Abstract
Although high income countries increasingly emphasize care at home, long-term residential care is and will remain the place where some of our most vulnerable live and work. Based on over 500 interviews with the entire range of actors in long-term residential care, intensive observations by interdisciplinary teams of at least 12 in 27 different sites in six countries and on background documents that take context into account, this paper explores tensions in long-term residential care. It argues that recognizing and balancing these tensions is critical to care and constitute promising practices. However, multiple pressures are shifting the balances in these tensions, with for-profit, chain ownership and the increasing pressure to emphasize clinical care among the most powerful forces.
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See Dementia Care Matters http://www.dementiacarematters.com/
References
Andersen, E. (2009). Working in long-term residential care: A qualitative metasummary encompassing roles, working environments, work satisfaction, and factors affecting recruitment and retention of nurse aides. Global Journal of Health Science, 1(2), 2–41.
Armstrong, P. (2013). Puzzling skills. Canadian Review of Sociology, 53(3), 256–283.
Armstrong, P., Armstrong, H., & Scott-Dixon, K. (2008). Critical to care; the invisible women in health services. Toronto: University of Toronto Press.
Armstrong, P., Banerjee, A., Szebehely, M., Armstrong, H., Daly, T., & Lafrance, S. (2009). They deserve better: The long-term care experience in Canada and Scandinavia. Ottawa: Canadian Centre for Policy Alternatives.
Armstrong, P., Armstrong, H., & Daly, T. (2012). The thin blue line: Long-term care as an indicator of equity in welfare states. Canadian Woman’s Studies, 29(3), 49–60.
Association of Workers Compensations Boards of Canada (2013). 2012 Injury Statistics. http://awcbc.org/?page_id=14.
Banerjee, A., & Armstrong, P. (2015). Centring care: Explaining regulatory tensions in residential care for older persons residential care. Studies in Political Economy, 95, 7–28.
Barry, T., Brannon, D., & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist, 45(3), 309–317.
Bostock L., & Humphries, R. (2011). At a glance 45: Social Care and Clinical commissioning for people with long-term conditions. London: Scie. http://www.scie.org.uk/publications/ataglance/ataglance 45.asp.
Braithwaite, J., Makkai, T., & Braithwaite, V. (2007). Regulating aged care: Ritualisms and the new pyramid. Camberley: Edward Elgar Publishing.
Cameron, W. B. (1963). Informal Sociology. A casual introduction to sociological thinking. New York: Random House.
Canadian Institute for Health Information (CIHI) (2014). Drug Use Among Seniors on Public Drug Programs in Canada. 2012 Ottawa: CIHI https://secure.cihi.ca/free_products/Drug_Use_in_Seniors_on_Public_Drug_Programs_2012_EN_web.pdf.
Chouinard, V., Hall, E., & Wilton, R. (Eds.). (2010). Towards enabling geographies: ‘disabled’ bodies and minds in Society and space. Farnham: Ashgate Press.
Daly, M., & Lewis, J. (2000). The concept of social care and the analysis of contemporary welfare states. The British Journal of Sociology, 51(2), 281–298.
Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Cambridge: Polity Press.
Finch, J., & Groves, D. (Eds.). (1983). A labour of love: Women, work and caring. London: Routledge.
Fukui, H., Arai, A., & Toyoshima, K. (2012). Efficacy of music therapy in treatment for the patients with Alzheimer’s Disease. International Journal of Alzheimer's Disease. 2012 Article ID 531646, 6, doi:10.1155/2012/531646.
Gerard, M. N. (2010). A diagnosis of conflict: Theoretical barriers to integration in mental health services & their philosophical undercurrents. Philosophy, Ethics, and Humanities in Medicine, 5(4). doi:10.1186/1747-5341-5-4.
Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. New York: Anchor Books.
Grandjean, B., Aiken, L., & Bonjean, C. (1976). Professional autonomy and the work satisfaction of nursing educators. Nursing Research, 25(3), 216–221.
Harrington, C. (2001). Residential nursing facilities in the United States. British Medical Journal, 323(7311), 507–510.
Harrington, C. (2013). Understanding the relationship of nursing home ownership and quality in the United States. In G. Meagher, & M. Szebehely (Eds.), Marketization in Nordic Eldercare: A research report on Legislation, Oversight, Extent and Consequences (pp. 229–240). Stockholm: Stockholm University.
Harrington, C., Choiniere, J., Goldmann, M., Jacobsen, F., Lloyd, L., McGregor, M., Stamatopoulos, V., & Szebehely, M. (2012a). Nursing home staffing standards and staffing levels in six countries. Journal of Nursing Scholarship, 44(1), 88–98. doi:10.1111/j.1547-5069.2011.01430.x.
Harrington, C., Olney, B., Carrillo, H., & Kang, T. (2012b). Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies. Health Services Research, 47(1, pt1), 106–128.
Harrington, C., Stockton, J., & Hoopers, S. (2014). The effects of regulation and litigation on a large for-profit nursing home chain. Journal of Health Politics, Policy and Law, 39(4), 781–809. doi:10.1215/03616878-2743039.
Hjaltadóttir, I., Hallberg, I. R., Ekwall, K. A., & Nyberg, P. (2011). Predicting mortality of residents at admission to nursing home: A longitudinal cohort study. BMC Health Services Research, 11:86. doi:10.1186/1472-6963-11-86.
Kamp, A. (2012). The quest for the meaning of work: Competing concepts of meaning. In A. Kamp & H. Hvid (Eds.), Elderly Care in Transition (pp. 51–82). Copenhagen Business School: Copenhagen.
Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285–308.
Kelly, A., Conell-Price, J., Covinsky, K., et al. (2010). Length of stay for older adults residing in nursing homes at the end of life. Journal of the American Geriatrics Society, 58(9), 1701–1706.
Lloyd, L., Banerjee, A., Fadnes, F., Harrington, C., & Szehebely, M. (2014). It's a scandal!: Comparing the causes and consequences of nursing home media scandals in five countries. International Journal of Sociology and Social Policy, 34(1–2), 2–18. doi:10.1108/IJSSP-03-2013-0034.
Lowndes, R., Armstrong, P., & Daly, T. (2015). The meaning of “dining”: The social organization of food in LTC. Food Studies: An Interdisciplinary Journal, 4(1), 19–34.
Marin, A. (2010). Confidential letter to the deputy minister of health and long term care Mr. Rafi Saäd. Toronto: Ontario Ombudsman.
Messing, K. (1998). One-eyed Science. Occupational health and women workers. Philadelphia: Temple University Press.
Mukamel, D. B., Weimer, D. L., Harrington, C., Spector, W. D., Ladd, H., & Li, Y. (2012). The effect of state regulatory stringency on nursing home quality. Health Services Research, 47(5), 791–813.
Music and Memory (2014). Alzheimer Society of Toronto’s iPod Project Study Finds Personalized Music Benefits Caregivers, Too. https://musicandmemory.org/?s=Alzheimer+society+of+toronto.
Næss, A., Kvale Havig, A., & Vabø, M. (2013). Contested spaces – The perpetual quest for change in Norwegian nursing homes. In A. Hujala, S. Rissanen, & S. Vihma (Eds.), Designing Well-being in Elderly Care Homes (pp. 68–85). Helsinki: Aalto University.
Ontario Ministry of Health and Long-Term Care (2012). Performance improvement and compliance branch inspection protocol. Dining: Observation.
Ontario Ministry of Health and Long-Term Care. (2014). Home, Community and Residential Care Services Seniors' Care: Long-Term Care Homes. http://www.health.gov.on.ca/en/public/programs/ltc/15_facilities.aspx
Ringard, A., Sagan, A., Sperre Saunes, I., & Lindahl, A. K. (2013). Norway. Health system review. Health Systems in Transition, 15(1), 1–182. http://www.euro.who.int/__data/assets/pdf_file/0018/237204/HiT-Norway.pdf..
Sherrington, C. J., Whitney, C., Lord, S. R., Herbert, R. D., Cumming, R. G., & Close, J. C. T. (2008). Effective exercise for the prevention of falls: A systematic review and meta-analysis. Journal of the American Geriatric Society, 56(12), 2234–2243. doi:10.1111/j.1532-5415.2008.02014.
Simmins, S. F., & Reuben, D. (2000). Nutritional intake monitoring for nursing home residents: A comparison of staff documentation, direct observation, and photography methods. Journal of American Geriatric Society, 48(2), 209–213.
Slama, C. A., & Bergman-Evans, B. (2000). A troubling triangle. An exploration of loneliness, helplessness, and boredom of residents of a veterans home. Journal of Psychosocial Nursing and Mental Health Services, 38(12), 36–43.
Stolt, R., Blonquist, P., & Winblas, U. (2011). Privatization of social services: Quality differences in Swedish elderly care. Social Science & Medicine, 72(4), 560–567.
Storm, P. (2013) Care work in Swedish nursing homes. In: A. Hujala, S. Rissanen, & S. Vihma (Eds.), Designing Well-being in Elderly Care Homes (pp. 148–161). Helsinki: Aalto University.
Szebehely, M. and Meagher, G. (2013). Four Nordic countries-four responses to the international trend of marketisation. In G. Meagher, & M. Szebehely (Eds.), Marketization in Nordic Eldercare: A Research Report on Legislation, Oversight, Extent and Consequences (pp. 241–284). Stockholm: Stockholm University.
The King’s Fund (2014) Commission on the Future of Health and Social Care in England. A new settlement for health and social care Interim Report (K. Barker, Chair) London: The King’s Fund. http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/commission-interim-new-settlement-health-social-care-apr2014.pdf..
Waerness, K. (1984). The rationality of caring. Economic and Industrial Democracy, 5(2), 185–211.
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Pat Armstrong declares no conflict of interest.
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As there is no person or personal data appearing in the paper, there is no one from whom a permission should be obtained in order to publish personal data.
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This research received ethics approval from York University as well as from specific homes studied, where this was required.
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This paper is a product of a seven-year team project on ‘Re-imagining Long-term Residential Care: An International Study of Promising Practices’ funded by the Social Sciences and Humanities Research Council of Canada (File# 412–2010-1004: Pat Armstrong, Principal Investigator), with additional funding from the European Research Area in Ageing 2 project for a study on ‘Healthy Ageing In Residential Places’. Primary data for this paper comes from the team work and all 26 of the faculty from our team participating in the sites visits, as well as 10 students and additional academics in Norway, Germany, Sweden and the UK. They deserve full credit although none of them are responsible for my analysis. A list of team members can be found on our website www.yorku.ca/reltc
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Armstrong, P. Balancing the Tension in Long-Term Residential Care. Ageing Int 43, 74–90 (2018). https://doi.org/10.1007/s12126-017-9284-8
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DOI: https://doi.org/10.1007/s12126-017-9284-8