October 20, 2020

This Policy Briefing Report on Long-Term Care focuses on the workforce. The report begins by reviewing the research context and policy environment in Canada’s long-term care sector before the arrival of COVID-19. It summarizes the existing knowledge base for far-sighted and integrated solutions to challenges in the long-term care sector. The report then outlines profound, long-standing deficiencies in the long-term care sector that contributed to the magnitude of the COVID-19 crisis. Equally important contributors to this crisis are the characteristics of the older adults living in nursing homes, their caregivers and the physical environment of nursing homes. The long-standing deficiencies in Canada’s long-term care sector and the characteristics of the key players had direct impact on the immediate causes of the COVID-19 crisis in our nursing homes. This report enumerates those immediate causes. The report then articulates principles for action and recommendations for urgent action.

Residents of long-term care (LTC) whose deaths are imminent are likely to trigger a transfer to the emergency department (ED), which may not be appropriate. Using data from an observational study, we employed structural equation modeling to examine relationships among organizational and resident variables and death during transitions between LTC and ED. We identified 524 residents involved in 637 transfers from 38 LTC facilities and 2 EDs. Our model fit the data, (χ(2) = 72.91, df = 56, p = .064), explaining 15% variance in resident death. Sustained shortness of breath (SOB), persistent decreased level of consciousness (LOC) and high triage acuity at ED presentation were direct and significant predictors of death. The estimated model can be used as a framework for future research. Standardized reporting of SOB and changes in LOC, scoring of resident acuity in LTC and timely palliative care consultation for families in the ED, when they are present, warrant further investigation.

Despite growing support for the clinical application of frailty, including regular frailty screening for older adults, little is known about how older adults perceive frailty screening. The purpose of this study was to examine older adults’ perspectives on frailty screening to inform knowledge translation and service improvements for older adults with frailty. RESEARCH DESIGN: interpretive descriptive qualitative design. PARTICIPANTS: a total of 39 non-frail (18%), pre-frail (33%) and frail or very frail (49%) South Australian older adults aged 62-99 years, sampled from community, assisted living and residential aged care settings. METHODS: seven focus groups were conducted and analysed by two independent investigators using inductive thematic analysis. RESULTS: three themes were identified. First, older adults question the necessity and logic of an objective frailty measure. Second, older adults believe any efforts at frailty screening need to culminate in an action. Third, older adults emphasise that frailty screening needs to be conducted sensitively given negative perceptions of the term frailty and the potential adverse effects of frailty labelling. DISCUSSION AND IMPLICATIONS: previous screening experiences and underlying beliefs about the nature of frailty as inevitable shaped openness to, and acceptance of, frailty screening. Findings correspond with previous research illuminating the lack of public awareness of frailty and the nascent stage of frailty screening implementation. Incorporating consumer perspectives, along with perspectives of other stakeholder groups when considering implementing frailty screening, is likely to impact uptake and optimise suitability-important considerations in person-centred care provision.

To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities. METHOD: Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman’s correlation coefficient and Chi-squared test (p<0.05). RESULTS: Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices. CONCLUSION: This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and authentic leadership practices of healthcare managers. Flexible organizational cultures influence the adoption of authentic leadership, participatory management model and also improves quality.

Pediatric functional constipation (FC) reportedly affects at least 1 in 10 children worldwide. Parent and family education is a key component for successful treatment, yet there is little research exploring what information families need and how to best support them. The aim of this review is to synthesize current evidence on the experiences and information needs of parents caring for a child with FC. We systematically searched published research and completed screening against a priori inclusion criteria. Thirteen studies (n = 10 quantitative, n = 3 qualitative) were included. We found 2 main themes, precarious footing and profound and pervasive effects. Heavy caregiving burdens fueled doubts, misinformation, relationship breakdown, and treatment deviation. In light of clinical recommendations, our findings reveal a potential mismatch between parents’ needs and care provision for FC. It is likely that both parents and health care providers would benefit from resources and interventions to improve care related to pediatric FC.

This article discusses the results of a content and critical discourse analysis of Canadian federal policy documentation relating to the development of a national Canadian dementia strategy. These documents span from 2013 and focus upon Canadian federal policy directives and directions up to the release, and including the release, of a national strategy in June 2019. The analyses, supplemented by a subtextual examination of these documents guided by Bacchi, C. (2012). Introducing the “What’s the problem represented to be? approach. In A. Bletsas & C. Beasley (Eds.), Engaging with carol Bacchi: Strategic interventions & exchanges. University of Adelaide Press “What’s the Problem Represented to be?” framework, focus upon the treatment of gender in policy documentation and the specific gender-related policy framework, known as GBA+ (gender-based analysis and intersectionality), which is intended to bring about health equity to disadvantaged groups. As women, particularly, working class women and their carers, as well as women with additional intersecting factors, such as being lesbian or bisexual, are less likely to receive the dementia-related care and services they need, precipitating a premature move to residential care; GBA+ is an essential policy framework in the attempt to address these inequities. However, findings point to a superficial treatment of gender, GBA, and GBA+ in federal policy documents and lack a meaningful invocation of women’s gendered and intersectional lived experiences of dementia. Additionally, the Canadian federal government’s Dementia Strategy for Canada: Together We Aspire (2019) is grounded in a rendition of citizenship that does not work to unearth the complex relationships between citizenship, old age, gender and intersectional factors. As a result, the Dementia Strategy for Canada: Together We Aspire (2019) presents a version of citizenship that homogenizes older adults and prevents representations of older adults as diverse, complex and continually changing groupings. Therefore, inspired by Bartlett, R., Gjernes, T., Lotherington, A.-T., & Obstefelder, A. (2018). Gender, citizenship and dementia care: A scoping review of studies to inform policy and future research. Health & Social Care in the Community, 26(1), 14-26, I advocate for the application of a feminist and intersectional citizenship lens in Canadian federal dementia-related policymaking documentation going forward.