Job Satisfaction for Caregivers and Other Employees in Innovative Long-Term Care Homes for Residents With Cognitive Problems.

New housing models have emerged in Europe, Australia, the United States, and Canada. Intended for individuals with neurocognitive disorders, these models are characterized by a philosophy centered on the person, self-determination, liberty of choice, flexibility of care, acceptance of risk, and autonomy. Work and care are organized according to the pace and preferences of residents.

Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial.

Background: Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing.

Prioritization of indicators of the quality of care provided to older adults with frailty by key stakeholders from five canadian provinces.

Background: To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population.

Methods: In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview.

Family Medicine Supervisors' Preferences for Improving Their Teaching Skills in Senior Care.

Background And Objectives: Many clinical supervisors in family medicine feel ill-equipped to teach senior care to their family medicine residents (trainees). We therefore sought to explore their preferred learning strategies for improving their clinical and teaching skills with regard to senior care.

Methods: In this qualitative study, we conducted focus groups and interviews with supervisors from four family medicine clinics, to explore their preferred educational strategies.

A computerized and innovative tool to guide interdisciplinary assessment: Exploring the feasibility of the implementation of the Competency Assessment Tool (CAT).

Unlabelled: An electronic tool, the Competency Assessment Tool (CAT), was developed in order to guide interdisciplinary teams through clinical competency assessment.

Objectives: To support the implementation and perpetuation of the CAT, the objectives were: 1) document health and social service professionals' needs in order to support the use of the CAT; 2) identify the facilitating factors and those hindering the implementation of the CAT in a healthcare establishment; 3) identify strategies favoring the use of the CAT.

Participants: Health and social service professionals and doctors were recruited.

Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial.

Background And Objectives: Informal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults' preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision.

Key stakeholders' views on the quality of care and services available to frail seniors in Canada.

Background: Frail seniors often receive ineffective care, which does not meet their needs. It is still unclear how healthcare systems should be redesigned to be more sensitive to the needs and values of frail seniors and their caregivers. We thus aimed to describe key stakeholders' perspectives on the current healthcare and services available to frail seniors.

"Please listen to me": A cross-sectional study of experiences of seniors and their caregivers making housing decisions.

Background: Little is known about the decision-making experiences of seniors and informal caregivers facing decisions about seniors' housing decisions when objective decision making measures are used.

Objectives: To report on seniors' and caregivers' experiences of housing decisions.

Design: A cross-sectional study with a quantitative approach supplemented by qualitative data.

What Do Clinical Supervisors Require to Teach Residents in Family Medicine How to Care for Seniors?

We assessed clinicians' continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations.

Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions.

Background: Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care.

Aim: To evaluate the impact of a multidimensional intervention to improve quality of care and quality of dying in advanced dementia in long-term care facilities.

Design: Quasi-experimental study with the intervention taking place in two long-term care facilities versus usual care in two others over a 1-year period.

Implementing shared decision-making in interprofessional home care teams (the IPSDM-SW study): protocol for a stepped wedge cluster randomised trial.

Introduction: The frail elderly in Canada face a tough decision when they start to lose autonomy: whether to stay at home or move to another location. This study seeks to scale up and evaluate the implementation of shared decision-making (SDM) in interprofessional (IP) home care teams caring for elderly clients or their caregivers facing a decision about staying at home or moving elsewhere.

Methods: A stepped wedge cluster randomised trial involving 8 Health and Social Service Centers (HSSCs) will be conducted with IP home care teams.

Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention.

Background: Seniors with severe dementia residing in nursing homes (NHs) frequently receive large numbers of medications. With disease progression, the medications' harm-benefit ratio changes and they need to be reviewed, adjusted, or discontinued. Evidence on successful interventions to optimize medication use among these residents is lacking.

[Assessment of the implementation of an innovative experience: network of integrated services for the elderly in the Bois-Franc region.].

Conscious of problems related to coordination of services for the elderly on its territory, the working group on health and social services of the Bois-Francs in the Mauricie and Centre-du-Québec regions implemented in February 1997, after two years of planning, a new coordination model of services for the frail elderly. This model is innovative because it combines the unique entry, case management, individualized services plan as well as the presence of three levels of concertation : strategic, tactical and clinical. The model also has the characteristic of offering comprehensive services to the elderly.

Quality of life indicators in long-term care: opinions of elderly residents and their families.

Background: There are very few studies that have integrated the opinions of nursing home residents and their families into the process of developing valid outcome measures for the quality of life in long-term care facilities.

Purpose: The objective of this study was to identify the interpersonal and environmental characteristics for the best substitute living environment, as perceived by recently (< 6 months) and not as recently (> 6 months of residency) admitted residents and their families.

Methods: A qualitative research approach was used with 27 elderly residents and families from five nursing homes.

PRISMA: a new model of integrated service delivery for the frail older people in Canada.

Purpose: PRISMA is an innovative co-ordination-type Integrated Service Delivery System developed to improve continuity and increase the efficacy and efficiency of services, especially for older and disabled populations.

Description: The mechanisms and tools developed and implemented by PRISMA include: (1) co-ordination between decision-makers and managers, (2) a single entry point, (3) a case management process, (4) individualised service plans, (5) a single assessment instrument based on the clients' functional autonomy, and (6) a computerised clinical chart for communicating between institutions for client monitoring purposes.

Preliminary Results: The efficacy of this model has been tested in a pilot project that showed a decreased incidence of functional decline, a decreased burden for caregivers and a smaller proportion of older people wishing to be institutionalised.

Improving the psychosocial work environment.

Aim: This paper reports a pilot project to evaluate the effectiveness of a participatory organizational intervention to improve the psychosocial work environment in one long-term care unit.

Background: Since the early 1990s, health care institutions in Quebec have been constantly changing in order to improve the efficiency of the health care system. These changes have affected the work environment and have contributed to higher rates of burnout and absenteeism among nurses and other health care workers.

Physical restraint use among nursing home residents: A comparison of two data collection methods.

BACKGROUND: In view of the issues surrounding physical restraint use, it is important to have a method of measurement as valid and reliable as possible. We determined the sensitivity and specificity of physical restraint use a) reported by nursing staff and b) reviewed from medical and nursing records in nursing home settings, by comparing these methods with direct observation. METHODS: We sampled eight care units in skilled nursing homes, seven care units in nursing homes and one long-term care unit in a hospital, from eight facilities which included 28 nurses and 377 residents.

Frail elderly patients. New model for integrated service delivery.

Problem Being Addressed: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity.

Objective Of Program: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services.

Program Description: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination.