COLLEGE STUDENTS' ATTITUDES TOWARD RESIDENTIAL CARE FACILITIES

This study was designed to explore college students attitudes toward residential care settings for older adults. Subjects were 109 female students aged 18 to 71 years (M = 24.8, SD = 9.49) and 22 male students aged 19 to 43 years (M = 23.3, SD = 5.24) enrolled in a Psychology of Aging course at a local state college. Students interviewed older residents of 96 different long-term care facilities and completed a questionnaire that assessed their impressions of the facility and its residents. Students openness to living in long-term care settings and positive and negative statements about the facility visited were the main measures of student attitudes toward such settings. Nursing homes were perceived more negatively than any other type of long-term care setting. Students who had been affected by meeting the needs of an elderly relative were more open to living in residential care settings, as were students who interviewed residents who were satisfied with their lives. Nursing homes elicited the least openness to living in residential care facilities, whereas assisted care and continuing care facilities elicited the most openness. Students who perceived residents as mentally alert made fewer negative statements about the facilities visited.     

Teaching Philosophy and Methods of Restorative Care to Assisted Living Owners and Staff

To implement restorative care in assisted living facilities, staff need to understand the philosophy and learn methods to help residents maintain optimal function. In this study, the researchers developed a multimedia training program designed to teach staff how to encourage residents to increase their participation in dressing themselves. Researchers conducted a pilot test to measure the short-term effects of the training on 40 staff from two states. Program effects were measured by completing a survey developed by the researchers. Pretest scores were significantly related to gender (women as a group had higher scores than men). Results indicated significant gains in knowledge at posttest. In addition, 93% of participants described positive changes related to restorative care that they planned to make at their facility as a result of the training.     

Care or scare: the safety of youth in congregate care in New York City

OBJECTIVE: This qualitative study examined stakeholders' perceptions of the safety of youth ages 12 and older living in congregate care facilities within the New York City foster care system. The study explored the youth's physical safety, the safety of their personal belongings, the physical conditions of congregate care settings, and the relationship between staff quality and youth safety. METHOD: The study involved interviews with family court judges, representatives of private child welfare agencies, attorneys who represent children in foster care, social workers, representatives of advocacy and other relevant organizations in New York City, and former foster youth who had been placed in congregate care settings. RESULTS: Safety in congregate care environments was an issue of significant concern. Threats to the youth's safety were found to emanate from peer-on-peer violence, stealing of personal belongings, inappropriate staff conduct, and the poor physical conditions of facilities. Youth's sense of safety was strongly linked to staff quality, including staff ability to relate effectively to youth and to maintain control of congregate care environments. CONCLUSIONS: Existing regulations in New York State appear to have had little effect in ensuring the safety of youth in many group and residential care facilities. Steps to improve safety outcomes for youth in these settings are proposed.     

Alzheimer's Disease and Other Dementias: An Organizational Approach to Identifying and Addressing Practices and Learning Needs of Family Physicians

ABSTRACT

Caring for patients with dementia is complex and demanding. Since family physicians (FPs) provide much of this care, we examined their practices, learning needs, and barriers to care concerning Alzheimer's disease and other dementias. We surveyed 392 (approximately 50%) Nova Scotia FPs and conducted focus groups and interviews with: FPs; staff of long-term care facilities; health professionals in home care; patients and their caregivers; FPs with advanced geriatric training; geriatricians; and psychiatrists. Results suggest that many FPs do not perform assessment and management practices as frequently as they ideally should. However, systemic factors, not only inadequate knowledge, affect care.     

The Long-Term Care Workforce Crisis: Dementia-Care Training Influences on Job Satisfaction and Career Commitment

The present study compares changes in job satisfaction and career commitment among Alzheimer's care staff participating in a two-phase, state-level training collaborative to improve dementia care. Results reveal an increase in extrinsic job satisfaction and a decrease in career commitment. Findings could be related to the effects of both the training interventions and the time lag in data collection. Decreases in career identity depended on whether participants showed a deeper involvement in aging concerns with respect to future employment. Implications for the implementation of future interventions for direct-care staff within a context of organizational and systems-based change are discussed.     

Sexuality in Older Adults: Effect of an Education Intervention on Attitudes and Beliefs of Residential Aged Care Staff

The sexual needs and wellbeing of older people living in residential aged care receives scant attention in practice, is easily dismissed by care staff, and remains a significant challenge for aged care service providers. This study reports on the evaluation of an education program delivered to residential aged care nurses to improve their knowledge about, and attitudes towards, older people's sexuality in this context. Participants' attitudes and beliefs towards older people expressing their sexuality in long-term care, including same sex couples and people with dementia, were more permissive following education. Findings further underscore the value of sexuality education as an important factor in dispelling the commonly held negative views of residential aged care staff about older people expressing their sexuality, thereby improving staff responses to this issue.     

Children’s participation and agency in Italian residential care for children: Adult-child interactions at dinnertime

This paper analyzes the impact of adults’ interactive moves and strategies on children’s participation and agency at dinnertime in two Italian residential care facilities, one of the most widely used alternative care life-context for children and youth coming from vulnerable families. Participants are 14 children and 11 educators living in two residential care facilities in Rome (Italy). Adopting an interactional and multimodal analytic approach, this paper focuses on two dinnertime activities: the routine activity of praying before eating and the very frequent one of talking about rules and transgressions. The comparative analysis of the two facilities shows how, in stable patterns of adult-child interactions recurring across different activities in the same facility, adults’ strategies and interactive maneuvers differently impact on children’s participation and agency and consequent socialization practices. In the conclusion, we emphasize the relevance and implications of this study for either research in educational sciences and for professionals operating in alternative care and related fields.

     

Institutionalized Children in Russia: Grouping the Regions by the Scale of the Phenomenon

This study provides an initial classification of information on the social and geographic distribution of children’s residential care institutions in Russia, and it characterizes the relationship between this information and the level of criminalization and victimization of minors. We provide data on the number of such residential care facilities and their child placement statistics in the various regions of the Russian Federation. We rank these regions according to these variables, and we classify them into three clusters: favorable, troubled, and unstable. We discovered material differences between the Russian regions across all variables. At the same time, Russia’s federal districts differ significantly from each other only in terms of rates of crime and the victimization of minors and not in terms of their number of residential care facilities, wards, and the “concentration” of such institutions. We discovered that the factor of “institutionalized children” contributed significantly to the regional level of juvenile delinquency on the basis of the results of a correlation and regression analysis. The region’s average number of wards per residential care facility and the predominance of Muslim population turned out to be insignificant variables. The first excluded variable (characterizing living conditions) is important for developing and optimizing children’s residential care plans. It is discussed in the Letter of the Ministry of Education and Science of the Russian Federation dated 9/1/2014 no. VK-1850/07. The second excluded variable is used to analytically reconstruct the set of factors that cause significant interregional variances in the number of residential care facilities and their wards.     

Community involvement of persons with severe retardation living in community residences

A national survey was conducted with 294 community residential facilities (CRFs) serving adults with severe retardation. Respondents were asked to rate 38 community-based activities twice: one rating representing the activity involvement of the residents living in the CRFs, and one rating representing the perceived activity involvement of "average," well-integrated community members. Nonhandicapped community members were perceived to have significantly more involvement in 30 activities than adults living in CRFs. Group home and foster home residents were perceived to be more involved in employment or day activities outside the residence, use of health care services, walking or wheelchair strolling for pleasure, and use of parks or zoos than nonhandicapped community members.     

Educating and Training the Workforce to Work with People with Dementia: Two Projects from the United Kingdom

Educating and training the dementia workforce is a global challenge, given the expected increasing number of people living with dementia across the world as the population ages. Two projects from the UK (one regionally and one locality based) investigated courses available to the workforce and mapped the content of identified courses against a locally developed dementia care pathway. The locality project included a survey of what percentage of staff time was spent with people living with dementia, and what percentage of staff caseloads were devoted to people living with dementia. There was a great variation in the extent of education and training available, with some stages of the dementia care pathway poorly addressed. An educational strategy for the dementia workforce in the UK might include four categories of education and training: basic dementia awareness, intermediate level, advanced level, and dementia awareness for managers. Staff requiring education and training might be divided into three groups: those employed to work specifically with people living with dementia and their families; those working with people who have other conditions but some of whom will have a coincidental dementia; those working with other conditions but in settings where a high proportion of their patients have a comorbid dementia. To improve workforce skills in dementia care will require actions across the whole of education and training for professionals and untrained workers who provide services to this group.     

Intensive oversight of youth residential treatment: Staff perspectives on the New York State Justice Center for the Protection of People with Special Needs

Youth care workers in U.S. residential treatment centers (RTCs) provide 24-h care to youth whose significant psychosocial needs cannot be managed in a less restrictive setting. They have sometimes abused or neglected youth in their care. This study investigates staff perspectives on a new form of intensive oversight developed in New York State to prevent maltreatment of youth in care facilities. It asks: How does intensive oversight and investigation mandated by a state-run agency for the protection of people in care affect residential youth care workers in RTCs? Derived from a 15-month ethnographic study of an RTC serving a child welfare population conducted in 2015 and 2016, these results suggest that intensive oversight may have unanticipated consequences for RTCs, the youth care workforce, and youth in care. Consistent with other studies of regulation and surveillance in risk societies, participants reported that fear of prolonged and intimidating investigations, false allegations, and unavoidable violations of policy negatively affected their practice and contributed to staff turnover. Organizational consequences included serious staffing challenges and increased costs of overtime and administrative management of compliance. Some participants suggested that the form of intensive oversight studied here may have reduced the quality of care received by youth by disrupting therapeutic relationships, causing youth to be cared for by unfamiliar workers, and compelling workers to act defensively to prevent allegations rather than in the best interest of youth. We suggest that, under conditions of intensive oversight, youth care workers, like their clients, should be considered an at risk population whose well being is essential for the provision of high quality care. We conclude with modest recommendations to organizations and jurisdictions using or considering intensive oversight practices to protect the rights and safety of youth in RTCs.     

Connecting cultural models of home-based care and childminders' career paths: an eco-cultural analysis

Family day care or childminding involves a particularly transient workforce. This paper introduces Eco(logical)-Cultural Theory (ECT) to examine the cultural organisation of childminding and presents an ECT analysis of pilot survey results: asking minders about their daily routines and their career paths. Reasons for becoming a minder and aspirations for the future varied and were associated with the organisation of daily routines. Among minders who wished to continue childminding, daily routines were related to cultural models. Those aspiring to work in centres rather than homes tended to organise daily activities high in structure (i.e. similarity from day to day). Most reported dissatisfaction with home-based facilities, suggesting dissonance between models of care and local ecology. The childminding workforce is diverse and an ECT approach focused on asking childminders about their daily lives may yield valuable empirical data to inform professional development efforts.     

Effects of Video Feedback on Social Behaviour of Young People with Mild Intellectual Disability and Staff Responses

The present study evaluates the effects of a multifaceted training procedure on the inappropriate and appropriate social behaviour of young people with mild intellectual disability and on staff responses. The training package included youth training with video feedback and self-management procedures and staff training with video and graphic feedback. The data were collected using a reversal baseline design. The results showed an increase in the occurrence of appropriate behaviour on the part of young people with mild intellectual disability. Inconsistent changes were found for inappropriate social behaviour. The provision of video and graphic feedback successfully modified the performance of direct-care staff members. Recommendations are made for further research on factors related to behaviour change in staff and young people with intellectual disability.     

Dementia-related work activities of home care nurses and aides: Frequency,perceived competence,and continuing education priorities

ABSTRACT

An understanding of the specific dementia learning needs of home care staff is needed to plan relevant continuing education (CE) programs and supports. The study’s objective was to examine frequency and perceived competence in performing 20 dementia-related work activities, and identify CE priorities among home care staff. A cross-sectional survey of all home care staff in a primarily rural health region was used to gather data. Of 111 eligible staff, 82 participated (41 nursing aides, 41 nurses/case managers). To explore the relationship between activity frequency (F) and competence (C), the proportion of nurses and aides in four quadrants for each activity was examined: (1) low F-low C, (2) low F-high C, (3) high F-low C, and (4) high F-high C. Nurses/case managers were significantly more likely than aides to regularly perform 11 activities and to report high competence in 9 activities (p < .05); aides were more likely to assist with two activities (personal care and daily living activities). Thus, nurses/case managers performed a broader range of activities and reported higher competence overall. The top CE topic for both groups was recognizing differences between dementia subtypes, but rankings for most activities varied by group. Aides’ CE priorities indicated a desire to develop competence in low frequency-low competence activities, suggesting an expanded role in supporting dementia patients and their families. Nurses’ CE priority topics were in the high F-high C quadrant, indicating a need to further develop competence in these activities. Findings have implications for planning CE programming for home care providers.     

Partnering to run a community-based program for deaf-blind young adults.

Community-based programs that assist deaf-blind young adults with living skills can be a cost effective alternative to institutional care. Their unique medical, psychosocial training, and daily living needs require services and support from a variety of agencies and providers. The elements and concepts necessary to conduct a program 24 hours a day for young adults who are deaf and blind includes sound management, realistic staff expectations for clients, developmentally appropriate activities, family participation in planning accessible medical and psychological services, and close collaboration with universities and community organizations. Management must also be sensitive to the emotional concerns of the staff and provide ongoing opportunities for supervision and training.     

Lifetime prevalence and incidence of sexual victimization of adolescents in institutional care

The frequency of sexual victimization in high-risk populations like adolescents in institutional care has hardly been studied. In this study, we report lifetime prevalence and incidence from a nationwide German sample including 322 adolescents (mean age 16.69 years, 43% female) from 20 residential care facilities and 12 boarding schools. Lifetime prevalence for severe sexual victimization (in and outside of institution) was 46.7% for girls and 8.0% for boys. Moreover, 5% of all adolescents experienced severe sexual victimization for the first time after they were admitted to the current institution (mean duration of stay in the current institution 3.08 years). Offenders were mostly adolescents of the same age whereas staff members played a minor role as perpetrators. We conclude that the high rate of sexual victimization among adolescents in institutional care should be considered during decision-making processes concerning out-of-home placement and during a stay in residential care.     

Focus on dementia care: Continuing education preferences,challenges, and catalysts among rural home care providers

ABSTRACT

Home care staff who provide housekeeping and personal care to individuals with dementia generally have lower levels of dementia care training compared with other health care providers. The study's purposes were to determine whether the professional role of home care staff in a predominantly rural region was associated with preferences for delivery formats of dementia-specific continuing education (CE) programs, and challenges and catalysts to attending CE on any topic. From January through March, 2014, 82 of 111 eligible home care staff in one Saskatchewan health region completed a cross-sectional postal survey (73.9% response rate). The survey included 41 nurses/case managers (client care coordinators, assessors, and team managers) and 41 continuing care aides (home health aides). Nurses/case managers and aides were equally likely to report moderate to high interest in locally delivered CE and low interest in Internet-based and computer-based CE. Compared with nurses/case managers, aides were more likely to report challenges to CE attendance due to CE not being a requirement of their position or relevant to their work. Low staffing levels were the top challenge regardless of professional role. Nurses/case managers and aides were equally likely to identify locally offered programs and paid time off as the top two catalysts of CE attendance. Given the growing number of individuals with dementia receiving home care services, the current study suggests that continuing education should be offered locally and included in rural staff’s paid time in order to encourage attendance.     

Development and Pilot Testing of a Food Safety Curriculum for Managers and Staff of Residential Childcare Institutions (RCCIs)

Food safety training materials, targeted for residential childcare institution (RCCI) staff of facilities of 20 residents or less, were developed, piloted, and evaluated. The goal was to assist in the implementation of a Hazard Analysis Critical Control Points (HACCP)‐based food safety plan as required by Food and Nutrition Service/United States Department of Agriculture. RCCI staff and instructor training manuals, Food Safety Basics: Food Safety Education for RCCIs was developed and pilot tested in RCCIs in both Rhode Island and Massachusetts. The program was evaluated by participants and pre‐/posttraining onsite inspector and microbial assessments. The core curriculum contained 3 modules and corresponding activities: Module 1: cause, prevention, and strategies to reduce foodborne illness; Module 2: components of a HACCP‐based food safety plan and standard operating procedures; and Module 3: actual food safety plan development, including instructions for implementation and corresponding monitoring procedures required. There were 50 to 82 RCCI staff members that attended 2 or 3 modules. Participants rated the modules 4.5 ± 0.4, 4.3 ± 0.4, and 4.4 ± 0.4 out of 5‐point Likert scale (1 = strongly disagree, 5 = strongly agree) for teaching modules 1, 2, and 3, respectively. The evaluations assessed their understanding of key topic areas taught. Onsite inspections showed improvement in many critical food safety issues. Some deficiencies still appeared to be problematic, such as refrigerator temperature monitoring and issues with storage and cross‐contamination.     

The crucial role of the micro caregiving environment: Factors associated with attachment styles in alternative care in Chile

The distribution of attachment styles has been shown to differ between groups of children living with their parents and children placed in alternative care (AC), defined as residential or foster. However, this is the first study in Latin America to explore possible factors affecting the quality of attachment in children living in both residential and foster care. Two groups of children (N = 57) were compared: one group living in Residential Homes (RC) and the other in Foster Care (FC) in Chile. Children’s, caregivers’ and structural factors (e.g., child: caregiver ratios) and their links with attachment styles were investigated. The micro caregiving environment (i.e., the specific individual child caregiver relationship), especially the caregivers’ engagement, sensitivity, disciplinary control and affection, as well as some structural factors (i.e., child: caregiver ratios), were linked to attachment security in children. Specifically, better emotional caregiving and lower child-caregiver ratios were associated with higher rates of secure attachment. The association between quality of care (as measured by the HOME inventory) and attachment styles seems to be influenced by caregiver relationships (as measured by CCSERSS). Caregiver relationship factors (i.e., affection, engagement and sensitivity) directly impact the quality of the attachment children establish with them while living in AC. However, the relationships that caregivers establish with children under their care can be facilitated by good quality structural factors, particularly child-caregiver ratios.     

Exploring the development of competence in Lean management through action learning groups: a study of the introduction of Lean to a facilities management function

The introduction of a Lean approach to management requires the development of understanding and capability. This in turn requires a structured training intervention and other supporting activities. This paper explores, through a case study, the way in which action learning groups (ALGs) supported the development of Lean capabilities in the facilities management (FM) function of a large organisation. This case study indicates that Lean can be applied in a FM context and that ALGs are effective in supporting such a development in capability. Some environmental factors are identified as having an impact on the likelihood of success in using ALGs: leadership engagement, perceived level of empowerment, organisational readiness, level of resource committed and individual readiness to be involved.