Using Collective Impact to Examine Direct Service Worker Training and Credentialing in North Carolina: Recommendations for Change.

Older adults and people living with disabilities receive home- and community-based services (HCBS) from approximately 113,000 often under-resourced and inadequately supported direct service workers (e.g., personal care aides, direct support professionals, nurse aides) in North Carolina.

Health Insurance Matters: Insurance Coverage and Health Service Use Among Direct Care Workers in the United States.

Objectives: Direct care workers (DCWs) play a central role in supporting individuals' health and well-being across care settings, yet may face barriers to accessing health care themselves, particularly because of high rates of uninsurance.

Design: An observational study using pooled National Health Interview Survey (NHIS) data from 2014 to 2018.

Setting And Participants: The sample included survey respondents employed as direct care workers (DCWs), including hospital aides, home care workers, and nursing and residential care aides.

Who's in the House? Staffing in Long-Term Care Homes Before and During COVID-19 Pandemic.

Critical gaps exist in our knowledge on how best to provide quality person-centered care to long-term care (LTC) home residents which is closely tied to not knowing what the ideal staff is complement in the home. A survey was created on staffing in LTC homes before and during the COVID-19 pandemic to determine how the staff complement changed. Perspectives were garnered from researchers, clinicians, and policy experts in eight countries and the data provides a first approximation of staffing before and during the pandemic.

The Imperative to Reimagine Assisted Living.

Assisted living (AL) has existed in the United States for decades, evolving in response to older adults' need for supportive care and distaste for nursing homes and older models of congregate care. AL is state-regulated, provides at least 2 meals a day, around-the-clock supervision, and help with personal care, but is not licensed as a nursing home. The key constructs of AL as originally conceived were to provide person-centered care and promote quality of life through supportive and responsive services to meet scheduled and unscheduled needs for assistance, an operating philosophy emphasizing resident choice, and a residential environment with homelike features.

Transforming Direct Care Jobs, Reimagining Long-Term Services and Supports.

The diverse array of individuals who receive long-term services and supports share one common experience, which is the need for assistance with personal care and/or other daily activities. The direct care workers (including nursing assistants, home health aides, and personal care aides) who provide this assistance play a critical role in keeping individuals safe, supporting their health and well-being, and helping prevent adverse outcomes. Yet despite decades of research, advocacy, and incremental policy and practice reform, direct care workers remain inadequately compensated, supported, and respected.

It Is Time to Resolve the Direct Care Workforce Crisis in Long-Term Care.

Nearly 4.6 million direct care workers-including personal care aides, home health aides, and nursing assistants-provide daily support to older adults and people with disabilities across a range of settings in the United States, predominantly in long-term care (LTC). Even as the population grows older and drives up demand for LTC, the sector continues its decades-long struggle to fill direct care positions and stabilize this essential workforce.

Nursing home residents' perspectives on their social relationships.

Aims And Objectives: To explore nursing home residents' perspectives on their relationships with other residents, family members and staff.

Background: The cultivation of social relationships is central to promoting well-being in nursing homes, as these relationships allow residents, family members and staff to be valued as unique persons and empowered as partners in care. Few studies have examined how nursing home residents perceive the relationships in their social networks, both within and beyond the facility.

Historical Mismatch Between Home-Based Care Policies And Laws Governing Home Care Workers.

Americans generally want to remain in their homes even if they develop chronic health problems or disabilities that qualify them for nursing home care. While family members or friends provide the preponderance of home-based support, millions of Americans use paid personal assistance services (PAS). Inexorable demographic trends are increasing the numbers of people who need paid home-based PAS, with this need rapidly outstripping the capacity of the paid PAS workforce.

Resident Challenges With Pain and Functional Limitations in Chinese Residential Care Facilities.

Background And Objectives: Pain and functional limitations can severely impede older adults' quality of life. In Chinese residential care facilities, limited research suggests that residents potentially have significant unmet care needs with pain and related functional limitations. Therefore, we aimed to explore residents' challenges and self-management strategies in these two areas.

Person-directed care planning in nursing homes: A scoping review.

Aim: Federal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person-directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person-directed care planning (PDCP).

Methods: A multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts.

Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia.

Background And Objectives: To draw from systematic and other literature reviews to identify, describe, and critique nonpharmacological practices to address behavioral and psychological symptoms of dementia (BPSDs) and provide evidence-based recommendations for dementia care especially useful for potential adopters.

Research Design And Methods: A search of systematic and other literature reviews published from January 2010 through January 2017. Nonpharmacological practices were summarized to describe the overall conceptual basis related to effectiveness, the practice itself, and the size and main conclusions of the evidence base.

Person-Directed Care Planning in Nursing Homes: Resident, Family, and Staff Perspectives.

Empowering individuals to direct their own care is central to person-centered care and health care policy. However, there is limited knowledge of how "person-directed care planning" (PDCP) can be achieved in particular settings. This study identifies key structures and processes for operationalizing and implementing PDCP in nursing homes.

Resident challenges with daily life in Chinese long-term care facilities: A qualitative pilot study.

As traditional family-based care in China declines, the demand for residential care increases. Knowledge of residents' experiences with long-term care (LTC) facilities is essential to improving quality of care. This pilot study aimed to describe residents' experiences in LTC facilities, particularly as it related to physical function.

The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents.

Objectives: Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections (UTIs) in nursing home (NH) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship.

Methods: Chart review of 260 randomly-selected cases from 247 NH residents treated with an antibiotic for a presumed UTI in 31 NHs in North Carolina. We examined the prescribing pathway from presenting illness, to the prescribing event, illness work-up and subsequent clinical events including emergency department use, hospitalization, and death.

Nurse and Medical Provider Perspectives on Antibiotic Stewardship in Nursing Homes.

Objectives: To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs).

Design: Cross-sectional survey.

Setting: NHs in North Carolina (N = 31).

Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff.

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice.

Pneumonia Identification Using Nursing Home Records.

Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs.

A short report on knowledge exchange through research-based theatre: 'inside out of mind'.

The short report describes the development from page to stage of a work of theatre based on an ethnographic study. The originating research focused on the work of health care assistants (nurse's aides) whose direct impact on the quality of life of highly dependent people is often overlooked. The research followed hospital personnel on wards specialising in the 'challenging behaviour' associated with dementia in central England.