Long-term care for the elderly in Taiwan

An aging population, the prevalence of chronic disease and functional disabilities, and changes in society have caused a greater demand for long-term care in Taiwan. The development of long-term care has gone through four stages: undeveloped, early beginning, expanding, and establishment. Problems in several areas including lack of care providers and facilities, expenses of care, and difficulty coordinating health and social services are issues that must be explored. Well-planned and managed long-term care services are an important task for the Taiwanese government to address so holistic care of elders can be provided in this new century.     

Depressive symptoms in long-term care residents in Taiwan

AIM: This paper reports a study to investigate the prevalence of and risk factors for depressive symptoms in elders in long-term care facilities in Taiwan. BACKGROUND: Depression has been identified as a major health concern and is very common among frail elders in Western nursing homes. It is under-diagnosed, and may be associated with eating difficulties and subsequent malnutrition, functional ability and sociodemographic factors. There have been no previous studies of these issues in Taiwan. METHODS: Residents of 18 long-term care facilities were recruited. Those able to communicate in the Mandarin or Taiwanese dialect, resided in long-term care facilities including skilled nursing facilities and intermediate care facilities, and who scored three or above on the Short Portable Mental Status Questionnaire were selected. Data were collected using the Geriatric Depression Scale, Barthel Index and Masticatory Index, and age, duration of institutionalization, and level of impaired swallowing were also measured. RESULTS: The number of participants identified as depressed was 267 (52.05%). There was no significant difference noted relating to age, gender, duration of institutionalization, type of institution, mental status and masticatory ability between the depressed and non-depressed groups, but significant differences of functional status and impaired swallowing between the two groups were found. However, functional status, impaired swallowing, and type of institution were three independent factors associated with depressive symptoms after controlling for all other factors. CONCLUSIONS: Future studies on the detection of symptoms of depression should use a validated observational measure to overcome under-reporting of symptoms by the frailest residents.     

Daily rehabilitation nursing increases the nursing time spent on residents

Nurses are primary managers of rehabilitation nursing activities. When improving rehabilitation nursing, it is important to understand the content of care provided and time spent on residents. This study discusses the allocation of nursing staff time within a context of rehabilitation nursing. The variables of rehabilitation nursing and residents' characteristics were derived from the Resident Assessment Instrument. The wage-adjusted direct nursing time was obtained from a time measurement study carried out in November 2002 in long-term care facilities in southern Finland. The average direct wage-adjusted nursing time spent on resident was 93.8 min per day. Residents receiving daily rehabilitation nursing were allocated ∼8 min more wage-adjusted direct nursing time than their peers. More 'hands in care' staff is required for adopting rehabilitation nursing in long-term care units. Maximizing residents' independency should be the goal for rehabilitation care and therefore the focus for allocating both nursing and rehabilitation staff to units and facilities.     

Effects of a Relationship-Enhancing Program of Care on Outcomes

Purpose: To examine the effects of a relationship-enhancing program of care (REPC) on resident and care provider outcomes.
Design and Methods: A quasi-experimental, repeated measures design, with intervention and comparison groups. Questionnaires were distributed to 50 residents, and observations were conducted of 40 residents and 34 nursing staff at baseline and 3 months after the intervention, on two Canadian nursing home units. An investigator-designed educational program based on Winnicott's theory of relationships and the empirical literature, was provided to care providers and their supervisors on the intervention unit. Repeated measures analysis of variance (RM-ANOVA) was used to compare the intervention and comparison groups in regard to changes in the outcomes over time.
Findings: The REPC had statistically significant effects on (a) residents' perceptions of care providers' relational care, (b) care providers' relational behaviors, and (c) continuity of care.
Conclusions: Evidence showed that these care providers were taught how to enhance their relational skills with residents living in long-term care facilities without added staff. Recommendations for practice and research are discussed.     

Staff perceptions of residents across the long-term care landscape

AIMS: This paper reports a study to determine how facility-, resident-, family- and staff-level indicators are empirically associated with staff members' perceptions of residents in nursing homes (NHs), assisted living facilities (ASLs) and family care homes (FCHs). BACKGROUND: While various efforts have described the ramifications of staff-resident interactions in nursing homes (NHs), few studies identify the factors that potentially influence staff members' perceptions of residents in multiple long-term care settings. METHODS: The participants were 41 care staff located in five NHs, five ASLs, and 16 FCHs randomly selected in Kentucky, United States of America. Face-to-face and telephone interviews were conducted with care staff, residents in their care, family members of residents, and administrators of participating facilities. Telephone interviews measured staff perceptions of residents on two domains: cohesion (perceived feelings of closeness between staff and residents) and knowledge of residents' personal lives and care needs. RESULTS: Regression models found that staff who were married, reported more positive attitudes towards family members, and worked in smaller facilities reported greater staff-resident cohesion. In addition, staff who cared for a higher percentage of residents with learning difficulties indicated greater knowledge of residents. CONCLUSION: The findings emphasize the need to consider elements of staff-family relationships when considering staff perceptions of residents. They also imply that clinical interventions designed to enhance social relationships in NHs can be extended across the long-term care landscape to influence the staff-resident-family triad positively.     

Residents' autonomy: nursing home personnel's perceptions

While delivering quality care, nursing home personnel may unintentionally adversely affect residents' sense of personal autonomy. Faced with the challenge of respecting resident autonomy and simultaneously adhering to nursing home standards, nursing home staff often experience a frustrating ethical conflict. This study examines the effects of sets of independent variables on six autonomy dimensions to examine nursing home personnel's perceptions of how care was provided in their facility. For each of six case studies, respondents were asked the following question: "If Mr. or Mrs. X were at your facility, what would have been decided?" Responses were recorded along a continuum that indicated whether the resident would be allowed to make his or her own decisions or whether the nursing home staff would decide for the resident. Findings indicated staff members' education and race had the greatest effect on their perceptions of personal autonomy. Somewhat surprisingly, staffing levels, turnover rates, and restraint usage did not affect their views of autonomy. Additional research is recommended to more completely examine the complex dimensions of autonomy and to identify what changes nursing home staff and administrators could implement to improve residents' quality of life.     

Factors associated with staff injuries in intermediate care facilities in British Columbia, Canada

BACKGROUND: Large variations in staff injury rates across intermediate care facilities suggest that injuries may be driven by facility-specific work environment factors. OBJECTIVES: To identify work organization, psychosocial, and biomechanical factors associated with staff injuries in intermediate care facilities, to pinpoint management practices that may contribute to lower staff injuries, and to generate a provisional conceptual framework of work organization characteristics. METHODS: Four representative intermediate care facilities with high staff injury rates and four facilities with comparable low staff injury rates were selected from Workers' Compensation Board (WCB) databases. Methods included on-site injury data collection and review of associated WCB data, ergonomic study of workloads, a telephone survey of resident care staff, manager-staff interviews, and focus groups. Pearson product-moment correlation coefficients identified associations between variables. Analysis of variance and t tests were used to determine differences between low and high staff injury rate facilities. Content analysis guided the qualitative analysis. RESULTS: There were no significant differences between low and high staff injury rate facilities in terms of workers' characteristics, residents' characteristics, and per capita public funding. The ergonomic study supported the survey data in demonstrating a relation among low staffing levels, greater muscle loading, and greater risk of injury. As compared with facilities that had high staff injury rates, facilities with low staff injury rates had significantly more favorable staffing levels and supportive work environments. Perceived quality of care was strongly correlated with burnout, health, and satisfaction. CONCLUSIONS: Safer work environments are promoted by favorable staffing levels, convenient access to mechanical lifts, workers' perceptions of employer fairness, and management practices that support the caregiving role.     

Zeitgeists and development trends in long-term care facility design

Through literature analysis, in-depth interviews, and the application of the Delphi survey, this study explored long-term care resident priorities with regard to long-term care facility design in terms of both physical and psychological needs. This study further clarified changing trends in long-term care concepts; illustrated the impact that such changes are having on long-term care facility design; and summarized zeitgeists related to the architectural design of long-term care facilities. Results of our Delphi survey indicated the following top five priorities in long-term care facility design: (1) creating a home-like feeling; (2) adhering to Universal Design concepts; (3) providing well-defined private sleeping areas; (4) providing adequate social space; and (5) decentralizing residents' rooms into clusters. The three major zeitgeists related to long-term care facility design include: (1) modern long-term care facilities should abandon their traditional "hospital" image and gradually reposition facilities into homelike settings; (2) institution-based care for the elderly should be de-institutionalized under the concept of aging-in-place; and (3) living clusters, rather than traditional hospital-like wards, should be designed into long-term care facilities.     

Team inclusion and empowerment among nursing staff in long-term care

Team-based approaches to long-term care are increasingly part of the landscape in residential care facilities to improve staff performance and resident outcomes vis-à-vis empowering direct care staff. This study characterizes licensed and unlicensed nursing staffs’ (N = 95) perceptions of inclusion as care team members by co-workers, supervisors and non-nursing clinicians. Further, we explored whether inclusion was correlated with heightened empowerment and its related dimensions using the Perception of Empowerment Instrument. Linear regression analyses revealed that levels of total empowerment, autonomy, responsibility and participation were associated with how included team members felt and by which members of the care team. These findings shed light on the potential importance of tailoring staff training to target specific team members to increase a sense of empowerment that aligns with the specific dimension(s) for a targeted group.     

Experiences of recently relocated residents of a long-term care facility in Ontario: assessing quality qualitatively

BACKGROUND: Canadians overwhelmingly support universal coverage for health services and seniors' entitlement to high standards of care in long-term care facilities (LTCFs). Government rhetoric reflects these values, but claims of fiscal prudence often means translation into policy and improved care is uneven. Ontario is moving towards standardized "quality of care" measures, but such measures often ignore residents' views and socio-psychological issues. OBJECTIVES AND SETTING: Assessment of residents' experiences in a new "state of the art" LTCF and their understanding of "quality of care" shortly after relocation from two older hospital style facilities. DESIGN AND METHODS: Unobtrusive observations of activities of residents and staff in the LTCF by several researchers generated an analysis of field notes. In addition, one-on-one, in-depth, semi-structured interviews with residents generated qualitative interview data, analyzed utilizing a grounded theory approach. PARTICIPANTS: All residents deemed either moderately cognitively impaired or not impaired were invited to participate. Of these two groups, 18 seniors (five male and 13 female) with a mean age of 84.35yr agreed to be interviewed. Participants were all Caucasian and from a wide variety of social-economic levels. RESULTS: Two meta-themes "Relationships are the foundation of quality care" and "Waiting, activity & grieving loss of personhood" best explained residents' experiences of the LTCF. The two meta-themes were inter-connected and reflected the centrality of socio-psychological "quality of life" issues, especially resident-staff relationships as prominent aspects of seniors' understanding of quality of care. Improvements in facilities and programs were undermined by inattention to staff-patient ratios and continuity in staffing. CONCLUSIONS: Seniors said little regarding the fabulous new facility, but discussed quality of care as a socio-psychological concept intimately connected to staff relations. Government and administrative inattention to issues of sufficient funding for staff, relationship needs and continuity of care for seniors threatened to undermine residents' experiences of meaning, as well as any potential benefits from facilities and program improvements.     

The meaning of mobility for residents and staff in long-term care facilities

BACKGROUND: Although the physical and psychological effects of decreased mobility have been documented, little is known about what it means to be mobile from the institutionalized elders' perspective. Even less is known about nurses' perceptions regarding institutionalized elders' mobility and about mobility enhancing strategies. AIM: The purpose of this study was to generate knowledge about the phenomenon of mobility from both the nurses' and institutionalized elders' perspective. DESIGN: An exploratory qualitative design was used. Focus groups with residents and nursing staff were conducted in three long-term care facilities in a large metropolitan city in 1998. Ethical approval was received from the ethics committees in all three facilities prior to study implementation. Twenty long-term care facility residents and 15 nursing staff participated in the study. METHODS: A trained facilitator used an interview guide to moderate discussions in which residents' and nurses' opinions and feelings about mobility were solicited. The group responses were tape recorded, transcribed and coded. The codes reflected major concepts or abstractions of the data and emerged from the participants' verbal responses to the research questions. FINDINGS: Both groups identified mobility as being pivotal to the residents' quality of life and well-being. The residents viewed mobility as a means of freedom, choice and independence, and they made great efforts to maintain their mobility. The nurses also valued the importance of mobility and assisted the residents through preparatory care, environmental modifications and encouragement. Factors that related to the residents' willingness to be mobile, environmental barriers and the impact of waiting were compared between the two groups. CONCLUSION: Mobility involves more than the movement from one point to another. The nature of the assistive nurse-client relationship and the resident's subjective perspective must become central to understanding the meaning of mobility for residents in a long-term care facility.     

Does geriatric nursing staff burnout predict well-being of LTC residents?

Nursing staff in residential settings are exposed to a large number of stressors. This study examined the relationship between geriatric nursing staff (GNS) burnout and the well-being of residents in long-term care (LTC) facilities. Data were obtained concerning 590 older residents who were served by 315 GNS in 172 LTC facilities in Taiwan, using multilevel modeling. The depersonalization (DP) dimension of burnout in GNS was consistently related to various resident well-being outcomes. Higher DP among GNS was associated with lower residential satisfaction and perceived quality-of-life, as well as more depressive symptoms among older LTC residents. The findings support the claim that DP among GNS has a greater role in determining LTC resident well-being than other dimensions of burnout. Efforts should be made to mitigate the emergence of DP among GNS. Support and education are also needed to enable GNS to foster positive interactions and relationships with LTC residents.     

The effects of a Socially Supportive Activities Program (SSAP) on mood in long term care: A pilot study

This study examined the effects of a facilitated 10-week Socially Supportive Activities Program (SSAP) designed to improve mood in a geriatric institutional setting. A sample of 68 Taiwanese elders in long-term care facilities with depressive symptoms were randomly assigned to either an experimental group (N = 35) or a control group (N = 33). Outcomes were measured before the intervention, week 1, and at week 12, one-week post intervention. In the experimental group, pre-post measurement results demonstrated significant reductions in depressive symptoms, measured by Geriatric Depression Scale, and significantly higher levels of self-transcendence, measured by the Self-Transcendence Scale. An additional post-intervention measure of mood was collected with the Apparent Emotional Rating Scale. The AERS also demonstrated a significantly higher score (better mood) in the experimental group than in the control group. This study supports the use of a structured, facilitated, well-designed social activities program like the SSAP, to enhance and improve mood in elders who live in long-term care facilities.     

Nurses' Perceptions of Safety Culture in Long-Term Care Settings

Purpose: To describe perceptions of workplace safety culture among nurses employed in long-term care (LTC) settings.
Design: A cross-sectional survey. Respondents were licensed nurses ( N =550) with membership in gerontological nursing professional organizations in the United States ( n =296), Canada ( n =251), and other ( n =3).
Methods: An anonymous, self-administered, mail-in questionnaire, which included the Hospital Survey on Patient Safety Culture as well as questions about individual and institutional characteristics. The survey included key aspects of safety culture, such as work setting, supervisor support, communication about errors, and frequency of events reported.
Findings: Nurse-managers reported significantly more positive safety culture perceptions compared with licensed staff nurses. Additionally, licensed nurses employed in government-run facilities had significantly less positive safety culture perceptions compared with those working in nonprofit organizations.
Conclusions: Interventions designed to improve safety culture in LTC settings should be focused on the concerns of licensed staff nurses and the improvement of communication between these nurses and their managers.
Clinical Relevance: Enhancing safety culture in long-term care settings may facilitate improvements in resident safety. Assessment of workplace safety culture is the first step in identifying barriers that nurses face to provide safe resident care.     

北京市五区县老年人口长期护理机构护理供给现况分析

伴随着我国人口的老龄化,失能老年人口数量将会增加,而家庭结构的演化又使居家的长期护理不能满足失能老人的需求,我国失能老年人口的长期护理问题亟待解决。文章通过对北京市老年人口长期护理机构的调查,对目前长期护理机构的产权性质、护理人员的资质和报酬、床位利用情况、护理内容和服务质量进行了总结,并发现目前机构内长期护理处于较低的发展水平,老年痴呆患者的长期护理无法解决,自理老人占据较多的长期护理供给市场,农村失能老人面临更多的困难。提出了有关长期护理机构设置和发展的政策建议。     

Exploring the meaning of quality of life for assisted living residents: A photo-elicitation study

Assisted living is a popular alternative to residential care, promoting independence and enabling self-care through a supportive living environment. Practitioner understanding of quality of life (QoL) experiences are vital to facilitate good physical and mental health in assisted living. An idiographic case study approach explored resident experiences by combining photo-elicitation and interpretive phenomenological analysis. QoL was understood through three themes: facilitation of identity coherence and transition, the essential nature of socialising, and perceptions of a supportive environment. Assisted living has the potential to act as a bearer for cues of identity continuity with nostalgic devices facilitating environment transition and limiting biographical disruption. Furthermore, opportunities for social contact offer a protective function for residents adapting to negative life challenges such as bereavement. To foster health and QoL in withdrawn residents’ facilities should develop peer support programmes with benefits for both mentor and mentee.