Transition to residential care: experiences of elderly Chinese people in Hong Kong

A qualitative study was designed to explore the experiences of transition into residential care among elderly Chinese people in Hong Kong. With the elderly people's consent, in-depth interviews were conducted with 10 residents 1 week after their admission into a residential care home. The purpose of the interviews was to explore what the transition experience was like for the Chinese elders and how they settled into residential life. Content analysis of the interview data revealed the significance of cultural influences in the transition experiences. A number of issues suggested in the literature as barriers to adjustment to residential care, such as living with rules and regulations, lack of privacy and autonomy were not regarded as important by the Chinese elders. The Chinese values of balance, harmony and collectivism have made it easier for them to remain open and accept the communal way of living. Yet, these same values have restricted the elders in developing new relationships with staff and other residents. This appears to be the particular challenge facing Chinese elderly residents. Implications for professionals working with elderly residents are discussed in the light of these findings.     

District nurses' experiences of providing care in residential care home settings

Little research describes the involvement and contribution of primary health care services in residential homes, despite policy and research concerns that older people in residential homes are a vulnerable population for whom care must be improved. The aim of this research was to explore the actual and potential contribution of primary care nurses in residential homes for older people, particularly district nurses. Five focus groups were held with district nurses in one county in England, to explore how participants represented their views, values and experiences of working in residential homes. Our major finding was the importance of context in shaping the experience of district nursing involvement. General practitioner attachment determined the frequency of visiting homes and affected workload. District nurses had regular contact with residential homes for discrete nursing tasks, but appropriateness of referrals and input was not agreed. The focus group discussions with district nurses revealed how problematic their work in residential homes was and a lack of consensus about their role. The data suggested that uncertainty about providing care in a setting that straddles the health and social care, public and private divide, and anxieties about managing their workload overshadowed their acknowledged concerns about the older people in residential care homes. Further research is needed to substantiate the findings, obtain residents' views and address issues of how to achieve integrated and equitable health and social care for this group.     

Mental health knowledge in residential aged care: a descriptive review of the literature

Health care staff knowledge of mental health is vital in the provision of quality care for older people in residential aged care settings. This paper aims to describe mental health knowledge competence of health care staff in residential aged care through a review of existing literature and to explore the link between knowledge, attitudes and education about older people and mental health. A literature review was conducted using electronic databases and library catalogues to identify articles published in English during the period 1982-2002. There is insufficient evidence within the literature to draw conclusions about staff knowledge levels in relation to mental health, however, the literature identified a link between continuing education, knowledge levels and staff attitudes to older people with mental health disorders. Future studies are needed to investigate existing levels of mental health knowledge among health care staff in residential aged care and to identify and evaluate strategies to enhance their ability to provide care for this population.     

Autonomy for older people in residential care: a selective literature review

Autonomy is an important concept because it brings dignity to peoples' lives, regardless of physical circumstances. The United Nations (UN) Madrid International Plan of Action on Ageing emphasises the need to include older adults in autonomous decision-making processes. However, many older people living in residential care find that their autonomy is curtailed. This is largely because autonomy for older people is poorly understood, and hence, nurses working with older people need to become clear about what autonomy is and how it can be facilitated. In this, the first of three papers, the literature is reviewed specifically to establish the meaning of autonomy for older people in residential care as opposed to autonomy in a wider context. This important distinction may help nurses working with older people to begin to facilitate autonomy more effectively.     

Resident perspectives of the determinants of quality of life in residential care in Ireland

Title.  Resident perspectives of the determinants of quality of life in residential care in Ireland.
Aim.  This paper is a report of a study conducted to identify the determinants of quality of life for older people living in residential care, including exploration of mediating factors at personal and institutional levels and to construct a model of these.
Background.  The quality of life of older people living in residential care is an under-researched area. The focus in the gerontology literature has been on quality of care rather than quality of life for these people. There is emerging consensus, however, that quality of life for older people is a complex, multidimensional concept, incorporating both subjective and objective elements, whether people live at home or in residential care.
Method.  A grounded theory study was conducted in 2005–2006. A total of 101 interviews were undertaken with older people across 12 sites, representing different types of residential care in Northern Ireland. The constant comparative technique was used to analyse data.
Findings.  Four themes having an impact on the quality of life of residents were identified: ethos of care; sense of self and identity; connectedness; and activities and therapies. Mediating and facilitating and/or constraining factors for quality of life were also identified. The core category was conceptualized as 'maximizing potential'.
Conclusion.  Achieving optimal quality of life for older people in residential care will remain elusive unless all the factors which affect on it are taken into account by practitioners and policy-makers. Improving the quality of life of older people in residential care will require action in respect of all of the domains identified in this paper.     

Enhancing autonomy for older people in residential care: what factors affect it?

As the population ages, the expectations of consumers rise and future care provision for older people will demand that autonomy is operationalised in residential care facilities. This paper looks at international publications related to identifying the factors which facilitate or hinder residents autonomy and directs the reader to reflect on their own custom and practice. There are many factors which both facilitate and hinder the level of autonomy which older people experience in residential care. This paper will discuss the three most pertinent factors that are discussed repeatedly in the literature, and they are as follows: the organisations approach to care, person-centred care and life planning.     

Older Youth Nearing Their Exit from Congregate Care: Current Innovative Programs

The present paper reviews literature on older youth in foster care with a focus on those older youths in residential. We aim to examine what has been written in the scholarly literature about this specific group. Literature was reviewed from the last decade on the problems these youths face and potential solutions for them in the program literature. A literature review was done utilizing keywords. Further, this paper presents highlights from two informational interviews with residential agencies. Here we aim to describe what the Executive Directors and staff members believe older youths need, how they work with them and the important components of a residential facility for older youth. Findings uncovered that both agencies highlighted the importance of pro-social attachments, or caring relationships, along with education and safety. Also, the critical importance of preparing youths enough so that when they leave residential they will have reduced the gap between their skills and others their age, so as to be able to compete in society for jobs and further education. Limitations include lack of generalizability, among others.     

Discharging older people from hospital to care homes: implications for nursing

This paper summarizes a research study which explored the experiences of older people being discharged from hospital to nursing and residential homes in the North East of England. While there has been considerable research which has looked at the discharge of patients from hospital to their own homes, little literature could be found which addressed discharge to care homes. While this may reflect an assumption that this form of discharge is less problematic, it is arguable that this is only the case for staff - there is a body of literature on re-location which suggests that the move to a care home is a major life event for older people. Taking a qualitative approach, this study interviewed 20 older people and 17 of their family members after discharge from hospital to a care home. We found that few people had been offered opportunities to discuss their move with nurses, and that older people tended to adopt a stoical attitude. In focus groups, interviews and written responses from 23 members of staff in the hospital and in care homes, we found that there was a lack of clarity over whose role it was to initiate such discussions. The paper concludes with some discussion of the implications for nursing practice of changing care interfaces.     

Consumer expectations of residential aged care: reflections on the literature

The decision-making process that accompanies aged-care home placement is complex and there is a paucity of literature documenting the experiences of those who undertake the activity. The deficiency extends to an understanding of consumer expectations about the quality of the services they encounter once admission has been obtained. Although fewer than 7% of Australian women and 3% of Australian men aged 65 years occupied residential aged care places in 1999-2000, the probability that they will do so at some point in their lives is 0.42 and 0.24, respectively. This study examined 20 papers on this subject found through an extensive search of the literature. Themes identified include the search and selection process of residential aged-care facilities, consumer expectations and satisfaction of placement outcomes, and global and community expectations of quality of care.     

Perceptions of Hong Kong Chinese elders on adjustment to residential care

While there is an increasing number of elders moving into residential care homes in Hong Kong, very little is known about how they adjust to the changes associated with living in such homes. A grounded theory study was therefore conducted to explore the processes through which Chinese elders adjust following a move to residential care. Audiotaped in-depth interviews were conducted with 18 elders one week after residential home admission and then every month until no new information about their adjustment experiences could be discovered. Constant comparative analysis of data revealed that newly admitted elders adjust through the four stages of orienting, normalizing, rationalizing and stabilizing as they struggle to regain normality in a life that is as close to that lived before admission as possible. The purpose of this paper is to report on Chinese elders' normalizing experiences in the second stage of adjustment. It found that a number of experiences suggested in the literature, as barriers to residential living, such as living with rules and regulations, lack of privacy and autonomy, are not regarded as important by Chinese elders. However, establishing relations with other residents and staff appears to be a particular challenge. It concludes that the life experience and socio-cultural values of Chinese elders have to be addressed when trying to effectively help Chinese elders adjust to life in residential care. The findings also highlight the need for better collaboration between nursing and social work staff in their efforts to promote elders' adjustment.     

Foot health in older people and the nurses' role in foot health care–a review of literature

Scand J Caring Sci; 2010; 24; 194–201
Foot health in older people and the nurses' role in foot health care–a review of literature
Aims:  To describe foot health in older people and the role of nurses in foot health care. There is value in developing preventive measures in foot health care in older people, in creating educational programmes for nurses of foot care and in developing foot health evaluation instrument for nurses.
Methods:  The literature was retrieved from the Medline and CINAHL databases between 1980 and January 2008. Altogether 35 articles were reviewed.
Findings:  Based on the review, older people have a variety of foot health problems. Nurses have a theoretical knowledge of foot care, but they do not consider their clinical skills adequate.
Conclusions:  Future research should focus on evaluating in which areas of foot care nurses' knowledge is strongest and how effective their foot caring activities are. Nurses work closely with older people and are in a position to identify and prevent their foot health problems.     

Multi‐professional communication for older people in transitional care: a review of the literature

Aims and objectives. To synthesise research‐reporting literature about multi‐professional communication between health and social care professionals within transitional care for older people, with particular attention on outcomes, enabling contextual factors and constraints. Background. Older adults experience high rates of morbidity and health care usage, and frequently transit between health services, and community and social care providers. These transition episodes place elders at increased risk of adverse incidents due to poor communication of information. Integrated multi‐professional models of care built on enhanced communication have been widely promoted as a strategy to improve transitional care for older people. However, a range of findings exist in the literature to guide service providers and researchers. Design. Comprehensive literature search and review strategies were employed to identify, describe and synthesise relevant studies. Ten databases were searched in addition to Google Scholar. Conclusions. Specified discharge worker roles, multi‐professional care coordination teams, and information technology systems promote better service satisfaction and subjective quality of life for older people when compared with standard hospital discharge. Improved multi‐professional communication reduces rates of re‐admission and length of stay indicating greater cost effectiveness and efficiency for the health and social care systems. Systems of care emphasizing information exchange, education and negotiation between stakeholders facilitate communication in transitional care contexts for older adults. Conversely, lack of dialogue and lack of understanding of others’ roles are barriers to communication in transitional care. Implications for practice. Enhanced multi‐professional communication, transitional pathways, and role clarity are required to improve the quality, sustainability and responsiveness of aged care into the future. Recommendations for further research include: (i) Investigation of pathways promoting person‐centred care planning including the older person, their family and relevant practitioners; (ii) Development of interventions aimed at improving multi‐professional communication and transitional aged care with marginalised and socially disadvantaged elders on indicators of equity and access; (iii) Investigation of changing roles for practitioners in multi‐professional teams with a focus on community‐based teams including nurses specialising in aged care and general practice.     

A sense of home in residential care

Moving into a residential care facility requires a great deal of adjustment to an environment and lifestyle entirely different from that of one's previous life. Attachment to place is believed to help create a sense of home and maintain self‐identity, supporting successful adjustment to contingencies of ageing. The purpose of this study was to deepen our understanding of processes and strategies by which older people create a sense of home in residential care. Our findings show that a sense of home in residential care involves strategies related to three dimensions of the environment – attachment to place, to space and attachment beyond the institution – and that the circumstances under which older people manage or fail in creating attachment, consist of psychosocial processes involving both individual and shared attitudes and beliefs. Assuming that attachment is important to human existence regardless of age, attention must be paid to optimize the circumstances under which attachment is created in residential care, and how nursing interventions can help speed up this process due to the frail and vulnerable state of most older residents.     

Caring for older people with dementia in residential care: nursing students' experiences

AIM: This paper is a report of selected findings from two projects aimed at improving nursing students' experiences of caring for older people in elder care settings. BACKGROUND: With a growing number of older people the prevalence of dementia is rapidly increasing, such that it is now a primary reason for admission to residential care. This has implications for the preparation and support of nursing students on clinical placements as people with dementia represent a key focus of their nursing activities. METHOD: Two projects were conducted in Tasmania between 2001 and 2005, involving 87 second year Bachelor of Nursing students who participated in 3-week clinical placements in eight residential elder care facilities. During the placements, students and their mentors participated in a series of weekly focus group discussions to explore their experiences of caring for residents with dementia. Thematic analysis of the data was conducted. FINDINGS: Staff in the facilities struggled to support students effectively and often failed to recognize that students found residents' behaviour disturbing. Despite having some theoretical understanding of dementia, students reported being unsure of how to respond to residents and often felt scared and intimidated. CONCLUSION: Better preparation and support are needed for students on placements involving residents with dementia. Feasible strategies for more effective support include increased curriculum content about caring for people with dementia, and improved collaboration between university schools of nursing and settings for care of older people.     

Residential Group Care as a Last Resort: Challenging the Rhetoric

ABSTRACT

There is a prevalent view in England that family-based care is the preferred placement option for children placed in out-of-home care. Nonetheless, it is acknowledged that for some young people residential group care can offer the best chance of positive outcomes, transition, and in some cases a route to permanence. With an emphasis on innovation, there has been a recent governmental focus on the role and purpose of these placements. This conceptual paper explores how the political and legislative context has influenced the current opinion and use of residential care, as well as examining the importance of factors such as attachment and relationships, parenting/intervention, the notion of home, a sense of belonging, and adolescent development. Evidence exploring associated risk and resilience factors is also discussed. We question whether adopting a child development perspective and moving the discourse away from placement type to placement purpose would better support children and young people to fulfill their life chances. Residential care undoubtedly offers a different experience to that of family-based care, although, further research assessing a wider range of attributable outcomes is necessary to understand how policy and practice can intervene to best support development and opportunity for children placed in out-of-home care.     

Residential care placement: perceptions among elderly Chinese people in Hong Kong

A qualitative study was designed to explore the perceptions of residential care placement among elderly Chinese people in Hong Kong. Content analysis of the semi-structured interviews with 20 community residents aged 60 years or over revealed that elderly people in Hong Kong generally had mixed feelings towards such placement. While they believed that residential care was an unavoidable alternative to family care in their later lives it was an important source of fear in their later years, especially for those who perceived their health as deteriorating. Residential care homes were generally seen as the ultimate 'dumping place' where one would 'idle till death' and the quality of care provided in these homes was anticipated to be problematic. It was found that most of these beliefs were formed as a result of indirect experience through 'listening to stories of neglect or abuse from friends and relatives whose relatives were residential care home residents'. Implications for professionals working with elderly people are discussed in the light of these findings.     

A study of nurses' knowledge of a palliative approach in residential aged care facilities

Aim. To identify residential aged care nurses’ current knowledge of palliative care for older residents in need of end‐of‐life care. Background. Recently, there has been a growing interest in the delivery of palliative care in residential aged care facilities. While it is recognized that aged care nurses do possess palliative care knowledge the actual level of their knowledge has not been well documented. Design/method. An analytical study using a validated questionnaire tool – Palliative Care Quiz for Nursing, developed by Ross et al. [Journal of Advanced Nursing 23 (1996) 126–137] , combined with a demographic survey of Registered Nurses and assistants in nursing working in five high care residential aged care facilities in inner city region of Sydney, Australia. Results. The total Palliative Care Quiz for Nursing score possible was 20. The mean score for Registered Nurses was 11.7 (SD 3.1) and for AINs 5.8 (SD 3.3), the difference between scores being significant (t = 8.7, df 95, P = 0.000). Misconceptions in palliative care were identified for both the groups of carers. Conclusion. This research has highlighted the need for ongoing palliative care education for both the groups of primary carers. Relevance to clinical practice. The findings of this research highlight the existing palliative care knowledge of residential aged care nurses and provides evidence for education programmes.     

House calls: is there an APN in the house?

PURPOSE: To report how a group of geriatric advanced practice nurses (APNs) participated in a house calls program that increased access to care for homebound and frail community-dwelling elders. DATA SOURCES: Selected literature and author experiences, illustrated with clinical examples. CONCLUSIONS: Many frail older adults are unable to access healthcare due to functional impairments related to multiple, chronic medical conditions. Many of these adults inappropriately utilize the emergency department for episodic care. IMPLICATIONS FOR PRACTICE: The model of care maximizes utilization of APNs to provide cost effective, culturally sensitive, quality care. The goal of geriatric assessment and primary care in this practice is to add quality to later years of life, promoting dignity and comfort to older adults and their families.