorbing flooring has been advocated as an effective method for preventing hip fractures resulting from falls. This study identifies the cost-effectiveness of impact-absorbing flooring compared to standard flooring in residential care facilities for the elderly in a Swedish setting. An incremental cost-effectiveness analysis was performed comparing impact-absorbing flooring to standard flooring using a Markov decision model. A societal perspective was adopted and incremental costs were compared to incremental gains in quality-adjusted life years (QALYs). Data on costs, probability transitions and health-related quality of life measures were retrieved from the published literature and from Swedish register data. Probabilistic sensitivity analysis was performed through a Monte Carlo simulation. The base-case analysis indicates that the impact-absorbing flooring reduces costs and increases QALYs. When allowing for uncertainty we find that 60% of the simulations indicate that impact-absorbing flooring is cost-saving compared to standard flooring and an additional 20% that it has a cost per QALY below a commonly used threshold value : Using a modelling approach, we find that impact-absorbing flooring is a dominant strategy at the societal level considering that it can save resources and improve health in a vulnerable population. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  10. Medication errors in residential aged care facilities: a distributed cognition analysis of the information exchange process.

    Science.gov (United States)

    Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna

    2013-05-01

    Medication safety is a pressing concern for residential aged care facilities (RACFs). Retrospective studies in RACF settings identify inadequate communication between RACFs, doctors, hospitals and community pharmacies as the major cause of medication errors. Existing literature offers limited insight about the gaps in the existing information exchange process that may lead to medication errors. The aim of this research was to explicate the cognitive distribution that underlies RACF medication ordering and delivery to identify gaps in medication-related information exchange which lead to medication errors in RACFs. The study was undertaken in three RACFs in Sydney, Australia. Data were generated through ethnographic field work over a period of five months (May-September 2011). Triangulated analysis of data primarily focused on examining the transformation and exchange of information between different media across the process. The findings of this study highlight the extensive scope and intense nature of information exchange in RACF medication ordering and delivery. Rather than attributing error to individual care providers, the explication of distributed cognition processes enabled the identification of gaps in three information exchange dimensions which potentially contribute to the occurrence of medication errors namely: (1) design of medication charts which complicates order processing and record keeping (2) lack of coordination mechanisms between participants which results in misalignment of local practices (3) reliance on restricted communication bandwidth channels mainly telephone and fax which complicates the information processing requirements. The study demonstrates how the identification of these gaps enhances understanding of medication errors in RACFs. Application of the theoretical lens of distributed cognition can assist in enhancing our understanding of medication errors in RACFs through identification of gaps in information exchange. Understanding

  11. How to enhance route learning and visuo-spatial working memory in aging: a training for residential care home residents.

    Science.gov (United States)

    Mitolo, Micaela; Borella, Erika; Meneghetti, Chiara; Carbone, Elena; Pazzaglia, Francesca

    2017-05-01

    This study aimed to assess the efficacy of a route-learning training in a group of older adults living in a residential care home. We verified the presence of training-specific effects in tasks similar to those trained - route-learning tasks - as well as transfer effects on related cognitive processes - visuo-spatial short-term memory (VSSTM; Corsi Blocks Test (CBT), forward version), visuo-spatial working memory (VSWM; CBT, backward version; Pathway Span Tasks; Jigsaw Puzzle Test) - and in self-report measures. The maintenance of training benefits was examined after 3 months. Thirty 70-90-year-old residential care home residents were randomly assigned to the route-learning training group or to an active control group (involved in non-visuo-spatial activities). The trained group performed better than the control group in the route-learning tasks, retaining this benefit 3 months later. Immediate transfer effects were also seen in visuo-spatial span tasks (i.e., CBT forward and backward version and Pathway Span Task); these benefits had been substantially maintained at the 3-month follow-up. These findings suggest that a training on route learning is a promising approach to sustain older adults' environmental learning and some related abilities (e.g., VSSTM and VSWM), even in residential care home residents.

  12. Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities

    Directory of Open Access Journals (Sweden)

    Scherer Samuel

    2009-08-01

    Full Text Available Abstract Background Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF staff and General Practitioners (GPs relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. Methods A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey and 202 GPs (19% of metropolitan GPs. Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Results Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern

  13. Models for predicting turnover of residential aged care nurses: a structural equation modelling analysis of secondary data.

    Science.gov (United States)

    Gao, Fengsong; Newcombe, Peter; Tilse, Cheryl; Wilson, Jill; Tuckett, Anthony

    2014-09-01

    Nurse turnover in the residential aged care industry is a pressing issue. Researchers have shown ongoing interest in exploring how the factors that are amendable to change in aged care policy, regulation and funding and in organizational procedures (e.g. job demands, coping resources and psychological health of nurses) impact on turnover. However, the findings are mixed. This study tested two theoretical models of turnover to examine the structural relationships among job demands, coping resources, psychological health and turnover of residential aged care nurses. Although many previous studies operationalized turnover as intention to leave, the present study investigated actual turnover by following up with the same individuals over time, and thus provided more accurate predictive models of turnover behaviour. The sample, 239 Australian residential aged care nurses, came from the Nurses and Midwives e-cohort Study. Job demands, coping resources, and psychological health were measured using standardized instruments. Structural equation modelling was used to test the measurement and structural models. Controlling for a number of workforce and individual characteristics, coping resources (measured by job control, supervisor support, and co-worker support) were negatively and directly associated with turnover. Additionally, the findings supported the Job Demand-Control-Support model in that higher coping resources and lower job demands (indicated by psychological demands, physical demands, and effort) were related to better psychological health (measured by vitality, social functioning, role emotional, and mental health), and higher job demands were related to lower coping resources. Findings suggest that aged care policy makers and service providers might consider increasing coping resources available to nurses and minimizing job demands of care work to reduce turnover and improve nurses' psychological health. Moreover, findings from this Australian study may provide

  14. Demonstration of the usefulness of a theoretical framework for humanising care with reference to a residential aged care service in Australia.

    Science.gov (United States)

    Borbasi, Sally; Galvin, Kathleen T; Adams, Trevor; Todres, Les; Farrelly, Brona

    2013-03-01

    To demonstrate the usefulness of a theoretical framework for humanising care of dementia patients. The term humanisation of care has been increasingly used to describe an approach to health care that is informed by core dimensions of what it means to be human. Recent developments in dementia care highlight the importance of maintaining personhood in people with dementia. A conceptual framework is proposed by which the humanisation of care can be understood and applied. Eight dimensions that articulate core features of what needs to be attended to in order for a person to feel more deeply 'met' as a human being are discussed. Evidence from an evaluative study of a dementia outreach service is used to illustrate the usefulness of the humanising framework. Case study examples demonstrate the value of this framework by describing how a dementia outreach service enables care staff in residential aged care facilities to change their focus in the provision of care to residents with dementia. Each of the eight dimensions of humanisation/dehumanisation is used to illustrate how the dementia outreach service team have led to the improvements in resident care. Positive outcomes can be achieved by providing humanised care to residents with dementia. The paper highlights the potential for the humanising framework to be used in dementia care and shows how the framework can be helpfully translated into practice so that carers are supported to adopt an inclusive view of care delivery. A comprehensive framework, grounded in a strong philosophical foundation, can name a breadth of criteria for humanly sensitive care and can be translated into practice in such a way as to potentially transform the provision of care to residents in residential aged care facilities. © 2012 Blackwell Publishing Ltd.

  15. Setting the equation: establishing value in spine care.

    Science.gov (United States)

    Resnick, Daniel K; Tosteson, Anna N A; Groman, Rachel F; Ghogawala, Zoher

    2014-10-15

    Topic review. Describe value measurement in spine care and discuss the motivation for, methods for, and limitations of such measurement. Spinal disorders are common and are an important cause of pain and disability. Numerous complementary and competing treatment strategies are used to treat spinal disorders, and the costs of these treatments is substantial and continue to rise despite clear evidence of improved health status as a result of these expenditures. The authors present the economic and legislative imperatives forcing the assessment of value in spine care. The definition of value in health care and methods to measure value specifically in spine care are presented. Limitations to the utility of value judgments and caveats to their use are presented. Examples of value calculations in spine care are presented and critiqued. Methods to improve and broaden the measurement of value across spine care are suggested, and the role of prospective registries in measuring value is discussed. Value can be measured in spine care through the use of appropriate economic measures and patient-reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives.

  16. Integrating mental health care into residential homes for the elderly: an analysis of six Dutch programs for older people with severe and persistent mental illness

    NARCIS (Netherlands)

    Depla, Marja F. I. A.; Pols, Jeannette; de Lange, Jacomine; Smits, Carolien H. M.; de Graaf, Ron; Heeren, Thea J.

    2003-01-01

    Integrating mental health care into residential homes for the elderly is a potentially effective model to address the complex care needs of older chronically mentally ill people. Because no research was available on the implementation of such integrated care in practice, six programs already

  17. Effectiveness of interventions to improve family-staff relationships in the care of people with dementia in residential aged care: a systematic review protocol.

    Science.gov (United States)

    Nguyen, Mynhi; Pachana, Nancy A; Beattie, Elizabeth; Fielding, Elaine; Ramis, Mary-Anne

    2015-11-01

    The objective of this review is to identify and appraise existing evidence regarding the effectiveness of interventions designed to enhance staff-family relationships for people with dementia living in residential aged care facilities.More specifically, the objectives are to identify the effectiveness of constructive communication, cooperation programs, and practices or strategies to enhance family-staff relationships. The effectiveness of these interventions will be measured by comparing the intervention to no intervention, comparing one intervention with another, or comparing pre- and post-interventions.Specifically the review question is: What are the most effective interventions for improving communication and cooperation to enhance family-staff relationships in residential aged care facilities? In our aging world, dementia is prevalent and is a serious health concern affecting approximately 35.6 million people worldwide. This figure is expected to increase two-fold by 2030 and three-fold by 2050. Although younger-onset dementia is increasingly recognized, dementia is most commonly a disease that affects the elderly. Among those aged 65 to 85, the prevalence of dementia increases exponentially, and doubles with every five-year increase in age.Dementia is defined as a syndrome, commonly chronic or progressive in nature, and caused by a range of brain disorders that affect memory, thinking and the ability to perform activities of daily living. While the rate of progression and manifestation of decline differs, all cases of dementia share a similar trajectory of decline. The progressive decline in cognitive functions and ultimately physical function that these people face affects not only the person with the disease but also their family caregivers and health care staff.The manifestation of dementia presents unique and extreme challenges for the family caregiver. Generally it causes great physical, emotional and social strain because the caregiving process is long

  18. [Design and validation of a satisfaction and quality of life scale for users of residential and social care centres].

    Science.gov (United States)

    Literas, Luciano; Navarro, Albert; Fontanals, María Dulce

    2010-01-01

    In a comprehensive approach to ageing care, the promotion of personal and emotional well-being is fundamental, as well as the development of tools to evaluate outcomes. This approach needs to take into account the subjective perception of the elderly by gathering evidence using indicators that express impacts and satisfaction. Thus, the SAR Foundation's Satisfaction and Quality of Life Scale (SyCV-FSAR) has been developed and validated to assess well-being in residential care settings. Bibliographical reviews, interviews and focal groups with professionals (doctors, nurses, social workers, quality managers, etc.) were conducted to define the questionnaire that was first piloted and then applied in a final survey. Test of validity was carried out by factorial analysis (FA), principal axis factoring and Oblimin rotation. The sampling adequacy was measured by Kaiser-Meyer-Olkin test and Bartlett's sphericity. Test of reliability was carried out by internal consistency analysis (Cronbach's alpha). A total of 475 users took part in the survey, 69.1% of those who fulfilled the criteria. Of these 60.0% were women, an average age 82.1, 47.2% of them between 75 and 84 years old, with a MMSE of 27. The FA identified three factors ("Residential service and geriatric care", "Personal framework" and "Social relationships") that explained 27.5% of the total variability. The measure of sampling adequacy by Kaiser-Meyer-Olkin test was 0.80, and the Bartlett's sphericity test was significant (P<0.001). The global α Cronbach was 0.82. According to the results obtained in the study we can conclude that the SyCV-FSAR Scale is a reliable, simple and easy-to-apply tool, which gathers the users' perception on key aspects of daily life in residential and social care centres. Copyright © 2009 SEGG. Published by Elsevier Espana. All rights reserved.

  19. Leadership and Registered Nurses (RNs) working after-hours in Residential Aged Care Facilities (RACFs): A structured literature review.

    Science.gov (United States)

    Nhongo, Dorika; Hendricks, Joyce; Bradshaw, Julie; Bail, Kasia

    2018-06-12

    Registered nurses (RNs) working in Residential Aged Care Facilities are required to undertake complex management tasks including leading nursing care teams, supervising non-nursing staff, and allocating workloads according to residents' care needs, staff skills and experience. Registered nurses plan, assess, manage medication, evaluate each resident's care, liaise with doctors and allied health professionals and are responsible for evidence-based practice in accordance with the Nursing Standards for Practice (2016). Researchers have commented that effective nurse leadership can improve quality of care, improved resident outcomes and reduce adverse events. The aim of this literature review is to synthesise and analyse the literature pertinent to the RN's competence and confidence to undertake the leadership role when working in residential aged care facilities after-hours and to determine any association of leadership with quality resident outcomes. A review of original research papers based on the structured methodology described by Kable, Pich and Maslin-Prothero (2012). The review was conducted according to the 12-step structured framework by Kable et al. (2012). The search included peer-reviewed papers published between 2002 and 2017 on RN leadership after-hours, factors contributing to or with relationships to nursing leadership. Nineteen papers were found that researched the impact of leadership in aged care settings. The literature review concluded that nursing leadership has been linked to the quality of care and clinical outcomes in the aged care setting. However, RNs in the aged care setting have limited opportunities to develop key leadership competencies and confidence in order to meet the many challenges found in this environment due to lack of access to aged-care-specific leadership education. Minimal publications address the importance of the leadership of after-hours RNs. Results from this literature review will inform future research in this area

  20. Electronic Information Systems Use in Residential Care Facilities: The Differential Effect of Ownership Status and Chain Affiliation.

    Science.gov (United States)

    Davis, Jullet A; Zakoscielna, Karolina; Jacobs, Lindsey

    2016-03-01

    The use of electronic information systems (EISs) including electronic health records continues to increase in all sectors of the health care industry. Research shows that EISs may be useful for improving care delivery and decreasing medical errors. The purpose of this project is twofold: First, we describe the prevalence of EIS use among residential care facilities (RCFs), and second, we explore utilization differences by ownership status and chain affiliation. We anticipate that RCFs that are non-profit and non-chain will use more EIS than other categories of RCFs. Data for this project come from the 2010 National Survey of Residential Care Facilities. The sample consists of 2,300 facilities. Overall use of EIS was greatest among RCFs that are non-profit and chain-affiliated. Conversely, the use was lowest among for-profit RCFs that were also non-chain affiliated. This may suggest that these facilities lack the necessary resources or motivation to invest in information systems. © The Author(s) 2014.

  1. Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people.

    Science.gov (United States)

    McCormack, Brendan; Dewing, Jan; Breslin, Liz; Coyne-Nevin, Ann; Kennedy, Kate; Manning, Mary; Peelo-Kilroe, Lorna; Tobin, Catherine; Slater, Paul

    2010-06-01

    To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people. The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the 'Person-Centred Nursing Index'. Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses' perceptions of caring, indicating a shift from a dominant focus on 'technical' aspects of care, to one where 'intimate' aspects of care were more highly valued. The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships. © 2010 Blackwell Publishing Ltd.

  2. Child maltreatment and quality of life: a study of adolescents in residential care.

    Science.gov (United States)

    Greger, Hanne Klæboe; Myhre, Arne Kristian; Lydersen, Stian; Jozefiak, Thomas

    2016-05-10

    Childhood maltreatment is an important risk factor for mental and physical health problems. Adolescents living in residential youth care (RYC) have experienced a high rate of childhood maltreatment and are a high-risk group for psychiatric disorders. Quality of life (QoL) is a subjective, multidimensional concept that goes beyond medical diagnoses. There is a lack of research regarding the associations between childhood maltreatment and QoL. In the present study, we compare self-reported QoL between adolescents in RYC in Norway with and without maltreatment histories, and adolescents from the general population. We also study the impact of number of types of adversities on QoL. Adolescents aged 12-23 years living in RYC in Norway were invited to participate in the study; 400 participated, yielding a response rate of 67 %. Maltreatment histories were assessed through interviews with trained research assistants, and completed by 335 adolescents. Previous exposure to maltreatment was reported by 237 adolescents. The Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents (KINDL-R) was used. Nonexposed peers in RYC (n = 98) and a sample of adolescents from the general population (n = 1017) were used for comparison. General linear model analyses (ANCOVA) were conducted with five KINDL-R life domains as dependent variables. Linear regression was used to study the effect of number of types of adversities. Exposed adolescents in RYC reported poorer QoL than peers in control groups. Compared with nonexposed peers in RYC, the 95 % confidence intervals for mean score differences on the KINDL-R subdomains (0-100 scale) were 1.9-11.4 (Physical Well-being), 2.2-11.1 (Emotional Well-being), -0.7-10.0 (Self-esteem), and 1.8-10.9 (Friends). Compared with the general population sample, the 95 % confidence intervals for mean score differences were 9.7-17.6 (Physical Well-being), 7.9-15.3 (Emotional Well-being), 3.6-12.5 (Self-esteem), and 5

  3. Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia.

    Science.gov (United States)

    Fowler, Cathrine; Schmied, Virginia; Dickinson, Marie; Dahlen, Hannah Grace

    2017-02-01

    To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015. For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care. A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups. Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity. There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers. Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families. © 2016 John Wiley & Sons Ltd.

  4. Staphylococcus aureus carriage in older populations in community residential care homes: Prevalence and molecular characterization of MRSA isolates.

    Science.gov (United States)

    Galán-Sánchez, Fátima; Pérez-Eslava, Maria; Machuca, Jesús; Trujillo-Soto, Teresa; Arca-Suarez, Jorge; Rodríguez-Iglesias, Manuel

    2018-06-20

    The epidemiology of S. aureus depends on conditions in specific populations. Few studies of S. aureus colonization in the older population have been performed in Spain. The aim of this study was to determine the prevalence of methicillin-resistant S. aureus (MRSA) colonization and its molecular epidemiological characteristics in an institutionalized population in community residential care homes in Cadiz, Spain. A cross-sectional epidemiological study was conducted in three residential care homes for older people. Axilla and nostril samples were tested. Identification of S. aureus and antimicrobial susceptibility testing were by MALDI-TOF and MicroScan panels. MRSA strains were subjected to SCCmec typing, multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). The presence of Panton-Valentine leukocidin (PVL) genes was determined by PCR in all S. aureus strains. A total of 293 residents were included. Fifty-one residents (17.4%) were colonized with methicillin-sensitive S. aureus (MSSA) and 11 (3.8%) with MRSA. Resistance to at least two aminoglycosides was observed in 25.4% of MSSA and 90.9% and of MRSA isolates, and resistance to levofloxacin in 80.3% of MSSA and 100% of MRSA isolates. SCCmecIV was detected in all isolates and all except one (ST-125) were ST-8. None of the S. aureus isolates were positive for PVL. A low rate of S. aureus carriage was detected and the prevalence of MRSA was very low. ST8-MRSA-IVc was the dominant clone, and only one strain belonged to ST125-MRSA-IVc. We found MRSA transmission within the residential care homes and a very high rate of quinolone resistance in MSSA and MRSA. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  5. The decision of out-of-home placement in residential care after parental neglect: Empirically testing a psychosocial model.

    Science.gov (United States)

    Rodrigues, Leonor; Calheiros, Manuela; Pereira, Cícero

    2015-11-01

    Out-of-home placement decisions in residential care are complex, ambiguous and full of uncertainty, especially in cases of parental neglect. Literature on this topic is so far unable to understand and demonstrate the source of errors involved in those decisions and still fails to focus on professional's decision making process. Therefore, this work intends to test a socio-psychological model of decision-making that is a more integrated, dualistic and ecological version of the Theory of Planned Behavior's model. It describes the process through which the decision maker takes into account personal, contextual and social factors of the Decision-Making Ecology in the definition of his/her decision threshold. One hundred and ninety-five professionals from different Children and Youth Protection Units, throughout the Portuguese territory, participated in this online study. After reading a vignette of a (psychological and physical) neglect case toward a one-year-old child, participants were presented with a group of questions that measured worker's assessment of risk, intention, attitude, subjective norm, behavior control and beliefs toward residential care placement decision, as well as worker's behavior experience, emotions and family/child-related-values involved in that decision. A set of structural equation modeling analyses have proven the good fit of the proposed model. The intention to propose a residential care placement decision was determined by cognitive, social, affective, value-laden and experience variables and the perceived risk. Altogether our model explained 61% of professional's decision toward a parental neglect case. The theoretical and practical implications of these results are discussed, namely the importance of raising awareness about the existence of these biased psychosocial determinants. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Effectiveness of a low-threshold physical activity intervention in residential aged care – results of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Cichocki M

    2015-05-01

    Full Text Available Martin Cichocki,1 Viktoria Quehenberger,1 Michael Zeiler,1 Tanja Adamcik,1 Matthias Manousek,1 Tanja Stamm,2 Karl Krajic1 1Ludwig Boltzmann Institute Health Promotion Research, 2Medical University of Vienna & University of Applied Sciences FH Campus, Wien, Vienna, Austria Purpose: Research on effectiveness of low-threshold mobility interventions that are viable for users of residential aged care is scarce. Low-threshold is defined as keeping demands on organizations (staff skills, costs and participants (health status, discipline rather low. The study explored the effectiveness of a multi-faceted, low-threshold physical activity program in three residential aged-care facilities in Austria. Main goals were enhancement of mobility by conducting a multi-faceted training program to foster occupational performance and thus improve different aspects of health-related quality of life (QoL.Participants and methods: The program consisted of a weekly session of 60 minutes over a period of 20 weeks. A standardized assessment of mobility status and health-related QoL was applied before and after the intervention. A total of 222 of 276 participants completed the randomized controlled trial study (intervention group n=104, control group n=118; average age 84 years, 88% female.Results: Subjective health status (EuroQoL-5 dimensions: P=0.001, d=0.36 improved significantly in the intervention group, and there were also positive trends in occupational performance (Canadian Occupational Performance Measure. No clear effects were found concerning the functional and cognitive measures applied.Conclusion: Thus, the low-threshold approach turned out to be effective primarily on subjective health-related QoL. This outcome could be a useful asset for organizations offering low-threshold physical activity interventions. Keywords: physical activity, intervention, residential aged care, effectiveness, aged

  7. Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.

    Science.gov (United States)

    Bhuyan, Soumitra S; Zhu, He; Chandak, Aastha; Kim, Jungyoon; Stimpson, Jim P

    2014-12-01

    Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in

  8. Establishing a national research center on day care

    DEFF Research Database (Denmark)

    Ellegaard, Tomas

    The paper presents and discusses the current formation of a national research center on ECEC. The center is currently being established. It is partly funded by the Danish union of early childhood and youth educators. It is based on cooperation between a number of Danish universities and this nati...... current new public management policies. However there is also more conflicting issues that emerge in this enterprise – especially on interests, practice relevance and knowledge paradigms....

  9. The Design of an Effective Family Reintegration and Aftercare Program for Youth Successfully Leaving Residential Care.

    Science.gov (United States)

    Roley, Jeffrey H.

    The lack of support services following the release of adolescent youths from a residential treatment center back to their families is examined in this practicum. Consequently, the development of a family reintegration program for the treatment center is focused on the concept that effective aftercare begins at intake. Understandably, families…

  10. Childhood maltreatment and motivation for treatment in girls in compulsory residential care

    NARCIS (Netherlands)

    Leenarts, L.E.W.; Hoeve, M.; van de Ven, P.M.; Lodewijks, H.P.B.; Dorelijers, T.A.H.

    2013-01-01

    The first objective of the current study was to examine the relationship between childhood maltreatment, trauma-related symptoms and motivation for treatment in girls in compulsory residential treatment facilities. The second objective was to examine the extent to which various forms of childhood

  11. Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD.

    Science.gov (United States)

    Ericson-Lidman, Eva; Larsson, Lise-Lotte Franklin; Norberg, Astrid

    2014-06-01

    Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health. © 2013 Nordic College of Caring Science.

  12. Exploratory Investigation of Communication Management in Residential-Aged Care: A Comparison of Staff Knowledge, Documentation and Observed Resident-Staff Communication

    Science.gov (United States)

    Bennett, Michelle K.; Ward, Elizabeth C.; Scarinci, Nerina A.

    2016-01-01

    Background: There is a high prevalence of communication difficulty among older people living in residential-aged care. Such functional deficits can have a negative impact on resident quality of life, staff workplace satisfaction and the provision of quality care. Systematic research investigating the nature of communication management in…

  13. Letter from Chile: Re-establishing health care in Chile

    Science.gov (United States)

    Jiménez, Jorge

    1993-01-01

    Chile's long term social policy has produced very impressive outcomes in general health indicators, with a national health service established as early as 1952. During the years of the Pinochet dictatorship (1973-89) public health institutions were greatly affected, with sharp diminution in financing which affected investment and salaries. The democratic government initiated in 1990 faced a difficult situation, with underpaid staff and decrepit hospitals. The ministry took immediate action to improve salaries and start an ambitious health sector reform including investment in infrastructure, technology, and modern management. Decentralisation and autonomy, changes in payment for service mechanisms, and a public-private mix are the main objectives of this reform, keeping the public role as predominant in the proposed structure. This process has been affected by union unrest and public opinion dissatisfaction, which tend to present obstacles to progress in this complicated issue. Imagesp729-ap730-a

  14. The physical environment, activity and interaction in residential care facilities for older people: a comparative case study.

    Science.gov (United States)

    Nordin, Susanna; McKee, Kevin; Wallinder, Maria; von Koch, Lena; Wijk, Helle; Elf, Marie

    2017-12-01

    The physical environment is of particular importance for supporting activities and interactions among older people living in residential care facilities (RCFs) who spend most of their time inside the facility. More knowledge is needed regarding the complex relationships between older people and environmental aspects in long-term care. The present study aimed to explore how the physical environment influences resident activities and interactions at two RCFs by using a mixed-method approach. Environmental assessments were conducted via the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM), and resident activities, interactions and locations were assessed through an adapted version of the Dementia Care Mapping (DCM). The Observed Emotion Rating Scale (OERS) was used to assess residents' affective states. Field notes and walk-along interviews were also used. Findings indicate that the design of the physical environment influenced the residents' activities and interactions. Private apartments and dining areas showed high environmental quality at both RCFs, whereas the overall layout had lower quality. Safety was highly supported. Despite high environmental quality in general, several factors restricted resident activities. To optimise care for older people, the design process must clearly focus on accessible environments that provide options for residents to use the facility independently. © 2016 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

  15. Research report for fiscal 1997 on analysis and evaluation of demonstration tests for establishment of residential photovoltaic power generation load leveling technology; 1997 nendo kenkyu hokokusho. Jutaku you taiyoko hatsuden fuka heijunka gijutsu tou kakuritsu jissho shiken ni kansuru kaiseki hyoka

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    Tests and researches have been performed with the objectives to establish an evaluation technology for load leveling effect by using a small photovoltaic power generation system for residential use, to clarify the effectiveness of the system as a discrete power supply source through demonstration operation, and furthermore to achieve optimization of designs of the small photovoltaic power generation system for residential use. This paper summarizes the achievements in fiscal 1997. The current fiscal year has performed the continued collection of data of the demonstration operation, and analysis and evaluation on the photovoltaic power generation characteristics and the house load characteristics. According to the data analysis result for fiscals 1995 through 1997, it was shown that, although the photovoltaic power generation system for residential use does not contribute much to load leveling in a house, it contributes to load leveling in the distribution line on the whole or a case as large as a grid. In addition, according to the survey on users who have installed the photovoltaic power generation system, it was indicated that the consciousness of electric power and energy conservation has heightened. The capacity of a photovoltaic power generation system for residential use is 3 kW for a standard type of home, which can take care of more than 60% of the house load. It was concluded that, if a storage battery of small capacity is accommodated, the system is effective for reduction of momentary peak load, enhancement of the power quality, and supply of power at a disaster. (NEDO)

  16. Becoming at home in residential care for older people: a material culture perspective.

    Science.gov (United States)

    Lovatt, Melanie

    2018-02-01

    Residential homes encourage new residents to bring belongings with them, so that they can personalise their room and 'feel at home'. Existing literature on material culture in residential homes views objects as symbols and repositories of home and identity, which can facilitate a sense of belonging in residents through their display in residents' rooms. I suggest that this both misunderstands the processual and fluid nature of home and identity, and conceptualises objects as essentially passive. This article uses ethnographic data and theories of practice and relationality to argue that rather than the meaning of home being inherent in objects, or felt subjectively by residents, meaning is generated through ongoing, everyday interactions between the two. I show that residents became at home by acquiring new things -as well as displaying existing possessions - and also through interacting with mundane objects in everyday social and relational practices such as cleaning and hosting. I conclude that being at home in older people's residential homes need not be so different from being at home at other stages of the life course and in other settings. This challenges conceptualisations of older people's homes - and older age itself - as somehow unknowable and unfamiliar. © 2018 Foundation for the Sociology of Health & Illness.

  17. Physiological effects of a companion robot on blood pressure of older people in residential care facility: a pilot study.

    Science.gov (United States)

    Robinson, Hayley; MacDonald, Bruce; Broadbent, Elizabeth

    2015-03-01

    To investigate the effects of interacting with the companion robot, Paro, on blood pressure and heart rate of older people in a residential care facility. This study used a repeated measures design. Twenty-one residents in rest home and hospital level care had their blood pressure taken three times; before, during and after interacting with the seal robot. Four residents who did not interact with the robot were excluded from the final analysis (final n = 17). The final analysis found that systolic and diastolic blood pressure changed significantly over time as did heart rate. Planned comparisons revealed that systolic and diastolic blood pressure decreased significantly from baseline to when residents had Paro (systolic, P = 0.048; diastolic, P = 0.05). Diastolic blood pressure increased significantly after Paro was withdrawn (P = 0.03). Interacting with Paro has a physiological effect on cardiovascular measures, which is similar to findings with live animals. © 2013 ACOTA.

  18. Solving the "Personhood Jigsaw Puzzle" in Residential Care Homes for the Elderly in the Hong Kong Chinese Context.

    Science.gov (United States)

    Kong, Sui-Ting; Fang, Christine Meng-Sang; Lou, Vivian W Q

    2017-02-01

    End-of-life care studies on the nature of personhood are bourgeoning; however, the practices utilized for achieving personhood in end-of-life care, particularly in a cultural context in which interdependent being and collectivism prevail, remain underexplored. This study seeks to examine and conceptualize good practices for achieving the personhood of the dying elderly in residential care homes in a Chinese context. Twelve interviews were conducted with both medical and social care practitioners in four care homes to collect narratives of practitioners' practices. Those narratives were utilized to develop an "end-of-life case graph." Constant comparative analysis led to an understanding of the practice processes, giving rise to a process model of "solving the personhood jigsaw puzzle" that includes "understanding the person-in-relationship and person-in-time," "identifying the personhood-inhibiting experiences," and "enabling personalized care for enhanced psychosocial outcomes." Findings show how the "relational personhood" of the elderly can be maintained when physical deterioration and even death are inevitable.

  19. Family involvement in decision making for people with dementia in residential aged care: a systematic review of quantitative literature.

    Science.gov (United States)

    Petriwskyj, Andrea; Gibson, Alexandra; Parker, Deborah; Banks, Susan; Andrews, Sharon; Robinson, Andrew

    2014-06-01

    Ensuring older adults' involvement in their care is accepted as good practice and is vital, particularly for people with dementia, whose care and treatment needs change considerably over the course of the illness. However, involving family members in decision making on people's behalf is still practically difficult for staff and family. The aim of this review was to identify and appraise the existing quantitative evidence about family involvement in decision making for people with dementia living in residential aged care. The present Joanna Briggs Institute (JBI) metasynthesis assessed studies that investigated involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this paper presents the quantitative findings. A comprehensive search of 15 electronic databases was performed. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as being relevant; 10 were quantitative, with 1 mixed method study. Two independent reviewers assessed the studies for methodological validity and extracted the data using the JBI Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The findings were synthesized and presented in narrative form. The findings related to decisions encountered and made by family surrogates, variables associated with decisions, surrogates' perceptions of, and preferences for, their roles, as well as outcomes for people with dementia and their families. The results identified patterns within, and variables associated with, surrogate decision making, all of which highlight the complexity and variation regarding family involvement. Attention needs to be paid to supporting family members in decision making in collaboration with staff.

  20. Mechanisms which help explain implementation of evidence-based practice in residential aged care facilities: a grounded theory study.

    Science.gov (United States)

    Masso, Malcolm; McCarthy, Grace; Kitson, Alison

    2014-07-01

    The context for the study was a nation-wide programme in Australia to implement evidence-based practice in residential aged care, in nine areas of practice, using a wide range of implementation strategies and involving 108 facilities. The study drew on the experiences of those involved in the programme to answer the question: what mechanisms influence the implementation of evidence-based practice in residential aged care and how do those mechanisms interact? The methodology used grounded theory from a critical realist perspective, informed by a conceptual framework that differentiates between the context, process and content of change. People were purposively sampled and invited to participate in semi-structured interviews, resulting in 44 interviews involving 51 people during 2009 and 2010. Participants had direct experience of implementation in 87 facilities, across nine areas of practice, in diverse locations. Sampling continued until data saturation was reached. The quality of the research was assessed using four criteria for judging trustworthiness: credibility, transferability, dependability and confirmability. Data analysis resulted in the identification of four mechanisms that accounted for what took place and participants' experiences. The core category that provided the greatest understanding of the data was the mechanism On Common Ground, comprising several constructs that formed a 'common ground' for change to occur. The mechanism Learning by Connecting recognised the ability to connect new knowledge with existing practice and knowledge, and make connections between actions and outcomes. Reconciling Competing Priorities was an ongoing mechanism whereby new practices had to compete with an existing set of constantly shifting priorities. Strategies for reconciling priorities ranged from structured approaches such as care planning to more informal arrangements such as conversations during daily work. The mechanism Exercising Agency bridged the gap between

  1. The lived experiences of resilience in Iranian adolescents living in residential care facilities: A hermeneutic phenomenological study

    Science.gov (United States)

    Nourian, Manijeh; Nourozi Tabrizi, Kian; Rassouli, Maryam; Biglarrian, Akbar

    2016-01-01

    Background Resilience is one of the main factors affecting human health, and perceiving its meaning for high-risk adolescents is of particular importance in initiating preventive measures and providing resilience care. Objectives This qualitative study was conducted to explain the meaning of resilience in the lived experiences of Iranian adolescents living in governmental residential care facilities. Materials and methods This study was conducted using the hermeneutic phenomenological method. Semi-structured interviews were conducted with eight adolescents aged 13–17 living in governmental residential care facilities of Tehran province affiliated to the Welfare Organization of Iran who articulated their experiences of resilience. Sampling lasted from May 2014 to July 2015 and continued until new themes were no longer emerging. The researchers analyzed the verbatim transcripts using Van Manen's six-step method of phenomenology. Results The themes obtained in this study included “going through life's hardships,” “aspiring for achievement,” “self-protection,” “self-reliance,” and “spirituality.” Conclusion Our study indicates that the meaning of resilience coexists with self-reliance in adolescents’ lived experiences. Adolescents look forward to a better future. They always trust God in the face of difficulties and experience resilience by keeping themselves physically and mentally away from difficulties. Adverse and bitter experiences of the past positively affected their positive view on life and its difficulties and also their resilience. The five themes that emerged from the findings describe the results in detail. The findings of this study enable nurses, health administrators, and healthcare providers working with adolescents to help this vulnerable group cope better with their stressful life conditions and improve their health through increasing their capacity for resilience. PMID:26942909

  2. The lived experiences of resilience in Iranian adolescents living in residential care facilities: A hermeneutic phenomenological study

    Directory of Open Access Journals (Sweden)

    Manijeh Nourian

    2016-03-01

    Full Text Available Background: Resilience is one of the main factors affecting human health, and perceiving its meaning for high-risk adolescents is of particular importance in initiating preventive measures and providing resilience care. Objectives: This qualitative study was conducted to explain the meaning of resilience in the lived experiences of Iranian adolescents living in governmental residential care facilities. Materials and methods: This study was conducted using the hermeneutic phenomenological method. Semi-structured interviews were conducted with eight adolescents aged 13–17 living in governmental residential care facilities of Tehran province affiliated to the Welfare Organization of Iran who articulated their experiences of resilience. Sampling lasted from May 2014 to July 2015 and continued until new themes were no longer emerging. The researchers analyzed the verbatim transcripts using Van Manen's six-step method of phenomenology. Results: The themes obtained in this study included “going through life's hardships,” “aspiring for achievement,” “self-protection,” “self-reliance,” and “spirituality.” Conclusion: Our study indicates that the meaning of resilience coexists with self-reliance in adolescents’ lived experiences. Adolescents look forward to a better future. They always trust God in the face of difficulties and experience resilience by keeping themselves physically and mentally away from difficulties. Adverse and bitter experiences of the past positively affected their positive view on life and its difficulties and also their resilience. The five themes that emerged from the findings describe the results in detail. The findings of this study enable nurses, health administrators, and healthcare providers working with adolescents to help this vulnerable group cope better with their stressful life conditions and improve their health through increasing their capacity for resilience.

  3. The lived experiences of resilience in Iranian adolescents living in residential care facilities: A hermeneutic phenomenological study.

    Science.gov (United States)

    Nourian, Manijeh; Shahbolaghi, Farahnaz Mohammadi; Tabrizi, Kian Nourozi; Rassouli, Maryam; Biglarrian, Akbar

    2016-01-01

    Resilience is one of the main factors affecting human health, and perceiving its meaning for high-risk adolescents is of particular importance in initiating preventive measures and providing resilience care. This qualitative study was conducted to explain the meaning of resilience in the lived experiences of Iranian adolescents living in governmental residential care facilities. This study was conducted using the hermeneutic phenomenological method. Semi-structured interviews were conducted with eight adolescents aged 13-17 living in governmental residential care facilities of Tehran province affiliated to the Welfare Organization of Iran who articulated their experiences of resilience. Sampling lasted from May 2014 to July 2015 and continued until new themes were no longer emerging. The researchers analyzed the verbatim transcripts using Van Manen's six-step method of phenomenology. The themes obtained in this study included "going through life's hardships," "aspiring for achievement," "self-protection," "self-reliance," and "spirituality." Our study indicates that the meaning of resilience coexists with self-reliance in adolescents' lived experiences. Adolescents look forward to a better future. They always trust God in the face of difficulties and experience resilience by keeping themselves physically and mentally away from difficulties. Adverse and bitter experiences of the past positively affected their positive view on life and its difficulties and also their resilience. The five themes that emerged from the findings describe the results in detail. The findings of this study enable nurses, health administrators, and healthcare providers working with adolescents to help this vulnerable group cope better with their stressful life conditions and improve their health through increasing their capacity for resilience.

  4. Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home

    Directory of Open Access Journals (Sweden)

    Janmaat Tonnie ACM

    2005-05-01

    Full Text Available Abstract Background Intermediate care was developed in order to bridge acute, primary and social care, primarily for elderly persons with complex care needs. Such bridging initiatives are intended to reduce hospital stays and improve continuity of care. Although many models assume positive effects, it is often ambiguous what the benefits are and whether they can be transferred to other settings. This is due to the heterogeneity of intermediate care models and the variety of collaborating partners that set up such models. Quantitative evaluation captures only a limited series of generic structure, process and outcome parameters. More detailed information is needed to assess the dynamics of intermediate care delivery, and to find ways to improve the quality of care. Against this background, the functioning of a low intensity early discharge model of intermediate care set up in a residential home for patients released from an Amsterdam university hospital has been evaluated. The aim of this study was to produce knowledge for management to improve quality of care, and to provide more generalisable insights into the accumulated impact of such a model. Methods A process evaluation was carried out using quantitative and qualitative methods. Registration forms and patient questionnaires were used to quantify the patient population in the model. Statistical analysis encompassed T-tests and chi-squared test to assess significance. Semi-structured interviews were conducted with 21 staff members representing all disciplines working with the model. Interviews were transcribed and analysed using both 'open' and 'framework' approaches. Results Despite high expectations, there were significant problems. A heterogeneous patient population, a relatively unqualified staff and cultural differences between both collaborating partners impeded implementation and had an impact on the functioning of the model. Conclusion We concluded that setting up a low intensity

  5. Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Pediatric cardiac intensive care has evolved as a distinct discipline in well-established pediatric cardiac programs in developed nations. With increasing demand for pediatric heart surgery in emerging economies, a number of new programs are being established. The development of robust pediatric cardiac intensive care units (PCICU is critical to the success of these programs. Because of substantial resource limitations existing models of PCICU care cannot be applied in their existing forms and structure. A number of challenges need to be addressed to deliver pediatric cardiac intensive care in the developing world. Limitations in infrastructure, human, and material resources call for a number of innovations and adaptations. Additionally, a variety of strategies are required to minimize costs of care to the individual patient. This review provides a framework for the establishment of a new PCICU program in face of resource limitations typically encountered in the developing world and emerging economies.

  6. Ideologies of care in community residential services: what do caregivers believe?

    Science.gov (United States)

    Heaney, C A; Burke, A C

    1995-10-01

    Ideologies of care, or systems of beliefs about the importance of particular goals and activities, help guide how care is provided. One currently pervasive ideology of care is that of normalization. In this paper, the ideologies of care of both house managers and direct care staff in group homes are contrasted. Results indicate that the ideology of direct care staff is less differentiated than that of the house managers. In addition, house managers are more likely to subscribe to a normalization ideology and less likely to subscribe to a family orientation ideology than are direct care staff. Ideological differences between house managers and direct care staff are only partially explained by differences in the demographic composition of the two groups.

  7. Developing a theoretical model and questionnaire survey instrument to measure the success of electronic health records in residential aged care.

    Science.gov (United States)

    Yu, Ping; Qian, Siyu

    2018-01-01

    Electronic health records (EHR) are introduced into healthcare organizations worldwide to improve patient safety, healthcare quality and efficiency. A rigorous evaluation of this technology is important to reduce potential negative effects on patient and staff, to provide decision makers with accurate information for system improvement and to ensure return on investment. Therefore, this study develops a theoretical model and questionnaire survey instrument to assess the success of organizational EHR in routine use from the viewpoint of nursing staff in residential aged care homes. The proposed research model incorporates six variables in the reformulated DeLone and McLean information systems success model: system quality, information quality, service quality, use, user satisfaction and net benefits. Two variables training and self-efficacy were also incorporated into the model. A questionnaire survey instrument was designed to measure the eight variables in the model. After a pilot test, the measurement scale was used to collect data from 243 nursing staff members in 10 residential aged care homes belonging to three management groups in Australia. Partial least squares path modeling was conducted to validate the model. The validated EHR systems success model predicts the impact of the four antecedent variables-training, self-efficacy, system quality and information quality-on the net benefits, the indicator of EHR systems success, through the intermittent variables use and user satisfaction. A 24-item measurement scale was developed to quantitatively evaluate the performance of an EHR system. The parsimonious EHR systems success model and the measurement scale can be used to benchmark EHR systems success across organizations and units and over time.

  8. Effectiveness and safety of a high-dose weekly vitamin D (20,000 IU) protocol in older adults living in residential care.

    Science.gov (United States)

    Feldman, Fabio; Moore, Crystal; da Silva, Liz; Gaspard, Gina; Gustafson, Larry; Singh, Sonia; Barr, Susan I; Kitts, David D; Li, Wangyang; Weiler, Hope A; Green, Timothy J

    2014-08-01

    To report 25 hydroxyvitamin D (25OHD) concentrations, an indicator of vitamin D status, in older adults living in residential care 1 year after a protocol of weekly 20,000 IU of vitamin D was started. Cross-sectional. Five residential care facilities in British Columbia, Canada. Residents aged 65 and older from five facilities (N=236). Participants provided a blood sample. Demographic and health information was obtained from the medical record. Mean 25OHD was 102 nmol/L (95% confidence interval (CI)=98-106 nmol/L). Three percent of residents had a 25OHD concentration of less than 40 nmol/L, 6% 2.6 mmol/L), a potential consequence of too much vitamin D, was present in 14%, although 25OHD levels did not differ in those with and without hypercalcemia (108 vs 101 nmol/L; P=.17). Twelve months after implementation of a 20,000-IU/wk vitamin D protocol for older adults in residential care, mean 25OHD concentrations were high, and there was no evidence of poor vitamin D status. Given the absence of demonstrated benefit of high 25OHD concentrations to the residential care population, dosages less than 20,000 IU/wk of vitamin D are recommended. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  9. Family Life and the Impact of Previous and Present Residential and Day Care Support for Children with Major Cognitive and Behavioural Challenges: A Dilemma for Services and Policy

    Science.gov (United States)

    Brown, R. I.; Geider, S.; Primrose, A.; Jokinen, N. S.

    2011-01-01

    Introduction: Since the development of inclusion and integration, parents have increasingly become the major, and sometimes the only, carers of their children with disabilities. Many families speak of stress and frustration with service and community support, and some have turned to residential and specialised day care services to overcome…

  10. Longitudinal relation between general well-being and self-esteem : Testing differences for adolescents admitted to secure residential care and after discharge

    NARCIS (Netherlands)

    Barendregt, C.S.; Laan, A.J.; Bongers, I.L.; van Nieuwenhuizen, Ch.

    2016-01-01

    This study investigated the longitudinal relation between general well-being and self-esteem of male adolescents with severe psychiatric disorders. Moreover, the transition out of secure residential care was studied. Adolescents (N = 172) were assessed three times with 6 months between each

  11. Understanding the elevated risk of substance use by adolescents in special education and residential youth care : The role of individual, family and peer factors

    NARCIS (Netherlands)

    Kepper, Annelies|info:eu-repo/dai/nl/313935157; Van Den Eijnden, Regina|info:eu-repo/dai/nl/17399394X; Monshouwer, Karin|info:eu-repo/dai/nl/202651967; Vollebergh, Wilma|info:eu-repo/dai/nl/090632893

    2014-01-01

    Adolescents who attend special education for behavioural problems (SEB) and adolescents who live in a residential youth care institution (RYC) are characterised by behavioural disorders and problematic family backgrounds and have an increased risk for substance use. Though it is likely that the high

  12. A System for Planning and Achieving Comprehensive Health Care in Residential Institutions for the Mentally Retarded.

    Science.gov (United States)

    Decker, Harold A.

    Based on a view of health care intertwining medicine intimately with other components of institutional care, the monograph presents a system of concepts and operating techniques for providing comprehensive health care to institutionalized retardates. Background of the system is explained in terms of its research basis (two studies by the author of…

  13. Establishing contact and gaining trust : an exploratory study of care avoidance

    NARCIS (Netherlands)

    Schout, Gert; de Jong, Gideon; Zeelen, Jacques

    Title. Establishing contact and gaining trust: an exploratory study of care avoidance. Aim. This paper is a report of a study conducted to explore the competencies especially deep-rooted personal qualities - of care providers who succeed in making contact and gaining trust with clients who are

  14. Estimating length of stay in publicly-funded residential and nursing care homes: a retrospective analysis using linked administrative data sets.

    Science.gov (United States)

    Steventon, Adam; Roberts, Adam

    2012-10-31

    Information about how long people stay in care homes is needed to plan services, as length of stay is a determinant of future demand for care. As length of stay is proportional to cost, estimates are also needed to inform analysis of the long-term cost effectiveness of interventions aimed at preventing admissions to care homes. But estimates are rarely available due to the cost of repeatedly surveying individuals. We used administrative data from three local authorities in England to estimate the length of publicly-funded care homes stays beginning in 2005 and 2006. Stays were classified into nursing home, permanent residential and temporary residential. We aggregated successive placements in different care home providers and, by linking to health data, across periods in hospital. The largest group of stays (38.9%) were those intended to be temporary, such as for rehabilitation, and typically lasted 4 weeks. For people admitted to permanent residential care, median length of stay was 17.9 months. Women stayed longer than men, while stays were shorter if preceded by other forms of social care. There was significant variation in length of stay between the three local authorities. The typical person admitted to a permanent residential care home will cost a local authority over £38,000, less payments due from individuals under the means test. These figures are not apparent from existing data sets. The large cost of care home placements suggests significant scope for preventive approaches. The administrative data revealed complexity in patterns of service use, which should be further explored as it may challenge the assumptions that are often made.

  15. Estimating length of stay in publicly-funded residential and nursing care homes: a retrospective analysis using linked administrative data sets

    Directory of Open Access Journals (Sweden)

    Steventon Adam

    2012-10-01

    Full Text Available Abstract Background Information about how long people stay in care homes is needed to plan services, as length of stay is a determinant of future demand for care. As length of stay is proportional to cost, estimates are also needed to inform analysis of the long-term cost effectiveness of interventions aimed at preventing admissions to care homes. But estimates are rarely available due to the cost of repeatedly surveying individuals. Methods We used administrative data from three local authorities in England to estimate the length of publicly-funded care homes stays beginning in 2005 and 2006. Stays were classified into nursing home, permanent residential and temporary residential. We aggregated successive placements in different care home providers and, by linking to health data, across periods in hospital. Results The largest group of stays (38.9% were those intended to be temporary, such as for rehabilitation, and typically lasted 4 weeks. For people admitted to permanent residential care, median length of stay was 17.9 months. Women stayed longer than men, while stays were shorter if preceded by other forms of social care. There was significant variation in length of stay between the three local authorities. The typical person admitted to a permanent residential care home will cost a local authority over £38,000, less payments due from individuals under the means test. Conclusions These figures are not apparent from existing data sets. The large cost of care home placements suggests significant scope for preventive approaches. The administrative data revealed complexity in patterns of service use, which should be further explored as it may challenge the assumptions that are often made.

  16. Cost-effectiveness of food, supplement and environmental interventions to address malnutrition in residential aged care: a systematic review.

    Science.gov (United States)

    Hugo, Cherie; Isenring, Elisabeth; Miller, Michelle; Marshall, Skye

    2018-05-01

    observational studies have shown that nutritional strategies to manage malnutrition may be cost-effective in aged care; but more robust economic data is needed to support and encourage translation to practice. Therefore, the aim of this systematic review is to compare the cost-effectiveness of implementing nutrition interventions targeting malnutrition in aged care homes versus usual care. residential aged care homes. systematic literature review of studies published between January 2000 and August 2017 across 10 electronic databases. Cochrane Risk of Bias tool and GRADE were used to evaluate the quality of the studies. eight included studies (3,098 studies initially screened) reported on 11 intervention groups, evaluating the effect of modifications to dining environment (n = 1), supplements (n = 5) and food-based interventions (n = 5). Interventions had a low cost of implementation (<£2.30/resident/day) and provided clinical improvement for a range of outcomes including weight, nutritional status and dietary intake. Supplements and food-based interventions further demonstrated a low cost per quality adjusted life year or unit of physical function improvement. GRADE assessment revealed the quality of the body of evidence that introducing malnutrition interventions, whether they be environmental, supplements or food-based, are cost-effective in aged care homes was low. this review suggests supplements and food-based nutrition interventions in the aged care setting are clinically effective, have a low cost of implementation and may be cost-effective at improving clinical outcomes associated with malnutrition. More studies using well-defined frameworks for economic analysis, stronger study designs with improved quality, along with validated malnutrition measures are needed to confirm and increase confidence with these findings.

  17. Optimising mobility through the sit-to-stand activity for older people living in residential care facilities: A qualitative interview study of healthcare aide experiences.

    Science.gov (United States)

    Kagwa, Sharon A; Boström, Anne-Marie; Ickert, Carla; Slaughter, Susan E

    2018-03-01

    To explore the experience of HCAs encouraging residents living in residential care to complete the sit-to-stand activity and to identify the strategies HCAs used to integrate the activity into their daily work routines. Decreased mobility in advanced ageing is further reduced when entering a residential care facility. Interventions such as the sit-to-stand activity have been shown to have a positive effect on the mobility of older people. There is evidence to suggest that healthcare aides are able to support residents to complete the sit-to-stand activity as part of their daily work routines; however, little is known about how healthcare aides actually do this with residents living in residential care. A qualitative interview study included seven purposively sampled HCAs working in residential care facilities. Semistructured interviews were analysed using inductive qualitative content analysis. The HCAs' experience with the sit-to-stand activity was represented by the following four categories: Resident participation, Feeling misunderstood and disrespected, Time and workload, and Management involvement. HCAs identified three strategies to help them support residents to complete the sit-to-stand activity: Motivating residents, Completing activity in a group and Using time management skills. HCAs reported some encouragement from managers and cooperation from residents to complete the sit-to-stand activity with residents; however, they also felt constrained by time limitations and workload demands and they felt misunderstood and disrespected. HCAs were able to identify several strategies that helped them to integrate the sit-to-stand activity into their daily routines. This study highlights the challenges and supportive factors of implementing the sit-to-stand activity into the daily work routine of HCAs. The study also identifies the strategic role of nurse managers when implementing interventions in residential care facilities. © 2017 John Wiley & Sons Ltd.

  18. First 2 Years of Experience of "Residential Care" at "Sakalawara Rehabilitation Services," National Institute of Mental Health and Neurosciences, Bengaluru, India.

    Science.gov (United States)

    Manjunatha, Narayana; Agarwal, Preeti Pansari; Shashidhara, Harihara N; Palakode, Mohan; Raj, E Aravind; Mary Kapanee, Aruna Rose; Nattala, Prashanthi; Kumar, C Naveen; Sudhir, Paulomi; Thirthalli, Jagadisha; Bharath, Srikala; Sekar, Kasi; Varghese, Mathew

    2017-01-01

    There is an unmet need for continuity-of-care is well known for those with severe mental disorders (SMDs) after acute care at hospitals in India. The "Sakalawara Rehabilitation Services (SRS)" functioned from March 2014 at "Sakalawara Community Mental Health Centre" (SCMHC) of "National Institute of Mental Health and Neurosciences," Bengaluru, India in the concepts of residential care (half-way-home) with the aim to develop a replicable model. To review the inpatient records after the initial 2 years of experience in residential care at SCMHC. Retrospective file review of inpatients at SCMHC from March 2014 to March 2016 in a semi-structured proforma designed for the study. Ethical committee of NIMHANS Bengaluru has approved the study. The total number of inpatients during this period was 85. It was found that Schizophrenia spectrum disorders were the most common diagnosis among these patients. The activity of daily living and psycho-education were the most common individual interventions. The majority of families underwent structured family psycho-educational interventions. This review also demonstrated the feasibility of tele-aftercare in continuity of care after discharge of patients. SRS kind of residential set-up is feasible and demonstrated effectiveness in maintaining continuity of care of SMDs. There is a need for better structured and customized interventions. There is further a scope for tele (video) aftercare for those with SMDs.

  19. A Novel Implementation Strategy in Residential Care Settings to Promote EBP: Direct Care Provider Perceptions and Development of a Conceptual Framework.

    Science.gov (United States)

    Slaughter, Susan E; Bampton, Erin; Erin, Daniel F; Ickert, Carla; Jones, C Allyson; Estabrooks, Carole A

    2017-06-01

    Innovative approaches are required to facilitate the adoption and sustainability of evidence-based care practices. We propose a novel implementation strategy, a peer reminder role, which involves offering a brief formal reminder to peers during structured unit meetings. This study aims to (a) identify healthcare aide (HCA) perceptions of a peer reminder role for HCAs, and (b) develop a conceptual framework for the role based on these perceptions. In 2013, a qualitative focus group study was conducted in five purposively sampled residential care facilities in western Canada. A convenience sample of 24 HCAs agreed to participate in five focus groups. Concurrent with data collection, two researchers coded the transcripts and identified themes by consensus. They jointly determined when saturation was achieved and took steps to optimize the trustworthiness of the findings. Five HCAs from the original focus groups commented on the resulting conceptual framework. HCAs were cautious about accepting a role that might alienate them from their co-workers. They emphasized feeling comfortable with the peer reminder role and identified circumstances that would optimize their comfort including: effective implementation strategies, perceptions of the role, role credibility and a supportive context. These intersecting themes formed a peer reminder conceptual framework. We identified HCAs' perspectives of a new peer reminder role designed specifically for them. Based on their perceptions, a conceptual framework was developed to guide the implementation of a peer reminder role for HCAs. This role may be a strategic implementation strategy to optimize the sustainability of new practices in residential care settings, and the related framework could offer guidance on how to implement this role. © 2017 Sigma Theta Tau International.

  20. Studying feasibility and effects of a two-stage nursing staff training in residential geriatric care using a 30 month mixed-methods design [ISRCTN24344776

    Directory of Open Access Journals (Sweden)

    Hantikainen Virpi

    2011-05-01

    Full Text Available Abstract Background Transfer techniques and lifting weights often cause back pain and disorders for nurses in geriatric care. The Kinaesthetics care conception claims to be an alternative, yielding benefits for nurses as well as for clients. Starting a multi-step research program on the effects of Kinaesthetics, we assess the feasibility of a two-stage nursing staff training and a pre-post research design. Using quantitative and qualitative success criteria, we address mobilisation from the bed to a chair and backwards, walking with aid and positioning in bed on the staff level as well as on the resident level. In addition, effect estimates should help to decide on and to prepare a controlled trial. Methods/Design Standard basic and advanced Kinaesthetics courses (each comprising four subsequent days and an additional counselling day during the following four months are offered to n = 36 out of 60 nurses in a residential geriatric care home, who are in charge of 76 residents. N = 22 residents needing movement support are participating to this study. On the staff level, measurements include focus group discussions, questionnaires, physical strain self-assessment (Borg scale, video recordings and external observation of patient assistance skills using a specialised instrument (SOPMAS. Questionnaires used on the resident level include safety, comfort, pain, and level of own participation during mobilisation. A functional mobility profile is assessed using a specialised test procedure (MOTPA. Measurements will take place at baseline (T0, after basic training (T1, and after the advanced course (T2. Follow-up focus groups will be offered at T1 and 10 months later (T3. Discussion Ten criteria for feasibility success are established before the trial, assigned to resources (missing data, processes (drop-out of nurses and residents and science (minimum effects criteria. This will help to make rational decision on entering the next stage of the research

  1. Make a Move: A Comprehensive Effect Evaluation of a Sexual Harassment Prevention Program in Dutch Residential Youth Care.

    Science.gov (United States)

    van Lieshout, Sanne; Mevissen, Fraukje E F; van Breukelen, Gerard; Jonker, Marianne; Ruiter, Robert A C

    2016-06-27

    Sexual harassment-unwanted sexual comments, advances, or behaviors-and sexual violence are still prevalent worldwide, leading to a variety of physical, cognitive, and emotional problems among those being harassed. In particular, youth in care are at risk of becoming perpetrators (and victims) of sexual harassment. However, in general, there are very few interventions targeting this at-risk group, and no such programs exist in the Netherlands. To this end, a group intervention program-Make a Move-targeting determinants of sexual harassment was developed. This program was implemented and evaluated among boys (N = 177) in Dutch residential youth care (20 institutions). A pre-test, post-test, and 6-month follow-up design including an intervention and a waiting list control group with randomized assignment of institutions (cluster randomized trial) was used to measure the effects of the intervention on determinants of sexual harassment. Multilevel (mixed) regression analysis with Bonferroni correction for multiple testing (α = .005) showed no significant effects of Make a Move on determinants of sexual harassment (ps > .03, Cohen's ds < .44). Results are discussed in light of a three-way explanatory model focusing on intervention content, evaluation, and implementation as potential explanations for not finding any measurable intervention effects. © The Author(s) 2016.

  2. How do community-dwelling LGBT people perceive sexuality in residential aged care? A systematic literature review.

    Science.gov (United States)

    Mahieu, Lieslot; Cavolo, Alice; Gastmans, Chris

    2018-01-22

    To investigate what empirical studies report on the perceptions of community-dwelling LGBT adults regarding sexuality and sexual expression in residential aged care (RAC), and how their sexuality should be addressed in RAC. Relevant papers were identified through electronic searches in databases; and by reference tracking and citation tracking. Data were extracted using a standardized data extraction form and were compared, related, and synthesized using thematic analyses. We evaluated the methodological quality of the studies. Eighteen articles were identified. Three major topics emerged regarding sexuality in RAC: (1) factors affecting LGBT people's perceptions, subdivided into (a) discrimination, (b) loss of sexual identity, (c) failure to acknowledge the same-sex partner, and (d) lack of privacy; (2) LGBT-specific RAC facilities; and (3) characteristics of LGBT friendly RAC facilities and caregivers. LGBT people have clear perceptions about how sexuality and sexual expression is or should be managed in RAC. Despite the general increase in acceptance of sexual minorities, many community-dwelling LGBT people believe older LGBT residents are discriminated against because of their sexual orientation or gender identity. Taking into account these opinions is crucial for increasing accessibility of RAC to LGBT people and to ensure the quality of the provided care.

  3. Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory

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    Bamford Claire

    2012-10-01

    Full Text Available Abstract Background Optimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT to understand the barriers and facilitators to implementing the guidelines and inform future implementation. Methods We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT. Results Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence, and as a result, relatively few staff invested in the guidelines (cognitive participation. Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action. Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring. Conclusions The successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to

  4. Training of Residential Social Care Staff to Meet the Needs of Older People with Intellectual Disabilities who Develop Age-Related Health Problems: An Exploratory Study.

    Science.gov (United States)

    Northway, Ruth; Jenkins, Robert; Holland-Hart, Daniella

    2017-09-01

    Despite awareness of the age related health needs of people with intellectual disabilities little is known regarding how residential social care staff are prepared to meet such needs. Data were gathered via semi-structured interviews from 14 managers of supported living settings. Transcripts were thematically analysed. Staff may work in supported living settings with no prior experience of care work, and previous knowledge/experience of supporting people in relation to their health is not required. Whilst health related training is provided there is a lack of specific training regarding healthy ageing, and training seems to be reactive to changing needs of tenants meaning that proactive monitoring for changes in health status may not occur. Whilst some training is provided for residential social care staff in relation to health and ageing a more proactive approach is required which should include a focus on healthy ageing. © 2016 John Wiley & Sons Ltd.

  5. Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada.

    Science.gov (United States)

    Jaworsky, Denise; Gadermann, Anne; Duhoux, Arnaud; Naismith, Trudy E; Norena, Monica; To, Matthew J; Hwang, Stephen W; Palepu, Anita

    2016-08-01

    This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.

  6. In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness

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    Nelson Sara

    2008-12-01

    Full Text Available Abstract Background A joint NHS-Local Authority initiative in England designed to provide a dedicated nursing and physiotherapy in-reach team (IRT to four residential care homes has been evaluated. The IRT supported 131 residents and maintained 15 'virtual' beds for specialist nursing in these care homes. Methods Data captured prospectively (July 2005 to June 2007 included: numbers of referrals; reason for referral; outcome (e.g. admission to IRT bed, short-term IRT support; length of stay in IRT; prevented hospital admissions; early hospital discharges; avoided nursing home transfers; and detection of unrecognised illnesses. An economic analysis was undertaken. Results 733 referrals were made during the 2 years (range 0.5 to 13.0 per resident per annum resulting in a total of 6,528 visits. Two thirds of referrals aimed at maintaining the resident's independence in the care home. According to expert panel assessment, 197 hospital admissions were averted over the period; 20 early discharges facilitated; and 28 resident transfers to a nursing home prevented. Detection of previously unrecognised illnesses accounted for a high number of visits. Investment in IRT equalled £44.38 per resident per week. Savings through reduced hospital admissions, early discharges, delayed transfers to nursing homes, and identification of previously unrecognised illnesses are conservatively estimated to produce a final reduction in care cost of £6.33 per resident per week. A sensitivity analysis indicates this figure might range from a weekly overall saving of £36.90 per resident to a 'worst case' estimate of £2.70 extra expenditure per resident per week. Evaluation early in implementation may underestimate some cost-saving activities and greater savings may emerge over a longer time period. Similarly, IRT costs may reduce over time due to the potential for refinement of team without major loss in effectiveness. Conclusion Introduction of a specialist nursing in

  7. Examining a "Household" Model of Residential Long-term Care in Nova Scotia

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    Janice Keefe

    2017-04-01

    Full Text Available In 2006, Nova Scotia began to implement its Continuing Care Strategy which was grounded in a vision of providing client-centered care for continuing care clients, including residents of nursing homes. Considerable evidence pointed to the benefits of the “household” model of care—which led the province to adopt the smaller self-contained household model as a requirement for owners/operators seeking to build government-funded new and replacement nursing homes. The specific goals of the reform (the adoption of the household model included increasing the proportion of single rooms, improving the home-likeness of the facility, and more generally, providing high-quality care services. The reform was influenced by recognition of the need for change, rapid population aging in the province, and strong political will at a time when fiscal resources were available. To achieve the reform, Nova Scotia Department of Health released two key documents (2007 to guide the design and operation of all new and replacement facilities procured using a request for proposal process: The Long Term Care Program Requirements and the Space and Design Requirements. Results from a research study examining resident quality of life suggest regardless of physical design or staffing approach high resident quality of life can be experienced, while at the same time recognizing that the facilities with “self-contained household” design and expanded care staff roles were uniquely supporting relationships and home-likeness and positively impacting resident quality of life.

  8. Re-Imagining the Care Home: A Spatially Responsive Approach to Arts Practice with Older People in Residential Care

    Science.gov (United States)

    Hatton, Nicola

    2014-01-01

    This paper considers some of the spatial challenges of doing arts projects with older people in care homes, including those living with dementia. It reflects on the author's own experience of running a performance project with residents with at a care home in North London. Drawing on Lefebvre's concept of socially produced space, it argues that…

  9. Cost Effectiveness of Falls and Injury Prevention Strategies for Older Adults Living in Residential Aged Care Facilities.

    Science.gov (United States)

    Church, Jody L; Haas, Marion R; Goodall, Stephen

    2015-12-01

    To evaluate the cost effectiveness of interventions designed to prevent falls and fall-related injuries among older people living in residential aged care facilities (RACFs) from an Australian health care perspective. A decision analytic Markov model was developed that stratified individuals according to their risk of falling and accounted for the risk of injury following a fall. The effectiveness of the interventions was derived from two Cochrane reviews of randomized controlled trials for falls/fall-related injury prevention in RACFs. Interventions were considered effective if they reduced the risk of falling or reduced the risk of injury following a fall. The interventions that were modelled included vitamin D supplementation, annual medication review, multifactorial intervention (a combination of risk assessment, medication review, vision assessment and exercise) and hip protectors. The cost effectiveness was calculated as the incremental cost relative to the incremental benefit, in which the benefit was estimated using quality-adjusted life-years (QALYs). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Vitamin D supplementation and medication review both dominated 'no intervention', as these interventions were both more effective and cost saving (because of healthcare costs avoided). Hip protectors are dominated (less effective and more costly) by vitamin D and medication review. The incremental cost-effectiveness ratio (ICER) for medication review relative to vitamin D supplementation is AU$2442 per QALY gained, and the ICER for multifactorial intervention relative to medication review is AU$1,112,500 per QALY gained. The model is most sensitive to the fear of falling and the cost of the interventions. The model suggests that vitamin D supplementation and medication review are cost-effective interventions that reduce falls, provide health benefits and reduce health care costs in older adults living in RACFs.

  10. Massage, a complementary therapy effectively promoting the health and well-being of older people in residential care settings: a review of the literature.

    Science.gov (United States)

    McFeeters, Sarah; Pront, Leeanne; Cuthbertson, Lesley; King, Lindy

    2016-12-01

    To explore the potential benefits of massage within daily routine care of the older person in residential care settings. Globally, the proportion of people over 65 years is rapidly rising. Increased longevity means older people may experience a rise in physiological and psychological health problems. These issues potentially place an increased demand for quality long-term care for the older person. Complementary approaches such as massage appear to be needed in quality residential care. A critical literature review was undertaken. A literature review pertaining to massage in the older resident was conducted using a range of online databases. Fourteen studies dated 1993-2012 met the inclusion criteria and were critically evaluated as suitable resources for this review. Evidence suggests massage may be advantageous from client and nursing perspectives. Clients' perceive massage to positively influence factors such as pain, sleep, emotional status and psychosocial health. Evidence also demonstrates massage to benefit the client and organisation by reducing the necessity for restraint and pharmacological intervention. Massage may be incorporated into care provision and adopted by care providers and family members as an additional strategy to enhance quality of life for older people. Massage offers a practical activity that can be used to enhance the health and well-being of the older person in residential care. Massage offers benefit for promoting health and well-being of the older person along with potential increased engagement of family in care provision. Integration of massage into daily care activities of the older person requires ongoing promotion and implementation. © 2016 John Wiley & Sons Ltd.

  11. Comparison of Four Probabilistic Models (CARES, Calendex, ConsEspo, SHEDS) to Estimate Aggregate Residential Exposures to Pesticides

    Science.gov (United States)

    Two deterministic models (US EPA’s Office of Pesticide Programs Residential Standard Operating Procedures (OPP Residential SOPs) and Draft Protocol for Measuring Children’s Non-Occupational Exposure to Pesticides by all Relevant Pathways (Draft Protocol)) and four probabilistic mo...

  12. Health status, quality of life, residential stability, substance use, and health care utilization among adults applying to a supportive housing program.

    Science.gov (United States)

    Hwang, Stephen W; Gogosis, Evie; Chambers, Catharine; Dunn, James R; Hoch, Jeffrey S; Aubry, Tim

    2011-12-01

    Supportive housing, defined as subsidized housing in conjunction with site-based social services, may help improve the health and residential stability of highly disadvantaged individuals. This study examined changes in health status, quality of life, substance use, health care utilization, and residential stability among 112 homeless and vulnerably housed individuals who applied to a supportive housing program in Toronto, Canada, from December 2005 to June 2007. Follow-up interviews were conducted every 6 months for 18 months. Comparisons were made between individuals who were accepted into the program (intervention) and those who were wait-listed (usual care) using repeated-measures analyses. Individuals who were accepted into the housing program experienced significantly greater improvements in satisfaction with living situation compared with individuals in the usual care group (time, F(3,3,261) = 47.68, p life measures, health status, health care utilization, or substance use between the two groups over time. Significant improvement in residential stability occurred over time, independent of assigned housing group (time, F(3,3,261) = 9.96, p housing on homeless individuals was limited by the small number of participants who were literally homeless at baseline and by the large number of participants who gained stable housing during the study period regardless of their assigned housing status. Nonetheless, this study shows that highly disadvantaged individuals with a high prevalence of poor physical and mental health and substance use can achieve stable housing.

  13. Exploring the specific needs of an understudied group : Children with intellectual disability in residential child care

    NARCIS (Netherlands)

    Sainero, Ana; del Valle, Jorge F.; Lopez, Monica; Bravo, Amaia

    Children and adolescents who live in out of home care in the child protection system are considered to be vulnerable to manifesting mental health disorders as well as other types of difficulties. This risk is greater in the case of children who display any type of disability. The aim of this study

  14. Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study.

    Science.gov (United States)

    Kwong, Enid Wy; Hung, Maria Sy; Woo, Kevin

    2016-11-25

    A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff's practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate

  15. Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study

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    Enid WY Kwong

    2016-11-01

    Full Text Available Abstract Background A need exits to develop a protocol for preventing pressure ulcers (PUs in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. Methods A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning, changing (action, and refreezing (results were carried out. During each cycle, focus group interviews, field observations of the care staff’s practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. Results The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the

  16. The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.

    Science.gov (United States)

    Connolly, Martin J; Boyd, Michal; Broad, Joanna B; Kerse, Ngaire; Lumley, Thomas; Whitehead, Noeline; Foster, Susan

    2015-01-01

    To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Cluster randomized controlled trial. RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. A total of 1998 residents of 18 intervention facilities and 18 control facilities. A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  17. Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol.

    Science.gov (United States)

    Yi Mohammadi, Joanna Jin; Franks, Kay; Hines, Sonia

    2015-10-01

    The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia.More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth. Dementia poses a significant challenge for health and social policy in Australia. The quality of life of individuals, their families and friends is impacted by dementia. Older people with dementia often have other health comorbidities resulting in the need for a higher level of care. From 2009 to 2010, 53% of permanent residents in Residential Aged Care Facilities (RACFs) had dementia on admission. Older Australians are retaining more of their natural teeth, therefore residents entering RACFs will have more of their natural teeth and require complex dental work than they did in previous generations. Data from the Australian Institute of Health and Welfare showed that more than half the residents in RACFs are now partially dentate with an average of 12 teeth each. Furthermore, coronal and root caries are significant problems, especially in older Australians who are cognitively impaired.Residents in aged care facilities frequently have poor oral health and hygiene with moderate to high levels of oral disease and overall dental neglect. This is reinforced by aged care staff who acknowledge that the demands of feeding, toileting and behavioral issues amongst residents often take precedence over oral health care regimens. Current literature shows that there is a general reluctance on the part of aged care staff to prioritize oral care due to limited knowledge as well as existing psychological barriers to working on another person's mouth. Although staff routinely deal with residents' urinary and faecal incontinence, deep psychological barriers exist when working on someone

  18. A cluster-randomised trial of staff education to improve the quality of life of people with dementia living in residential care: the DIRECT study.

    Directory of Open Access Journals (Sweden)

    Christopher Beer

    Full Text Available BACKGROUND: The Dementia In Residential care: EduCation intervention Trial (DIRECT was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care. METHODOLOGY/PRINCIPAL FINDINGS: This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤ 24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15 higher at four-week follow-up among residents in facilities randomly assigned to the education intervention. CONCLUSION: The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit. TRIAL REGISTRATION: ANZCTR.org.au ACTRN12607000417482.

  19. A cluster-randomised trial of staff education to improve the quality of life of people with dementia living in residential care: the DIRECT study.

    Science.gov (United States)

    Beer, Christopher; Horner, Barbara; Flicker, Leon; Scherer, Samuel; Lautenschlager, Nicola T; Bretland, Nick; Flett, Penelope; Schaper, Frank; Almeida, Osvaldo P

    2011-01-01

    The Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care. This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤ 24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15) higher at four-week follow-up among residents in facilities randomly assigned to the education intervention. The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit. ANZCTR.org.au ACTRN12607000417482.

  20. Measuring the performance of electronic health records: a case study in residential aged care in Australia.

    Science.gov (United States)

    Yu, Ping; Qian, Siyu; Yu, Hui; Lei, Jianbo

    2013-01-01

    Measuring the performance of electronic health records (EHR) is an important, yet un-resolved challenge. Various measurements have addressed different aspects of EHR success, yet a holistic, comprehensive measurement tool needs to be developed to capture the potential EHR success variables completely. A self-administered questionnaire survey instrument was developed based on the theoretical framework of the DeLone and McLean Information Systems Success Model. It measures nigh variables of EHR success: system quality, information quality, service quality, training, self efficacy, intention to use, use, user satisfaction and net benefits. The instrument was used to measure the performance of aged care EHR systems in three aged care organizations. The results suggest that the instrument was reliable.

  1. A qualitative study examining the preparedness of dental hygiene students for a service-learning placement in residential aged care.

    Science.gov (United States)

    Wallace, J P; Blinkhorn, A S; Blinkhorn, F A

    2017-02-01

    The aim of this qualitative study was to measure the effect of a specifically designed orientation re-enactment DVD used to facilitate dental hygiene students transition from the classroom to a Residential Aged Care Facility (RACF) service-learning placement with less personal anxiety and more confidence in their role during the placement. Final year students (n = 47) were randomly allocated to one of 17 RACFs on the NSW, Central Coast, Australia. All students were then randomly allocated to a two-group study with the active group assigned to view the DVD prior to their placement. Students who viewed the DVD were asked not to discuss the content with students who were assigned to the control group. Post-placement focus groups were organized, recorded and transcribed verbatim. Data were collated, analysed and unitized into emergent themes. Representative quotes are presented in the results. The study was informed by 4 years of previous quantitative and qualitative process evaluation of the RACF programme. Focus group discussions identified that those students who had seen the DVD reported a shorter timeframe to successfully transition from the classroom to the RACF and stated that the DVD provided them with a realistic expectation of the RACF environment and their role in the placement experience. The orientation DVD reduced student anxiety and improved student confidence in their role during the placement by providing a realistic orientation of the RACF environment. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use.

    Science.gov (United States)

    Pont, Lisa G; Raban, Magda Z; Jorgensen, Mikaela L; Georgiou, Andrew; Westbrook, Johanna I

    2018-06-08

    The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. A cross-sectional analysis of eMAR data. 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Permanent residents living in a participating facility on 1 October 2015. None. Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.

  3. 76 FR 43237 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

    Science.gov (United States)

    2011-07-20

    ... have a choice of health plans to fit their needs. Exchanges will give individuals and small businesses... Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan (CO-OP) Program... implement the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster the...

  4. Nonphysician Care Providers Can Help to Increase Detection of Cognitive Impairment and Encourage Diagnostic Evaluation for Dementia in Community and Residential Care Settings.

    Science.gov (United States)

    Maslow, Katie; Fortinsky, Richard H

    2018-01-18

    In the United States, at least half of older adults living with dementia do not have a diagnosis. Their cognitive impairment may not have been detected, and some older adults whose physician recommends that they obtain a diagnostic evaluation do not follow through on the recommendation. Initiatives to increase detection of cognitive impairment and diagnosis of dementia have focused primarily on physician practices and public information programs to raise awareness about the importance of detection and diagnosis. Nonphysician care providers who work with older adults in community and residential care settings, such as aging network agencies, public health agencies, senior housing, assisted living, and nursing homes, interact frequently with older adults who have cognitive impairment but have not had a diagnostic evaluation. These care providers may be aware of signs of cognitive impairment and older adults' concerns about their cognition that have not been expressed to their physician. Within their scope of practice and training, nonphysician care providers can help to increase detection of cognitive impairment and encourage older adults with cognitive impairment to obtain a diagnostic evaluation to determine the cause of the condition. This article provides seven practice recommendations intended to increase involvement of nonphysician care providers in detecting cognitive impairment and encouraging older adults to obtain a diagnostic evaluation. The Kickstart-Assess-Evaluate-Refer (KAER) framework for physician practice in detection and diagnosis of dementia is used to identify ways to coordinate physician and nonphysician efforts and thereby increase the proportion of older adults living with dementia who have a diagnosis. © The Author(s) 2018. 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.

  5. A pilot study on the feasibility of training nurses to formulate multicomponent oral health interventions in a residential aged care facility.

    Science.gov (United States)

    Deutsch, Alan; Siegel, Emma; Cations, Monica; Wright, Clive; Naganathan, Vasi; Brodaty, Henry

    2017-12-01

    This 10 weeks feasibility study investigated whether residential care nurses with 12 hours advanced oral health training in assessments and saliva testing could formulate, implement and monitor individualised oral care plans of early dementia residents. Four trained lead advocate nurses using SXI-D, OHIP14, oral health assessment tool (OHAT) assessments and a modified saliva test formulated nurse scheduled comprehensive oral care plans (NSCOCPs) by selecting and scheduling preventive products and procedures multiple times throughout the day to alkalise the mouth of 8 residents as an adjunct to assisted brushing and high-fluoride toothpaste. Nurse assessments, saliva tests and care plans were validated against oral health therapist (OHT) findings. Care plan agreement between Nurse and OHT intervention selection and scheduling was high (75%-88%). Untrained nurse compliance was very high, 86%-99% for the 4930 scheduled interventions. Untrained nurses delivered multiple scheduled interventions by following NSCOCPs despite initially not understanding the reason for each of 9 interventions categories. NSCOCPs could track and monitor whether a recommended intervention had been completed by general nursing staff over 3 nursing shifts. The role of nurses may have to be expanded beyond traditional roles to meet the growth and changes in oral health needs in residential facilities. Intensive training of a few lead advocate nurses to assess risk and formulate individualised NSCOCPs provides a method to transfer knowledge to untrained staff and deliver multicomponent preventive interventions soon after entry into residential care where timely visits by dental professionals to examine residents and prescribe preventive interventions are infrequent or unlikely. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  6. Establishing end-of-life boards for palliative care of patients with advanced diseases.

    Science.gov (United States)

    Masel, Eva K; Unseld, Matthias; Adamidis, Feroniki; Roider-Schur, Sophie; Watzke, Herbert H

    2018-04-01

    Interdisciplinary tumor board decisions improve the quality of oncological therapies, while no such boards exist for end-of-life (EOL) decisions. The aim of this study was to assess the willingness of hemato-oncological and palliative care professionals to develop and participate in EOL boards. An aim of an EOL board would be to establish an interdisciplinary and comprehensive care for the remaining lifetime of patients suffering from advanced incurable diseases. Staff from the interdisciplinary teams of all hemato-oncological and palliative care wards in Vienna were invited to anonymously participate in an online survey. 309 professionals responded. 91% respondents reported a need to establish an EOL board, 63% expressed their willingness to actively participate in an EOL board, and 25% were indecisive. Regarding patient presence, 50% voted for an EOL board in the presence of the patients, and 36% voted for an EOL board in the absence of the patients. 95% had the opinion that an EOL board could improve patient care in the last phase of life. 64% stated that the development of an EOL board would be worthwhile, while 28% did not see enough resources available at their institutions. Regarding the desired type of documentation, 61% voted for a centrally available EOL decision, and 31% supported an in-house-based documentation. 94% voted for the availability of an information folder about EOL care. The willingness of professionals to establish an EOL board was very high. Further steps should be taken to implement such boards to improve EOL care.

  7. The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study.

    Science.gov (United States)

    Stergiopoulos, Vicky; Schuler, Andrée; Nisenbaum, Rosane; deRuiter, Wayne; Guimond, Tim; Wasylenki, Donald; Hoch, Jeffrey S; Hwang, Stephen W; Rouleau, Katherine; Dewa, Carolyn

    2015-08-28

    Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model. In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains. We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures. Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.

  8. Quality of life among adolescents living in residential youth care: do domain-specific self-esteem and psychopathology contribute?

    Science.gov (United States)

    Jozefiak, Thomas; Kayed, Nanna S; Ranøyen, Ingunn; Greger, Hanne K; Wallander, Jan L; Wichstrøm, Lars

    2017-10-01

    Many adolescents living in residential youth care (RYC) institutions perceive their quality of life (QoL) to be low. Enhancing QoL is thus important, but little is known about the potential contributors to their QoL. Early interpersonal trauma and subsequent removal from home and repeated relocations to new placements are expected to affect mental health and self-esteem. We therefore investigated if domain-specific self-esteem contributed to QoL among adolescents living in RYC institutions over and beyond their levels of psychopathology. All youth in Norwegian RYC institutions between the ages 12-23 years were invited to participate. Of a total of 98 RYC institutions, 86 participated, and 400 of 601 eligible youths were examined. The participants' primary contact completed the Child Behavior Checklist to assess psychopathology. The adolescents completed a revised version of the Self-Perception Profile for Adolescents and the questionnaire for measuring health-related quality of life in children and adolescents (KINDL-R). After adjusting for psychopathology, age, and gender, self-esteem domains uniquely explained 42% of the variance in Qol, where social acceptance (β = 0.57) and physical appearance (β = 0.25) domains significantly predicted concurrent QoL. The self-esteem domains, social acceptance and physical appearance, add substantially to the explained variance in QoL among adolescents living in RYC institutions, over and beyond the levels of psychopathology. These self-esteem domains may be targets of intervention to improve QoL, in addition to treating their psychopathology.

  9. The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Lynna Chen

    2016-11-01

    Full Text Available Abstract Background Benzodiazepines are commonly prescribed in residential aged care facilities (RACFs for their sedative and anxiolytic effects. The objective of this study was to investigate the association between benzodiazepine use and sleep quality in residents of RACFs. Methods A cross-sectional study involving 383 participants was conducted in six Australian RACFs. Night-time sleep quality, day-time drowsiness and day-time napping behavior were assessed using a validated questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs and 95% confidence intervals (CIs for the association between benzodiazepine use and sleep quality. Covariates included pain, dementia severity, depression, insomnia and other sedative use. Results Of the 383 residents (mean age 87.5 years, 77.5% female, 96(25.1% used a benzodiazepine on a regular basis. Residents who used long-acting benzodiazepines on a regular basis had higher night-time sleep quality than non-users (AOR = 4.00, 95%CI 1.06 – 15.15. Residents who used short-acting benzodiazepines on a PRN only basis had longer daytime napping times than non-users (AOR = 1.77, 95%CI 1.01 – 3.08. No benzodiazepine category was associated with day-time drowsiness. Conclusions The association between benzodiazepine use and sleep quality is dependent on the half-life and prescribing pattern of the benzodiazepine. Short-acting PRN benzodiazepines were associated with lower night time sleep quality and longer day-time napping compared to long-acting regular benzodiazepines. Longitudinal studies are needed to determine whether these findings reflect channeling of short-acting agents to residents at higher risk of sleep disorders.

  10. Examination of the utility of the promoting action on research implementation in health services framework for implementation of evidence based practice in residential aged care settings.

    Science.gov (United States)

    Perry, Lin; Bellchambers, Helen; Howie, Andrew; Moxey, Annette; Parkinson, Lynne; Capra, Sandra; Byles, Julie

    2011-10-01

    This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care. Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care. This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007-2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities. Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents' home, staff's workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged. Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  11. The aging population: imperative to uncouple sex and gender to establish "gender equal" health care.

    Science.gov (United States)

    Bachmann, Gloria A; Mussman, Brianna

    2015-04-01

    The transgender community has long been marginalized in society. As the world's population ages, gender-unbiased health services for this growing population, with age-related chronic illnesses, will be essential. To optimally eliminate hurdles that trans individuals often confront when requesting services, it appears judicious to eliminate the strict and antiquated definition of what constitutes "normal" female and "normal" male. A review of literature on transgender medicine on PubMed over the last five years was conducted. Existing statistics indicate that unacceptable bias and discrimination are occurring, making trans patients less likely to seek care. There are emerging initiatives that address the transgender and gender non-conforming population. Ongoing needs include defining what constitutes "gender equal," understanding the continuum of gender identity, and establishing and implementing guidelines for gender equal counseling and care. With the routine practice of defining sex at birth and equating sex with gender in the health care setting, the transgender patient encounters multiple barriers to accessing and acquiring health care services. These strict gender labels appear to preclude the institution of gender equal care. Care templates on gender equal patient encounters should be implemented to better address transgender health needs in a non-biased manner. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. The contribution of Australian residential early parenting centres to comprehensive mental health care for mothers of infants: evidence from a prospective study

    Directory of Open Access Journals (Sweden)

    Fisher Jane RW

    2010-04-01

    Full Text Available Abstract Background Australia's public access residential early parenting services provide programs to assist parents who self-refer, to care for their infants and young children. Treatment programs target infant feeding and sleeping difficulties and maternal mental health. There is limited systematic evidence of maternal and infant mental health, psychosocial circumstances or presenting problems, or the effectiveness of the programs. The aim of this study was to contribute to the evidence base about residential early parenting services. Methods A prospective cohort design was used. A consecutive sample of mothers with infants under one year old recruited during admission to a public access residential early parenting service for a 4 or 5 night stay in Melbourne, Australia was recruited. They completed structured self-report questionnaires, incorporating standardised measures of infant behaviour and maternal mood, during admission and at one and six months after discharge. Changes in infant behaviour and maternal psychological functioning after discharge were observed. Results 79 women completed the first questionnaire during admission, and 58 provided complete data. Women admitted to the residential program have poor physical and mental health, limited family support, and infants with substantial behaviour difficulties. One month after discharge significant improvements in infant behaviour and maternal psychological functioning were observed (mean (SD daily crying and fussing during admission = 101.02 (100.8 minutes reduced to 37.7 (55.2 at one month post discharge, p Conclusions This psycho-educational approach is an effective and acceptable early intervention for parenting difficulties and maternal mood disturbance, and contributes to a system of comprehensive mental health care for mothers of infants.

  13. Silent and suffering: a pilot study exploring gaps between theory and practice in pain management for people with severe dementia in residential aged care facilities

    Directory of Open Access Journals (Sweden)

    Peisah C

    2014-10-01

    Full Text Available Carmelle Peisah,1–3 Judith Weaver,1 Lisa Wong,1 Julie-Anne Strukovski1 1Behaviour Assessment Management Service, Specialist Mental Health Services for Older People, Mental Health Drug and Alcohol, Northern Sydney Local Health District, 2University of Sydney, 3University of NSW, Sydney, NSW, Australia Background: Pain is common in older people, particularly those in residential aged care facilities (RACF and those with dementia. However, despite 20 years of discourse on pain and dementia, pain is still undetected or misinterpreted in people with dementia in residential aged care facilities, particularly those with communication difficulties. Methods: A topical survey typology with semistructured interviews was used to gather attitudes and experiences of staff from 15 RACF across Northern Sydney Local Health District. Results: While pain is proactively assessed and pain charts are used in RACF, this is more often regulatory-driven than patient-driven (eg, prior to accreditation. Identification of pain and need for pain relief was ill defined and poorly understood. Both pharmacological and nonpharmacological regimes were used, but in an ad hoc, variable and unsystematic manner, with patient, staff, and attitudinal obstacles between the experience of pain and its relief.Conclusion: A laborious “pain communication chain” exists between the experience of pain and its relief for people with severe dementia within RACF. Given the salience of pain for older people with dementia, we recommend early, proactive consideration and management of pain in the approach to behaviors of concern. Individualized pain measures for such residents; empowerment of nursing staff as “needs interpreters”; collaborative partnerships with common care goals between patients where possible; RACF staff, doctors, and family carers; and more meaningful use of pain charts to map response to stepped pain protocols may be useful strategies to explore in clinical settings

  14. Residential child care

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal

    2013-01-01

    Anmeldelsen gennemgår Connelly og Milligans præsentation af skotske døgninstitutioner ved at placere dette tema inden for rammerne af socialpolitikken og ved at pege på spændingen mellem børns hhv. unges ønsker og de muligheder, stederne kan tilbyde....

  15. Establishing community-based integrated care for elderly patients through interprofessional teamwork: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    Asakawa T

    2017-10-01

    Full Text Available Tomohiro Asakawa,1 Hidenobu Kawabata,1 Kengo Kisa,2 Takayoshi Terashita,3 Manabu Murakami,4 Junji Otaki1 1Department of Medical Education and General Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, 2Kutchan-Kosei General Hospital, Kutchan, Hokkaido, 3Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences, Kamioki-machi, Maebashi, Gunma, 4International Relations Office, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan Background: Working in multidisciplinary teams is indispensable for ensuring high-quality care for elderly people in Japan’s rapidly aging society. However, health professionals often experience difficulty collaborating in practice because of their different educational backgrounds, ideas, and the roles of each profession. In this qualitative descriptive study, we reveal how to build interdisciplinary collaboration in multidisciplinary teams. Methods: Semi-structured interviews were conducted with a total of 26 medical professionals, including physicians, nurses, public health nurses, medical social workers, and clerical personnel. Each participant worked as a team member of community-based integrated care. The central topic of the interviews was what the participants needed to establish collaboration during the care of elderly residents. Each interview lasted for about 60 minutes. All the interviews were recorded, transcribed verbatim, and subjected to content analysis. Results: The analysis yielded the following three categories concerning the necessary elements of building collaboration: 1 two types of meeting configuration; 2 building good communication; and 3 effective leadership. The two meetings described in the first category – “community care meetings” and “individual care meetings” – were aimed at bringing together the disciplines and discussing individual cases, respectively. Building good communication referred to the activities

  16. Establishing Relationships and Navigating Boundaries When Caring for Children With Medical Complexity at Home.

    Science.gov (United States)

    Nageswaran, Savithri; Golden, Shannon L

    Children with medical complexity receive care from many healthcare providers including home healthcare nurses. The objective of our study, based on a conceptual framework, was to describe the relationships between parents/caregivers of children with medical complexity and home healthcare nurses caring for these children. We collected qualitative data in 20 semistructured in-depth interviews (15 English, 5 Spanish) with 26 primary caregivers of children with medical complexity, and 4 focus groups of 18 home healthcare nurses inquiring about their experiences about home healthcare nursing services for children with medical complexity. During an iterative analysis process, we identified recurrent themes related to caregiver-nurse relationships. Our study showed that: (1) caregiver-nurse relationships evolved over time and were determined by multiple factors; (2) communication and trust were essential to the establishment of caregiver-nurse relationships; (3) both caregivers and nurses described difficulties of navigating physical, professional, personal, and emotional boundaries, and identified strategies to maintain these boundaries; and (4) good caregiver-nurse relationships helped in the care of children with medical complexity, reduced caregiver burden, resulted in less stress for nurses, and was a factor in nurse retention. We conclude that trusted relationships between caregivers and nurses are important to the home care of children with medical complexity. Interventions to develop and maintain good caregiver-nurse relationships are necessary.

  17. Implementing the Affordable Care Act: State Action to Establish SHOP Marketplaces.

    Science.gov (United States)

    Dash, Sarah J; Lucia, Kevin W; Thomas, Amy

    2014-03-01

    The Affordable Care Act seeks to help small employers offer coverage by reforming the small-group market and establishing Small Business Health Options Program (SHOP) marketplaces. Seventeen states and the District of Columbia chose to operate their own SHOP marketplaces in 2014, with the federal government operating the SHOP marketplace in 33 states. This brief examines state decisions to enhance the value of SHOP marketplaces for small employers and finds that most have set predictable participation and eligibility requirements and will offer a competitive choice of insurers and plans. States also are seeking to facilitate small employers' shopping experience through online tools and access to personalized assistance. While not all SHOP marketplaces are yet functioning as intended, their establishment offers an opportunity to identify successful strategies for improving the affordability and accessibility of coverage for small employers.

  18. Quasi-experiments to establish causal effects of HIV care and treatment and to improve the cascade of care

    Science.gov (United States)

    Bor, Jacob; Geldsetzer, Pascal; Venkataramani, Atheendar; Bärnighausen, Till

    2015-01-01

    Purpose of review Randomized, population-representative trials of clinical interventions are rare. Quasi-experiments have been used successfully to generate causal evidence on the cascade of HIV care in a broad range of real-world settings. Recent findings Quasi-experiments exploit exogenous, or quasi-random, variation occurring naturally in the world or because of an administrative rule or policy change to estimate causal effects. Well designed quasi-experiments have greater internal validity than typical observational research designs. At the same time, quasi-experiments may also have potential for greater external validity than experiments and can be implemented when randomized clinical trials are infeasible or unethical. Quasi-experimental studies have established the causal effects of HIV testing and initiation of antiretroviral therapy on health, economic outcomes and sexual behaviors, as well as indirect effects on other community members. Recent quasi-experiments have evaluated specific interventions to improve patient performance in the cascade of care, providing causal evidence to optimize clinical management of HIV. Summary Quasi-experiments have generated important data on the real-world impacts of HIV testing and treatment and on interventions to improve the cascade of care. With the growth in large-scale clinical and administrative data, quasi-experiments enable rigorous evaluation of policies implemented in real-world settings. PMID:26371463

  19. Quasi-experiments to establish causal effects of HIV care and treatment and to improve the cascade of care.

    Science.gov (United States)

    Bor, Jacob; Geldsetzer, Pascal; Venkataramani, Atheendar; Bärnighausen, Till

    2015-11-01

    Randomized, population-representative trials of clinical interventions are rare. Quasi-experiments have been used successfully to generate causal evidence on the cascade of HIV care in a broad range of real-world settings. Quasi-experiments exploit exogenous, or quasi-random, variation occurring naturally in the world or because of an administrative rule or policy change to estimate causal effects. Well designed quasi-experiments have greater internal validity than typical observational research designs. At the same time, quasi-experiments may also have potential for greater external validity than experiments and can be implemented when randomized clinical trials are infeasible or unethical. Quasi-experimental studies have established the causal effects of HIV testing and initiation of antiretroviral therapy on health, economic outcomes and sexual behaviors, as well as indirect effects on other community members. Recent quasi-experiments have evaluated specific interventions to improve patient performance in the cascade of care, providing causal evidence to optimize clinical management of HIV. Quasi-experiments have generated important data on the real-world impacts of HIV testing and treatment and on interventions to improve the cascade of care. With the growth in large-scale clinical and administrative data, quasi-experiments enable rigorous evaluation of policies implemented in real-world settings.

  20. Is a change in functional capacity or dependency in activities of daily living associated with a change in mental health among older people living in residential care facilities?

    Directory of Open Access Journals (Sweden)

    Conradsson M

    2013-11-01

    Full Text Available Mia Conradsson,1 Håkan Littbrand,1,2 Gustaf Boström,1 Nina Lindelöf,1 Yngve Gustafson,1 Erik Rosendahl1,2 1Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden; 2Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden Aim: Functional capacity and dependency in activities of daily living (ADL could be important mediators for an association between physical exercise and mental health. The aim of this study was to investigate whether a change in functional capacity or dependency in ADL is associated with a change in depressive symptoms and psychological well-being among older people living in residential care facilities, and whether dementia can be a moderating factor for this association. Methods: A prospective cohort study was undertaken. Participants were 206 older people, dependent in ADL, living in residential care facilities, 115 (56% of whom had diagnosed dementia. Multivariate linear regression, with comprehensive adjustment for potential confounders, was used to investigate associations between differences over 3 months in Berg Balance Scale (BBS and Geriatric Depression Scale (GDS-15 scores, and in BBS and Philadelphia Geriatric Center Morale Scale (PGCMS scores. Associations were also investigated between differences in Barthel ADL Index and GDS-15 scores, and in Barthel ADL Index and PGCMS scores. Results: There were no significant associations between changes in scores over 3 months; the unstandardized β for associations between BBS and GDS-15 was 0.026 (P=0.31, BBS and PGCMS 0.045 (P=0.14, Barthel ADL Index and GDS-15 0.123 (P=0.06, and Barthel ADL Index and PGCMS -0.013 (P=0.86. There were no interaction effects for dementia. Conclusion: A change in functional capacity or dependency in ADL does not appear to be associated with a change in depressive symptoms or psychological well-being among older people living in residential care

  1. Care pathway, towards the establishment of tailored funding: Reasons and criteria for success.

    Science.gov (United States)

    Emery, Grégory; Le Fur, Camille; Epis-de-Fleurian, Anne-Aurélie; Josseran, Anne

    2018-02-01

    Care pathways are often at the forefront of political thinking about health care practices in France without ever finding a durable means for their extension. Closely linked to funding of healthcare system, they have, once again, been the object of so many economical discussions in 2017, as part of a more optimistic climate of governance which is therefore more open to change. Our changing system, the development and increasingly chronic nature of diseases, the scale of technological breakthroughs, these are all factors driving this topic forward. The object of this work, after a necessary study of the semantics of the term "pathway" and even "funding", was to identify all prerequisites and good practices for the stakeholders to develop a pilot pathway and then its relevant implementation in France. To do so, the members of the Round Table have relied on the presentation of examples of care pathways in order to identify triggers to a progressive, adapted extension to the whole territory. The group has identified key elements and priorities for the establishment of public funding beyond existing funding to incentive team work, particularly in the case of treatment rupture points and/or when they have diverging interests. Finally, creating a climate of confidence among patients, professionals, hospitals, the ARS, payers and manufacturers in handling change management will become the key challenges of the implementation of future pathways. Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  2. Effectiveness of meaningful occupation interventions for people living with dementia in residential aged care: a systematic review.

    Science.gov (United States)

    Travers, Catherine; Brooks, Deborah; Hines, Sonia; O'Reilly, Maria; McMaster, Mitchell; He, Wei; MacAndrew, Margaret; Fielding, Elaine; Karlsson, Lina; Beattie, Elizabeth

    2016-12-01

    The ability to participate in valued activities, whether for work, leisure or family, is an important aspect of personal identity. In dementia, progressive memory loss means that abilities developed over a lifetime begin to be lost as well, contributing to the loss of self and identity. Some studies have reported that activities or interventions tailored to be meaningful to the person with dementia (defined as any activity important to the individual) are more effective in addressing behavioral and psychological symptoms of dementia (BPSD) and improving quality of life (QoL) than those that are not so tailored. However, the effectiveness of individualizing interventions or activities for this population is not known. In response to consumer feedback by the Consumer Dementia Research Network that this question ought to be addressed, this review was undertaken, the aim of which was to determine the effectiveness of meaningful occupation interventions for people living with dementia in residential aged care facilities (RACFs). People living with dementia in RACFs (nursing homes).Any intervention that was individualized to be meaningful to the participant, versus any active control condition or usual care.Experimental and observational studies. Quality of life, BPSD (such as agitation, aggression, depression, wandering and apathy), mood, function, cognition and sleep. The search strategy aimed to identify both published and unpublished studies, with the following 12 databases extensively searched: PubMed, CINAHL, PsycINFO, ISI Web of Science, OTSeeker, Embase, Cochrane CENTRAL, clinicaltrials.gov, Mednar, OpenSIGLE, New York Academy of Medicine Library Gray Literature Report, ProQuest Dissertations and Theses. The search strategy was limited to papers published in English between 2004 and January 31, 2015. All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. Data from included papers were extracted using a

  3. Should we provide oral health training for staff caring for people with intellectual disabilities in community based residential care? A cost-effectiveness analysis.

    Science.gov (United States)

    Mac Giolla Phadraig, Caoimhin; Nunn, June; Guerin, Suzanne; Normand, Charles

    2016-04-01

    Oral health training is often introduced into community-based residential settings to improve the oral health of people with intellectual disabilities (ID). There is a lack of appropriate evaluation of such programs, leading to difficulty in deciding how best to allocate scarce resources to achieve maximum effect. This article reports an economic analysis of one such oral health program, undertaken as part of a cluster randomized controlled trial. Firstly, we report a cost-effectiveness analysis of training care-staff compared to no training, using incremental cost-effectiveness ratios (ICERs). Effectiveness was measured as change in knowledge, reported behaviors, attitude and self-efficacy, using validated scales (K&BAS). Secondly, we costed training as it was scaled up to include all staff within the service provider in question. Data were collected in Dublin, Ireland in 2009. It cost between €7000 and €10,000 more to achieve modest improvement in K&BAS scores among a subsample of 162 care-staff, in comparison to doing nothing. Considering scaled up first round training, it cost between €58,000 and €64,000 to train the whole population of staff, from a combined dental and disability service perspective. Less than €15,000-€20,000 of this was additional to the cost of doing nothing (incremental cost). From a dental perspective, a further, second training cycle including all staff would cost between €561 and €3484 (capital costs) and €5815 (operating costs) on a two yearly basis. This study indicates that the program was a cost-effective means of improving self-reported measures and possibly oral health, relative to doing nothing. This was mainly due to low cost, rather than the large effect. In this instance, the use of cost effectiveness analysis has produced evidence, which may be more useful to decision makers than that arising from traditional methods of evaluation. There is a need for CEAs of effective interventions to allow comparison

  4. Outcomes in knowledge, attitudes and confidence of nursing staff working in nursing and residential care homes following a dementia training programme.

    Science.gov (United States)

    Scerri, Anthony; Scerri, Charles

    2017-11-08

    Dementia training programmes for staff working in long-term care settings have been found to be effective in improving staff outcomes. This study investigated the impact of a dementia training programme for all Maltese nursing staff working in public nursing/residential homes on their knowledge, attitudes and confidence. Additionally, we identified the predictors of these domains before and after the programme. A 14-hour training programme focusing on dementia management, care and policy was developed for all nursing staff working in public nursing and residential homes in Malta. A pretest-posttest design was used to evaluate the participants' knowledge of dementia, attitudes and confidence in working with residents with dementia using validated tools. Demographic variables were measured and compared with each staff domain. The majority of nursing staff attended the training programme with 261 fully completed questionnaires being collected pre-training and 214 post-training. The programme significantly improved nursing staff knowledge, attitudes and confidence. Stepwise regression analysis of each staff domain showed that the strongest predictor in all models at pre-training was the intensity of previous training programmes. Furthermore, staff who attended previous training continued to improve in their attitudes and confidence following programme completion. The study continues to shed further evidence on the impact of dementia training programs on staff outcomes. It also indicated that the intensity of previous participation in dementia training programmes was related to the participants' knowledge, attitudes and confidence and that continual exposure to training had a cumulative effect.

  5. Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program.

    Science.gov (United States)

    Hewitt, Jennifer; Goodall, Stephen; Clemson, Lindy; Henwood, Timothy; Refshauge, Kathryn

    2018-04-01

    Falls prevention is an international priority, and residents of long-term aged care fall approximately 3 times more often than community dwellers. There is a relative scarcity of published trials in this setting. Our objective was to undertake a randomized controlled trial to test the effect of published best practice exercise in long-term residential aged care. The trial was designed to determine if combined high level balance and moderate intensity progressive resistance training (the Sunbeam Program) is effective in reducing the rate of falls in residents of aged care facilities. A cluster randomized controlled trial of 16 residential aged care facilities and 221 participants was conducted. The broad inclusion criterion was permanent residents of aged care. Exclusions were diagnosed terminal illness, no medical clearance, permanent bed- or wheelchair-bound status, advanced Parkinson's disease, or insufficient cognition to participate in group exercise. Assessments were taken at baseline, after intervention, and at 12 months. Randomization was performed by computer-generated sequence to receive either the Sunbeam program or usual care. A cluster refers to an aged care facility. The program consisted of individually prescribed progressive resistance training plus balance exercise performed in a group setting for 50 hours over a 25-week period, followed by a maintenance period for 6 months. The primary outcome measure was the rate of falls (number of falls and days followed up). Secondary outcomes included physical performance (Short Physical Performance Battery), quality of life (36-item Short-Form Health Survey), functional mobility (University of Alabama Life Space Assessment), fear of falling (Falls Efficacy Scale International), and cognition (Addenbrooke's Cognitive Evaluation-revised). The rate of falls was reduced by 55% in the exercise group (incidence rate ratio = 0.45, 95% confidence interval 0.17-0.74); an improvement was also seen in physical

  6. Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists.

    Directory of Open Access Journals (Sweden)

    Hanni P Puspitasari

    Full Text Available As primary healthcare professionals, community pharmacists have both opportunity and potential to contribute to the prevention and progression of chronic diseases. Using cardiovascular disease (CVD as a case study, we explored factors that influence community pharmacists' everyday practice in this area. We also propose a model to best illustrate relationships between influencing factors and the scope of community pharmacy practice in the care of clients with established CVD.In-depth, semi-structured interviews were conducted with 21 community pharmacists in New South Wales, Australia. All interviews were audio-recorded, transcribed ad verbatim, and analysed using a "grounded-theory" approach.Our model shows that community pharmacists work within a complex system and their practice is influenced by interactions between three main domains: the "people" factors, including their own attitudes and beliefs as well as those of clients and doctors; the "environment" within and beyond the control of community pharmacy; and outcomes of their professional care. Despite the complexity of factors and interactions, our findings shed some light on the interrelationships between these various influences. The overarching obstacle to maximizing the community pharmacists' contribution is the lack of integration within health systems. However, achieving better integration of community pharmacists in primary care is a challenge since the systems of remuneration for healthcare professional services do not currently support this integration.Tackling chronic diseases such as CVD requires mobilization of all sources of support in the community through innovative policies which facilitate inter-professional collaboration and team care to achieve the best possible healthcare outcomes for society.

  7. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

    Science.gov (United States)

    Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen

    2015-01-01

    Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established.

    Directory of Open Access Journals (Sweden)

    Jacopo M Legramante

    Full Text Available The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with "elderly frequent users".A retrospective study was performed during the calendar year 2014 (1st January 2014 - 31st December 2014 analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models.A total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4-1.7 and hospitalization (OR 3.8: CI 3.7-4. Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9-3.2.Older patients presented clinical and social characteristics related to the definition of "elderly frail frequent users". The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established.Enhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating

  9. Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established.

    Science.gov (United States)

    Legramante, Jacopo M; Morciano, Laura; Lucaroni, Francesca; Gilardi, Francesco; Caredda, Emanuele; Pesaresi, Alessia; Coscia, Massimo; Orlando, Stefano; Brandi, Antonella; Giovagnoli, Germano; Di Lecce, Vito N; Visconti, Giuseppe; Palombi, Leonardo

    2016-01-01

    The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with "elderly frequent users". A retrospective study was performed during the calendar year 2014 (1st January 2014 - 31st December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models. A total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4-1.7) and hospitalization (OR 3.8: CI 3.7-4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9-3.2). Older patients presented clinical and social characteristics related to the definition of "elderly frail frequent users". The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established. Enhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile

  10. Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study.

    Science.gov (United States)

    Dahlkvist, Eva; Hartig, Terry; Nilsson, Annika; Högberg, Hans; Skovdahl, Kirsti; Engström, Maria

    2016-09-01

    To test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden. Many older people in residential facilities suffer from complex health problems. Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health. A multi-level, cross-sectional, correlational design. Questionnaires were administered June-August, 2011 to convenience samples of residents at 72 facilities for older people with complex healthcare needs. One to 10 eligible residents were sampled during self-motivated garden visits at each facility (n = 290). They reported on their garden experiences and health. Facility staff reported on objective garden characteristics and barriers to access. A serial mediation model was tested with multiple linear regression analysis. The total indirect effect of greenery on self-perceived health was positive and significant. Garden greenery appears to affect health by enhancing a sense of being away, affording possibilities to experience the outdoor environment as interesting and encouraging visitation. Among residents in homes with multiple barriers, only fascination mediated the relationship between greenery and self-perceived health. Ample greenery in outdoor space at residential facilities for older people appears to promote experiences of being away and fascination, more frequent visitation and better health. © 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  11. The association between the physical environment and the well-being of older people in residential care facilities: A multilevel analysis.

    Science.gov (United States)

    Nordin, Susanna; McKee, Kevin; Wijk, Helle; Elf, Marie

    2017-12-01

    To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities. Many older people in care facilities have cognitive and physical frailties and are at risk of experiencing low levels of well-being. High-quality physical environments can support older people as frailty increases and promote their well-being. Although the importance of the physical environment for residents' well-being is recognized, more research is needed. A cross-sectional survey of 20 care facilities from each of which 10 residents were sampled. As the individual resident data were nested in the facilities, a multilevel analysis was conducted. Data were collected during 2013 and 2014. The care facilities were purposely sampled to ensure a high level of variation in their physical characteristics. Residents' demographic and health data were collected via medical records and interviews. Residents' well-being and perceived quality of care were assessed via questionnaires and interviews. Environmental quality was assessed with a structured observational instrument. Multilevel analysis indicated that cognitive support in the physical environment was associated with residents' social well-being, after controlling for independence and perceived care quality. However, no significant association was found between the physical environment and residents' psychological well-being. Our study demonstrates the role of the physical environment for enhancing the social well-being of frail older people. Professionals and practitioners involved in the design of care facilities have a responsibility to ensure that such facilities meet high-quality specifications. © 2017 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  12. What are the roles involved in establishing and maintaining informational continuity of care within family practice? A systematic review

    Directory of Open Access Journals (Sweden)

    Agarwal Gina

    2008-12-01

    Full Text Available Abstract Background Central to establishing continuity of care is the development of a relationship between doctor and patient/caregiver. Transfer of information between these parties facilitates the development of continuity in general; and specifically informational continuity of care. We conducted a systematic review of published literature to gain a better understanding of the roles that different parties – specifically doctors, patients, family caregivers, and technology – play in establishing and maintaining informational continuity of care within family practice. Methods Relevant published articles were sought from five databases. Accepted articles were reviewed and appraised in a consistent way. Fifty-six articles were retained following title and abstract reviews. Of these, 28 were accepted for this review. Results No articles focused explicitly on the roles involved in establishing or maintaining informational continuity of care within family practice. Most informational continuity of care literature focused on the transfer of information between settings and not at the first point of contact. Numerous roles were, however, were interpreted using the data extracted from reviewed articles. Doctors are responsible for record keeping, knowing patients' histories, recalling accumulated knowledge, and maintaining confidentiality. Patients are responsible for disclosing personal and health details, transferring information to other practitioners (including new family doctors, and establishing trust. Both are responsible for developing a relationship of trust. Technology is an important tool of informational continuity of care through holding important information, providing search functions, and providing a space for recorded information. There is a significant gap in our knowledge about the roles that family caregivers play. Conclusion The number of roles identified and the interrelationships between them indicates that establishing and

  13. Residential Treatment Centers for Child Abuse

    Directory of Open Access Journals (Sweden)

    Serhat Nasiroglu

    2014-02-01

    Full Text Available Every year millions of reports are being held and cases regarding those reports in courts are carrying on about abusement and omission against children . Abusement against children has been seen throughout of the history. Significant and permanent impacts can occur upon child abusement and neglect on victim children. It is important to know the psychological dynamics which have been lived by the children by the mental health professionalsto protect the children after the abusement report has been written. Cognitive Behaviour Therapy and medications are being used commonly in the treatment of abusement cases. However in some cases it is necessary to send away the victims from environment, enable them to continue their education life, make sure that they are treated by the professional individuals in safe area. For this end there are many Residential Treatment Centers around the world. and ldquo;Oguz Kagan Koksal Social Care and Rehabilitation Center and rdquo; was established in Adana as the first Residential Treatment Center in Turkey. In this report the historical dimensions of the child abusement, the definition of it, its psychological dynamics, the psychological disorders caused by it, treatment approaches and residential treatment centers have been reviewed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(1.000: 67-78

  14. Establishing an external quality assessment scheme for point-of-care international normalized ratio in Thailand.

    Science.gov (United States)

    Tientadakul, P; Chuntarut, A

    2015-08-01

    Effective warfarin therapy management has gained national interest, resulting in the increased use of point-of-care testing (POCT) for international normalized ratio (INR). External quality assessment (EQA) is recommended to ensure quality of the testing. CoaguChek XS and CoaguChek XS Plus are the only commonly available POCT INR monitors in Thailand. Therefore, Thailand NEQAS for Blood Coagulation initiated the scheme for POCT INR in 2013, including only hospitals using these devices. Questionnaires were sent to the hospitals, enquiring about their interest in EQA participation. Two surveys were distributed; each included five certified European Concerted Action on Anticoagulation (ECAA) INR plasma sets. Unsatisfactory performance was indicated by a 15% deviation from the certified mean INR value. There were 156 hospitals using the devices. Thirty-five hospitals responded to the questionnaires. Medical personnel undertaking POCT INR were limited to laboratory staff in 29 (83%) of these centers, and 31 hospitals actually participated. The medians of results from participants were the same or nearly the same as the certified mean INRs. External quality assessment for POCT INR in Thailand is feasible using the ECAA plasmas as control materials. The results therefore appear encouraging to other developing countries to establish their own EQA schemes. © 2014 John Wiley & Sons Ltd.

  15. Adolescents in secure residential care: the role of active and passive coping on general well-being and self-esteem.

    Science.gov (United States)

    Barendregt, Charlotte S; Van der Laan, André M; Bongers, Ilja L; Van Nieuwenhuizen, Chijs

    2015-07-01

    Coping, general well-being and self-esteem play an important role during the process of adaptation to turning points in life-course. This study aimed to investigate the effect of coping on both the development of general well-being and self-esteem of adolescents with severe psychiatric problems in secure residential care. In addition, risk and protective factors were taken into account. Adolescents between the age of 16 and 18 (N = 172) were followed for 1.5 years. General well-being and self-esteem were assessed with the Lancashire Quality of Life Profile and the Self-Perception Profile for Adolescents, respectively. In addition, the Utrecht Coping List for Adolescents and the Structured Assessment of Violence Risk in Youth were administered. Results showed that the longitudinal relation between general well-being and self-esteem is no longer significant after adding active and passive coping to the model. The use of active coping strategies was associated with a higher self-esteem. The use of passive coping strategies was associated with a lower self-esteem and also a lower perceived general well-being. Having multiple risks in the individual and/or social/contextual domain affected the developmental pattern of general well-being. During treatment of adolescents with severe psychiatric problems in secure residential care, attention should be paid for enhancing those capabilities and skills, like coping, which help adolescents to fulfill their needs and consequently enhance their well-being. Enhancing the well-being of adolescents might in the long run decrease the chance of reoffending and/or psychiatric relapse.

  16. THE PSYCHOLOGICAL TREATMENT OF CHILDREN AND ADOLESCENTS IN RESIDENTIAL CARE. CONTRIBUTIONS TO A SPECIFIC FIELD OF INTERVENTION

    Directory of Open Access Journals (Sweden)

    Antonio Galán Rodríguez

    2014-09-01

    Full Text Available Psychological treatment is provided to a great number of minors fostered in residential centres of the child protection system; however, a deep and systematic analysis regarding the specific topics of this field has not yet been carried out. We analyse the ways of organizing units to attend children, taking into account three different options (general practice, specific practice in common settings, and specialized programs, and their advantages and disadvantages. We consider the role of the theoretical models, underlining the need for complexity and critical analysis, illustrated by reviewing three common models (the psychopathological, trauma-informed, and attachment models. Finally, we pay attention to the specificity of the technical interventions, calling for modified adaptations based on the characteristics of the minors, specific topics in this field, and some particular aspects of the context.

  17. Profile of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care.

    Science.gov (United States)

    Yampolskaya, Svetlana; Mowery, Debra; Dollard, Norín

    2014-05-01

    This study examined characteristics and profiles of youth receiving services in 1 of Florida's Medicaid-funded residential mental health treatment programs--State Inpatient Psychiatric Program (SIPP)--between July 1, 2004, and June 30, 2008 (N=1,432). Latent class analysis (LCA) was used to classify youth, and 3 classes were identified: Children With Multiple Needs, Children With No Caregivers, and Abused Children With Substantial Maltreatment History. The results of LCA showed that Children With Multiple Needs experienced the greatest risk for adverse outcomes. Compared with youth in the other 2 classes, these children were more likely to get readmitted to SIPP, more likely to become involved with the juvenile justice system, and more likely to experience involuntary mental health assessments. Implications of the findings are discussed. PsycINFO Database Record (c) 2014 APA, all rights reserved

  18. Residential environmental evaluation of local cities considering regional characteristic and personal residential preference-a case study of Saga City,Japan

    Institute of Scientific and Technical Information of China (English)

    GE Jian; HOKAO Kazunori

    2004-01-01

    Questionnaire surveys and subjective evaluations on residential environment were performed in order to grasp the main factors of residential environment of small local cities. The suitable evaluation index system was established, and the regional residential environment characteristics and personal residential preference types were analyzed, so that their influence on residential environment evaluation could be grasped. The results can be applied to the residential environment planning, construction and monitoring of local cities.

  19. Decision-making experiences of family members of older adults with moderate dementia towards community and residential care home services: a grounded theory study protocol.

    Science.gov (United States)

    Le Low, Lisa Pau; Lam, Lai Wah; Fan, Kim Pong

    2017-06-05

    Caring and supporting older people with dementia have become a major public health priority. Recent reports have also revealed a diminishing number of family carers to provide dementia care in the future. Carers who are engaged in the caring role are known to bear significant psychological, practical and economic challenges as the disease advances over time. Seemingly, evidence indicates that the burden of care can be relieved by formal services. This study aims to explore decision-making experiences of family members of older adults with moderate dementia towards the use of community support (CS) and residential care home (RCH) services. A large multi-site constructivist grounded theory in a range of non-government organizations and a private aged home will frame this Hong Kong study. Purposive sampling will begin the recruitment of family members, followed by theoretical sampling. It is estimated that more than 100 family members using CS and RCH services will participate in an interview. The process of successive constant comparative analysis will be undertaken. The final product, a theory, will generate an integrated and comprehensive conceptual understanding which will explain the processes associated with decision-making of family members for dementia sufferers. Deeper understanding of issues including, but not exclusive to, service needs, expectations and hopes among family carers for improving service support to serve dementia sufferers in CS and RCH services will also be revealed. Importantly, this study seeks to illustrate the practical and strategic aspects of the theory and how it may be useful to transfer its applicability to various service settings to better support those who deliver formal and informal care to the dementia population.

  20. Survival, Signaling, and Security: Foster Carers' and Residential Carers' Accounts of Self-Harming Practices Among Children and Young People in Care.

    Science.gov (United States)

    Evans, Rhiannon E

    2018-05-01

    Research on clinicians' interpretations of self-harming practices has shown that they can often be negative. To date there has been limited consideration of other professionals' narratives, notably those working in social care. This article presents focus group and interview data generated with foster carers ( n = 15) and residential carers ( n = 15) to explore the symbolic meanings ascribed to self-harm among the children and young people they care for. Three repertoires of interpretation are presented: survival, which conceives self-harm as a mechanism for redefining the identity of "looked-after"; signaling, which understands self-harm as a communicative tool for the expression of emotion; and security, which sees self-harming practices as testing the authenticity and safety of the caring relationship. Through their focus on sociocultural narratives, carers position themselves as experts on self-harm due to their intimacy with young people's social worlds. This construction potentially creates distance from health professionals, which is problematic given the current privileging of interprofessional working.

  1. Residential greenhouse

    Energy Technology Data Exchange (ETDEWEB)

    1985-02-01

    The following report examines the technical and economic viability of residential greenhouse additions in Whitehorse, Yukon. The greenhouse was constructed using the south facing wall of an existing residence as a common wall. Total construction costs were $18,000, including labour. Annual fuel demand for the residence has been reduced by about 10 per cent for an annual saving of $425. In addition, produce to the value of $1,000 is grown annually in the greenhouse for domestic consumption and commercial resale. Typically the greenhouse operates for nine months each year. There is a net thermal loss during the months of November, December and January as a result of the large area of glazing. As well as supplementing the heating supply solar greenhouses can provide additional cash crops which can be used to offset the cost of construction. Humidity problems are minimal and can be dealt with by exhausting high humidity air. One system which has been considered for the greenhouse is to use a standard residential heat pump to remove excess moisture and to pump heat into the house. This would have a secondary benefit of excluding the need to circulate greenhouse air through the house. Thus any allergenic reactions to the greenhouse air would be prevented. 8 refs., 3 figs, 2 tabs.

  2. Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program.

    Science.gov (United States)

    Hewitt, Jennifer; Refshauge, Kathryn M; Goodall, Stephen; Henwood, Timothy; Clemson, Lindy

    2014-01-01

    Falls are common among older adults. It is reported that approximately 60% of residents of aged care facilities fall each year. This is a major cause of morbidity and mortality, and a significant burden for health care providers and the health system. Among community dwelling older adults, exercise appears to be an effective countermeasure, but data are limited and inconsistent among studies in residents of aged care communities. This trial has been designed to evaluate whether the SUNBEAM program (Strength and Balance Exercise in Aged Care) reduces falls in residents of aged care facilities. Is the program more effective and cost-effective than usual care for the prevention of falls? Single-blinded, two group, cluster randomized trial. 300 residents, living in 20 aged care facilities. Progressive resistance and balance training under the guidance of a physiotherapist for 6 months, then facility-guided maintenance training for 6 months. Usual care. Number of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive well-being, resource use, and cost-effectiveness. Measurements will be taken at baseline, 6 months, and 12 months. The number of falls will be analyzed using a Poisson mixed model. A logistic mixed model will be used to analyze the number of residents who fall during the study period. Intention-to-treat analysis will be used. This study addresses a significant shortcoming in aged care research, and has potential to impact upon a substantial health care problem. Outcomes will be used to inform care providers, and guide health care policies.

  3. Distribution of physical therapists working on public and private establishments in different levels of complexity of health care in Brazil.

    Science.gov (United States)

    Costa, Larissa R; Costa, José L R; Oishi, Jorge; Driusso, Patricia

    2012-01-01

    The Brazilian Health System is organized on a regional and hierarchical form with three levels of complexity of health care. The Primary Care represents the first element of a continuing health care process, complemented by specialized actions. However, the centrality of the specialized care is still a problem in Brazil, especially in the private sector. Studies on the distribution of professionals in the health system allowing the formulation of appropriate policies are needed. To investigate the distribution of physical therapists in the levels of complexity of health care and between public and private establishments, according to data from the National Register of Health Service Providers (NRHSP). A descriptive cross-sectional study was performed considering NRHSP-national bank data collected in March 2010 and demographic census 2010 data. Data were analyzed through descriptive statistics techniques. We identified 53,181 registries of physical therapists, 60% linked to the private sector. Only 13% of all entries were linked to primary care. The predominance in specialized care occurred in the public sector (65%) and private sector (100%). The specialized establishments of private sector linked to the southeast region (16,043) were the main sites of physical therapists. Only the public sector in the south had a majority in the Primary Care. When considering the sizes of the cities, there is focus on specialist care in bigger cities. This study identified the concentration of physical therapists in the specialized care, mostly in metropolis and big cities and in the private sector, with restricted to participation in the primary care.

  4. Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program

    Directory of Open Access Journals (Sweden)

    Hewitt J

    2014-02-01

    Full Text Available Jennifer Hewitt,1 Kathryn M Refshauge,1 Stephen Goodall,2 Timothy Henwood,3 Lindy Clemson1 1Faculty of Health Sciences, University of Sydney, 2Centre for Health Economic Research and Evaluation, University of Technology, Sydney, NSW, 3University of Queensland/Blue Care Research and Practice Development Centre, The University of Queensland, Brisbane, QLD, Australia Introduction: Falls are common among older adults. It is reported that approximately 60% of residents of aged care facilities fall each year. This is a major cause of morbidity and mortality, and a significant burden for health care providers and the health system. Among community dwelling older adults, exercise appears to be an effective countermeasure, but data are limited and inconsistent among studies in residents of aged care communities. This trial has been designed to evaluate whether the SUNBEAM program (Strength and Balance Exercise in Aged Care reduces falls in residents of aged care facilities. Research question: Is the program more effective and cost-effective than usual care for the prevention of falls? Design: Single-blinded, two group, cluster randomized trial. Participants and setting: 300 residents, living in 20 aged care facilities. Intervention: Progressive resistance and balance training under the guidance of a physiotherapist for 6 months, then facility-guided maintenance training for 6 months. Control: Usual care. Measurements: Number of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive well-being, resource use, and cost-effectiveness. Measurements will be taken at baseline, 6 months, and 12 months. Analysis: The number of falls will be analyzed using a Poisson mixed model. A logistic mixed model will be used to analyze the number of residents who fall during the study period. Intention-to-treat analysis will be used. Discussion: This study addresses a significant shortcoming in aged care research, and has potential to impact

  5. Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home

    NARCIS (Netherlands)

    Plochg, Thomas; Delnoij, Diana M. J.; van der Kruk, Tineke F.; Janmaat, Tonnie A. C. M.; Klazinga, Niek S.

    2005-01-01

    Background: Intermediate care was developed in order to bridge acute, primary and social care, primarily for elderly persons with complex care needs. Such bridging initiatives are intended to reduce hospital stays and improve continuity of care. Although many models assume positive effects, it is

  6. Establishment and assessment of cataract surgery in Day-care Unit at northwest of China

    OpenAIRE

    Xiu-Li Zhang; Xing Yang; Juan-Juan Yang; Bao-Jian Yan; Jing-Ming Li; Cheng Pei; Li Qin

    2018-01-01

    AIM: To describe the protocol and economic cost of the Day-care Unit cataract surgery procedure in northwest of China.METHODS: Patients who received phacoemulcification and intraocular lens implantation in both Day-care Unit and regular Unit were recruited from January 2016 to December 2016. The baseline data and average cost were recorded and analyzed. Furthermore, satisfaction questionnaire of patients were collected.RESULTS: Patients with Day-care Unit showed shorter registration duration,...

  7. 75 FR 34140 - Establishment of the Personal Care Attendants Workforce Advisory Panel

    Science.gov (United States)

    2010-06-16

    ... services and supports; aging and disability populations and services; practices that help reduce high personal care attendant workforce vacancy and turnover rates; Medicaid, Medicare, the Older Americans Act...

  8. Supporting the long-term residential care needs of older homeless people with severe alcohol-related brain injury in Australia: the Wicking Project.

    Science.gov (United States)

    Rota-Bartelink, Alice; Lipmann, Bryan

    2007-01-01

    For years, community service providers have been frustrated with the lack in availability of long-term, specialized supported accommodation for older people, particularly older homeless people, with severe acquired brain injury (ABI) and challenging behaviors. Although the incidence of ABI (particularly alcohol-related brain injury) is far wider than being confined to the homeless population, it is frequently misdiagnosed and very often misunderstood Wintringham is an independent welfare company in Melbourne, Australia, that provides secure, affordable, long-term accommodation and high quality services to older homeless people. The high incidence of alcohol abuse among the resident population has led us to adapt our model ofcare to accommodate a complexity of need. However, there are some individuals with severely affected behaviors that continue to challenge Wintringham's capacity to provide adequate support. The deficiency in highly specialized, long-term supported accommodation for older people with severe alcohol-related brain injury (ARBI) is the driving force behind this project. We aim to further develop and improve the current Wintringham model of residential care to better support people with these complex care needs. We will report on the synthesis of this project which aims to test a specialized model that can be reproduced or adapted by other service providers to improve the life circumstances of these frequently forgotten people.

  9. Do interventions with staff in long-term residential facilities improve quality of care or quality for life people with dementia? A systematic review of the evidence.

    Science.gov (United States)

    Bird, Mike; Anderson, Katrina; MacPherson, Sarah; Blair, Annaliese

    2016-12-01

    Common sense suggests and research indicates relationships between staff factors in residential dementia care and quality of life (QOL) for residents, with poor care increasing suffering. However, we do not have a coherent picture of which staff interventions have an impact on quality of care (QOC) or resident QOL. A comprehensive search of 20 years' peer-reviewed literature using Medline, PsycINFO, Embase, PubMed, CINAHL, and the Cochrane, Campbell Collaboration identified 4,760 studies meriting full text review. Forty-six met the inclusion criteria, namely interventions in long-term facilities helping staff develop their capacity to provide better care and/or QOL for residents with dementia. Thirty-five other papers comprised an associated predictor review. Conclusions from these limited data are further compromised because nine studies failed to measure effects on residents and only half assessed effects after the project team withdrew. Of these, excellent studies produced change over the medium (3-4 months) or longer term, including reduction in challenging behavior and restraint use but this applied only to a minority. A number of studies failed to measure effects on QOC, limiting conclusions about mechanisms underlying change. In general, level of intervention required depended on the target. For outcomes like restraint use, structured education sessions with some support appear adequate. Programs to reduce pain require more support. For complicated issues like challenging behavior and increasing co-operation in showering, detailed, supportive, on-site interventions are required. Improvements in restraint and staff/resident interactions were the most promising findings. (Review registration number: PROSPERO 2014:CRD42014015224).

  10. Holistic models for end of life care: establishing the place of culture

    NARCIS (Netherlands)

    Selman, L.; Speck, P.; Barfield, R.C.; Gysels, M.; Higginson, I.J.; Harding, R.

    2014-01-01

    Introduction This article presents a holistic model for clinical palliative care and research which expands and improves previous models by fully recognizing the place of culture in illness. Methods Literature review and philosophical enquiry. Results Holistic models of patient care are essential to

  11. Establishment and assessment of cataract surgery in Day-care Unit at northwest of China

    Directory of Open Access Journals (Sweden)

    Xiu-Li Zhang

    2018-04-01

    Full Text Available AIM: To describe the protocol and economic cost of the Day-care Unit cataract surgery procedure in northwest of China.METHODS: Patients who received phacoemulcification and intraocular lens implantation in both Day-care Unit and regular Unit were recruited from January 2016 to December 2016. The baseline data and average cost were recorded and analyzed. Furthermore, satisfaction questionnaire of patients were collected.RESULTS: Patients with Day-care Unit showed shorter registration duration, less cost including housing and nursing charge as well as higher rate of patient satisfaction. Meanwhile, Day-care Unit shorten the time the doctors and nurses spending on filling the medical charts.CONCLUSION:Day-care Unit cataract surgery procedure could benefit both patients and medical staffs and is worthy to generalize.

  12. Beyond bankable dollars: establishing a business case for improving health care.

    Science.gov (United States)

    Bailit, Michael; Dyer, Mary Beth

    2004-09-01

    To address widespread deficiencies in the quality of health care, the authors argue that health care organizations need to be able to make a "business case" for improving quality--a compelling rationale for financial investment in quality improvement programs. The authors' framework for such a business case is organized around three broad areas: direct financial considerations, strategic considerations, and internal organizational considerations. Within these categories, they offer a total of 10 specific business case arguments, with examples, for investing in quality improvement.

  13. The relationship between physical activity, and physical performance and psycho-cognitive functioning in older adults living in residential aged care facilities.

    Science.gov (United States)

    Bootsman, Natalia J M; Skinner, Tina L; Lal, Ravin; Glindemann, Delma; Lagasca, Carmela; Peeters, G M E E Geeske

    2018-02-01

    Insight into modifiable factors related to falls risk in older adults living in residential aged care facilities (RACFs) is necessary to tailor preventive strategies for this high-risk population. Associations between physical activity (PA), physical performance and psycho-cognitive functioning have been understudied in aged care residents. This study investigated associations between PA, and both physical performance and psycho-cognitive functioning in older adults living in RACFs. Cross-sectional study. Forty-four residents aged 85±8years were recruited from four RACFs located in Southeast Queensland. PA was assessed as the average time spent walking in hours/day using activPAL3™. Physical performance tests included balance, gait speed, dual-task ability, reaction time, coordination, grip strength, and leg strength and power. Psycho-cognitive questionnaires included quality of life, balance confidence, fear of falling and cognitive functioning. Associations between PA and each outcome measure were analysed using linear or ordinal regression models. The average time spent walking was 0.5±0.4h/day. Higher levels of PA were significantly associated with better balance (compared with low PA, medium: B=1.6; high: B=1.3) and dual-task ability (OR=7.9 per 0.5h/day increase). No statistically significant associations were found between PA and the other physical and psycho-cognitive measures. More physically active residents scored higher on balance and dual-task ability, which are key predictors of falls risk. This suggests that physical activity programs targeting balance and dual-task ability could help prevent falls in aged care residents. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  14. Sterilization of health care products - Radiation. Part 2: Establishing the sterilization dose

    International Nuclear Information System (INIS)

    2006-01-01

    This part of ISO 11137 describes methods that may be used to establish the sterilization dose in accordance with one of the two approaches specified in 8.2 of ISO 11137-1:2006. The methods used in these approaches are: a) dose setting to obtain a product-specific dose; b) dose substantiation to verify a preselected dose of 25 kGy or 15 kGy. The basis of the dose setting methods described in this part of ISO 11137 (Methods 1 and 2) owe much to the ideas first propounded by Tallentire (Tallentire, 1973 [17]; Tallentire, Dwyer and Ley, 1971 [18]; Tallentire and Khan, 1978 [19]). Subsequently, standardized protocols were developed (Davis et al., 1981 [8]; Davis, Strawderman and Whitby, 1984 [9]) which formed the basis of the dose setting methods detailed in the AAMI Recommended Practice for Sterilization by Gamma Radiation (AAMI 1984, 1991 [4], [6]). Methods 1 and 2 and the associated sterilization dose audit procedures use data derived from the inactivation of the microbial population in its natural state on product. The methods are based on a probability model for the inactivation of microbial populations. The probability model, as applied to bioburden made up of a mixture of various microbial species, assumes that each such species has its own unique D 10 value. In the model, the probability that an item will possess a surviving microorganism after exposure to a given dose of radiation is defined in terms of the initial number of microorganisms on the item prior to irradiation and the D 10 values of the microorganisms. The methods involve performance of tests of sterility on product items that have received doses of radiation lower than the sterilization dose. The outcome of these tests is used to predict the dose needed to achieve a predetermined sterility assurance level, SAL. Methods 1 and 2 may also be used to substantiate 25 kGy if, on performing a dose setting exercise, the derived sterilization dose for an SAL of 10 -6 is u ≤25 kGy. The basis of the method

  15. Make a move : A comprehensive effect evaluation of a sexual harassment prevention program in Dutch residential youth care

    NARCIS (Netherlands)

    van Lieshout, Sanne; Mevissen, Fraukje E F; van Breukelen, Gerard; Jonker, Marianne; Ruiter, Robert A C

    2016-01-01

    Sexual harassment-unwanted sexual comments, advances, or behaviors-and sexual violence are still prevalent worldwide, leading to a variety of physical, cognitive, and emotional problems among those being harassed. In particular, youth in care are at risk of becoming perpetrators (and victims) of

  16. A purposeful Yet Nonimposing Approach: How Japanese Home Care Nurses Establish Relationships With Older Clients and Their Families.

    Science.gov (United States)

    Iwasaki, Takako; Yamamoto-Mitani, Noriko; Sato, Kana; Yumoto, Yoshie; Noguchi-Watanabe, Maiko; Ogata, Yasuko

    2017-11-01

    Relationship development is crucial to nursing practice with families. However, little is known about the process of building relationships with multiple family members in home care settings and in various cultures. The objective of this study was to explore the experiences of home care nurses about how they established relationships with older clients and their families in Japan. Grounded theory was used to guide the research. Twenty-three expert home care nurses participated in semistructured interviews concerning their family nursing practice. The establishment of relationships with clients/family members was based on a purposeful yet nonimposing approach composed of four aspects: keeping a mindful distance from the family, not being a threat to family life, being a comfortable neighbor, and gaining trust as a competent nurse. Through a purposeful nonimposing approach, Japanese home care nurses promoted and nurtured nurse-family relationships and became involved in the life of the family. These findings provide a useful foundation to guide practice with families and grow knowledge about the process of establishing relationships with multiple family members in home settings.

  17. The Significance of Education for Establishment in the Care Sector: Women and Men and Care Workers with a Migrant Background

    Science.gov (United States)

    Johansson, Stina; Ahnlund, Petra

    2014-01-01

    In this article, we have followed women and men with a Swedish or an immigrant background that have completed the Upper Secondary Health Care Program. In which occupations do they work? Who employs them? Which target groups do they serve? Official statistics and survey data were used. The interaction between occupational structure and educational…

  18. Establishing breach of the duty of care in the tort of negligence.

    Science.gov (United States)

    Tingle, John

    This article, the third in a series on clinical negligence, looks at the law surrounding breach of the duty of care in negligence. It shows some of the principles that judges and lawyers use in order to decide whether a person has broken his/her duty of care in the tort of negligence. It will be seen that the principles are contained in decided court cases, some of which are quite old but are still relevant today. The focus of this article is on the rule that courts, in deciding the issue of a breach of duty of care, would judge the defendant's conduct by the standard of what the hypothetical, 'reasonable person' would have done in the circumstances of the case.

  19. Establishing breach of the duty of care in the tort of negligence: 2.

    Science.gov (United States)

    Tingle, John

    This article discusses the law surrounding breach of the duty of care in negligence. A mistake or error does not necessarily mean legal fault and negligence. Judges look at risks and benefits in determining what would have been the appropriate standard of care to be exercised in the circumstances and may decide that the defendant's conduct was reasonable. There are a number of interrelated factors which judges have to balance and these can be categorized as foreseeability of harm, magnitude of risk, burden of taking precautions, utility of the defendant's conduct and common practice.

  20. The Life of the Elderly in Residential Care Facilities - A Study of Autonomy and Life Situation of Elderly People in the Context of the Political Organisation of the Facilities

    DEFF Research Database (Denmark)

    Skjødt, Ulla

    as mutually informing each other. Empirical material is generated by participant observation studies and interviews in residential care facilities as well as policy documents concerning the arrangement of public help to impaired elderly people are analysed. Results: Analysis of the empirical material...... and of pertinent policy documents reveal that elderly are politically valued, when they manage to avoid drawing on the public services that are available to them. A current dominant political standardised concept of autonomy is rendered visible. In its generalised form this concept turns out to be contradictory......Abstract: Bridging the gap – in Public Health Nursing September 19th and 20th 2016 Organised by: Global Network of Public Health Nursing The Life of the Elderly in Residential Care Facilities - A Study of Autonomy and Life Situation of Elderly People in the Context of the Political Organisation...

  1. Patterns of emergency ambulance use, 2009-13: a comparison of older people living in Residential Aged Care Facilities and the Community.

    Science.gov (United States)

    Dwyer, R; Gabbe, B; Tran, T D; Smith, K; Lowthian, J A

    2018-04-24

    to examine demand for emergency ambulances by older people. retrospective cohort study using secondary analysis of routinely collected clinical and administrative data from Ambulance Victoria, and population data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. Victoria, Australia. people aged 65 years and over, living in Residential Aged Care Facilities (RACF) and the community, attended by emergency ambulance paramedics, 2009-13. rates of emergency ambulance attendance. older people living in RACF experienced high rates of emergency ambulance attendance, up to four times those for age- and sex-matched people living in the community. Rates remained constant during the study period equating to a consistent, 1.45% average annual increase in absolute demand. Rates peak among the 80-84-year group where the number of attendances equates to greater than one for every RACF-dwelling person each year. Increased demand was associated with winter months, increasing age and being male. these data provide strong evidence of high rates of emergency ambulance use by people aged 65 years and over living in RACF. These results demonstrate a clear relationship between increased rate of ambulance use among this vulnerable group of older Australians and residence, sex, age and season. Overall, absolute demand continues to increase each year adding to strain on health resources. Additional research is needed to elucidate individual characteristics, illness and health system contributors to ambulance use to inform strategies to appropriately reduce demand.

  2. Family medicine’s rapid establishment and early leadership role in Qatar’s health care system

    Directory of Open Access Journals (Sweden)

    Verjee MA

    2013-08-01

    Full Text Available Mohamud A Verjee,1 Mariam Ali Abdulmalik,2 Michael D Fetters31Department of Medical Education, Weill Cornell Medical College in Qatar, Qatar Foundation – Education City, Doha, Qatar; 2Primary Health Care Corporation, Doha, Qatar; 3Department of Family Medicine, University of Michigan, Michigan, USAAbstract: Family medicine is a focus of health care in Qatar, and it has emerged as a primary care pioneer in the Arabian Gulf Region. Strong governmental financial support has underpinned family medicine development in the country, and through proactive health care policy, free or highly affordable health care is available to all citizens and expatriates in primary health care centers and hospitals. An Ivy League and world-class medical school, Weill Cornell Medical College in New York established a second campus in Qatar in 2001, and enrolled its first students in 2002. The inaugural class graduated in 2008, including one graduate who matched to a family medicine residency in the United States. The College has already earned a reputation for an emphasis on cultural sensitivity in the curriculum. Qatar also has a well-established family medicine residency program overseen by the Primary Health Care Corporation. Its inaugural class of family medicine residents began training in 1995 and graduated in 1999. In contrast to a trend of fluctuating interest in family medicine training in many developed countries, the demand for residency slots in Qatar has been consistently high. Since November 2012, the Accreditation Council for Graduate Medical Education-International has approved all hospital-based residency positions. Formed in 2012, the Primary Health Care Corporation is dedicated to achieving accreditation for the family medicine residency in the near future. In 2011, Qatar’s 147 family physicians comprised about 18% of the total physician workforce. Through extended hours of operation at health centers, patients have ready access for acute care

  3. Improving burn care and preventing burns by establishing a burn database in Ukraine.

    Science.gov (United States)

    Fuzaylov, Gennadiy; Murthy, Sushila; Dunaev, Alexander; Savchyn, Vasyl; Knittel, Justin; Zabolotina, Olga; Dylewski, Maggie L; Driscoll, Daniel N

    2014-08-01

    Burns are a challenge for trauma care and a contribution to the surgical burden. The former Soviet republic of Ukraine has a foundation for burn care; however data concerning burns in Ukraine has historically been scant. The objective of this paper was to compare a new burn database to identify problems and implement improvements in burn care and prevention in this country. Retrospective analyses of demographic and clinical data of burn patients including Tukey's post hoc test, analysis of variance, and chi square analyses, and Fisher's exact test were used. Data were compared to the American Burn Association (ABA) burn repository. This study included 1752 thermally injured patients treated in 20 hospitals including Specialized Burn Unit in Municipal Hospital #8 Lviv, Lviv province in Ukraine. Scald burns were the primary etiology of burns injuries (70%) and burns were more common among children less than five years of age (34%). Length of stay, mechanical ventilation use, infection rates, and morbidity increased with greater burn size. Mortality was significantly related to burn size, inhalation injury, age, and length of stay. Wound infections were associated with burn size and older age. Compared to ABA data, Ukrainian patients had double the length of stay and a higher rate of wound infections (16% vs. 2.4%). We created one of the first burn databases from a region of the former Soviet Union in an effort to bring attention to burn injury and improve burn care. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  4. From home deliveries to health care facilities: establishing a traditional birth attendant referral program in Kenya.

    Science.gov (United States)

    Tomedi, Angelo; Stroud, Sophia R; Maya, Tania Ruiz; Plaman, Christopher R; Mwanthi, Mutuku A

    2015-07-16

    To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy. In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013. The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0% in the control and intervention groups, respectively (p facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care.

  5. Quasi-experiments to establish causal effects of HIV care and treatment and to improve the cascade of care

    OpenAIRE

    Bor, Jacob; Geldsetzer, Pascal; Venkataramani, Atheendar; B?rnighausen, Till

    2015-01-01

    Purpose of review Randomized, population-representative trials of clinical interventions are rare. Quasi-experiments have been used successfully to generate causal evidence on the cascade of HIV care in a broad range of real-world settings. Recent findings Quasi-experiments exploit exogenous, or quasi-random, variation occurring naturally in the world or because of an administrative rule or policy change to estimate causal effects. Well designed quasi-experiments have greater internal validit...

  6. 21 CFR 600.11 - Physical establishment, equipment, animals, and care.

    Science.gov (United States)

    2010-04-01

    ... manufacturing site must be performed under appropriate controls to prevent contamination of other products and... contamination of other products and other manufacturing areas within the building. Appropriate controls must... 21 Food and Drugs 7 2010-04-01 2010-04-01 false Physical establishment, equipment, animals, and...

  7. Developing inclusive residential care for older lesbian, gay, bisexual and trans (LGBT) people: An evaluation of the Care Home Challenge action research project.

    Science.gov (United States)

    Hafford-Letchfield, Trish; Simpson, Paul; Willis, Paul B; Almack, Kathryn

    2018-03-01

    There have been substantial achievements in legislative and human rights for lesbian, gay, bisexual and transgender (LGBT) older people and their visibility in health and social care has equally increased. These appear to have surpassed the ability of care services to meet their needs given documented concerns about the accessibility, inclusiveness and safety of care services particularly institutionalised care. This requires systemic change not easy to operationalise. This paper describes an action research initiative where six care homes belonging to a national care provider, collaborated to assess and develop their services with the support of local LGBT "Community Advisors" and academic partners. Framed within Rogers' (2003) change management framework and combined with a participatory leadership approach, a programme of intervention was implemented comprising structured activities around seven key areas thought to promote LGBT inclusion. A formal evaluation was conducted involving 35 pre- and post-intervention qualitative interviews with 18 people (community advisors; care home managers and senior managers). The findings are presented across three key themes (1) starting points on the journey; (2) challenges encountered along the journey (organisational and interpersonal); and (3) making change happen; opportunities, initiatives and gains. We make recommendations on the value of a programme approach for achieving tangible outcomes that demonstrate increased inclusion for older LGBT people living in long-term care settings. © 2017 John Wiley & Sons Ltd.

  8. Feasibility and benefits of group-based exercise in residential aged care adults: a pilot study for the GrACE programme

    Directory of Open Access Journals (Sweden)

    Samantha Fien

    2016-05-01

    Full Text Available The objective of the study was to examine the feasibility and benefits of a group resistance training exercise programme for improving muscle function in institutionalised older adults. A feasibility and acceptability study was designed for a residential aged care (RAC facility, based on the Gold Coast, Australia. Thirty-seven adults, mean age 86.8 ± 6.1 years (30 females living in a RAC facility. Participants were allocated into an exercise (n = 20 or control (n = 17 group. The exercise group, the Group Aged Care Exercise (GrACE programme, performed 12 weeks of twice weekly resistance exercises. Feasibility was measured via recruitment rate, measurement (physiological and surveys completion rate, loss-to-follow-up, exercise session adherence, adverse events, and ratings of burden and acceptability. Muscle function was assessed using gait speed, sit-to-stand and handgrip strength assessments. All intervention participants completed pre- and post-assessments, and the exercise intervention, with 85% (n = 17 of the group attending ≥ 18 of the 24 sessions and 15% (n = 3 attending all sessions. Acceptability was 100% with exercise participants, and staff who had been involved with the programme strongly agreed that the participants “Benefited from the programme.” There were no adverse events reported by any participants during the exercise sessions. When compared to the control group, the exercise group experienced significant improvements in gait speed (F(4.078 = 8.265, p = 0.007, sit to stand performance (F(3.24 = 11.033, p = 0.002 and handgrip strength (F(3.697 = 26.359, p < 0.001. Resistance training via the GrACE programme is feasible, safe and significantly improves gait speed, sit-to-stand performance and handgrip strength in RAC adults.

  9. Comparison of cleaning efficacy between in-use disinfectant and electrolysed water in an English residential care home.

    Science.gov (United States)

    Meakin, N S; Bowman, C; Lewis, M R; Dancer, S J

    2012-02-01

    Infection control in hospitals and care homes remains a key issue. They are regularly inspected regarding standards of hygiene, but visual assessment does not necessarily correlate with microbial cleanliness. Pathogens can persist in the inanimate environment for extended periods of time. This prospective study compared the effectiveness of a novel sanitizer containing electrolysed water, in which the active ingredient is stabilized hypochlorous acid (Aqualution™), with the effectiveness of the quaternary ammonium disinfectant in current use for microbial removal from hand-touch surfaces in a care home. The study had a two-period crossover design. Five surfaces were cleaned daily over a four-week period, with screening swabs taken before and after cleaning. Swabs were cultured in order to compare levels of surface microbial contamination [colony-forming units (cfu)/cm(2)] before and after cleaning with each product. Cleaning with electrolysed water reduced the mean surface bacterial load from 2.6 [interquartile range (IQR) 0.30-30.40] cfu/cm(2) to 0.10 (IQR 0.10-1.40) cfu/cm(2) [mean log(10) reduction factor 1.042, 95% confidence interval (CI) 0.79-1.30]. Cleaning with the in-use quaternary ammonium disinfectant increased the bacterial load from 0.90 (IQR 0.10-8.50) cfu/cm(2) to 93.30 (IQR 9.85-363.65) cfu/cm(2) (mean log(10) reduction -1.499, 95% CI -1.87 to -1.12) (P effective bacterial kill than the in-use quaternary ammonium disinfectant, which suggests that it may be useful as a surface sanitizer in environments such as care homes. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. Access to Community Living Infrastructure and Its Impact on the Establishment of Community-Based Day Care Centres for Seniors in Rural China.

    Science.gov (United States)

    Li, Man; Zhong, Renyao; Zhu, Shanwen; Ramsay, Lauren C; Li, Fen; Coyte, Peter C

    2018-06-06

    Community-based day care centres play an important role in service delivery for Chinese seniors. Little research has examined how community living infrastructure has influenced the establishment of these day care centres in rural communities. The purposes of this study were: (1) explore regional differences in community living infrastructure; and (2) to examine the impact of such infrastructure on the establishment of day care centres for Chinese seniors in rural communities. The data were derived from “The Fourth Sample Survey on the Living Conditions of Elderly People in Urban and Rural China (2015)”. The establishment of at least one day care centre was the outcome of interest, which was dichotomized at the community level into the establishment of at least one day care centre or the absence of any day care centres. Logistic regression analysis was employed to examine the impact of various community living infrastructural characteristics on the establishment of day care centres. The results showed that of the 4522 rural communities surveyed in 2015, only 10.1% had established at least one day care centre. Community living infrastructural characteristics that were significantly associated with the establishment of day care centres were the availability of cement/asphalt roads, natural gas, tap drinking water, sewage systems, and centralized garbage disposal. Our findings suggest that the significant association between community-level characteristics, especially community living infrastructure, and the establishment of rural day care centre for seniors may inform policy decision making.

  11. Access to Community Living Infrastructure and Its Impact on the Establishment of Community-Based Day Care Centres for Seniors in Rural China

    Directory of Open Access Journals (Sweden)

    Man Li

    2018-06-01

    Full Text Available Community-based day care centres play an important role in service delivery for Chinese seniors. Little research has examined how community living infrastructure has influenced the establishment of these day care centres in rural communities. The purposes of this study were: (1 explore regional differences in community living infrastructure; and (2 to examine the impact of such infrastructure on the establishment of day care centres for Chinese seniors in rural communities. The data were derived from “The Fourth Sample Survey on the Living Conditions of Elderly People in Urban and Rural China (2015”. The establishment of at least one day care centre was the outcome of interest, which was dichotomized at the community level into the establishment of at least one day care centre or the absence of any day care centres. Logistic regression analysis was employed to examine the impact of various community living infrastructural characteristics on the establishment of day care centres. The results showed that of the 4522 rural communities surveyed in 2015, only 10.1% had established at least one day care centre. Community living infrastructural characteristics that were significantly associated with the establishment of day care centres were the availability of cement/asphalt roads, natural gas, tap drinking water, sewage systems, and centralized garbage disposal. Our findings suggest that the significant association between community-level characteristics, especially community living infrastructure, and the establishment of rural day care centre for seniors may inform policy decision making.

  12. Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care

    Science.gov (United States)

    Hoben, Matthias; Estabrooks, Carole A.; Squires, Janet E.; Behrens, Johann

    2016-01-01

    We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90–0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing

  13. Regionalised tertiary psychiatric residential facilities.

    Science.gov (United States)

    Lesage, Alain; Groden, David; Goldner, Elliot M; Gelinas, Daniel; Arnold, Leslie M

    2008-01-01

    Psychiatric hospitals remain the main venue for long-term mental health care and, despite widespread closures and downsizing, no country that built asylums in the last century has done away with them entirely--with the recent exception of Italy. Differentiated community-based residential alternatives have been developed over the past decades, with staffing levels that range from full-time professional, to daytime only, to part-time/on-call. This paper reviews the characteristics of community-based psychiatric residential care facilities as an alternative to long-term care in psychiatric hospitals. It describes five factors decision makers should consider: 1. number of residential places needed; 2. staffing levels; 3. physical setting; 4. programming; and 5. governance and financing. In Italy, facilities with full-time professional staff have been developed since the mid-1990s to accommodate the last cohorts of patients discharged from psychiatric hospitals. In the United Kingdom, experiments with hostel wards since the 1980s have shown that home-like, small-scale facilities with intensive treatment and rehabilitation programming can be effective for the most difficult-to-place patients. More recently in Australia, Community Care Units (CCUs) have been applying this concept. In the Canadian province of British Columbia (BC), Tertiary Psychiatric Residential Facilities (TPRFs) have been developed as part of an effort to regionalise health and social services and downsize and ultimately close its only psychiatric hospital. This type of service must be further developed in addition to the need for forensic, acute-care and intermediate-level beds, as well as for community-based care such as assertive community treatment and intensive case management. All these types of services, together with long-term community-based residential care, constitute the elements of a balanced mental health care system. As part of a region's balanced mental health care plan, these Tertiary

  14. Insights into the impact and use of research results in a residential long-term care facility: a case study

    Directory of Open Access Journals (Sweden)

    Cranley Lisa A

    2012-09-01

    Full Text Available Abstract Background Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym nursing home because the Director of Care engaged actively in the study and TREC data showed that this site differed on some areas from other nursing homes in the province. The aims of the case study were two-fold: to gain a better understanding of how frontline staff engage with the research process, and to gain a better understanding of how to share more detailed research results with management. Methods We developed an Expanded Feedback Report for use during this study. In it, we presented survey results that compared Restwood to the best performing site on all variables and participating sites in the province. Data were collected regarding the Expanded Feedback Report through interviews with management. Data from staff were collected through interviews and observation. We used content analysis to derive themes to describe key aspects related to the study aims. Results We observed the importance of understanding organizational routines and the impact of key events in the facility’s environment. We gleaned additional information that validated findings from prior feedback mechanisms within TREC. Another predominant theme was the sense that the opportunity to engage in a research process was reaffirming for staff (particularly healthcare aides—what they did and said mattered, and TREC provided a means of having one’s voice heard. We gained valuable insight from the Director of Care about how to structure and format more detailed findings to assist with interpretation and use of results. Conclusions Four themes emerged regarding staff engagement with

  15. Interaction and common ground in dementia: Communication across linguistic and cultural diversity in a residential dementia care setting.

    Science.gov (United States)

    Strandroos, Lisa; Antelius, Eleonor

    2017-09-01

    Previous research concerning bilingual people with a dementia disease has mainly focused on the importance of sharing a spoken language with caregivers. While acknowledging this, this article addresses the multidimensional character of communication and interaction. As using spoken language is made difficult as a consequence of the dementia disease, this multidimensionality becomes particularly important. The article is based on a qualitative analysis of ethnographic fieldwork at a dementia care facility. It presents ethnographic examples of different communicative forms, with particular focus on bilingual interactions. Interaction is understood as a collective and collaborative activity. The text finds that a shared spoken language is advantageous, but is not the only source of, nor a guarantee for, creating common ground and understanding. Communicative resources other than spoken language are for example body language, embodiment, artefacts and time. Furthermore, forms of communication are not static but develop, change and are created over time. Ability to communicate is thus not something that one has or has not, but is situationally and collaboratively created. To facilitate this, time and familiarity are central resources, and the results indicate the importance of continuity in interpersonal relations.

  16. Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research.

    Science.gov (United States)

    Meißner, Anne; Schnepp, Wilfried

    2014-06-20

    Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses' experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process. A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities. The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents' records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude. In summary, the findings showed that members of staff experience IT as a benefit when

  17. The strategic case for establishing public-private partnerships in cancer care.

    Science.gov (United States)

    Holden, Debra J; Reiter, Kristin; O'Brien, Donna; Dalton, Kathleen

    2015-10-14

    In 2007, the National Cancer Institute (NCI) launched the NCI Community Cancer Centers Program (NCCCP) as a public-private partnership with community hospitals with a goal of advancing cancer care and research. In order to leverage federal dollars in a time of limited resources, matching funds from each participating hospital were required. The purpose of this paper is to examine hospitals' level of and rationale for co-investment in this partnership, and whether there is an association between hospitals' co-investment and achievement of strategic goals. Analysis using a comparative case study and micro-cost data was conducted as part of a comprehensive evaluation of the NCCCP pilot to determine the level of co-investment made in support of NCI's goals. In-person or telephone interviews with key informants were conducted at 10 participating hospital and system sites during the first and final years of implementation. Micro-cost data were collected annually from each site from 2007 to 2010. Self-reported data from each awardee are presented on patient volume and physician counts, while secondary data are used to examine the local Medicare market share. The rationale expressed by interviewees for participation in a public-private partnership with NCI included expectations of increased market share, higher patient volumes, and enhanced opportunities for cancer physician recruitment as a result of affiliation with the NCI. On average, hospitals invested resources into the NCCCP at a level exceeding $3 for every $1 of federal funds. Six sites experienced a statistically significant change in their Medicare market share. Cancer patient volume increased by as much as one-third from Year 1 to Year 3 for eight of the sites. Nine sites reported an increase in key cancer physician recruitment. Demonstrated investments in cancer care and research were associated with increases in cancer patient volume and perhaps in recruitment of key cancer physicians, but not in increased

  18. 29 CFR 779.381 - Establishments within special exceptions or exemptions.

    Science.gov (United States)

    2010-07-01

    .... (c) The amendments of 1966 also repealed the exemption from both the minimum wage and overtime pay....381 Section 779.381 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT..., residential care establishments, etc.) may utilize this exemption where they meet the Act's definition of...

  19. Consideration of social values in the establishment of accountable care organizations in the USA.

    Science.gov (United States)

    Keren, Ron; Littlejohns, Peter

    2012-01-01

    The purpose of this paper is to introduce the new US health organizations called accountable care organizations (ACOs) which are expected to improve the quality and reduce the cost of healthcare for Medicare enrolees. It assesses the importance of ACOs, defining and articulating the values that will underpin their strategic and clinical decision making. This paper uses a social values framework developed by Clark and Weale to consider the values relevant to ACOs. It is likely that social values could be made more explicit in a US setting than they have ever been before, via the new ACOs. Social values could start to form part of a local health economy's marketing strategy. ACOs are very new. This paper identifies that they will need to be very explicit about the values relevant to them. The development of ACOs and the articulation of social values therein may even form the basis of a meaningful dialogue on the importance of assessing value for money or cost-effectiveness in the wider US health policy environment.

  20. [The results of delivering surgical care to the wounded and sick in military medical establishments and impending tasks].

    Science.gov (United States)

    Briusov, P G; Efimenko, N A

    1997-07-01

    In article results of activity of the military surgeons on rendering of the surgical care to wounded and sick in 1996 are analyzed. During combat actions in Chechnya despite of severe forms of wounds and significant increase of combined battle traumas lethality among heavy wounded was reduced in 2 times. At common lethality rate in 1.3%, in hospitals from wounds 1.5% of wounded died, from traumas--0.7%, burns--2.9%, frostbitten--0.5%. As to peace time surgery, the analysis of main parameters of surgical work in military medical establishments, structure of diseases of servicemen, surgical activity, average terms of treatment, lethality after operations, defects in rendering of the surgical care is given. In conclusions the authors say about problems, that the military surgeons have today.

  1. Establishing female-only areas in psychiatry wards to improve safety and quality of care for women.

    Science.gov (United States)

    Kulkarni, Jayashri; Gavrilidis, Emmy; Lee, Stuart; Van Rheenen, Tamsyn E; Grigg, Jasmin; Hayes, Emily; Lee, Adeline; Ong, Roy; Seeary, Amy; Andersen, Shelley; Worsley, Rosie; Keppich-Arnold, Sandra; Stafrace, Simon

    2014-12-01

    Our aim was to assess the impact of creating a female-only area within a mixed-gender inpatient psychiatry service, on female patient safety and experience of care. The Alfred hospital reconfigured one of its two psychiatry wards to include a female-only area. Documented incidents compromising the safety of women on each ward in the 6 months following the refurbishment were compared. Further, a questionnaire assessing perceived safety and experience of care was administered to female inpatients on both wards, and staff feedback was also obtained. The occurrence of documented incidents compromising females' safety was found to be significantly lower on the ward containing a female-only area. Women staying on this ward rated their perceived safety and experience of care significantly more positively than women staying where no such gender segregation was available. Further, the female-only area was identified by the majority of surveyed staff to provide a safer environment for female patients. Establishing female-only areas in psychiatry wards is an effective way to improve the safety and experience of care for female patients. © The Royal Australian and New Zealand College of Psychiatrists 2014.

  2. Designing and evaluating an electronic patient falls reporting system: perspectives for the implementation of health information technology in long-term residential care facilities.

    Science.gov (United States)

    Mei, Yi You; Marquard, Jenna; Jacelon, Cynthia; DeFeo, Audrey L

    2013-11-01

    Patient falls are the leading cause of unintentional injury and death among older adults. In 2000, falls resulted in over 10,300 elderly deaths, costing the United States approximately $179 million in incidence and medical costs. Furthermore, non-fatal injuries caused by falls cost the United States $19 billion annually. Health information technology (IT) applications, specifically electronic falls reporting systems, can aid quality improvement efforts to prevent patient falls. Yet, long-term residential care facilities (LTRCFs) often do not have the financial resources to implement health IT, and workers in these settings are often not ready to adopt such systems. Additionally, most health IT evaluations are conducted in large acute-care settings, so LTRCF administrators currently lack evidence to support the value of health IT. In this paper, we detail the development of a novel, easy-to-use system to facilitate electronic patient falls reporting within a LTRCF using off-the-shelf technology that can be inexpensively implemented in a wide variety of settings. We report the results of four complimentary system evaluation measures that take into consideration varied organizational stakeholders' perspectives: (1) System-level benefits and costs, (2) system usability, via scenario-based use cases, (3) a holistic assessment of users' physical, cognitive, and marcoergonomic (work system) challenges in using the system, and (4) user technology acceptance. We report the viability of collecting and analyzing data specific to each evaluation measure and detail the relative merits of each measure in judging whether the system is acceptable to each stakeholder. The electronic falls reporting system was successfully implemented, with 100% reporting at 3-months post-implementation. The system-level benefits and costs approach showed that the electronic system required no initial investment costs aside from personnel costs and significant benefits accrued from user time savings

  3. Effects of a high‐intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial

    Science.gov (United States)

    Conradsson, Mia; Hörnsten, Carl; Rosendahl, Erik; Lindelöf, Nina; Holmberg, Henrik; Nordström, Peter; Gustafson, Yngve; Littbrand, Håkan

    2015-01-01

    Objectives The aim of this study is to evaluate the effect of a high‐intensity functional exercise program on depressive symptoms among older care facility residents with dementia. Methods Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini‐Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high‐intensity functional exercise program or a non‐exercise control activity conducted 45 min every other weekday for 4 months. The 15‐item Geriatric Depression Scale (GDS) and the Montgomery–Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7 months. Results No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7 months. Among participants with GDS scores ≥ 5, reductions in GDS score were observed in the exercise and control groups at 4 months (–1.58, P = 0.001 and –1.54, P = 0.004) and 7 months (–1.25, P = 0.01 and –1.45, P = 0.007). Among participants with MADRS scores ≥ 7, a reduction in MADRS score was observed at 4 months in the control group (–2.80, P = 0.009) and at 7 months in the exercise and control groups (–3.17, P = 0.003 and –3.34, P = 0.002). Conclusions A 4‐month high‐intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non‐exercise group activities may reduce high levels of depressive symptoms. PMID:26644304

  4. Main challenges of residential areas

    Directory of Open Access Journals (Sweden)

    Oana Luca

    2017-06-01

    Full Text Available The present article is a position paper aiming to initiate a professional debate related to the aspects related to the urban dysfunctions leading to the wear of the residential areas. The paper proposes a definition of the wear process, identify the main causes leading to its occurrence and propose a number of solutions to neutralise the dysfunctions. The three wearing phases of residential areas components are emphasized, exploring their lifecycle. In order to perform the study of urban wear, the status of the residential areas components can be established and monitored, and also the variables of the function that can mathematically model the specific wear process may be considered. The paper is considered a first step for the model adjustment, to be tested and validated in the following steps. Based on the mathematical method and model, there can be created, in a potential future research, the possibility of determining the precarity degree for residential areas/neighbourhoods and cities, by minimising the subjective component of the analyses preceding the decision for renovation or regeneration.

  5. Establishment of a community care center for isolation and management of Ebola patients - Bomi County, Liberia, October 2014.

    Science.gov (United States)

    Logan, Gorbee; Vora, Neil M; Nyensuah, Tolbert G; Gasasira, Alex; Mott, Joshua; Walke, Henry; Mahoney, Frank; Luce, Richard; Flannery, Brendan

    2014-11-07

    As of October 29, 2014, a total of 6,454 Ebola virus disease (Ebola) cases had been reported in Liberia by the Liberian Ministry of Health and Social Welfare, with 2,609 deaths. Although the national strategy for combating the ongoing Ebola epidemic calls for construction of Ebola treatment units (ETUs) in all 15 counties of Liberia, only a limited number are operational, and most of these are within Montserrado County. ETUs are intended to improve medical care delivery to persons whose illnesses meet Ebola case definitions, while also allowing for the safe isolation of patients to break chains of transmission in the community. Until additional ETUs are constructed, the Ministry of Health and Social Welfare is supporting development of community care centers (CCCs) for isolation of patients who are awaiting Ebola diagnostic test results and for provision of basic care (e.g., oral rehydration salts solutions) to patients confirmed to have Ebola who are awaiting transfer to ETUs. CCCs often have less bed capacity than ETUs and are frequently placed in areas not served by ETUs; if built rapidly enough and in sufficient quantity, CCCs will allow Ebola-related health measures to reach a larger proportion of the population. Staffing requirements for CCCs are frequently lower than for ETUs because CCCs are often designed such that basic patient needs such as food are provided for by friends and family of patients rather than by CCC staff. (It is customary in Liberia for friends and family to provide food for hospitalized patients.) Creation of CCCs in Liberia has been led by county health officials and nongovernmental organizations, and this local, community-based approach is intended to destigmatize Ebola, to encourage persons with illness to seek care rather than remain at home, and to facilitate contact tracing of exposed family members. This report describes one Liberian county's approach to establishing a CCC.

  6. Research report for fiscal 1995 on analysis and evaluation of demonstration tests for establishment of residential photovoltaic power generation load leveling technology (putting of related data into order); 1995 nendo kenkyu hokokusho. Jutaku you taiyoko hatsuden fuka heijunka gijutsu tou kakuritsu jissho shiken ni kansuru kaiseki hyoka (Kanren data no seibi)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    Research and development has been performed with the objectives to establish an evaluation technology for load leveling effect by using a small photovoltaic power generation system for residential use, to clarify the effectiveness of the system as a discrete power supply source through demonstration operation, and furthermore to achieve optimization of the small photovoltaic power generation system for residential use. This paper describes the actual state survey data related to grid connection systems for the small photovoltaic power generation system for residential use. The survey has been performed mainly on the system for individuals' use inside and outside Japan with regard to the small grid connection systems of 1-10 kW scale. The number of survey has reached 216 cases for 46 prefectures in Japan (1,004.02 kW in total), and 47 cases for 13 other countries (205.60 kW in total), or 263 cases in grand total (1,209.63 kW). These 263 cases were tabulated with items of owners (or the facility names and installation locations) as seen by territories (prefectures or countries), facility operators (or executing organizations), connection modes, and power generation scales. These data will serve for discussions on the load leveling effect and the optimized system forms. (NEDO)

  7. Research report for fiscal 1995 on analysis and evaluation of demonstration tests for establishment of residential photovoltaic power generation load leveling technology (putting of related data into order); 1995 nendo kenkyu hokokusho. Jutaku you taiyoko hatsuden fuka heijunka gijutsu tou kakuritsu jissho shiken ni kansuru kaiseki hyoka (Kanren data no seibi)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    Research and development has been performed with the objectives to establish an evaluation technology for load leveling effect by using a small photovoltaic power generation system for residential use, to clarify the effectiveness of the system as a discrete power supply source through demonstration operation, and furthermore to achieve optimization of the small photovoltaic power generation system for residential use. This paper describes the actual state survey data related to grid connection systems for the small photovoltaic power generation system for residential use. The survey has been performed mainly on the system for individuals' use inside and outside Japan with regard to the small grid connection systems of 1-10 kW scale. The number of survey has reached 216 cases for 46 prefectures in Japan (1,004.02 kW in total), and 47 cases for 13 other countries (205.60 kW in total), or 263 cases in grand total (1,209.63 kW). These 263 cases were tabulated with items of owners (or the facility names and installation locations) as seen by territories (prefectures or countries), facility operators (or executing organizations), connection modes, and power generation scales. These data will serve for discussions on the load leveling effect and the optimized system forms. (NEDO)

  8. Unaccompanied and separated foreign children in the care system ...

    African Journals Online (AJOL)

    Secondly, the study aimed to analyse the reasons for children's migration and the circumstances around their placement in residential care institutions in order to establish whether family reunification was ... Keywords: Foreign children; child protection; refugees; asylum seekers; child and youth care centres; children's court ...

  9. Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels.

    Science.gov (United States)

    Brach, Michael; Nieder, Frank; Nieder, Ulrike; Mechling, Heinz

    2009-11-24

    There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL), the organisational-institutional level (OIL) and the political-cultural level (PCL). Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial. The intervention consisted of (a) two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL), (b) a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL), (c) informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL). Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL), number of groups continued without external financial support (at the end of the project, and

  10. Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels

    Directory of Open Access Journals (Sweden)

    Nieder Ulrike

    2009-11-01

    Full Text Available Abstract Background There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL, the organisational-institutional level (OIL and the political-cultural level (PCL. Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial. Methods The intervention consisted of (a two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL, (b a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL, (c informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL. Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL, number of groups continued without external financial

  11. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

    Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

  12. 77 FR 28519 - Test Procedure Guidance for Room Air Conditioners, Residential Dishwashers, and Residential...

    Science.gov (United States)

    2012-05-15

    ... Guidance for Room Air Conditioners, Residential Dishwashers, and Residential Clothes Washers: Public... procedures for room air conditioners, residential dishwashers, and residential clothes washers. DATES: DOE...'s existing test procedures for residential room air conditioners, residential dishwashers, and...

  13. 75 FR 15495 - Agency Information Collection (Application for Furnishing Long-Term Care Services to...

    Science.gov (United States)

    2010-03-29

    ... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care... application used by a residential care facility or home that wishes to provide residential home care to...

  14. Comparison of a traditional and non-traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement.

    Science.gov (United States)

    Richards, Kieva; D'Cruz, Rachel; Harman, Suzanne; Stagnitti, Karen

    2015-12-01

    Dementia residential facilities can be described as traditional or non-traditional facilities. Non-traditional facilities aim to utilise principles of environmental design to create a milieu that supports persons experiencing cognitive decline. This study aimed to compare these two environments in rural Australia, and their influence on residents' occupational engagement. The Residential Environment Impact Survey (REIS) was used and consists of: a walk-through of the facility; activity observation; interviews with residents and employees. Thirteen residents were observed and four employees interviewed. Resident interviews did not occur given the population diagnosis of moderate to severe dementia. Descriptive data from the walk-through and activity observation were analysed for potential opportunities of occupational engagement. Interviews were thematically analysed to discern perception of occupational engagement of residents within their facility. Both facilities provided opportunities for occupational engagement. However, the non-traditional facility provided additional opportunities through employee interactions and features of the physical environment. Interviews revealed six themes: Comfortable environment; roles and responsibilities; getting to know the resident; more stimulation can elicit increased engagement; the home-like experience and environmental layout. These themes coupled with the features of the environment provided insight into the complexity of occupational engagement within this population. This study emphasises the influence of the physical and social environment on occupational engagement opportunities. A non-traditional dementia facility maximises these opportunities and can support development of best-practice guidelines within this population. © 2015 Occupational Therapy Australia.

  15. GLUCOSE CONTROL IN RWANDAN YOUTH WITH TYPE 1 DIABETES FOLLOWING ESTABLISHMENT OF SYSTEMATIC, HBA1C BASED, CARE AND EDUCATION

    Science.gov (United States)

    Marshall, Sara L.; Edidin, Deborah; Arena, Vincent C.; Becker, Dorothy J.; Bunker, Clareann H.; Gishoma, Crispin; Gishoma, Francois; LaPorte, Ronald E.; Kaberuka, Vedaste; Ogle, Graham; Sibomana, Laurien; Orchard, Trevor J.

    2014-01-01

    AIMS To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined. METHODS A 1–2 year follow-up of 214 members of the Rwanda Life for a Child program (aged < 26 years) with a first HbA1c between June 2009 and November 2010 was conducted. Data were analyzed for the entire cohort and by age (< 18 years, ≥ 18 years). Trajectory analysis was performed to identify trends in HbA1c. RESULTS Mean overall HbA1c decreased significantly from baseline (11.2±2.7%; 99±30 mmol/mol) to one- (10.2±2.6%; 88±28 mmol/mol) and two- (9.8±26%; 84±25 mmol/mol) year follow up visits. The prevalence of microalbuminuria did not significantly change (21.0%, 18.8%, and 19.6%), nor did nephropathy (4.7%, 7.8%, and 5.4%). However, rates of hypertension (31.8%, 44.9%, and 40.3%) were higher than expected. Five HbA1c groups were identified by trajectory analysis, and those with the worst control monitored their glucose significantly fewer times per week. CONCLUSIONS The establishment of regular care, HbA1c testing, and increased education is associated with significant improvements in glycemic control in youth with type 1 diabetes (T1D) in sub-Saharan Africa, but the high prevalence of hypertension is of concern. PMID:25458328

  16. Research report for fiscal 1996 on analysis and evaluation of demonstration tests for establishment of residential photovoltaic power generation load leveling technology; 1996 nendo kenkyu hokokusho. Jutaku you taiyoko hatsuden fuka heijunka gijutsu tou kakuritsu jissho shiken ni kansuru kaiseki hyoka

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    Tests and researches have been performed with the objectives to establish an evaluation technology for load leveling effect by using a small photovoltaic power generation system for residential use, to clarify the effectiveness of the system as a discrete power supply source through demonstration operation, and furthermore to achieve optimization of designs of the small photovoltaic power generation system for residential use. This paper summarizes the achievements in fiscal 1996. The current fiscal year has performed collection of data of the demonstration operation, checked the consistency in photovoltaic power generation characteristics, and housing and distribution line load characteristics, and the results were mounted on the database. The demonstration operation data were used to analyze and evaluate the facility utilization rate in the photovoltaic power generation, photovoltaic power generation dependence of the house load, load rate, and peak load reduction rate. As a result, it was found that not much of the peak load reduction effect by the photovoltaic power generation was recognized because the house load is related mainly on lighting load. However, as seen from the distribution line load, the peak load reduction was recognized when the house load and the commercial and industrial load are mixed, whereas it was revealed that the reduction effect is worth evaluation. (NEDO)

  17. Research report for fiscal 1995 on analysis and evaluation of demonstration tests for establishment of residential photovoltaic power generation load leveling technology; 1995 nendo kenkyu hokokusho. Jutaku you taiyoko hatsuden fuka heijunka gijutsu tou kakuritsu jissho shiken ni kansuru kaiseki hyoka

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    Research and development has been performed with the objectives to establish an evaluation technology for load leveling effect by using a small photovoltaic power generation system for residential use, to clarify the effectiveness of the system as a discrete power supply source through demonstration operation, and furthermore to achieve optimization of the small photovoltaic power generation system for residential use. This paper summarizes the achievements in fiscal 1995. With the demonstration operation in the current fiscal year, through-the-year data have been accumulated for the first time since the start of the demonstration operation, and were mounted on the load leveling database. As a result of analyzing the demonstration operation data, the following points were revealed: regarding the housing load, the lighting load is the main factor both in summer and winter; the effect of reducing the peak load by photovoltaic power generation is recognized at about 60% as maximum, but the substantial effect has large variation, hence stochastic; and the reverse current becomes the main factor during daytime, not necessarily leading to improvement of the housing load characteristics in the aspect of load rate. According to the surveys on the energy demand trends up to the year 2030, the power supply configuration, and introduction cost, it was revealed that the photovoltaic power generation can be sufficiently expected as a power supply to handle the peak load. (NEDO)

  18. [Refusal of application to care in Alzheimer's disease and related diseases: establishment of a mobile unit hospital extra].

    Science.gov (United States)

    Collignon, Julien; Rouch, Isabelle; Gonthier, Régis; Corbin-Seguin, Aude; Combe, Lorraine; Trombert-Paviot, Béatrice; Laurent, Bernard; Girtanner, Chantal

    2013-03-01

    Refusal of care and support in these patients with Alzheimer's disease and related illnesses at home is a cause of accelerated loss of autonomy and increases the risk of a crisis with early institutionalization. Factors contributing to the denial of care are poorly understood and very few epidemiological data exist. we compared age, diagnosis, level of severity of the disease, the type of behavioral, family status of 101 patients living in denial of care and support as seen by a mobile home (group UPEPc) to 136 control patients seen at the memory clinic (group CM). Patients living in denial of care appear to significantly low age [82/80.5, prefusing home care is specific and it is important to educate GPs conditions that favor an obstacle to medicalization. The advantage of a mobile extramural to analyze risk factors for refusal of care and propose alternatives should be further investigated.

  19. Developing a Strategy To Educate County Departments of Social Services in the Type of Referrals Needed for a Residential Child Caring Agency.

    Science.gov (United States)

    Keevert, Helen

    The focus of a child caring facility had changed from caring exclusively for orphans to serving a broader population of abandoned, abused, and neglected children. Because no effective marketing tool existed within this child caring agency to make agency identification and information readily accessible to county departments of social services…

  20. Analysis of a Residential Building Energy Consumption Demand Model

    Directory of Open Access Journals (Sweden)

    Meng Liu

    2011-03-01

    Full Text Available In order to estimate the energy consumption demand of residential buildings, this paper first discusses the status and shortcomings of current domestic energy consumption models. Then it proposes and develops a residential building energy consumption demand model based on a back propagation (BP neural network model. After that, taking residential buildings in Chongqing (P.R. China as an example, 16 energy consumption indicators are introduced as characteristics of the residential buildings in Chongqing. The index system of the BP neutral network prediction model is established and the multi-factorial BP neural network prediction model of Chongqing residential building energy consumption is developed using the Cshap language, based on the SQL server 2005 platform. The results obtained by applying the model in Chongqing are in good agreement with actual ones. In addition, the model provides corresponding approximate data by taking into account the potential energy structure adjustments and relevant energy policy regulations.

  1. Family ties and residential locations

    NARCIS (Netherlands)

    Mulder, C.H.; Cooke, T.J.

    2009-01-01

    In this paper, and in the Special Issue it introduces, the focus is on the role of family ties in residential location choice and, conversely, the role of residential locations in maintaining family ties. Not only do events in the nuclear family trigger residential relocations, but nearby family

  2. GREEN RETROFITTING RESIDENTIAL BUILDINGS

    Science.gov (United States)

    When compared with the rest of the world, the United States consumes a disproportionately large amount of energy and is a major source of greenhouse gases from fossil fuel combustion. As much as two thirds of U.S. electricity production is consumed by residential and commerci...

  3. Residential Mechanical Precooling

    Energy Technology Data Exchange (ETDEWEB)

    German, a. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States); Hoeschele, M. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States)

    2014-12-01

    This research conducted by the Alliance for Residential Building Innovation team evaluated mechanical air conditioner pre-cooling strategies in homes throughout the United States. EnergyPlus modeling evaluated two homes with different performance characteristics in seven climates. Results are applicable to new construction homes and most existing homes built in the last 10 years, as well as fairly efficient retrofitted homes.

  4. Residential care for abandoned children and their integration into a family-based setting in Uganda: lessons for policy and programming.

    Science.gov (United States)

    Walakira, Eddy J; Ochen, Eric A; Bukuluki, Paul; Alllan, Sue

    2014-01-01

    This article describes a model of care for abandoned and neglected infants in need of urgent physical, social, and medical support as implemented by the Child's i Foundation, an international, nongovernmental organization operating in Uganda. The model discounts the need for long-term care of young children within institutions and challenges the basis for intercountry adoption. Underpinned by the essentials of care continuum provided under the Uganda National Alternative Care Framework (Ministry of Gender, Labour and Social Development, 2012), the model emphasizes the need to effect the reintegration of the separated child within the family of his or her birth, or locally organize foster care or adoption. Highlighting policy and programming lessons, the model showcases a holistic approach to the problem and puts emphasis on interventions that are protective, promotional, and transformational and the use of a community-oriented approach. The model offers guidance to both government and nongovernment actors in addressing the problems of child neglect and abandonment through the implementation of the alternative care framework. © 2014 Michigan Association for Infant Mental Health.

  5. The Perceived Importance of Role-Specific Competencies for Health Care Leaders Establishes the Need to Expand Role Theory.

    Science.gov (United States)

    Babinski, Paul J

    2016-01-01

    This cross-sectional quantitative study was undertaken to determine the extent to which individuals who have differing health care leadership roles perceived the importance of selected leadership competencies in their specific roles based on their experience. A total of 313 participants responded to the health care questionnaire. Principal component analysis identified factor structure and Cronbach α at .96 supported the reliability of the factor analysis. Multivariate analysis of variance tested the 4 health care leadership roles to determine if an effect was present among the competencies. A subsequent analysis of variance test was conducted on the competencies to confirm an effect was present, and a Games-Howell post hoc test followed. These tests indicated that there was a significant difference in rating the perceived importance of specific leadership competencies by the health care leaders in each competency domain. The participants included in this study consisted of the chief executive officer (CEO), director of nursing (DON), operating room director (ORD), and director of radiology (DOR). Based on the Games-Howell post hoc test, a commonality existed between the leaders. The CEOs and DONs often indicated no significant difference in competency perception to one another in relation to the dependent variables, yet indicated a significant difference in competency perception when compared with the ORDs and DORs. Similarly, the ORD and DOR variables often indicated no significant difference in competency perception to one another in relation to the dependent variables, yet indicated a significant difference in competency perception compared with the CEO and DON variables. This study positively indicated that health care leadership's perception of competencies does differ between the various leadership roles.

  6. An Empirical Comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a Post-Hospitalisation Population of Frail Older People Living in Residential Aged Care.

    Science.gov (United States)

    Ratcliffe, Julie; Flint, Thomas; Easton, Tiffany; Killington, Maggie; Cameron, Ian; Davies, Owen; Whitehead, Craig; Kurrle, Susan; Miller, Michelle; Liu, Enwu; Crotty, Maria

    2017-06-01

    To empirically compare the measurement properties of the DEMQOL-U and DEMQOL-Proxy-U instruments to the EQ-5D-5L and its proxy version (CEQ-5D-5L) in a population of frail older people living in residential aged care in the post-hospitalisation period following a hip fracture. A battery of instruments to measure health-related quality of life (HRQoL), cognition, and clinical indicators of depression, pain and functioning were administered at baseline and repeated at 4 weeks' follow-up. Descriptive summary statistics were produced and psychometric analyses were conducted to assess the levels of agreement, convergent validity and known group validity between clinical indicators and HRQoL measures. There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5L and DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. At 4 weeks' follow-up, there was a marked improvement in EQ-5D-5L scores whereas DEMQOL-U scores had deteriorated. [EQ-5D-5L mean 0.45 (0.38); DEMQOL-U mean 0.58 (0.38)]. The EQ-5D and CEQ-5D-5L were more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U appeared more responsive to the changes in delirium and dementia symptoms often experienced by frail older people in this period. This study presents important insights into the HRQoL of a relatively under-researched population of post-hospitalisation frail older people in residential care. Further research should investigate the implications for economic evaluation of self-complete versus proxy assessment of HRQoL and the choice of preference-based instrument for the measurement and valuation of HRQoL in older people exhibiting cognitive decline, dementia and other co-morbidities.

  7. Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system.

    Science.gov (United States)

    Jiang, Lixin; Krumholz, Harlan M; Li, Xi; Li, Jing; Hu, Shengshou

    2015-10-10

    China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Feasibility and efficacy of a multi-factorial intervention to prevent falls in older adults with cognitive impairment living in residential care (ProF-Cog). A feasibility and pilot cluster randomised controlled trial.

    Science.gov (United States)

    Whitney, Julie; Jackson, Stephen H D; Martin, Finbarr C

    2017-05-30

    Falls are common in people with dementia living in residential care. The ProF-Cog intervention was developed to address fall risk factors specific to this population. The aim of this study was to evaluate the safety, acceptability, and feasibility of the intervention and provide an estimate of its efficacy. This was a cluster randomised controlled pilot study undertaken in care homes in London, UK. All permanent residents living in participating homes who were not terminally ill were invited to participate. The intervention included an assessment of falls risk factors followed by a tailored intervention which could include dementia care mapping, comprehensive geriatric assessment, occupational therapy input and twice-weekly exercise for 6 months as required to target identified risk factors. The control group received usual care without a falls risk assessment. Standing balance was the primary outcome. This and other outcome measures were collected at baseline and after 6 months. Falls were recorded for this period using incident reports. Changes were analysed using multi-level modelling. Adherence to the interventions, adverse events and trial feasibility were recorded. Nine care homes enrolled in the study with a total 191 participants (51% of those eligible); five homes allocated to the intervention with 103 participants, and four homes to the usual care control group with 88 participants. The intervention was safe with only one reported fall whilst undertaking exercise. Adherence to agreed recommendations on activity and the environment was modest (21 and 45% respectively) and to exercise was poor (41%). Balance scores (score range 0-49) analysed on 100 participants decreased by a mean of 3.9 in the control and 5.1 in the intervention groups, a non-significant difference (p = 0.9). In other measures, both groups declined equally and there was no difference in falls rates (IRR = 1.59 95%, CI 0.67-3.76). The intervention was safe but not clinically

  9. Using the Care Dependency Scale for identifying patients at risk for pressure ulcer.

    Science.gov (United States)

    Dijkstra, Ate; Kazimier, Hetty; Halfens, Ruud J G

    2015-11-01

    The aim of this study was to evaluate risk screening for pressure ulcer by using the Care Dependency Scale (CDS) for patients receiving home care or admitted to a residential or nursing home in the Netherlands. Pressure ulcer is a serious and persistent problem for patients throughout the Western world. Pressure ulcer is among the most common adverse events in nursing practice and when a pressure ulcer occurs it has many consequences for patients and healthcare professionals. Cross-sectional design. The convenience sample consisted of 13,633 study participants, of whom 2639 received home care from 15 organisations, 4077 were patients from 67 residential homes and 6917 were admitted in 105 nursing homes. Data were taken from the Dutch National Prevalence Survey of Care Problems that was carried out in April 2012 in Dutch healthcare settings. For the three settings, cut-off points above 80% sensitivity were established, while in the residential home sample an almost 60% combined specificity score was identified. The CDS items 'Body posture' (home care), 'Getting dressed and undressed' (residential homes) and 'Mobility' (nursing homes) were the most significant variables which affect PU. The CDS is able to distinguish between patients at risk for pressure ulcer development and those not at risk in both home care and residential care settings. In nursing homes, the usefulness of the CDS for pressure ulcer detection is limited. © 2015 John Wiley & Sons Ltd.

  10. Reliability and Validity of the Youth Empowerment Scale--Mental Health in Youth Departing Residential Care and Reintegrating into School and Community Settings

    Science.gov (United States)

    Huscroft-D'Angelo, Jacqueline; Trout, Alexandra L.; Lambert, Matthew C.; Thompson, Ronald

    2017-01-01

    Empowerment has been established as an important factor in resilience in adolescence. It has also been deemed critical for youth with emotional and behavioral disorders to achieve successful outcomes across academic, social, and behavioral domains, especially during a major transition. There is currently one measure used to evaluate empowerment in…

  11. Guidelines for residential commissioning

    Energy Technology Data Exchange (ETDEWEB)

    Wray, Craig P.; Walker, Iain S.; Sherman, Max H.

    2003-01-31

    Currently, houses do not perform optimally or even as many codes and forecasts predict, largely because they are field assembled and there is no consistent process to identify problems or to correct them. Residential commissioning is a solution to this problem. This guide is the culmination of a 30-month project that began in September 1999. The ultimate objective of the project is to increase the number of houses that undergo commissioning, which will improve the quality, comfort, and safety of homes for California citizens. The project goal is to lay the groundwork for a residential commissioning industry in California focused on end-use energy and non-energy issues. As such, we intend this guide to be a beginning and not an end. Our intent is that the guide will lead to the programmatic integration of commissioning with other building industry processes, which in turn will provide more value to a single site visit for people such as home energy auditors and raters, home inspectors, and building performance contractors. Project work to support the development of this guide includes: a literature review and annotated bibliography, which facilitates access to 469 documents related to residential commissioning published over the past 20 years (Wray et al. 2000), an analysis of the potential benefits one can realistically expect from commissioning new and existing California houses (Matson et al. 2002), and an assessment of 107 diagnostic tools for evaluating residential commissioning metrics (Wray et al. 2002). In this guide, we describe the issues that non-experts should consider in developing a commissioning program to achieve the benefits we have identified. We do this by providing specific recommendations about: how to structure the commissioning process, which diagnostics to use, and how to use them to commission new and existing houses. Using examples, we also demonstrate the potential benefits of applying the recommended whole-house commissioning approach to

  12. Establishing a Baseline: Community Benefit Spending by Not-for-Profit Hospitals Prior to Implementation of the Affordable Care Act.

    Science.gov (United States)

    Leider, Jonathon P; Tung, Greg J; Lindrooth, Richard C; Johnson, Emily K; Hardy, Rose; Castrucci, Brian C

    Community Benefit spending by not-for-profit hospitals has served as a critical, formalized part of the nation's safety net for almost 50 years. This has occurred mostly through charity care. This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Using data from 2009 to 2012 hospital tax and other governmental filings, we constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending. Data were collected in 2015 and analyzed in 2015 and 2016. Data were matched at the facility level for a non-profit hospital's IRS tax filings (Form 990, Schedule H) and CMS Hospital Cost Report Information System and Provider of Service data sets. During 2009, hospitals spent about 8% of total operating expenses on Community Benefit. This increased to between 8.3% and 8.5% in 2012. The majority of spending (>80%) went toward charity care, unreimbursed Medicaid, and subsidized health services, with approximately 6% going toward both community health improvement and health professionals' education. By 2012, national spending on Community Benefit likely exceeded $60 billion. The largest hospital systems spent the vast majority of the nation's Community Benefit; the top 25% of systems spent more than 80 cents of every Community Benefit dollar. Community Benefit spending has remained relatively steady as a proportion of total operating expenses and so has increased over time-although charity care remains the major focus of Community Benefit spending overall. More than $60 billion was spent on Community Benefit prior to implementation of the ACA. New reporting and spending requirements from the IRS, alongside changes by the ACA, are changing incentives for hospitals in how they spend Community Benefit dollars. In the short term, and especially the long term, hospital systems would do well to partner with public health, other social services, and even

  13. Understanding the information dynamics of medication administration in residential aged care facilities (RACFs): a prerequisite for design of effective ICT systems.

    Science.gov (United States)

    Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna

    2013-01-01

    Medication information is a critical part of the information required to ensure residents' safety in the highly collaborative care context of RACFs. Studies report poor medication information as a barrier to improve medication management in RACFs. Research exploring medication work practices in aged care settings remains limited. This study aimed to identify contextual and work practice factors contributing to breakdowns in medication information exchange in RACFs in relation to the medication administration process. We employed non-participant observations and semi-structured interviews to explore information practices in three Australian RACFs. Findings identified inefficiencies due to lack of information timeliness, manual stock management, multiple data transcriptions, inadequate design of essential documents such as administration sheets and a reliance on manual auditing procedures. Technological solutions such as electronic medication administration records offer opportunities to overcome some of the identified problems. However these interventions need to be designed to align with the collaborative team based processes they intend to support.

  14. "Maybe we should talk about it anyway": a qualitative study of understanding expectations and use of an established technology innovation in caring practices.

    Science.gov (United States)

    Stokke, Randi

    2017-09-15

    Technological innovations are strongly promoted to meet the demands posed by increased pressure on home care services and to assist ageing in place in western societies. Although heavily advocated as plug and play solutions, technologies have proven difficult and unpredictable when integrated into home care services. We need greater insight into what happens when technologies are integrated into caring practices. All technologies come with expectations as to their function. This study explores how actors who are involved with the social alarm, which is an established technology innovation, relate to, perceive and articulate these expectations of the technology in everyday living. The article presents results from a two-case study, using a triangulation of qualitative methods in order to gain an in-depth understanding of technology in use in home care services through "thick descriptions". The study was conducted in Norway and data were analysed using a stepwise deductive-inductive analysis. The empirical findings demonstrate that expectations regarding the social alarm, even though it represents a simple and well-established technology, are complex and multidimensional. The notion of script and domestication provided relevant tools for exploring these expectations and for understanding how actors interpret and adapt their practices of using the technology. This enabled a more comprehensive understanding of how technology opens up for different interpretations and puts values in play. This article suggests exploring technology in use as scripted in multidimensional script, and offers a frame for doing so. It also reveals how technology scripts and articulation prove important for understanding the complex reality when integrated into home care practices, thus identifying how using the technology leads to the taming and unleashing of both technology and actors. The study offers an increased understanding of how and why technology is unpredictable and works

  15. [Establishing the idea of holistic integrative medicine, optimizing the quality of health care service in prevention and treatment].

    Science.gov (United States)

    Sun, Xing-guo

    2015-07-01

    Under background of reductionism in the modern science, physiology and medicine are stepwise refined into system, organ, disease, cell and gene etc. Although clinical medicine, only service in whole human object, obviously brought tremendous progress, it also appeared obvious defects and limits at the same time. Professionalized and specialized medicine not only needs to be integrated from basics to clinical fields, but also from prevention, health management, clinical treatment and functional rehabilitation medicine. People are indivisible organic whole. Professionalization, translation and integration must be combined. In order to provide the best quality and optimized medical service for the Chinese people and to lead in the world, we have to strengthen professional and technical knowledge, and have to establish the holistic integrative medical philosophy for physiology and medicine too.

  16. Re-thinking residential mobility

    Science.gov (United States)

    van Ham, Maarten; Findlay, Allan M.

    2015-01-01

    While researchers are increasingly re-conceptualizing international migration, far less attention has been devoted to re-thinking short-distance residential mobility and immobility. In this paper we harness the life course approach to propose a new conceptual framework for residential mobility research. We contend that residential mobility and immobility should be re-conceptualized as relational practices that link lives through time and space while connecting people to structural conditions. Re-thinking and re-assessing residential mobility by exploiting new developments in longitudinal analysis will allow geographers to understand, critique and address pressing societal challenges. PMID:27330243

  17. Large-Scale Residential Demolition

    Science.gov (United States)

    The EPA provides resources for handling residential demolitions or renovations. This includes planning, handling harmful materials, recycling, funding, compliance assistance, good practices and regulations.

  18. PERCEIVED FEASIBILITY OF ESTABLISHING DEDICATED ELDER ABUSE PROGRAMS OF CARE AT HOSPITAL-BASED SEXUAL ASSAULT/DOMESTIC VIOLENCE TREATMENT CENTETR.

    Science.gov (United States)

    Du Mont, Janice; Mirzaei, Aftab; Macdonald, Sheila; White, Meghan; Kosa, Daisy; Reimer, Linda

    2014-12-01

    Elder abuse is an increasingly important issue that must be addressed in a systematic and coordinated way. Our objective was to evaluate the perceived feasibility of establishing an elder abuse care program at hospital-based sexual assault and domestic violence treatment centers in Ontario, Canada. In July 2012, a questionnaire focused on elder abuse care was distributed to all of Ontario's Sexual Assault/Domestic Violence Treatment Centre (SA/DVTC) Program Coordinators/Managers. We found that the majority of Program Coordinators/ Managers favored expansion of their program mandates to include an elder abuse care program. However, these respondents viewed collaboration with a large network of well trained professionals and available services in the community that address elder abuse as integral to responding in a coordinated manner. The expansion of health services to address the needs of abused older adults in a comprehensive and integrated manner should be considered as an important next step for hospital-based violence care programs worldwide.

  19. ASHRAE and residential ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.

    2003-10-01

    In the last quarter of a century, the western world has become increasingly aware of environmental threats to health and safety. During this period, people psychologically retreated away from outdoors hazards such as pesticides, smog, lead, oil spills, and dioxin to the seeming security of their homes. However, the indoor environment may not be healthier than the outdoor environment, as has become more apparent over the past few years with issues such as mold, formaldehyde, and sick-building syndrome. While the built human environment has changed substantially over the past 10,000 years, human biology has not; poor indoor air quality creates health risks and can be uncomfortable. The human race has found, over time, that it is essential to manage the indoor environments of their homes. ASHRAE has long been in the business of ventilation, but most of the focus of that effort has been in the area of commercial and institutional buildings. Residential ventilation was traditionally not a major concern because it was felt that, between operable windows and envelope leakage, people were getting enough outside air in their homes. In the quarter of a century since the first oil shock, houses have gotten much more energy efficient. At the same time, the kinds of materials and functions in houses changed in character in response to people's needs. People became more environmentally conscious and aware not only about the resources they were consuming but about the environment in which they lived. All of these factors contributed to an increasing level of public concern about residential indoor air quality and ventilation. Where once there was an easy feeling about the residential indoor environment, there is now a desire to define levels of acceptability and performance. Many institutions--both public and private--have interests in Indoor Air Quality (IAQ), but ASHRAE, as the professional society that has had ventilation as part of its mission for over 100 years, is the

  20. Costs of day hospital and community residential chemical dependency treatment.

    Science.gov (United States)

    Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya; Witbrodt, Jane

    2008-03-01

    at residential versus day hospital programs were similar for women and for Whites. For non-Whites, and marginally for men, a preference for residential care would appear to come at a higher cost. Lengths of stay in residential treatment were significantly longer than in day hospital, but costs per week were lower. Women and Whites appear to be equally well-served in residential and day hospital programs, with no significant cost differential. Provision of residential treatment for non-Whites may be more costly than day hospital, because their residential stays are likely to be 3 times longer than they would be if treated in day hospital. For men, residential care will be marginally more costly. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Residential treatment appears to represent a cost-effective alternative to day hospital for female and White clients with severe alcohol and drug problems who are not at environmental risk. The much shorter stays in day hospital than at residential among non-Whites highlight the need for research to better understand how to best meet the needs and preferences of non-White clients when considering both costs and outcomes.

  1. Residential Mechanical Precooling

    Energy Technology Data Exchange (ETDEWEB)

    German, Alea [Davis Energy Group, Davis, CA (United States). Alliance for Residential Building Innovation (ARBI); Hoeschele, Marc [Davis Energy Group, Davis, CA (United States). Alliance for Residential Building Innovation (ARBI)

    2014-12-01

    Residential air conditioning (AC) represents a challenging load for many electric utilities with poor load factors. Mechanical precooling improves the load factor by shifting cooling operation from on-peak to off-peak hours. This provides benefits to utilities and the electricity grid, as well as to occupants who can take advantage of time-of-use (TOU) electricity rates. Performance benefits stem from reduced compressor cycling, and shifting condensing unit operation to earlier periods of the day when outdoor temperatures are more favorable to operational efficiency. Finding solutions that save energy and reduce demand on the electricity grid is an important national objective and supports key Building America goals. The Alliance for Residential Building Innovation team evaluated mechanical AC precooling strategies in homes throughout the United States. EnergyPlus modeling was used to evaluate two homes with different performance characteristics in seven climates. Results are applicable to new construction homes and most existing homes built in the last 10 years, as well as fairly efficient retrofitted homes. A successful off-peak AC strategy offers the potential for increased efficiency and improved occupant comfort, and promotes a more reliable and robust electricity grid. Demand response capabilities and further integration with photovoltaic TOU generation patterns provide additional opportunities to flatten loads and optimize grid impacts.

  2. Residential energy demand in Brazil

    International Nuclear Information System (INIS)

    Arouca, M.; Gomes, F.M.; Rosa, L.P.

    1981-01-01

    The energy demand in Brazilian residential sector is studied, discussing the methodology for analyzing this demand from some ideas suggested, for developing an adequate method to brazilian characteristics. The residential energy consumption of several fuels in Brazil is also presented, including a comparative evaluation with the United States and France. (author)

  3. 'The Taste Buddies': Participation and empowerment in a residential home for older people

    NARCIS (Netherlands)

    Baur, V.E.; Abma, T.A.

    2012-01-01

    The active participation and autonomy of older people living in residential homes is considered to be problematic. However, in our action research project conducted in a Dutch residential care organisation we found ways to enhance residents' direct participation. This form of participation is

  4. Residential hospice environments: evidence-based architectural and landscape design considerations.

    Science.gov (United States)

    Verderber, Stephen

    2014-01-01

    The residential hospice care movement is increasingly accepted and supported globally, and yet, unfortunately, the amount of literature on best practices in the planning and design of residential hospice facilities and adjacent outdoor spaces remains relatively small. This paper reports on a compendium of architectural and landscape design considerations that reflect the fundamental dimensions of the residential hospice experience: site and context, arrival spaces, communal and private spaces of the residential milieu, transitional spaces, and nature connectivity. Additionally, key staffing and administrative ramifications of this built-environment compendium are addressed, as are prognostications and challenges for the future.

  5. Residential Energy Performance Metrics

    Directory of Open Access Journals (Sweden)

    Christopher Wright

    2010-06-01

    Full Text Available Techniques for residential energy monitoring are an emerging field that is currently drawing significant attention. This paper is a description of the current efforts to monitor and compare the performance of three solar powered homes built at Missouri University of Science and Technology. The homes are outfitted with an array of sensors and a data logger system to measure and record electricity production, system energy use, internal home temperature and humidity, hot water production, and exterior ambient conditions the houses are experiencing. Data is being collected to measure the performance of the houses, compare to energy modeling programs, design and develop cost effective sensor systems for energy monitoring, and produce a cost effective home control system.

  6. Advocacy for Kids: A View from the Residential Trenches.

    Science.gov (United States)

    Parsons, Jon R.

    1995-01-01

    Presents the concept of advocacy in the trenches, wherein residential care staff intercede with and for dysfunctional families, dysfunctional children, and the bureaucracy. This advocacy emphasizes individualized treatment and case-by-case networking, focusing not on broad causes but on what is in the best interest of each child. (ET)

  7. Medicine authentication technology as a counterfeit medicine-detection tool: a Delphi method study to establish expert opinion on manual medicine authentication technology in secondary care.

    Science.gov (United States)

    Naughton, Bernard; Roberts, Lindsey; Dopson, Sue; Brindley, David; Chapman, Stephen

    2017-05-06

    This study aims to establish expert opinion and potential improvements for the Falsified Medicines Directive mandated medicines authentication technology. A two-round Delphi method study using an online questionnaire. Large National Health Service (NHS) foundation trust teaching hospital. Secondary care pharmacists and accredited checking technicians. Seven-point rating scale answers which reached a consensus of 70-80% with a standard deviation (SD) of <1.0. Likert scale questions which reached a consensus of 70-80%, a SD of <1.0 and classified as important according to study criteria. Consensus expert opinion has described database cross-checking technology as quick and user friendly and suggested the inclusion of an audio signal to further support the detection of counterfeit medicines in secondary care (70% consensus, 0.9 SD); other important consensus with a SD of <1.0 included reviewing the colour and information in warning pop up screens to ensure they were not mistaken for the 'already dispensed here' pop up, encouraging the dispenser/checker to act on the warnings and making it mandatory to complete an 'action taken' documentation process to improve the quarantine of potentially counterfeit, expired or recalled medicines. This paper informs key opinion leaders and decision makers as to the positives and negatives of medicines authentication technology from an operator's perspective and suggests the adjustments which may be required to improve operator compliance and the detection of counterfeit medicines in the secondary care sector. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. FastStats: Home Health Care

    Science.gov (United States)

    ... this? Submit What's this? Submit Button NCHS Home Home Health Care Recommend on Facebook Tweet Share Compartir Data are ... National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  9. Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study

    Directory of Open Access Journals (Sweden)

    Alexander Bischoff

    2016-05-01

    Full Text Available Background: In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO nursing school and make recommendations for other similar initiatives. Design: This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Results: Six themes emerged from the experiences that shaped the course of the project: 1 Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public–private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2 Communication was an important and often underrated factor for all types of development projects. 3 Managing the unknown and 4 managing expectations characterised the project inception. Almost all themes had to do with 5 handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6 the need to adjust to ever-changing targets. Conclusions: This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1 Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2 Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve

  10. Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study.

    Science.gov (United States)

    Bischoff, Alexander

    2016-01-01

    In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO) nursing school and make recommendations for other similar initiatives. This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Six themes emerged from the experiences that shaped the course of the project: 1) Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public-private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2) Communication was an important and often underrated factor for all types of development projects. 3) Managing the unknown and 4) managing expectations characterised the project inception. Almost all themes had to do with 5) handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6) the need to adjust to ever-changing targets. This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1) Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2) Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve themselves; 3) Think flexibly and do not stubbornly

  11. A smartphone-based pain management app for adolescents with cancer: establishing system requirements and a pain care algorithm based on literature review, interviews, and consensus.

    Science.gov (United States)

    Jibb, Lindsay A; Stevens, Bonnie J; Nathan, Paul C; Seto, Emily; Cafazzo, Joseph A; Stinson, Jennifer N

    2014-03-19

    Pain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and system design features, which are designed using user-centered methods, are required. To develop the decision algorithm and system requirements that will inform the pain management advice provided by a real-time smartphone-based pain management app for adolescents with cancer. A systematic approach to algorithm development and system design was utilized. Initially, a comprehensive literature review was undertaken to understand the current body of knowledge pertaining to pediatric cancer pain management. A user-centered approach to development was used as the results of the review were disseminated to 15 international experts (clinicians, scientists, and a consumer) in pediatric pain, pediatric oncology and mHealth design, who participated in a 2-day consensus conference. This conference used nominal group technique to develop consensus on important pain inputs, pain management advice, and system design requirements. Using data generated at the conference, a prototype algorithm was developed. Iterative qualitative testing was conducted with adolescents with cancer, as well as pediatric oncology and pain health care providers to vet and refine the developed algorithm and system requirements for the real-time smartphone app. The systematic literature review established the current state of research related to nonpharmacological pediatric cancer pain management. The 2-day consensus conference established which clinically important pain inputs by adolescents would require action (pain management advice) from the app, the appropriate advice the app should provide to adolescents in pain, and the functional requirements of the app

  12. Research report for fiscal 1995 on analysis and evaluation of demonstration tests for establishment of residential photovoltaic power generation load leveling technology, of which evaluation on weatherability of devices used in residential photovoltaic power generation system; 1995 nendo kenkyu hokokusho. Jutaku you taiyoko hatsuden fuka heijunka gijutsu tou kakuritsu jissho shiken ni kansuru kaiseki hyoka no uchi jutaku you taiyoko hatsuden system kiki no taikosei hyoka

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    Weatherability tests have been performed on devices used in the residential photovoltaic power generation system by means of exposure, with the objectives to analyze and evaluate the safety and reliability due to aging of the devices used in the residential photovoltaic power generation system. This paper summarizes the achievements in fiscal 1995. In the outdoor exposure test on solar cell modules, multi-crystalline silicon solar cell modules were selected as the test specimens, and thermo-couples were embedded in the modules to measure the temperatures. Also for the purpose of comparison, storage test specimens were stored in a constant temperature and humidity chamber. The exposure tests were carried out in three locations of the city of Choshi in Chiba Prefecture, the Miyako Island test site in Okinawa Prefecture, and the Miyako Island seashore. In the measurement and evaluation, appearance observation and measurements of output characteristics and insulation resistance were executed in summer and winter. No noticeable changes were observed in the measurements after lapse of four months and six months. In the outdoor exposure tests of metal test pieces, aluminum alloys were tested for corrosion caused by contact with different kinds of metals. Although the test period was short in the current fiscal year, difference in corrosion degrees in the aluminum alloys was found already in three months. (NEDO)

  13. Research report for fiscal 1996 on analysis and evaluation of demonstration tests for establishment of residential photovoltaic power generation load leveling technology, of which evaluation on weatherability of devices used in residential photovoltaic power generation system; 1996 nendo kenkyu hokokusho. Jutaku you taiyoko hatsuden fuka heijunka gijutsu tou kakuritsu jissho shiken ni kansuru kaiseki hyoka no uchi jutaku you taiyoko hatsuden system kiki no taikosei hyoka

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    Weatherability tests have been performed on devices used in the residential photovoltaic power generation system by means of exposure, with the objectives to analyze and evaluate the safety and reliability due to aging of the devices used in the residential photovoltaic power generation system. This paper summarizes the achievements in fiscal 1996. In the outdoor exposure tests on solar cell modules, results of the tests were derived for up to 18 months after the start of the exposure at Choshi City, Miyako Island and the Miyako Island seashore. In the appearance observation, some white rust has appeared in the contact section of the aluminum frames of the solar cell modules and fixing screws, which have been exposed at Miyako Island and the Miyako Island seashore, but no changes that may give influence on the performance of the solar cells have been observed. The results showed performance similar to or slightly inferior to that before the exposure as a whole. The insulation resistances were all found good. According to the result of the outdoor exposure test of metal test pieces, noticeable difference in the corrosion degrees was recognized in the contact corrosion section of the aluminum alloys exposed in three areas having different meteorological and environmental factors. Electroplated zinc was found to have severer pitting corrosion in the contact sections than treatment-free zinc. (NEDO)

  14. Research report for fiscal 1997 on analysis and evaluation of demonstration tests for establishment of residential photovoltaic power generation load leveling technology, of which evaluation on weatherability of devices used in residential photovoltaic power generation system; 1997 nendo kenkyu hokokusho. Jutaku you taiyoko hatsuden fuka heijunka gijutsu tou kakuritsu jissho shiken ni kansuru kaiseki hyoka no uchi jutaku you taiyoko hatsuden system kiki no taikosei hyoka

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    With the objectives to analyze and evaluate the safety and reliability due to aging of the devices used in the residential photovoltaic power generation system, weatherability tests have been performed on devices used in the residential photovoltaic power generation system by means of exposure. This paper summarizes the achievements in fiscal 1997. In the outdoor exposure tests on multi-crystalline silicon solar cell modules at Choshi City, Miyako Island and the Miyako Island seashore, the output characteristics after the exposure tests showed a result that the insolation intensity and the change in the short circuit current are approximately proportional, and the temperature in the module and the change in the open voltage are inversely proportional. The module characteristics retention rate showed no change in the 29-month exposure at all of the three exposure locations. The insulation resistance in the exposure test specimens have been good at 2,000 M{omega} or more in all the locations until 18 months have elapsed. However, the test specimens in Miyako Island and the Miyako Island seashore showed 99 M{omega} after 23 months, and 129 to 1,774 M{omega} after 29 months. According to the outdoor exposure tests of metal test pieces, noticeable difference was found in corrosion due to difference in the environment by each exposure location, whose order of the corrosion degree was the Miyako Island seashore > Miyako Island > Choshi City. (NEDO)

  15. Evaluation of a Residential Mental Health Recovery Service in North Queensland.

    Science.gov (United States)

    Heyeres, Marion; Kinchin, Irina; Whatley, Elise; Brophy, Lisa; Jago, Jon; Wintzloff, Thomas; Morton, Steve; Mosby, Vinitta; Gopalkrishnan, Narayan; Tsey, Komla

    2018-01-01

    Evidence shows that subacute mental health recovery occurs best when a person remains active within the community and fulfils meaningful and satisfying roles of their choosing. Several residential care services that incorporate these values have been established in Australia and overseas. This study describes (a) the development of an evaluation framework for a new subacute residential mental health recovery service in regional Australia and (b) reports on the formative evaluation outcomes. Continuous quality improvement and participatory research approaches informed all stages of the development of the evaluation framework. A program logic was established and subsequently tested for practicability. The resultant logic utilizes the Scottish Recovery Indicator 2 (SRI 2) service development tool, Individual Recovery Plans (IRPs), and the impact assessment of the service on psychiatric inpatient admissions (reported separately). Service strengths included a recovery-focused practice that identifies and addresses the basic needs of residents (consumers). The consumers of the service were encouraged to develop their own goals and self-manage their recovery plans. The staff of the service were identified as working effectively in the context of the recovery process; the staff were seen as supported and valued. Areas for improvement included more opportunities for self-management for residents and more feedback from residents and carers.

  16. Evaluation of a Residential Mental Health Recovery Service in North Queensland

    Directory of Open Access Journals (Sweden)

    Marion Heyeres

    2018-05-01

    Full Text Available BackgroundEvidence shows that subacute mental health recovery occurs best when a person remains active within the community and fulfils meaningful and satisfying roles of their choosing. Several residential care services that incorporate these values have been established in Australia and overseas.AimsThis study describes (a the development of an evaluation framework for a new subacute residential mental health recovery service in regional Australia and (b reports on the formative evaluation outcomes.MethodsContinuous quality improvement and participatory research approaches informed all stages of the development of the evaluation framework. A program logic was established and subsequently tested for practicability. The resultant logic utilizes the Scottish Recovery Indicator 2 (SRI 2 service development tool, Individual Recovery Plans (IRPs, and the impact assessment of the service on psychiatric inpatient admissions (reported separately.ResultsService strengths included a recovery-focused practice that identifies and addresses the basic needs of residents (consumers. The consumers of the service were encouraged to develop their own goals and self-manage their recovery plans. The staff of the service were identified as working effectively in the context of the recovery process; the staff were seen as supported and valued. Areas for improvement included more opportunities for self-management for residents and more feedback from residents and carers.

  17. 78 FR 32124 - Community Residential Care

    Science.gov (United States)

    2013-05-29

    ..., heating and air conditioning, interior building plans, laundry service, size and furnishing requirements..., Home and Community Based Services (10P4G), Veterans Health Administration, 810 Vermont Avenue NW... for placement in a CRC facility if VA is furnishing outpatient medical services or hospital...

  18. ENERGY STAR Certified Residential Dishwashers

    Data.gov (United States)

    U.S. Environmental Protection Agency — Certified models meet all ENERGY STAR requirements as listed in the Version 6.0 ENERGY STAR Program Requirements for Residential Dishwashers that are effective as of...

  19. ENERGY STAR Certified Residential Freezers

    Data.gov (United States)

    U.S. Environmental Protection Agency — Certified models meet all ENERGY STAR requirements as listed in the Version 5.0 ENERGY STAR Program Requirements for Residential Refrigerators and Freezers that are...

  20. ENERGY STAR Certified Residential Refrigerators

    Data.gov (United States)

    U.S. Environmental Protection Agency — Certified models meet all ENERGY STAR requirements as listed in the Version 5.0 ENERGY STAR Program Requirements for Residential Refrigerators and Freezers that are...

  1. Managing Austerity: Emotional Containment in a Residential Children’s Home Under Threat

    OpenAIRE

    Melaugh, Brian

    2016-01-01

    The aim of the study was to explore the process and practice of leading change in residential child care and assess the efficacy of ‘emotional containment’ in this context. Residential child care in Ireland is experiencing significant change. Change is an emotional experience for staff and leadership is named as pivotal in organisational change. However, there is gap in the literature because leadership and organisational change theory does not fully fit with the relational nature of resident...

  2. 78 FR 38810 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to...

    Science.gov (United States)

    2013-06-27

    ... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... 2900-0616.'' SUPPLEMENTARY INFORMATION: Title: Residential Care Home Program--Sponsor Application, VA... collection. Abstract: VA Form 10-2407 is an application used by a residential care facility or home that...

  3. Risks from Radon: Reconciling Miner and Residential Epidemiology

    International Nuclear Information System (INIS)

    Chambers, Douglas B.; Harley, Naomi H.

    2008-01-01

    Everyone is exposed to radon, an inert radioactive gas that occurs naturally and is present everywhere in the atmosphere. The annual dose from radon and its (short-lived) decay products is typically about one-half of the dose received by members of the public from all natural sources of ionizing radiation. Data on exposures and consequent effects have recently been reviewed by the National Council on Radiation Protection and Measurements (NCRP) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Studies of underground miners provides a well-established basis for estimating risks from occupational exposures to radon and for studying factors that may affect the dose response relationship such as the reduction of risk (coefficients) with increasing time since exposure. Miners' studies previously formed the basis for estimating risks to people exposed to radon at home, with downward extrapolation from exposures in mines to residential levels of radon. Presently, the risk estimates from residential studies are adequate to estimate radon risks in homes. Although there are major uncertainties in extrapolating the risks of exposure to radon from the miner studies to assessing risks in the home, there is remarkably good agreement between the average of risk factors derived from miner studies and those from pooled residential case-control studies. There are now over 20 analytical studies of residential radon and lung cancer. These studies typically assess the relative risk from exposure to radon based on estimates of residential exposure over a period of 25 to 30 years prior to diagnosis of lung cancer. Recent pooled analyses of residential case-control studies support a small but detectable lung cancer risk from residential exposure, and this risk increases with increasing concentrations. The excess relative risk of lung cancer from long-term residential exposure is about the same for both smokers and non-smokers; however, because the

  4. The Sensitivity of Residential Electricity Demand in Indonesia

    Directory of Open Access Journals (Sweden)

    Stranti Nastiti Kusumaningrum

    2018-03-01

    Full Text Available Since 2013, the residential electricity price for High VA (Volt-Ampere households has changed due to changes in pricing policies. This paper analyzes the responsiveness of residential electricity demand to the change in electricity prices and income among two different household groups (Low VA and High VA in 2011 and 2014. Using an electricity consumption model and the Quantile Regression method, the results show that residential electricity demand is price and income inelastic. Income elasticity is lower than price elasticity. Furthermore, the effects on price elasticity also found in the Low VA group, whose rate remained stable. At the same time, evidence proves the impact of the change in pricing policy on income elasticity remains unclear. This result implies that the government has to be more careful in regulating electricity prices for the low VA group, while maintaining economic stability.DOI: 10.15408/sjie.v7i2.6048

  5. Residential radon and lung cancer incidence in a Danish cohort

    DEFF Research Database (Denmark)

    Bräuner, Elvira Vaclavik; Andersen, Claus Erik; Sørensen, Mette

    2012-01-01

    High-level occupational radon exposure is an established risk factor for lung cancer. We assessed the long-term association between residential radon and lung cancer risk using a prospective Danish cohort using 57,053 persons recruited during 1993–1997. We followed each cohort member for cancer...... occurrence until 27 June 2006, identifying 589 lung cancer cases. We traced residential addresses from 1 January 1971 until 27 June 2006 and calculated radon at each of these addresses using information from central databases regarding geology and house construction. Cox proportional hazards models were used...... to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for lung cancer risk associated with residential radon exposure with and without adjustment for sex, smoking variables, education, socio-economic status, occupation, body mass index, air pollution and consumption of fruit and alcohol...

  6. Incentive Pass-through for Residential Solar Systems in California

    Energy Technology Data Exchange (ETDEWEB)

    Dong, C. G. [Univ. of Texas, Austin, TX (United States); Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Rai, Varun [Univ. of Texas, Austin, TX (United States)

    2014-10-01

    The deployment of solar photovoltaic (PV) systems has grown rapidly over the last decade, partly because of various government incentives. In the United States, among the largest and longest-running incentives have been those established in California. Building on past research, this report addresses the still-unanswered question: to what degree have the direct PV incentives in California been passed through from installers to consumers? This report helps address this question by carefully examining the residential PV market in California (excluding a certain class of third-party-owned PV systems) and applying both a structural-modeling approach and a reduced-form regression analysis to estimate the incentive pass-through rate. The results suggest an average pass-through rate of direct incentives of nearly 100%, though with regional differences among California counties. While these results could have multiple explanations, they suggest a relatively competitive market and well-functioning subsidy program. Further analysis is required to determine whether similar results broadly apply to other states, to other customer segments, to all third-party-owned PV systems, or to all forms of financial incentives for solar (considering not only direct state subsidies, but also utility electric bill savings and federal tax incentives).

  7. Working Together to Promote Diabetes Control: A Practical Guide for Diabetes Health Care Providers in Establishing a Working Alliance to Achieve Self-Management Support.

    Science.gov (United States)

    Jones, Allan; Vallis, Michael; Cooke, Debbie; Pouwer, François

    2016-01-01

    The quality of the "patient-carer" relationship is the foundation of self-management support and has been shown to influence treatment outcome in relation to psychological and somatic illness, including diabetes. It has long been accepted within applied psychology that the quality of the client-therapist relationship--termed the working alliance--is of central importance to treatment outcome and may account for a significant degree of the overall treatment effect. Diabetes healthcare providers have recently expressed a need for further training in communication techniques and in the psychological aspects of diabetes. Could we take a page from the psychological treatment manual on working alliance in therapy to guide the diabetes healthcare provider in their role of supporting the person with diabetes achieve and maintain better metabolic control? This paper examines the role of the working alliance in diabetes care and offers a practical guide to the diabetes healthcare provider in establishing a working alliance with the person with diabetes in managing diabetes.

  8. Staff behavior toward children and adolescents in a residential facility: A self-report questionnaire

    NARCIS (Netherlands)

    Huitink, C.; Embregts, P.J.C.M.; Veerman, J.W.; Verhoeven, L.T.W.

    2011-01-01

    The purpose of the present study was to examine psychometric properties of the Staff Behavior toward Clients questionnaire (SBC), a self-report measure for care staff working with children and adolescents with mild to borderline intellectual disabilities in residential care. Ninetynine care staff

  9. Evaluation of advanced technologies for residential appliances and residential and commercial lighting

    Energy Technology Data Exchange (ETDEWEB)

    Turiel, I.; Atkinson, B.; Boghosian, S.; Chan, P.; Jennings, J.; Lutz, J.; McMahon, J.; Rosenquist, G.

    1995-01-01

    Section 127 of the Energy Policy Act requires that the Department of Energy (DOE) prepare a report to Congress on the potential for the development and commercialization of appliances that substantially exceed the present federal or state efficiency standards. Candidate high-efficiency appliances must meet several criteria including: the potential exists for substantial improvement (beyond the minimum established in law) of the appliance`s energy efficiency; electric, water, or gas utilities are prepared to support and promote the commercialization of such appliances; manufacturers are unlikely to undertake development and commercialization of such appliances on their own, or development and production would be substantially accelerated by support to manufacturers. This report describes options to improve the efficiency of residential appliances, including water heaters, clothes washers and dryers, refrigerator/freezers, dishwashers, space heating and cooling devices, as well as residential and commercial lighting products. Data from this report (particularly Appendix 1)were used to prepare the report to Congress mentioned previously. For the residential sector, national energy savings are calculated using the LBL Residential Energy Model. This model projects the number of households and appliance saturations over time. First, end-use consumption is calculated for a base case where models that only meet the standard replace existing models as these reach the end of their lifetime. Second, models with efficiencies equal to the technology under consideration replace existing models that reach the end of their lifetime. For the commercial sector, the COMMEND model was utilized to project national energy savings from new technologies. In this report, energy savings are shown for the period 1988 to 2015.

  10. Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators.

    Science.gov (United States)

    Mattsson, Maria Søe; Mattsson, Nick; Jørsboe, Hanne B

    2014-11-05

    The Emergency Departments (EDs) reorganization process in Denmark began in 2007 and includes creating a single entrance for all emergency patients, establishing triage, having a specialist in the front and introducing the use of electronic overview boards and electronic patient files. The aim of this study was to investigate the quality of acute care in a re-organized ED based on national indicator project data in a pre and post reorganizational setting. Quasi experimental design was used to examine the effect of the health care quality in relation to the reorganization of an ED. Patients admitted at Nykøbing Falster Hospital in 2008 or 2012 were included in the study and data reports from the national databases (RKKP) regarding stroke, COPD, heart failure, bleeding and perforated ulcer or hip fracture were analysed. Holbæk Hospital works as a control hospital. Chi-square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P cases from RKKP. A significant positive change was seen in all of the additional eight indicators related to stroke at NFS (P < 0.001); however, COPD indicators were unchanged in both hospitals. In NFS two of eight heart failure indicators were significantly improved after the reorganization (p < 0.01). In patients admitted with a bleeding ulcer 2 of 5 indicators were significantly improved after the reorganization in NFS and HOL (p < 0.01). Both compared hospitals showed significant improvements in the two indicators concerning hip fracture (p < 0.001). Significant reductions in the 30 day-mortality in patients admitted with stroke were seen when the pre- and the post-intervention data were compared for both NFS and HOL (p = 0.024). During the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality decreased in the five diseases. The development of a common set of

  11. The establishment of bonds between professional and patient in TB treatment: the performance of primary health care services in a city in the interior of São Paulo.

    Science.gov (United States)

    Ponce, Maria Amélia Zanon; Vendramini, Silvia Helena Figueiredo; dos Santos, Marilene Rocha; Santos, Maria de Lourdes Sperli Geraldes; Scatena, Lúcia Marina; Villa, Tereza Cristina Scatena

    2011-01-01

    This study evaluated the performance of health care services implementing TB control actions in relation to the establishment of bonds between health professionals and patients in São José do Rio Preto, SP, Brazil from the perspective of patients, health professionals, and managers. A total of 108 patients, 37 health professionals and 15 managers were interviewed through a questionnaire containing 10 indicators of bond-establishment based on the instruments of the Primary Care Assessment Tool, adapted to evaluate tuberculosis control in Brazil. The three groups of actors considered the establishment of bonds satisfactory, though opinions of patients and managers differed in almost all indicators. This fact indicates that the view of managers is still predominantly focused on bureaucratic and administrative aspects, which shows the need for managers to integrate more management and care actions.

  12. Economic aspects of possible residential heating conservation

    Energy Technology Data Exchange (ETDEWEB)

    Hopkowicz, M.; Szul, A. [Technical Univ., Cracow (Poland)

    1995-12-31

    The paper presents methods of evaluation of energy and economy related effects of different actions aimed at conservation in residential buildings. It identifies also the method of selecting the most effective way of distribution funds assigned to weatherization as well as necessary improvements to be implemented within the heating node and the internal heating system of the building. The analysis of data gathered for four 11-stories high residential buildings of {open_quotes}Zeran{close_quotes} type being subject of the Conservation Demonstrative Project, included a differentiated scope of weatherization efforts and various actions aimed at system upgrading. Basing upon the discussion of the split of heat losses in a building as well as the established energy savings for numerous options of upgrading works, the main problem has been defined. It consists in optimal distribution of financial means for the discussed measures if the total amount of funds assigned for modifications is defined. The method based upon the principle of relative increments has been suggested. The economical and energy specifications of the building and its components, required for this method have also been elaborated. The application of this method allowed to define the suggested optimal scope of actions within the entire fund assigned for the comprehensive weatherization.

  13. Part-sales as an investment strategy : Analysis of part-selling of residential units in the Netherlands

    NARCIS (Netherlands)

    Hordijk, A.C.; Janssen, J.E.; Teuben, B.

    2006-01-01

    The ROZ/IPD Property index was established in 1994 to publicize an independent index on directly held real estate in the Netherlands. The real estate universe is split into the sectors: retail, offices, industrial, residential and mixed use/other. The residential sector consists of almost 50 % of

  14. Understanding Residential Polarization in a Globalizing City

    Directory of Open Access Journals (Sweden)

    Ibrahim Rotimi Aliu

    2013-12-01

    Full Text Available This study examines the spatial polarization that characterizes the dwellings in the African leading megacity of Lagos. Data were collected through an extensive housing survey carried out on 1,485 household residences in 56 wards within 12 administrative units in Lagos megacity. The spatial dimension of residential density in the city generates three unique residential patterns which are low residential density (LRD, medium residential density (MRD, and high residential density (HRD areas. Descriptive and multivariate inferential statistics were used to render explanations for the spatial variations in the residential quality variables in the study area. Findings indicated that a clear difference exists in the residential quality within the three residential density areas of Lagos. High correlations exist among the residential quality indicators and housing type. The principal component analysis shows that residential polarizations that occur in the LRD, MRD, and HRD are based on the location, dwelling facility, interior and exterior quality, neighborhood integrity, social bond, barrier to entry, and security. The practical implications of residential polarizations along the residential density areas are explicitly expressed.

  15. Technical Problems of Residential Construction

    Science.gov (United States)

    Nowogońska, Beata; Cibis, Jerzy

    2017-10-01

    Beauty, utility, durability - these are the features of good architecture and should also be the distinguishing qualities of every residential building. But do beauty and utility remain along with the passing of time? Performance characteristics are an indicator of both, the technical as well as aesthetic state of buildings. Aesthetic needs are in disagreement with the merciless aging process. The beauty of a city is formed not only by the original forms of new residential buildings, but also by existing tenement housing; thus preserving their aesthetics becomes a necessity. Time is continuously passing and along with it, aging intensifies. The aging process is a natural phenomenon for every material. The life expectancy of building materials is also limited. Along with the passing of time, the technical state of residential buildings continuously deteriorates. With the passing of time, the aesthetic values and preferences of users of flats change and the usability of the building decreases. The permanence of buildings, including residential buildings, is shaped not only by the forces of nature but also by activities of humans. A long lifespan is ensured by carrying out ongoing, systematic renovation-repair works. It is thanks to them that buildings derived from past centuries are still being used, and their market attractiveness is not decreasing.

  16. Residential solar-heating system

    Science.gov (United States)

    1978-01-01

    Complete residential solar-heating and hot-water system, when installed in highly-insulated energy-saver home, can supply large percentage of total energy demand for space heating and domestic hot water. System which uses water-heating energy storage can be scaled to meet requirements of building in which it is installed.

  17. Convergence of Residential Gateway Technology

    NARCIS (Netherlands)

    Hartog, F.T.H. den; Balm, M.; Jong, C.M. de; Kwaaitaal, J.J.B.

    2004-01-01

    A new OSI-based model is described that can be used for the classification of residential gateways. It is applied to analyze current gateway solutions and draw evolutionary paths for the medium to long term. From this it is concluded that particularly set-top boxes and broadband modems, as opposed

  18. Convergence of residential gateway technology

    NARCIS (Netherlands)

    Hartog, den F.T.H.; Balm, M.; Jong, de C.M.; Kwaaitaal, J.J.B.

    2004-01-01

    A new OSI-based model is described that can be used for the classification of residential gateways. It is applied to analyze current gateway solutions and draw evolutionary paths for the medium to long term. From this it is concluded that particularly set-top boxes and broadband modems, as opposed

  19. Trends of Sustainable Residential Architecture

    OpenAIRE

    Narvydas, A

    2014-01-01

    The article is based on Master’s research conducted during Scottish Housing Expo 2010. The aim of the research was to determine the prevailing trends in sustainable residential architecture. Each trend can be described by features detected during visual and technical observation of project data. Based on that architects may predict possible problems related to a specific trend.

  20. Reduce tax on residential mobility

    NARCIS (Netherlands)

    van Ewijk, C.; van Leuvensteijn, M.

    2010-01-01

    How can Europe increase structural growth? This column argues that labour market flexibility is key. As a major barrier to labour movement is rigidity in the housing market, abolishing transfer taxes on residential property could result in gains of up to 0.4% of GDP.

  1. Zones 30 : urban residential areas.

    NARCIS (Netherlands)

    2006-01-01

    Sustainable Safety uses a road categorization in which through traffic is concentrated on motorways and other main roads. In residential areas, which have a living, shopping, or work function, through traffic is discouraged by setting a speed limit of 30 km/h, and by speed reducing measures such as

  2. Analysis of Sociodemographic parameters of patients admitted in a newly established palliative care center in a regional cancer institute of north-west India

    Directory of Open Access Journals (Sweden)

    Mukesh Kumar Singhal

    2014-01-01

    Conclusions: Palliative care services are an indispensable part of a tertiary regional cancer care center. The oncologists should be made aware of the requirement of better relief of pain and other distressing symptoms to provide better quality of life to the patients suffering from advanced cancer.

  3. Establishing Cardiopulmonary Resuscitation Services in Sub-Saharan Africa: A Survey of Suggestions Made by Health Care Workers in Cross River State, Nigeria

    Directory of Open Access Journals (Sweden)

    Queeneth Ndukwe Kalu

    2018-05-01

    CONCLUSION: Healthcare workers perceive an urgent need for the establishment of CPR services in our health facilities and communities. There is need to address the triad of awareness, infrastructure and capacity building for the establishment of CPR services peculiar to Sub-Saharan Africa.

  4. Residential mobility and childhood leukemia.

    Science.gov (United States)

    Amoon, A T; Oksuzyan, S; Crespi, C M; Arah, O A; Cockburn, M; Vergara, X; Kheifets, L

    2018-07-01

    Studies of environmental exposures and childhood leukemia studies do not usually account for residential mobility. Yet, in addition to being a potential risk factor, mobility can induce selection bias, confounding, or measurement error in such studies. Using data collected for California Powerline Study (CAPS), we attempt to disentangle the effect of mobility. We analyzed data from a population-based case-control study of childhood leukemia using cases who were born in California and diagnosed between 1988 and 2008 and birth certificate controls. We used stratified logistic regression, case-only analysis, and propensity-score adjustments to assess predictors of residential mobility between birth and diagnosis, and account for potential confounding due to residential mobility. Children who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status. Odds ratios for leukemia among non-movers living mobility, including dwelling type, increased odds ratios for leukemia to 2.61 (95% CI: 1.76-3.86) for living mobility of childhood leukemia cases varied by several sociodemographic characteristics, but not by the distance to the nearest power line or calculated magnetic fields. Mobility appears to be an unlikely explanation for the associations observed between power lines exposure and childhood leukemia. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. RESIDENTIAL MORTGAGE IN MODERN RUSSIA

    Directory of Open Access Journals (Sweden)

    Dementiev N. P.

    2015-03-01

    Full Text Available The article presents a comparative analysis of residential mortgages in Russia and the United States. The primary ways of mortgage refinancing are outlined. Predominance of the elements of two-level refinancing system of residential mortgage in Russia and the United States is shown. The activity of the Agency for Housing Mortgage Lending (AHML, the basic tool of the Russian government’s mortgage policy, is described in detail. In its objectives and functions the AHML is similar to the American mortgage agencies Ginnie Mae, Fannie Mae and Freddie Mac. Similarities were identified in the Russian and US residential mortgages in the pre-crisis period (high rates of mortgage growth, favourable economic conjuncture, low interest rates, large increase in house prices, speculative housing demand. During the mortgage crisis, the policies of the Russian and US governments and monetary authorities had also much in common (monetary policy easing, cheap central banks loans, extended facilities of mortgage refinancing on the part of state agencies, mortgage rescue scheme, social mortgage programs. But the scope of mortgage in Russia is enormously narrow as compared to the US mortgage. The most important reason for that - low incomes of the Russian population.

  6. The Health Care in North Korea during the Period(1945-1948 between Liberation from Japanese Occupation and Establishment of North Korean Government

    Directory of Open Access Journals (Sweden)

    HWANG Sang-Ik

    2007-06-01

    Full Text Available This paper, mainly based on literature and documents from North Korea and Russia, described how health care system had been formulated during the period of between liberation from Japanese Occupation and formation of its own government in North Korea, which is so-called 'the Period of People's Democracy'.North Korea authorities, by themselves, address that their health care system is characterized by state medicine, universal free medical care, emphasis on preventive medicine, community(ho doctors in charge, provisions of modern medical services in parallel with traditional ones, imposed high value on ideologies of medical personnel, and mass participation of health programs so on, taken rise since this period.Under North Korea's socialistic regime, authorities started to restructure health care system through national health care organizations and institutes, which partially provided medical service free. Also, they emphasized preventive medicine against 'capitalistic' treatment-oriented medicine, and community(ho doctor in-charge was derived from this period.It showed that the mass participation on health program was equal hereafter and they had under bias toward more emphasis on ideology of medical personnel rather than their professionalism. The attempt to develop traditional medicine had been made during this period, however, much funding and support was not observed.In this period, it showed that a series of action to restructure health care system had been gradually carried out.

  7. Study on Greenhouse Gas Reduction Potential in Residential, Commercial and Transportation Sectors of Korea

    International Nuclear Information System (INIS)

    Kim, H. G.; Jeong, Y. J.

    2011-11-01

    The establishment of the sectoral model was made. The sectors cover residential, commercial and transportation sectors. The establishment of the model includes designing Reference Energy System, Development of the reference scenario, setting up various scenarios in which GHG reductions were taken into account by evaluating the reduction potential in the cost effective way

  8. Estimation of European Union residential sector space cooling potential

    International Nuclear Information System (INIS)

    Jakubcionis, Mindaugas; Carlsson, Johan

    2017-01-01

    Data on European residential space cooling demands are scarce and often of poor quality. This can be concluded from a review of the Comprehensive Assessments on the energy efficiency potential in the heating and cooling sector performed by European Union Member States under Art. 14 of the Energy Efficiency Directive. This article estimates the potential space cooling demands in the residential sector of the EU and the resulting impact on electricity generation and supply systems using the United States as a proxy. A georeferenced approach was used to establish the potential residential space cooling demand in NUTS-3 regions of EU. The total potential space cooling demand of the EU was estimated to be 292 TW h for the residential sector in an average year. The additional electrical capacity needed was estimated to 79 GW. With proper energy system development strategies, e.g. matching capacity of solar PV with cooling demand, or introduction of district cooling, the stresses on electricity system from increasing cooling demand can be mitigated. The estimated potential of space cooling demand, identified in this paper for all EU Members States, could be used while preparing the next iteration of EU MS Comprehensive Assessments or other energy related studies. - Highlights: • An estimation of EU space cooling demand potential in residential sector is presented. • An estimate of space cooling demand potential is based on using USA data as a proxy. • Significant cooling demand increase can be expected. • Cooling demand increase would lead to increased stress in energy supply systems. • Proper policies and strategies might measurably decrease the impact on energy systems.

  9. Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

    Science.gov (United States)

    Pereira, José L.; Davis, Daniel H.J.; Currow, David C.; Meagher, David; Rabheru, Kiran; Wright, David; Bruera, Eduardo; Hartwick, Michael; Gagnon, Pierre R.; Gagnon, Bruno; Breitbart, William; Regnier, Laura; Lawlor, Peter G.

    2014-01-01

    Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed. PMID:24480529

  10. SURVEY OF ESTABLISHING INSTITUTIONAL SYSTEM FOR CARE, EDUCATION AND REHABILITATION OF DISABLED PEOPLE IN THE REPUBLIC OF MACEDONIA IN THE PERIOD 1946-1996

    Directory of Open Access Journals (Sweden)

    Ljupcho AJDINSKI

    2004-12-01

    Full Text Available The period from the middle of the XIX to the middle of the XX century (1947, i.e., till passing the Statute of the World Health Organization, is a period in which not only the concept and the relationship was created and built up but also the institutionalized system for care, education and rehabilitation of disabled people in the world. During this one-century-period, institutional forms of social care, special education, professional training of disabled people were created.Unfortunately, our country did not have such a historical background. The society was not ready yet to accept the new ideas and to implement in practice the contemporary concepts in regard to the social care of the population that had been for ages on the margins of life.

  11. The relation between residential property and its surroundings and day- and night-time residential burglary

    NARCIS (Netherlands)

    Montoya, Lorena; Junger, Marianne; Ongena, Yfke

    This article examines how residential property and its surroundings influence day- and night-time residential burglary. Crime Prevention Through Environmental Design (CPTED) principles of territoriality, surveillance, access control, target hardening, image maintenance, and activity support underpin

  12. The Relation Between Residential Property and its Surroundings and Day- and Night-Time Residential Burglary

    NARCIS (Netherlands)

    Montoya, L.; Junger, Marianne; Ongena, Yfke

    This article examines how residential property and its surroundings influence day- and night-time residential burglary. Crime Prevention Through Environmental Design (CPTED) principles of territoriality, surveillance, access control, target hardening, image maintenance, and activity support underpin

  13. Optimal Scheduling of Residential Microgrids Considering Virtual Energy Storage System

    Directory of Open Access Journals (Sweden)

    Weiliang Liu

    2018-04-01

    Full Text Available The increasingly complex residential microgrids (r-microgrid consisting of renewable generation, energy storage systems, and residential buildings require a more intelligent scheduling method. Firstly, aiming at the radiant floor heating/cooling system widely utilized in residential buildings, the mathematical relationship between the operative temperature and heating/cooling demand is established based on the equivalent thermodynamic parameters (ETP model, by which the thermal storage capacity is analyzed. Secondly, the radiant floor heating/cooling system is treated as virtual energy storage system (VESS, and an optimization model based on mixed-integer nonlinear programming (MINLP for r-microgrid scheduling is established which takes thermal comfort level and economy as the optimization objectives. Finally, the optimal scheduling results of two typical r-microgrids are analyzed. Case studies demonstrate that the proposed scheduling method can effectively employ the thermal storage capacity of radiant floor heating/cooling system, thus lowering the operating cost of the r-microgrid effectively while ensuring the thermal comfort level of users.

  14. Maximizing Information from Residential Measurements of Volatile Organic Compounds

    Energy Technology Data Exchange (ETDEWEB)

    Maddalena, Randy [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Li, Na [Berkeley Analytical Associates, Richmond, CA (United States); Hodgson, Alfred [Berkeley Analytical Associates, Richmond, CA (United States); Offermann, Francis [Indoor Environmental Engineering, San Francisco, CA (United States); Singer, Brett [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2013-02-01

    Continually changing materials used in home construction and finishing can introduce new chemicals or changes in the VOC profile in residential air and the trend towards tighter homes can lead to higher exposure concentrations for many indoor sources. However, the complex mixture of VOCs in residential air makes it difficult to discover emerging contaminants and/or trends in pollutant profiles. The purpose of this study is to prepare a comprehensive library of chemicals found in homes, along with a semi-quantitative approach to maximize the information gained from VOC measurements. We carefully reviewed data from 108 new California homes and identified 238 individual compounds. The majority of the identified VOCs originated indoors. Only 31% were found to have relevant health based exposure guidelines and less than 10% had a chronic reference exposure level (CREL). The finding highlights the importance of extending IAQ studies to include a wider range of VOCs

  15. Moving from Outsider to Insider: Peer Status and Partnerships between Electricity Utilities and Residential Consumers

    Science.gov (United States)

    Morris, Peter; Buys, Laurie; Vine, Desley

    2014-01-01

    An electricity demand reduction project based on comprehensive residential consumer engagement was established within an Australian community in 2008. By 2011, both the peak demand and grid supplied electricity consumption had decreased to below pre-intervention levels. This case study research explored the relationship developed between the utility, community and individual consumer from the residential customer perspective through qualitative research of 22 residential households. It is proposed that an energy utility can be highly successful at peak demand reduction by becoming a community member and a peer to residential consumers and developing the necessary trust, access, influence and partnership required to create the responsive environment to change. A peer-community approach could provide policymakers with a pathway for implementing pro-environmental behaviour for low carbon communities, as well as peak demand reduction, thereby addressing government emission targets while limiting the cost of living increases from infrastructure expenditure. PMID:24979234

  16. A Study to Establish Baseline Data on the Retiree Population’s Perceptions of Access and Health Care Delivered through Outpatient Services at Ireland Army Community Hospital

    Science.gov (United States)

    1987-04-01

    common household products, there are many ideas and principles that are used in marketing consumer products that can be applied to primary health care...Design & Analysis, Chicago: Free Press, 1955. Kotler , Phillip., Marketing for Nonprofit Organizations, Englewood Cliffs, NJ: Prentice-Hall, Inc., 1975...to recapture ’the retiree population around IACH, Ft. Knox, KY. and to implement a marketing strategy which would attempt to recapture a portion of

  17. Residential Electricity Consumption in Poland

    Directory of Open Access Journals (Sweden)

    Edyta Ropuszyńska-Surma

    2016-01-01

    Full Text Available Key factors influencing electricity consumption in the residential sector in Poland have been identified. A fixed-effects model was used, which includes time effects, and a set of covariates, based on the model developed by Houthakker et al. This model estimates electricity demand by using lagged values of the dependent variable along with current and lagged values of electricity prices, and other variables that affect electricity demand such as: population, economic growth, income per capita, price of related goods, etc. The model has been identified according to the research results of the authors and those obtained by Bentzen and Engsted. The set of covariates was extended to the lagged electricity price given by a tariff (taken from two years previous to the time of interest and heating degree days index, a very important factor in European Union countries, where the climate is temperate. The authors propose four models of residential electricity demand, for which a confidence interval of 95% has been assumed. Estimation was based on Polish quarterly data for the years 2003-2013. (original abstract

  18. Residential ventilation standards scoping study

    Energy Technology Data Exchange (ETDEWEB)

    McKone, Thomas E.; Sherman, Max H.

    2003-10-01

    The goals of this scoping study are to identify research needed to develop improved ventilation standards for California's Title 24 Building Energy Efficiency Standards. The 2008 Title 24 Standards are the primary target for the outcome of this research, but this scoping study is not limited to that timeframe. We prepared this scoping study to provide the California Energy Commission with broad and flexible options for developing a research plan to advance the standards. This document presents the findings of a scoping study commissioned by the Public Interest Energy Research (PIER) program of the California Energy Commission to determine what research is necessary to develop new residential ventilation requirements for California. This study is one of three companion efforts needed to complete the job of determining the ventilation needs of California residences, determining the bases for setting residential ventilation requirements, and determining appropriate ventilation technologies to meet these needs and requirements in an energy efficient manner. Rather than providing research results, this scoping study identifies important research questions along with the level of effort necessary to address these questions and the costs, risks, and benefits of pursuing alternative research questions. In approaching these questions and corresponding levels of effort, feasibility and timing were important considerations. The Commission has specified Summer 2005 as the latest date for completing this research in time to update the 2008 version of California's Energy Code (Title 24).

  19. Integration of motor traffic in residential areas.

    NARCIS (Netherlands)

    Schreuder, D.A.

    1977-01-01

    In stead of banning the cars from residential areas, the plan is to integrate them in such a way that they can still be used, but that they will loose their predominant position. The areas where this integration is to take place are called residential yards. This paper concentrates on the lighting

  20. The crucial role of the micro caregiving environment: Factors associated with attachment styles in alternative care in Chile.

    Science.gov (United States)

    Garcia Quiroga, Manuela; Hamilton-Giachritsis, Catherine

    2017-08-01

    The distribution of attachment styles has been shown to differ between groups of children living with their parents and children placed in alternative care (AC), defined as residential or foster. However, this is the first study in Latin America to explore possible factors affecting the quality of attachment in children living in both residential and foster care. Two groups of children (N=57) were compared: one group living in Residential Homes (RC) and the other in Foster Care (FC) in Chile. Children's, caregivers' and structural factors (e.g., child: caregiver ratios) and their links with attachment styles were investigated. The micro caregiving environment (i.e., the specific individual child caregiver relationship), especially the caregivers' engagement, sensitivity, disciplinary control and affection, as well as some structural factors (i.e., child: caregiver ratios), were linked to attachment security in children. Specifically, better emotional caregiving and lower child-caregiver ratios were associated with higher rates of secure attachment. The association between quality of care (as measured by the HOME inventory) and attachment styles seems to be influenced by caregiver relationships (as measured by CCSERSS). Caregiver relationship factors (i.e., affection, engagement and sensitivity) directly impact the quality of the attachment children establish with them while living in AC. However, the relationships that caregivers establish with children under their care can be facilitated by good quality structural factors, particularly child-caregiver ratios. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Distribution of blood derivatives by registered blood establishments that qualify as health care entities; Prescription Drug Marketing Act of 1987; Prescription Drug Amendments of 1992; delay of applicability date. Final rule; delay of applicability date.

    Science.gov (United States)

    2006-11-13

    The Food and Drug Administration (FDA) is further delaying, until December 1, 2008, the applicability date of a certain requirement of a final rule published in the Federal Register of December 3, 1999 (64 FR 67720) (the final rule). The final rule implements the Prescription Drug Marketing Act of 1987 (PDMA), as modified by the Prescription Drug Amendments of 1992 (PDA), and the Food and Drug Administration Modernization Act of 1997 (the Modernization Act). The provisions of the final rule became effective on December 4, 2000, except for certain provisions whose effective or applicability dates were delayed in five subsequent Federal Register notices, until December 1, 2006. The provision with the delayed applicability date would prohibit wholesale distribution of blood derivatives by registered blood establishments that meet the definition of a "health care entity." In the Federal Register of February 1, 2006 (71 FR 5200), FDA published a proposed rule specific to the distribution of blood derivatives by registered blood establishments that qualify as health care entities (the proposed rule). The proposed rule would amend certain limited provisions of the final rule to allow certain registered blood establishments that qualify as health care entities to distribute blood derivatives. In response to the proposed rule, FDA received substantive comments. As explained in the SUPPLEMENTARY INFORMATION section of this document, further delaying the applicability of Sec. 203.3(q) (21 CFR 203.3(q)) to the wholesale distribution of blood derivatives by health care entities is necessary to give the agency additional time to address comments on the proposed rule, consider whether regulatory changes are appropriate, and, if so, to initiate such changes.

  2. How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency.

    Science.gov (United States)

    Wesson, Donald E; Kitzman, Heather E

    2018-01-16

    Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.

  3. Contribution of price/expenditure factors of residential energy consumption in China from 1993 to 2011: A decomposition analysis

    International Nuclear Information System (INIS)

    Liu, Zengming; Zhao, Tao

    2015-01-01

    Highlights: • Analysis about energy prices and the residential expenditure on energy in China. • Though the prices of energy declined, the price effect was negative. • The effect of price was the strongest restraining contribution. • Discussion on the proportion of energy expenditure in residential incomes. - Abstract: Since the establishment of the market economy in 1993, the residential consumption of commodities, including energy, has been highly influenced by prices in China. However, the contribution of the factors related to prices in residential energy consumption is relatively unexplored. This paper extends the KAYA identity with price and expenditure factors and then applies the LMDI method to a decomposition of residential energy consumption in China from 1993 to 2011. Our results show the following: (1) Though the prices of a majority of residential energy sources in China declined, the effect of energy prices restrained residential energy consumption because the expenditure structure changed during the period. (2) During the research period, the urban energy expenditure proportion experienced two progresses of rising and falling, and the rural proportion, which was stable before 2002, sharply increased. (3) The energy consumption intensity effect, which is the negative of the average energy price effect, contributed to most of the decrease in energy consumption, whereas residential income played a key role in the growth of consumption. According to the conclusions, we suggest further marketization and deregulation of energy prices, the promotion of advanced energy types and guidance for better energy consumption patterns

  4. Energy Performance of Three Residential College Buildings in University of Malaya Campus, Kuala Lumpur

    Directory of Open Access Journals (Sweden)

    Adi Ainurzaman Jamaludin

    2011-12-01

    Full Text Available Three residential colleges located in Kuala Lumpur, Malaysia, were selected for energy performance analysis in regards to its implementation of bioclimatic design strategies. Specifically, passive design strategies on daylighting and natural ventilation were examined. In Malaysia, the residential college or hostel is a multi-residential building providing accommodation to university students. The three residential colleges in this study, namely C1, C2 and C3, were built in different years with different designs and forms, particularly with regards to enclosure and facade design, solar control devices, passive daylight concepts, and natural ventilation strategies. The building designs were carefully studied and an electric consumption analysis was carried out in each residential college. This study revealed that the wide-scale implementation of bioclimatic design strategies in college C2 help reduced the annual energy consumption. The building bioclimatic design features that are accountable to reduce energy consumption are the internal courtyard and balconies on each unit of floor area, as shown in C3.Results from this study highly recommend internal courtyard and balcony building combination for multi residential building design, especially in tropical urban regions.

  5. Referral from primary care to a physical activity programme: establishing long-term adherence? A randomized controlled trial. Rationale and study design

    Directory of Open Access Journals (Sweden)

    Puig-Ribera Anna

    2009-01-01

    Full Text Available Abstract Background Declining physical activity is associated with a rising burden of global disease. There is little evidence about effective ways to increase adherence to physical activity. Therefore, interventions are needed that produce sustained increases in adherence to physical activity and are cost-effective. The purpose is to assess the effectiveness of a primary care physical activity intervention in increasing adherence to physical activity in the general population seen in primary care. Method and design Randomized controlled trial with systematic random sampling. A total of 424 subjects of both sexes will participate; all will be over the age of 18 with a low level of physical activity (according to the International Physical Activity Questionnaire, IPAQ, self-employed and from 9 Primary Healthcare Centres (PHC. They will volunteer to participate in a physical activity programme during 3 months (24 sessions; 2 sessions a week, 60 minutes per session. Participants from each PHC will be randomly allocated to an intervention (IG and control group (CG. The following parameters will be assessed pre and post intervention in both groups: (1 health-related quality of life (SF-12, (2 physical activity stage of change (Prochaska's stages of change, (3 level of physical activity (IPAQ-short version, (4 change in perception of health (vignettes from the Cooperative World Organization of National Colleges, Academies, and Academic Associations of Family Physicians, COOP/WONCA, (5 level of social support for the physical activity practice (Social Support for Physical Activity Scale, SSPAS, and (6 control based on analysis (HDL, LDL and glycated haemoglobin. Participants' frequency of visits to the PHC will be registered over the six months before and after the programme. There will be a follow up in a face to face interview three, six and twelve months after the programme, with the reduced version of IPAQ, SF-12, SSPAS, and Prochaska's stages

  6. Determination of sustainable values for the parameters of the construction of residential buildings

    Science.gov (United States)

    Grigoreva, Larisa; Grigoryev, Vladimir

    2018-03-01

    For the formation of programs for housing construction and planning of capital investments, when developing the strategic planning companies by construction companies, the norms or calculated indicators of the duration of the construction of high-rise residential buildings and multifunctional complexes are mandatory. Determination of stable values of the parameters for the high-rise construction residential buildings provides an opportunity to establish a reasonable duration of construction at the planning and design stages of residential complexes, taking into account the influence of market conditions factors. The concept of the formation of enlarged models for the high-rise construction residential buildings is based on a real mapping in time and space of the most significant redistribution with their organizational and technological interconnection - the preparatory period, the underground part, the above-ground part, external engineering networks, landscaping. The total duration of the construction of a residential building, depending on the duration of each redistribution and the degree of their overlapping, can be determined by one of the proposed four options. At the same time, a unified approach to determining the overall duration of construction on the basis of the provisions of a streamlined construction organization with the testing of results on the example of high-rise residential buildings of the typical I-155B series was developed, and the coefficients for combining the work and the main redevelopment of the building were determined.

  7. Determination of sustainable values for the parameters of the construction of residential buildings

    Directory of Open Access Journals (Sweden)

    Grigoreva Larisa

    2018-01-01

    Full Text Available For the formation of programs for housing construction and planning of capital investments, when developing the strategic planning companies by construction companies, the norms or calculated indicators of the duration of the construction of high-rise residential buildings and multifunctional complexes are mandatory. Determination of stable values of the parameters for the high-rise construction residential buildings provides an opportunity to establish a reasonable duration of construction at the planning and design stages of residential complexes, taking into account the influence of market conditions factors. The concept of the formation of enlarged models for the high-rise construction residential buildings is based on a real mapping in time and space of the most significant redistribution with their organizational and technological interconnection - the preparatory period, the underground part, the above-ground part, external engineering networks, landscaping. The total duration of the construction of a residential building, depending on the duration of each redistribution and the degree of their overlapping, can be determined by one of the proposed four options. At the same time, a unified approach to determining the overall duration of construction on the basis of the provisions of a streamlined construction organization with the testing of results on the example of high-rise residential buildings of the typical I-155B series was developed, and the coefficients for combining the work and the main redevelopment of the building were determined.

  8. Alcohol perceptions and behavior in a residential peer social network.

    Science.gov (United States)

    Kenney, Shannon R; Ott, Miles; Meisel, Matthew K; Barnett, Nancy P

    2017-01-01

    Personalized normative feedback is a recommended component of alcohol interventions targeting college students. However, normative data are commonly collected through campus-based surveys, not through actual participant-referent relationships. In the present investigation, we examined how misperceptions of residence hall peers, both overall using a global question and those designated as important peers using person-specific questions, were related to students' personal drinking behaviors. Participants were 108 students (88% freshman, 54% White, 51% female) residing in a single campus residence hall. Participants completed an online baseline survey in which they reported their own alcohol use and perceptions of peer alcohol use using both an individual peer network measure and a global peer perception measure of their residential peers. We employed network autocorrelation models, which account for the inherent correlation between observations, to test hypotheses. Overall, participants accurately perceived the drinking of nominated friends but overestimated the drinking of residential peers. Consistent with hypotheses, overestimating nominated friend and global residential peer drinking predicted higher personal drinking, although perception of nominated peers was a stronger predictor. Interaction analyses showed that the relationship between global misperception and participant self-reported drinking was significant for heavy drinkers, but not non-heavy drinkers. The current findings explicate how student perceptions of peer drinking within an established social network influence drinking behaviors, which may be used to enhance the effectiveness of normative feedback interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Potentially toxic concentrations of synthetic pyrethroids associated with low density residential land use

    Directory of Open Access Journals (Sweden)

    Stephen Marshall

    2016-11-01

    Full Text Available Trace organic compounds associated with human activity are now ubiquitous in the environment. As the population becomes more urbanised and the use of pesticides and person care products continues to increase, urban waterways are likely to receive higher loads of trace organic contaminants with unknown ecological consequences. To establish the extent of trace organic contamination in urban runoff, concentrations of emerging chemicals of concern were determined in sediments from 99 urban wetlands in and around Melbourne, Australia between February and April, 2015. As a preliminary estimation of potential risks to aquatic biota, we compared measured concentrations with thresholds for acute and chronic toxicity, and modelled toxic units as a function of demographic and land use trends. The synthetic pyrethroid insecticide bifenthrin was common and widespread, and frequently occurred at concentrations likely to cause toxicity to aquatic life. Personal care products DEET and triclosan were common and widely distributed, while the herbicides diuron and prometryn, and the fungicides pyrimethanil and trifloxystrobin occurred less frequently. Toxic unit modelling using random forests found complex and unexpected associations between urban land uses and trace organic concentrations. Synthetic pyrethroid insecticides were identified as emerging compounds of concern, particularly bifenthrin. In contrast with previous surveys, the highest bifenthrin concentrations were associated with lower housing and population density, implicating low-density residential land use in bifenthrin contamination. We discuss the implications for pesticide regulation and urban wetland management in a global context.

  10. Assessment of soil metal concentrations in residential and community vegetable gardens in Melbourne, Australia.

    Science.gov (United States)

    Laidlaw, Mark A S; Alankarage, Dileepa H; Reichman, Suzie M; Taylor, Mark Patrick; Ball, Andrew S

    2018-05-01

    Gardening and urban food production is an increasingly popular activity, which can improve physical and mental health and provide low cost nutritious food. However, the legacy of contamination from industrial and diffuse sources may have rendered surface soils in some urban gardens to have metals value in excess of recommended guidelines for agricultural production. The objective of this study was to establish the presence and spatial extent of soil metal contamination in Melbourne's residential and inner city community gardens. A secondary objective was to assess whether soil lead (Pb) concentrations in residential vegetable gardens were associated with the age of the home or the presence or absence of paint. The results indicate that most samples in residential and community gardens were generally below the Australian residential guidelines for all tested metals except Pb. Mean soil Pb concentrations exceeded the Australian HIL-A residential guideline of 300 mg/kg in 8% of 13 community garden beds and 21% of the 136 residential vegetable gardens assessed. Mean and median soil Pb concentrations for residential vegetable gardens was 204 mg/kg and 104 mg/kg (range soil Pb concentration for community vegetable garden beds was 102 mg/kg and 38 mg/kg (range = 17-578 mg/kg), respectively. Soil Pb concentrations were higher in homes with painted exteriors (p = 0.004); generally increased with age of the home (p = 0.000); and were higher beneath the household dripline than in vegetable garden beds (p = 0.040). In certain circumstances, the data indicates that elevated soil Pb concentrations could present a potential health hazard in a portion of inner-city residential vegetable gardens in Melbourne. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Key Residential Building Equipment Technologies for Control and Grid Support PART I (Residential)

    Energy Technology Data Exchange (ETDEWEB)

    Starke, Michael R [ORNL; Onar, Omer C [ORNL; DeVault, Robert C [ORNL

    2011-09-01

    based on the largest electrical energy consumers in the residential sector are space heating and cooling, washer and dryer, water heating, lighting, computers and electronics, dishwasher and range, and refrigeration. As the largest loads, these loads provide the highest potential for delivering demand response and reliability services. Many residential loads have inherent flexibility that is related to the purpose of the load. Depending on the load type, electric power consumption levels can either be ramped, changed in a step-change fashion, or completely removed. Loads with only on-off capability (such as clothes washers and dryers) provide less flexibility than resources that can be ramped or step-changed. Add-on devices may be able to provide extra demand response capabilities. Still, operating residential loads effectively requires awareness of the delicate balance of occupants health and comfort and electrical energy consumption. This report is Phase I of a series of reports aimed at identifying gaps in automated home energy management systems for incorporation of building appliances, vehicles, and renewable adoption into a smart grid, specifically with the intent of examining demand response and load factor control for power system support. The objective is to capture existing gaps in load control, energy management systems, and sensor technology with consideration of PHEV and renewable technologies to establish areas of research for the Department of Energy. In this report, (1) data is collected and examined from state of the art homes to characterize the primary residential loads as well as PHEVs and photovoltaic for potential adoption into energy management control strategies; and (2) demand response rules and requirements across the various demand response programs are examined for potential participation of residential loads. This report will be followed by a Phase II report aimed at identifying the current state of technology of energy management systems

  12. Residential electricity demand in Singapore

    International Nuclear Information System (INIS)

    Ang, B.W.; Goh, T.N.; Liu, X.Q.

    1992-01-01

    Residential electricity consumption in Singapore increased at a rate of 8.8% per year between 1972 and 1990. Estimates of the long-run income and price elasticities are 1.0 and -0.35, respectively. The energy-conservation campaigns that have been launched are found to have marginal effects on consumption. A statistical analysis shows that the consumption is sensitive to small changes in climatic variables, particularly the temperature, which is closely linked to the growing diffusion of electric appliances for environmental controls. There has been a temporal increase in the ownership levels of appliances associated with increasing household incomes. However, other factors were involved since the ownership levels would also increase over time after the elimination of the income effect. A large part of the future growth in electricity demand will arise from the growing need for air-conditioning, which will lead to increasingly large seasonal variations in electricity use. (author)

  13. Residential radon survey in Finland

    International Nuclear Information System (INIS)

    Arvela, H.; Maekelaeinen, I.; Castren, O.

    1993-02-01

    The study measured the indoor radon concentration in the dwellings of 3074 persons, selected randomly from the central population register of Finland. Alpha track detectors and two consecutive half year measuring periods were used. The national mean of indoor radon concentration for persons living in low-rise residential buildings as well as blocks of flats was 145 and 82 Bq/m 3 , respectively. The mean for the total population was 123 Bq/m 3 . Based on the decision of the Ministry of Social Affairs and Health in 1992, the indoor radon concentration should not exceed 400 Bq/m 3 in already existing houses, the target for new construction being less than 200 Bq/m 3 . According to the study, the percentage of the Finnish population living in houses with an indoor radon concentration exceeding 200, 400 and 800 Bq/m 3 was 12.3 %, 3.6 % and 1.0 %

  14. Economic analysis of an epilepsy outreach model of care in a university hospital setting.

    Science.gov (United States)

    Maloney, Eimer; McGinty, Ronan N; Costello, Daniel J

    2017-07-01

    The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. A longitudinal study to assess the role of sanitary inspections in improving the hygiene and food safety of eating establishments in a tertiary care hospital of North India

    Directory of Open Access Journals (Sweden)

    Puja Dudeja

    2017-01-01

    Full Text Available Introduction: Food safety inspections serve two purposes; determine compliance with the law and gather evidence for enforcement if there is noncompliance. The present study was conducted to assess the role of regular inspections on food safety in hospital premises. Methodology: This was an intervention based before and after study. A tool was prepared based on the Food Safety and Standards Regulations (FSSR (in India 2011. This included major, critical, and highly critical domains. Each item in the tool scored between 1 and 3 (poor, satisfactory, and good. Based on this, each eating establishment (EE was given a score on conformance to FSSR 2011. Monthly inspection was made over a year and corrective actions were suggested. Results: The minimum preintervention score was (41.28%, and maximum was (77.25%. There was no significant association between type of meal services and score EE (P > 0.05. Higher proportion of EEs within the hospital building had a satisfactory and good score as compared to EEs outside the hospital building but within hospital premises (P < 0.05. Postintervention, there was a significant change (increase in the scores of EEs. There was a significant increase in mean scores of EEs under major domains namely maintenance, layout of equipment, monitoring an detection, and elimination of food sources to the pests. Under critical and highly critical domains personal cleanliness, training, and self-inspection by food business operators improved significantly. Conclusion: Regular inspections can improve the food safety standards in EEs.

  16. Conflict Resolution, Restorative Justice Approaches and Bullying in Young People's Residential Units

    Science.gov (United States)

    Littlechild, Brian

    2011-01-01

    Restorative justice has been an increasing feature in the discourses within adult and youth justice criminal justice systems in recent years. This article examines interpersonal conflicts arising from crime, bullying and antisocial behaviour in residential care, and the advantages and disadvantages of utilising such approaches in relation to these…

  17. 78 FR 17777 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to...

    Science.gov (United States)

    2013-03-22

    ... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care Home Program--Sponsor Application, VA Form 2407. OMB Control Number: 2900-0616. Type of...

  18. 75 FR 2595 - Proposed Information Collection (Application for Furnishing Long-Term Care Services to...

    Science.gov (United States)

    2010-01-15

    ... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... comments for information needed to determine non-Federal nursing home or residential care home... information technology. Titles: a. Application for Furnishing Long-Term Care Services to Beneficiaries of...

  19. 12 CFR 541.23 - Residential real estate.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Residential real estate. 541.23 Section 541.23... AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.23 Residential real estate. The terms residential real estate... home used in part for business); (c) Other real estate used for primarily residential purposes other...

  20. 12 CFR 541.16 - Improved residential real estate.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Improved residential real estate. 541.16... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

  1. Residential Folk High Schools in Eastern Europe and the Baltic States.

    Science.gov (United States)

    Kulich, Jindra

    2002-01-01

    In Eastern Europe, Poland has the longest history of folk high schools. Although closed in Hungary during the 1950s, folk high schools have recently reemerged. There were attempts to establish them in Estonia, Lithuania, and Latvia following independence. Although the residential aspect of folk schools is desirable, economic and social conditions…

  2. Evaluation of DOE's Partnership in Low-Income Residential Retrofit (PILIRR) Program

    Energy Technology Data Exchange (ETDEWEB)

    Callaway, J.W.; Lee, A.D.

    1989-05-01

    In July 1986, the US Department of Energy (DOE) awarded competitive grants to five states to conduct pilot projects to establish partnerships and use resource leveraging to stimulate support for low-income residential energy retrofits. The projects were conducted under DOE's Partnerships in Low-Income Residential Retrofit (PILIRR) Program. These projects have been monitored and analyzed through a concurrent process evaluation conducted by the Pacific Northwest Laboratory (PNL). This study reports the findings of that evaluation. The overriding goal of the PILIRR Program was to determine whether the states could stimulate support for low-income residential energy improvements from non-federal sources. The goal for the process evaluation was to conduct an assessment of the processes used by the states and the extent to which they successfully established partnerships and leveraged resources. Five states were selected to participate in the program: Florida, Iowa, Kentucky, Oklahoma and Washington. Each state proposed a different approach to promote non-federal support for low-income residential weatherization. Three of the five states--Florida, Iowa, and Washington--established partnerships that led to retrofits during the monitoring period (October 1986--October 1988). Kentucky established its partnership during the monitoring period, but did not accomplish its retrofits until after monitoring was complete. Oklahoma completed development of its marketing program and had begun marketing efforts by the end of the monitoring period. 16 refs., 7 figs., 1 tab.

  3. A Case Study in Market Transformation for Residential Energy Efficiency Programs

    Energy Technology Data Exchange (ETDEWEB)

    Building Technologies Office

    2017-09-01

    This case study describes how the Midwest Energy Efficiency Alliance (MEEA) partnered with gas and electric utilities in Iowa to establish the Iowa residential heating, ventilation, and air conditioning System Adjustment and Verified Efficiency (HVAC SAVE) program, taking it to scale improving the performance and energy efficiency of HVAC systems, growing businesses, and gaining consumer trust.