February 7, 2023


New voluntary standards released for long-term care homes devastated by the pandemic
New National Long-Term Care Services Standard

CAN/HSO 21001:2023 – Long-Term Care Services
The Standards Council of Canada (SCC), Health Standards Organization (HSO), and the Canadian Standards Association (CSA Group) worked collaboratively to develop two new national standards for LTC. Both standards have been shaped by the needs and voices of Canada’s LTC home residents, workforce, local communities, and members of the general public.

The standards address the delivery of safe, reliable, and high-quality LTC services (HSO) and design, operation, and infection prevention and control practices in LTC homes (CSA Group).

This website outlines the main features of HSO’s CAN/HSO 21001:2023 – Long-Term Care Services National Standard of Canada (National Long-Term Care Services Standard). The standard reflects extensive research, the expertise and experience of committee members, and input from over 18,800 Canadians, laying the foundation for the future of long-term care in Canada.

New LTC standads not to be made mandatory
New national long-term care standards unveiled, but Ottawa not planning to make them mandatory

January 31, 2023
The federal government is not planning to introduce legislation to make the standards mandatory, said Guillaume Bertrand, a spokesperson for Health Minister Jean-Yves Duclos. As a result, Canada will continue to have a patchwork of practices, with some provinces – Quebec, British Columbia and Alberta – requiring homes to be accredited and adhere to standards of excellence while accreditation is voluntary for nursing homes in Ontario

Federal government plans to introduce legislation to improve quality of care in LTC
Ottawa to introduce legislation to complement new voluntary national standards for nursing homes

January 31, 2023
The federal government plans to improve the quality of care in nursing homes across Canada by introducing legislation that would complement new, voluntary national standards.

Overview of the challenges of COVID-19 and strategies undertaken by staff in LTC settings.
Long-Term Care and the COVID-19 Pandemic: Lessons Learned.
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Boltz M.
Nurs Clin North Am. 2023 Mar;58(1):35–48.
US nursing homes and other long-term care (LTC) communities such as assisted living and adult day care services have been disproportionally affected by COVID-19. Nurses and health care workers provided care and services despite health concerns for themselves and family members. Nurses on the frontline were called to act with extraordinary tenacity, skill, flexibility, and creativity to prevent infection; prevent complications; and optimize function, health, and well-being. The purpose of this article is to provide an overview of the challenges posed by the COVID-19 pandemic and the strategies prioritized and implemented by nurse and interdisciplinary colleagues in LTC settings.

Articles on LTC staff and Covid
Visibility and Accessibility of Hand Hygiene Stations and Fatigue Among Nurses Working in Long-Term Care (LTC) During the COVID-19 Pandemic.
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Cai H, Garcia A, Polivka B, Spreckelmeyer K, Yang FM.
HERD. 2023 Jan 23;19375867221149130.
OBJECTIVES: Evaluate the relationship between nurses’ perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses’ fatigue during the COVID-19 pandemic. BACKGROUND: LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses’ fatigue. METHODS: The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses’ perception of having visible and accessible HHS and fatigue among LTC nurses. RESULTS: The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC. CONCLUSIONS: This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses’ fatigue during the pandemic. A conceptual framework has been proposed for future studies.

Managers’ and Administrators’ Perspectives on Digital Technology Use in Regional Long-Term Care Homes During the COVID-19 Pandemic.
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Khowaja A, Syed N, Michener K, Mechelse K, Koning H.
Gerontol Geriatr Med. 2023 Dec;9:23337214221146664.
In this paper, we explore managers’ and administrators’ perspectives on digital technology use for residents during province-wide lockdowns (June-August 2021) during the COVID-19 pandemic in seven regional long-term care homes (LTC) in Niagara, Canada. Fifteen semi-structured interviews were conducted with participants representing operational, financial, and recreational departments where we discussed their needs and factors influencing the use of digital technology during the phases of increased restrictions on visitors and social isolation. Our findings indicate extensive use of cellular devices including smartphones, however additional iPads were needed to meet the ever-rising demand for virtual connections. Almost all participants revealed supportive leadership, redeployed staff, and community donations as main facilitators for technology use. Barriers related to managing varying elderly cognitive capacities and technical issues affected technology use. Based on our findings, we conclude that financial commitment and community support are integral for future-proofing LTC homes with technological innovations.

The Impact of COVID-19 on the Person-Centered Care Practices in Nursing Homes.
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Morgan JC, Ahmad W, Chen YZ, Burgess EO.
J Appl Gerontol. 2023 Feb 2;7334648231154544.
The COVID-19 pandemic has had a significant impact on long-term care residents, family, and staff. Nursing homes are facing persistent challenges such as staff shortage, lack of personal protective equipment (PPE), and staff experiencing mental health issues including burnout. COVID-19 precautions may have made implementing person-centered care (PCC) in nursing homes more difficult. This report provides a descriptive analysis of perceived COVID-19 impact on the PCC practice in nursing homes. Surveys (N = 379) were collected from 11 nursing homes across Georgia. PCC practice barriers include reduced choice for residents, staff anxiety related to COVID-19 precautions, increased prevalence of short-staffing, and expanded duties for direct care workers. Facilitators for PCC were also present and included staff engagement, the provision of mental health resources, supervisor support, and empowerment of staff. Applied practice and research to address these barriers and expand implementation of facilitators is needed.

How did gerontological societies respond to the challenges of the pandemic?
Responding to Covid-19: an analysis of position statements of gerontological societies worldwide.
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Emmer De Albuquerque Green C, Scharf T, Kessler EM.
Eur J Ageing. 2022 Dec;19(4):1229–41.
The Covid-19 pandemic, with its adverse implications for older adults, has generated unprecedented public interest in issues around age and ageing globally. We systematically investigated the responses of national gerontological and geriatric societies (NGGS) to emerging challenges during the first wave of the pandemic. Framed within traditional research topics in gerontology, the aim was to identify the spectrum of focal points and positions directed towards governments, policy makers, researchers and society. A comprehensive, two-phased data collection strategy generated N = 22 position statements of NGGS affiliated to the International Association of Gerontology and Geriatrics. Using Ayalon et al. (J Gerontol Ser B, 2020. https://doi.org/10.1093/geronb/gbaa066 ) thematic categorisation of gerontological research, we applied quantitative and qualitative content analysis to analyse “calls for action” within the statements. The content of NGGS’ position statements show a high level of agreement on the salient topics during the first wave of the pandemic and reveal shared values such as equality, diversity and inclusion of older adults and the discipline of gerontology to be an applied one with relevance to policy and practice. The results can support future interdisciplinary research in gerontology post Covid-19 based on a vision to contribute to a society of all ages.

Organizational factors that facilitate resident safety in nursing homes
Factors Differentiating Nursing Homes With Strong Resident Safety Climate: A Qualitative Study of Leadership and Staff Perspectives.
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Engle RL, Gillespie C, Clark VA, McDannold SE, Kazi LE, Hartmann CW.
J Gerontol Nurs. 2023 Feb;49(2):13–7.
The current qualitative study assessed leadership and staff perceptions related to resident safety at Department of Veterans Affairs (VA) nursing homes with a range of safety climates. We recruited a purposive sample of six VA nursing homes from geographically diverse regions of the United States and with diverse overall safety climate ratings. We conducted semi-structured phone interviews with 43 senior and middle level nursing home leaders and frontline providers (medical and nursing). We performed a thematic analysis of interview data to assess participant perceptions of factors that influence resident safety at higher and lower safety climate sites. Analyses identified two factors that differentiated VA nursing homes with high safety climate ratings from those with medium or low ratings: (1) communication about resident safety, particularly the important role of accessibility of physicians and managers; and (2) leadership support for and responsiveness to resident safety issues raised by frontline staff. Findings from high safety climate nursing homes underscore the importance of leadership accessibility, communication, support, and follow through regarding resident safety concerns. These results may provide a basis for designing safety climate interventions, such as those designed to improve communication, teamwork, and quality improvement structures and processes. [Journal of Gerontological Nursing, 49(2), 13-17.].

Analysis of how outer context is described by dissemination and implementation theories, models, and framework
A scoping review of outer context constructs in dissemination and implementation science theories, models, and frameworks.
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Escoffery C, Sekar S, Allen CG, Madrigal L, Haardoerfer R, Mertens A.
Transl Behav Med. 2023 Jan 24;ibac115.
Many studies have explored organizational factors that facilitate implementation. However, there is still a limited understanding of determinants external to the implementing organization and their effects on evidence-based intervention (EBI) adoption, implementation, and outcomes. The purpose of this scoping review was to assess definitions of context and identify salient determinants of outer context found in dissemination and implementation theories, models, and frameworks. We employed a compilation of dissemination and implementation frameworks from two reviews as the data source. We abstracted the following information: type of article, outcomes of the framework, presence of a context definition, presence of any outer setting definition and the definition, number and domains of outer setting mentioned, definitions of outer context constructs, and any quantitative measures of outer setting. We identified 19 definitions of outer context. Forty-seven (49%) frameworks reported one or more specific constructs of the outer setting. While the outer context domains described in the frameworks varied, the most common domains were policy (n = 24), community (n = 20), partnerships (n = 13), and communications (n = 12). Based on our review of the frameworks, more conceptualization and measurement development for outer context domains are needed. Few measures were found and definitions of domains varied across frameworks. Expanding outer context construct definitions would advance measure development for important factors external to the organizations related to EBI implementation.

Three strategies that can be used by staff to help them cope with grief
Grieving while you work, working while you grieve: Grieving while you work.
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Fahey DM, Rumaker K, Ordille J.
J Interprof Educ Pract. 2023 Jun;31:100604.
This work discusses the real and personal cost of the COVID-19 pandemic on the mind, body, and spirit of healthcare workers. It suggests a proactive and reactive response that participants can activate within themselves, their clinical teams, and their organizations. The pervasive losses, both death and non-death-related, have transformed how healthcare workers deliver care while grieving their personal and professional losses. This grief further complicates the mental health of healthcare workers. Evidence from previous outbreaks suggests that the psychological burden of the pandemic will have both short and long-term effects. Recovery involves healing the body with physical compassion, healing the mind by exploring difficult emotions, and healing the spirit by recognizing and reclaiming one’s purpose and meaning. Three strategies: Spark Joy, Ambiguity Bookmark, and Healing and Restoration: a Nautical Journey through Grief demonstrate how small and intentional changes provide momentum and set the course for long-term transformation.

Ethical challenges faced by LTC residents, families, staff, and organizations during the COVID pandemic
Ethical Issues in Long-term Care in Low-, Middle- and High-Income Countries During the COVID-19 Pandemic.
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Gandhi P, Petropanagos A, Popescu A, Bugaresti D, Nitti T, Chauhan N, et al.
Gerontol Geriatr Med. 2023 Dec;9:23337214221146660.
Long-term care (LTC) centers experienced an unprecedented emergency involving exponential mortality during the COVID-19 pandemic. Individuals residing in long-term care were particularly vulnerable to the effects of COVID-19, placing residents, staff, families, and organizations in a precarious position. Complex issues surrounding how to manage vulnerable populations during the pandemic have highlighted the importance of gathering information on ethical issues that require effective policy and decision-making. This project sought to identify the ethical issues faced in long-term care by residents, families, staff, and organizations from stakeholders themselves. A total of 305 participants from 45 countries responded, highlighting numerous ethical issues in long-term care during COVID-19. While numerous issues were mentioned, there was an overlap in the themes of responses between stakeholders. Visitation, isolation, harm, staff well-being, and the overall enforcement of policies during the pandemic represented the most often discussed issues. As a preliminary study of this issue, future research is necessary in order to effectively guide pandemic policymaking moving forward.

Exploring the role of physicians in NH quality improvement
Raising the Bar for Physicians Practicing in Nursing Homes: The Path to Sustainable Improvement.
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Katz PR, Smalbrugge M, Karuza J, Costa A, Nazir A, Wasserman MR, et al.
J Am Med Dir Assoc. 2023 Feb;24(2):131–3.
Improving the quality of care provided in nursing homes (NHs) has been the driver behind most of the major governmental sponsored reports and related legislation/regulation in NHs over the past 4 decades. Starting with the Institute of Medicine (IOM) report in 1986 and culminating in the recently released National Academy of Science, Engineering and Medicine (NASEM) treatise on NH quality, there has been a consistent emphasis on the critical role of the health care provider. The nursing profession [registered nurse (RN) / licensed practical nurse (LPN), certified nursing assistant (CNA)] has deservedly attracted special attention given their critical role in patient care and the fact that they constitute the bulk of the NH workforce. Unfortunately, there has been much less attention paid to the provision of medical care in the NH despite widespread acknowledgment of variable and often suboptimal state of medical practice in NHs.

Interest in pursuing trauma informed care in NHs
High Interest in Pursuing Trauma-Informed Care in Nursing Home Social Services Directors.
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Kusmaul N, Becker TD, Hector P, Bern-Klug M, Smith KM.
J Appl Gerontol. 2023 Jan 26;7334648231153729.
This study explored nursing home social services directors’ interest in pursuing trauma-informed care (TIC) training, and individual and organizational characteristics associated with their interest. Data from the 2019 National Nursing Home Social Services Directors Survey, a national cross-sectional survey, were used. Measures sought information on participants’ interest in TIC training, sociodemographic characteristics, and characteristics of employing nursing homes. Descriptive statistics and multivariate binary logistic regression analyses were used. Of the 924 respondents, 880 (95.2%) were included in the analysis. Most (71.7%) expressed high interest in TIC training. Younger age, fewer years of nursing home social services experience, being degreed and licensed in social work, and being a person of color were associated with greater odds of high interest in TIC training. Neither nursing home ownership nor social services staffing ratio was significantly associated with interest in TIC training. As policy requires TIC in nursing homes, these findings present a first step towards understanding implementation.

Improving organizational readiness for implementation through cognitive interviews
Using cognitive interviews to improve a measure of organizational readiness for implementation.
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McClam M, Workman L, Dias EM, Walker TJ, Brandt HM, Craig DW, et al.
BMC Health Serv Res. 2023 Jan 27;23(1):93.
BACKGROUND: Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC(2) heuristic posits that organizational readiness stems from an organization’s motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC(2)) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs. METHODS: We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using “think aloud” and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey. RESULTS: Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what “better” means). CONCLUSION: Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.

New article on staff interactions with NH residents
The Association Between Engagement in Activities of Daily Living and Care Interactions for Residents Living With Dementia.
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McPherson R, Resnick B, Galik E, Gruber-Baldini AL, Holmes S, Kusmaul N.
J Nurs Care Qual. 2022 Oct 21.
BACKGROUND: Care interactions are essential to residents with dementia. PURPOSE: The purpose of the study was to describe the characteristics and quality of staff-resident care interactions among nursing home residents living with dementia and to test whether the quality of staff-resident care interactions varied by resident level of engagement in the interaction. Specifically, it was hypothesized that controlling for age, gender, comorbidities, cognition, and function, actively engaged residents would have more positive care interactions with staff compared with passively engaged residents. METHODS: This was a secondary data analysis using baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia intervention study. RESULTS: A total of 532 residents were included. Actively engaged residents had significantly more positive interactions compared to passively engaged residents. CONCLUSIONS: Passively engaged residents may be at risk to receive poor quality care interactions. Strategies and interventions to optimize care interactions for these individuals are needed.

Bibliometric analysis of organizational culture research
Organisational Culture Research in Healthcare: A Big Data Bibliometric Study.
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Qin X, Wang R, Huang YN, Zhao J, Chiu HC, Tung TH, et al.
Healthcare (Basel). 2023 Jan 5;11(2).
Across international healthcare, organisational culture and work environment have become central to all patient safety. However, there is a lack of comprehensive overview to assess and track the evolution of the literature on organisational culture in healthcare. This study aims to describe the current situation and global trends in organisational culture research in healthcare. The methodology is based on bibliometric mapping using scientific visualisation software (CiteSpace and VOSviewer). The big data were collected from the Web of Science core citation database. After applying the search criteria, we retrieved 1559 publications, which have steadily increased over the last two decades. In addition, 92 countries and regions have published studies on organisational culture in healthcare. The United States has made significant contributions to this field. In particular, organisational culture occupies an important position in the quality management of different types of care and caregiving. At the same time, organisational culture in healthcare may be inadequately researched in terms of theoretical underpinnings, which in turn leads to a lack of widespread dissemination of practice, and research on organisational culture in healthcare through evidence-based medicine may remain a significant focus and hot topic throughout the research field in the coming years.

Analysis of interventions to reduce transitions from LTC to emergency or hospitals
Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review.
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Searle B, Barker RO, Stow D, Spiers GF, Pearson F, Hanratty B.
BMJ Open. 2023 Feb 2;13(2):e064914.
OBJECTIVE: UK long-term care facility residents account for 185 000 emergency hospital admissions each year. Avoidance of unnecessary hospital transfers benefits residents, reduces demand on the healthcare systems but is difficult to implement. We synthesised evidence on interventions that influence unplanned hospital admissions or attendances by long-term care facility residents. METHODS: This is a systematic review of randomised controlled trials. PubMed, MEDLINE, EMBASE, ISI Web of Science, CINAHL and the Cochrane Library were searched from 2012 to 2022, building on a review published in 2013. We included randomised controlled trials that evaluated interventions that influence (decrease or increase) acute hospital admissions or attendances of long-term care facility residents. Risk of bias and evidence quality were assessed using Cochrane Risk Of Bias-2 and Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Forty-three randomised studies were included in this review. A narrative synthesis was conducted and the weight of evidence described with vote counting. Advance care planning and goals of care setting appear to be effective at reducing hospitalisations from long-term care facilities. Other effective interventions, in order of increasing risk of bias, were: nurse practitioner/specialist input, palliative care intervention, influenza vaccination and enhancing access to intravenous therapies in long-term care facilities. CONCLUSIONS: Factors that affect hospitalisation and emergency department attendances of long-term care facility residents are complex. This review supports the already established use of advance care planning and influenza vaccination to reduce unscheduled hospital attendances. It is likely that more than one intervention will be needed to impact on healthcare usage across the long-term care facility population. The findings of this review are useful to identify effective interventions that can be combined, as well as highlighting interventions that either need evaluation or are not effective at decreasing healthcare usage. PROSPERO REGISTRATION NUMBER: CRD42020169604.

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