Meeting communication needs: topics of talk in the nursing home

Nursing home residents primarily rely on staff for communication and interpersonal relationships. Challenged by staffing shortages and increasingly complex care, staff who provide the most communication with residents lack awareness and skills to effectively communicate with older adults. This study, a secondary analysis of staff-resident interactions from one nursing home, explores communication topics and the effects of an intervention. Staff from one unit were recorded during 2 hours of caregiving to provide a representative sample of their communication with residents. Staff then attended an educational program targeting improved awareness of communication needs and reducing "elderspeak". Recording was repeated post-intervention. Baseline conversations focused on activities of daily living (ADLs), personal-social, technical care, and health assessment. Post-intervention ADL talk decreased in staff-resident interactions, while personal-social topics increased. These findings suggest that residents' limited opportunities for communication with staff are primarily focused on care tasks. With increased communication awareness, staff can learn to modify conversational topics to better meet older adults' psychosocial needs.     

Interviewing Elderly Residents in Assisted Living

The interpretation of interview data requires an understanding of its context. In this study, the context was Assisted Living (AL). Twenty-one interviews were conducted with elderly residents of 4 Midwestern Assisted Living Facilities (ALFs). Institutional fear and loneliness associated with ALF living framed residents’ interpretation of and responses to the interview questions. Residents feared transfer to a nursing home, and they experienced the loneliness of being cut off from their homes and put into the care of busy staff members. Their framing of and responses to questions (both qualitative and quantitative) reflected this context, and included the invocation of impairments, the reluctance to criticize staff, and the refusal to complain about the ALF or their present situation.

Demographic Characteristics

This article aims to describe the characteristics of and design elements in gardens/patios at 87 residential living homes for older people and to describe and compare residents’ and staff members’ perceptions of outdoor spaces. The aim was also to investigate factors related to residents' satisfaction with and stays in the garden/patio. The result showed that many gardens/patios had several recommended design elements and, at the same time, obvious deficiencies. The residents (n = 415) valued various aspects of the garden/patio more highly than did the staff (n = 667). Managers responsible for residential living homes for elderly people should take measures to ameliorate deficiencies and deficient elements in design and accessibility that are lacking so that the garden/patio can be used as an important health promotion resource in the care of elderly people. Residents and staff are important actors in such development work.     

“Such Trivial Matters:” How staff account for restrictions of residents' influence in nursing homes

National policies emphasize older people's right to autonomy, yet nursing home residents often have restricted opportunities to make decisions about everyday matters. We use qualitative interview data to analyze staff members' explanations of actions that conflict with both social norms and national policies. Two types of problematic actions are discussed: restrictions of elderly residents' influence in decision making and neglect of residents' complaints. While staff members describe residents' influence as desirable, they simultaneously formulate accounts that justify their inability to live up to this ideal. Further, we demonstrate how certain complaints are “made trivial” when they are described and treated in specific ways by the staff. We argue that the accounts offered by staff members draw on an implicit folk logic, a logic in which residents are allowed to exercise influence only as long as it does not conflict with the efficient running of the institution as a whole.     

Slaps,Punches, Pinches—But not Violence: Boundary‐Work in Nursing Homes for the Elderly

This article presents an analysis of boundary work in the context of care for the elderly, where violence appears to be widespread but is still relatively unacknowledged. Talk about aggressive patients was formulated in a particular way among workers in a nursing home. Nursing home staff described how the elderly residents sometimes slapped, pinched, or hit them. Although staff members could describe these acts as intentional, although they could hold patients responsible, and although this violence could end in injuries, demarcations were made such that aggressive acts were constructed as somehow not really “violence.” As “violent” is an inherently exclusionary label, this downplaying can be seen as an effort to avoid pushing persons outside the boundary of normalcy and of continued acceptance. Placing the elderly's violence outside the boundaries of violence means that the elderly remain “care takers,” the staff “caregivers,” and the nursing home a “caring context.”     

The ties that bind? Social networks of nursing staff and staff's behaviour towards residents with dementia

This study investigated social networks of nursing staff and staff's behaviour towards residents with dementia. We focused on two types of networks: communication networks among staff, and networks between nursing staff and relatives/acquaintances of residents. Data was collected in 37 long-term care units in nursing- and residential homes in the Netherlands.     

Supporting the Independence of Elderly Residents Through Control Over Their Environment

Increasing loss of control over one's life is associated with reduced interdependence and wellbeing in the elderly. A housing organization tries to prolong the independence of its residents by reinforcing the sense of competence endangered by age associated deterioration. Competence is enhanced by providing residents with genuine control over their lives and through access to real choices in necessities, in social contacts, in services and facilities. Choice and control are supported even at the cost of some increased resident risk-taking. A case study is presented showing the failure of a well-designed meals program without sufficient opportunity for choice and control. The paper concludes by citing conflicts which result from this approach, both for staff, internally, and externally with other community organizations which expect elderly to be cared for.     

Surprise in Social Work Education

Training is commonly seen as the most viable way of ensuring good quality care in residential homes for elderly people. The literature on training has focused on a shift in emphasis from traditional 'professional' social work training for staff at a senior level to training which is to be provided for junior level staff. To this end, Scottish/National Vocational Qualifications have been introduced which, through workplace assessment of competence, have been proclaimed to be the means by which to raise the status and career prospects of a social care workforce. This article argues that task-based competence is increasingly being seen as relevant for a 'para-professional' social care workforce such as that found in the residential care sector. In the light of this, research was undertaken to establish whether residents preferred 'trained' staff, holding formal qualifications and/or NVQs, to 'untrained' staff with no recognised qualifications. The research concluded that residents want kind, understanding and experienced staff, and when length of time in post was taken into account, the effect of training was negligible. The study concluded that homes need to select staff for their good personal qualities and encourage them to stay. Staff need training that integrates skill with understanding and above all, assessment should reflect this perspective. Moreover, residents need to be involved in the assessment process.     

Unpacking barriers to quality care for Deaf people in residential aged care facilities

Residential aged care providers often face difficulties in meeting the needs of residents with a lifelong disability. In this article, I explore these issues from the perspective of signing Deaf residents. While previous studies have documented a number of issues around staff training and communication for Deaf residents, there remains a dearth of literature considering the root causes of these problems. Drawing on interviews with a variety of service providers, this article suggests a number of ways current practices might be improved as well as discussing funding changes required to ensure Australian Deaf residents do not fall through the cracks.     

Facility Ownership and Resident Satisfaction with Assisted Living

Abstract

Although the majority of assisted living facilities operate as for-profit organizations and serve increasingly frail elderly populations, little is known about the impact of ownership on the quality of care in assisted living. This study examines the relationship between facility ownership and the quality of care in assisted living, using resident satisfaction as a quality indicator. The assessed aspects of satisfaction include health care, housekeeping, physical environment, relationships with staff, and social life/activities. The relationship of facility ownership to resident satisfaction is examined controlling for resident psychological well-being, functional ability, facility size, and staff resources. Data were collected in personal interviews with 156 residents, including 96 residents in eight for-profit facilities and 60 residents in five nonprofit facilities in Maryland. Residents in the sampled nonprofit facilities were more satisfied with assisted living than were residents in the for-profit facilities. In particular, residents in nonprofit facilities were more satisfied with health care, physical environment, and social life/activities in the facility. Better understanding of the relationship between facility ownership and resident satisfaction can help administrators create environments that maximize resident satisfaction in both nonprofit and for-profit facilities.     

Nearby Nature and Long-Term Care Facility Residents

Abstract

As the population in North America continues to age, long-term care facilities for housing the elderly are likely to become even more important. Because one of the primary foci of these facilities is on sustaining and enhancing quality of life while eventually helping patients and families cope with the dying process, both the physical and social environments are critical to the facilities' success and the users' well-being. Healing, or restorative gardens and other designed green spaces have been suggested by many academics and practitioners as important components of these environments, yet there has been relatively little systematic research on the use and benefits of nature in this context. Do elderly residents of long-term care facilities benefit from access to outdoor areas? What are the design characteristics that are most important for this unique population?

Forty elderly residents of three different urban long-term care facilities were interviewed about the importance of outdoor green spaces and views within the facility, their use of the facility's outdoor spaces, benefits they derive from those spaces, and barriers to using the spaces. Facilities differed both in terms of the amount of nature in their outdoor spaces and in the design of, scale of, and access to those spaces. Results show that overall residents place a high value on access to green spaces and derive a number of benefits from these spaces, yet they spend relatively little time in these settings. Barriers to greater use of outdoor spaces included physical limitations, lack of staff assistance, and design issues. Implications for the value of nature spaces in long-term care facilities are discussed, along with specific design recommendations.     

Sibling Roles in the Lives of Older Group Home Residents with Intellectual Disability: Working with Staff to Safeguard Wellbeing

Abstract

When parents die, siblings of older people with intellectual disability are likely to take responsibility for oversight of their wellbeing and negotiation with formal support services. This study explored the roles siblings played in the lives of older people with intellectual disability who live in group homes, and the relationships between residents’ siblings and group home staff. The siblings of 13 group home residents and the 17 supervisory staff associated with these services were interviewed, initially face-to-face and then intermittently by phone over a period of three years. Data were analysed using an inductive analytical approach. Siblings valued the relationship with their brother or sister with intellectual disability and played a significant role in safeguarding their wellbeing. Sibling–staff relationships fluctuated over time, sometimes becoming tense and difficult. Few protocols guided these relationships. A principle-based framework could facilitate negotiation between staff and siblings about expectations of communication and decision making.     

The missing family: Staff perspectives on and responses to familial noninvolvement in two diverse nursing homes

Although the continuum of familial involvement with nursing home residents includes those who are deeply engaged and those who are totally absent, little is known about how staff perceive and react to family noninvolvement. This article explores staff perspectives on and responses to family absence. Semistructured interviews were conducted with 52 employees and 18 residents from two NHs, one an urban facility with a largely chronic mentally ill population and the other a rural, tribally owned facility with a predominately cognitively impaired American Indian clientele. Medical record reviews were also conducted. Staff theories of family absence were informed primarily by dominant American and American Indian cultural values regarding kinship, psychiatric disorders, and institutionalization. In each facility, metaphoric kinship relationships between staff and residents compensated somewhat, but not entirely, for perceived family noninvolvement. This research highlights the cultural variability of staff perspectives on family absence but also points to similar strategies for coping with it.     

Staff perceptions of staff-family interactions in nursing homes

Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home staff members and family members of nursing home residents, as part of a larger multi-method comparative case study. Here, we report on 6-month case studies of two nursing homes where in-depth interviews, shadowing experiences, and direct observations were completed. Staff members from both nursing homes described staff–family interactions as difficult, problematic and time consuming, yet identified strategies that when implemented consistently, influenced the staff–family interaction positively. Findings suggest explanatory processes in staff–family interactions, while pointing toward promising interventions.     

Independence in assisted living

The aims of this study were to understand the meaning of independence for residents of assisted living and to identify factors influencing the operationalization of independence in this setting. Qualitative interviews were conducted with 17 providers and 55 residents in 17 assisted-living facilities in Georgia. Data were analyzed by using the grounded theory method. Findings show that assisted-living residents retained a strong value for independence and that independence had multiple dimensions of meaning. Whereas independence in most cases was reduced to performing everyday activities of daily living (ADLs), the multidimensional nature of meaning allowed residents with significant disability both to continue to perceive themselves as independent and to find satisfaction in their remaining abilities. Resident self-care requires significant effort from both residents and providers, but it also has far-reaching potential to help residents maintain intact identities and may hold the key to extending their stay in the assisted-living facility (ALF) environment.     

Coming together and pulling apart: Exploring the influence of functional status on co-resident relationships in assisted living

Social relationships can have considerable influence on physical and mental well-being in later life, particularly for those in long-term care settings such as assisted living (AL). Research set in AL suggests that other residents are among the most available social contacts and that co-resident relationships can affect life satisfaction, quality of life, and well-being. Functional status is a major factor influencing relationships, yet AL research has not studied in-depth or systematically considered the role it plays in residents' relationships. This study examines the influences of physical and mental function on co-resident relationships in AL and identifies the factors shaping the influence of functional status. We present an analysis of qualitative data collected over a one-year period in two distinct AL settings. Data collection included: participant observation, informal interviews, and formal in-depth interviews with staff, residents, administrators and visitors, as well as surveys with residents. Grounded theory methods guided our data collection and analysis. Our analysis identified the core category, “coming together and pulling apart”, which signifies that functional status is multi-directional, fluid, and operates in different ways in various situations and across time. Key facility- (e.g., admission and retention practices, staff intervention) and resident-level (e.g., personal and situational characteristics) factors shape the influence of functional status on co-resident relationships. Based on our findings, we suggest strategies for promoting positive relationships among residents in AL, including the need to educate staff, families, and residents.     

Geropsychiatric education programs. Providing skills and understanding

1. The treatment of mental health problems is a growing concern in long-term care facilities; up to 80% of nursing home residents suffer from some type of mental illness, but most receive no active treatment. 2. Nursing home staff do not receive sufficient training on mental health issues, the aging process, and assessment and management of psychiatric symptoms in the elderly. 3. Psychiatric nurses can provide a number of quality geriatric mental health programs to increase staff knowledge and promote quality of care.     

Potential for the Abuse of Medication for the Elderly in Residential and Nursing Homes in the UK

ABSTRACT

Abuse of the medication prescribed to the elderly living in long-stay care homes may be perpetrated by a minority of unscrupulous doctors, pharmacists, or home staff caring for the residents. Disorganised practices and homes, poor communications, and sloppy professional practices may create opportunities for over-dosing, errors, fraud, or theft. This article describes the circumstances leading to the potential abuse of elderly residents' medication, and the measures that may be taken to avoid or minimise such abuse from occurring.     

Staff-resident interaction in the nursing home: An ethnographic study of socio-economic disparities and community contexts

In recent years, nursing home (NH) researchers have paid increasing attention to socio-economic and racial/ethnic disparities in quality of care. Although there is growing evidence of disparities in resident health outcomes, less is known about the ways in which these differences manifest in care processes from a qualitative perspective. This paper addresses this gap by comparing staff-resident interactions in two urban, non-profit NHs, including roughly 50 staff participants in each facility. The researcher conducted ethnographic observation in one facility serving a white, middle class community and another serving low-income Black and Hispanic clients from an underserved neighborhood. Grounded theory methods generated three categories of interaction—activating, relating, and attending—which were performed differently in the two NHs. In the more affluent facility, staff interacted with residents in a dynamic fashion, adapting to residents’ responses, and they were relatively well equipped with resident-specific information when responding to individual concerns. In the safety-net facility, staff interacted with residents in a one-directional, “didactic” fashion, providing instruction without a mechanism for adapting to residents’ responses, and they were not as well equipped with resident-specific information. These differences reflected disparities between the two facilities in staff communication skills, underscoring the importance of workforce development to enhance the quality of staff-resident interaction and promote resident-centered care. This study raises further questions about the role of neighborhood contexts in shaping organizational processes that influence quality of life for NH residents. Moreover, the study offers a unique contribution to the NH literature by generating a typology of styles of interaction that can be used to develop a conceptual framework for understanding staff-resident interaction in the nursing home. Such a framework can inform efforts to improve residents’ quality of life.