Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-10T15:08:07.691Z Has data issue: false hasContentIssue false
  • English
  • Français

Principles of good care for long-term care facilities

Published online by Cambridge University Press:  02 July 2010

Maggie C. Gibson ,
Mary W. Carter ,
Edward Helmes  and
Anna-Karin Edberg
Maggie C. Gibson*
Affiliation:
St. Joseph's Health Care and Lawson Health Research Institute, London, Ontario, Canada
Mary W. Carter
Affiliation:
Center on Aging, Department of Community Medicine, West Virginia University, Morgantown, West Virginia, U.S.A.
Edward Helmes
Affiliation:
Department of Psychology, James Cook University, Townsville, Queensland, Australia
Anna-Karin Edberg
Affiliation:
Department of Health Sciences, Lund University, Lund, Sweden
*
Correspondence should be addressed to: Dr. Maggie Gibson, Veterans Care Program, Parkwood Hospital, St. Joseph's Health Care London, 801 Commissioners Road East, London, Ontario, Canada, N6C 5J1. Phone: 519-685-4292 ext. 42708; Fax: 519-685-4031. Email: maggie.gibson@sjhc.london.on.ca.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care Facilities aims to support and strengthen mental health services in the long-term care sector. The purpose of this paper is to identify broad principles that may underpin the drive towards meeting the mental health needs of residents of long-term care facilities and their families, as well as to enhance the overall delivery of residential care services.

Methods: Principles of good care are extrapolated from an analysis of international consensus documents and existing guidelines and discussed in relation to the research and practice literature.

Results: Although the attention to principles is limited, this review reveals an emerging consensus that: (1) residential care should be situated within a continuum of services which are accessible on the basis of need; (2) there should be an explicit focus on quality of care in long-term care facilities; and (3) quality of life for the residents of these facilities should be a primary objective. We take a broad perspective on the challenges associated with actualizing each of these principles, taking into consideration key issues for families, facilities, systems and societies.

Conclusions: Recommendations for practice, policy and advocacy to establish an internationally endorsed principles-based framework for the evolution and development of good mental health care within long-term care facilities are provided.

Keywords

agedinstitutionalizedcontinuum of carequality of carequality of liferesidential caremental healthphilosophy of care
Type
Focus on mental health issues in long-term-care homes
Information
International Psychogeriatrics , Volume 22 , Special Issue 7: Focus on mental health issues in long-term-care homes , November 2010 , pp. 1072 - 1083
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agüero-Torres, H., von Strauss, E., Viitanen, M., Winblad, B. and Fratiglioni, L. (2001). Institutionalization in the elderly: the role of chronic diseases and dementia: cross-sectional and longitudinal data from a population-based study. Journal of Clinical Epidemiology, 54, 795–801.CrossRefGoogle ScholarPubMed
Alzheimer's Association (2006). Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes. Chicago: Alzheimer's Association. Available at: http://www.alz.org/national/documents/brochure_DCPRphases1n2.pdf.Google Scholar
Alzheimer's Australia (2009). Making Choices Future Dementia Care: Projections, Problems and Preferences. Australia: Alzheimer's Australia. Available at: http://www.alzheimers.org.au/upload/Dementia23April2009.pdf.Google Scholar
American Geriatrics Society and American Association for Geriatric Psychiatry (2003). Consensus statement on improving the quality of mental health care in U.S. nursing homes: management of depression and behavioral symptoms associated with dementia. Journal of the American Geriatrics Society, 51, 1287–1298.CrossRefGoogle Scholar
American Medical Directors Association (2003). Depression Clinical Practice Guideline. Columbia, MD: American Medical Directors Association.Google Scholar
Aminoff, B. Z. and Adunsky, A. (2005). Dying dementia patients: too much suffering, too little palliation. American Journal of Hospice and Palliative Medicine, 22, 344.CrossRefGoogle ScholarPubMed
Aria, Y. (1993). Quality of care in private nursing homes: improving inspection. International Journal of Health Care Quarterly Assurance, 6, 13–16.Google Scholar
Barrientos, A., Gorman, M. and Heslop, A. (2003). Old age poverty in developing countries: contributions and dependence in later life. World Development, 31, 555–570.CrossRefGoogle Scholar
Brodaty, H., Draper, B. and Low, L. F. (2003). Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work. Journal of Advanced Nursing, 44, 583–590.CrossRefGoogle ScholarPubMed
Brodsky, J., Habib, J. and Siegel, B. (2002). Lessons for Long-Term Care Policy: The Cross-Cluster Initiative on Long-Term Care. Geneva: World Health Organization. Available at: http://whqlibdoc.who.int/hq/2002/WHO_NMH7CCL_02.1.pdf.Google Scholar
Brodsky, J., Habib, J. and Hirschfeld, M. (2003). Long-Term Care in Developing Countries: Ten Case-Studies. Geneva: World Health Organization. Available at: http://whqlibdoc.who.int/publications/2003/9241562498.pdf.Google Scholar
Chu, L. W. and Chi, I. (2008). Nursing homes in China. Journal of the American Medical Directors Association, 9, 237–243.CrossRefGoogle ScholarPubMed
Conn, D. et al. (2006). National Guidelines for Seniors’ Mental Health: The Assessment and Treatment of Mental Health Issues in Long Term Care Homes (Focus on Mood and Behaviour Symptoms). Toronto: Canadian Coalition for Seniors Mental Health. Available at: http://www.ccsmh.ca/en/guidelinesUsers.cfm.Google Scholar
Dellefield, M. E. (2006). Interdisciplinary care planning and the written care plan in nursing homes: a critical review. The Gerontologist, 46, 128–133.CrossRefGoogle ScholarPubMed
Dewing, J. (2004). Concerns relating to the application of frameworks to promote person-centredness in nursing with older people. Journal of Clinical Nursing, 13, 39–44. doi: 10.1111/j.1365-2702.2004.00925.x.CrossRefGoogle Scholar
Edvardsson, D., Winblad, B. and Sandman, P. O. (2008). Person-centred care of people with severe Alzheimer's disease: current status and ways forward. Lancet Neurology, 7, 362–367. doi: 10.1016/S1474-4422(08)70063-2.CrossRefGoogle ScholarPubMed
Falk, H., Persson, L. O. and Wijk, H. (2007). A psychometric evaluation of a Swedish version of the Quality of Life in Late-Stage Dementia (QUALID) scale. International Psychogeriatrics, 19, 1040–1050. doi: 10.1017/S1041610207005777.CrossRefGoogle ScholarPubMed
Franke, A. L. (2003). Palliative Care for Terminally Ill Patients in the Netherlands. The Hague: Ministry of Health, Welfare and Sport. Available at: http://www.minvws.nl/en/folders/staf/palliative_care_for_terminally_ill_patients_in_the_netherlands.asp.Google Scholar
Franklin, L. L., Ternestedt, B. M. and Nordenfelt, L. (2006). Views on dignity of elderly nursing home residents. Nursing Ethics, 13, 130–146.CrossRefGoogle ScholarPubMed
Fuh, J. L. and Wang, S. J. (2006). Assessing quality of life in Taiwanese patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 103–107. doi: 10.1002/gps.1425.CrossRefGoogle ScholarPubMed
Fujisawa, R. and Colombo, F. (2009). The Long-Term Care Workforce: Overview and Strategies to Adapt Supply to a Growing Demand. Paris: OECD Working Paper Series No. 44. Available at: http://www.olis.oecd.org/olis/2009doc.nsf/LinkTo/NT00000F0A/$FILE/JT03261422.PDFGoogle Scholar
Gibson, M. J. (2006). International Perspective on Long-Term Care. AARP Public Policy Institute. Available at: http://assets.aarp.org/www.aarp.org_/cs/gap/ldrstudy_longterm_030507.pdf.Google Scholar
Graham, N. et al. (2003). Reducing the stigma and discrimination against older people with mental disorders: a technical consensus statement. International Journal of Geriatric Psychiatry, 18, 670–678.CrossRefGoogle ScholarPubMed
Hallberg, I. R. (2006). Palliative care as a framework for older people's long-term care. International Journal of Palliative Nursing, 12, 224–229.CrossRefGoogle ScholarPubMed
Hirsch, R. D. (2008). Persons with dementia caught between medicine, care and politics. Zeitschrift fur Gerontologie und Geriatrie: Organ der Deutschen Gesellschaft fur Gerontologie und Geriatrie, 41, 106–116. doi: 10.1007/s00391-008-0535-x.CrossRefGoogle ScholarPubMed
Houser, A., Fox-Grage, W. and Gibson, M. J. (2006). Across the States: Profiles of Long-Term Care and Independent Living. AARP Public Policy Institute. Available at: http://www.aarp.org/research/ppi/ltc/hcbs/articles/d18763_2006_ats.html.Google Scholar
Hsieh, P. C. and Su, H. F. (2007). Retention and attrition of certified care assistants in the long-term care industry from the Taipei area: an interview survey. International Journal of Nursing Studies, 44, 93–104. doi: 10.1016/j.ijnurstu.2005.11.024.CrossRefGoogle ScholarPubMed
Hughes, J. C. (2006). Palliative Care in Severe Dementia. London: Quay Books.Google Scholar
Janes, N., Sidani, S., Cott, C. and Rappolt, S. (2008). Figuring it out in the moment: a theory of unregulated care providers’ knowledge utilization in dementia care settings. Worldviews on Evidence-Based Nursing, 5, 13–24. doi: 10.1111/j.1741-6787.2008.00114.x.CrossRefGoogle Scholar
Josefsson, K., Sonde, L., Winblad, B. and Robins Wahlin, T. B. (2007). Work situation of registered nurses in municipal elderly care in Sweden: a questionnaire survey. International Journal of Nursing Studies, 44, 71–82. doi: 10.1016/j.ijnurstu.2005.10.014.CrossRefGoogle ScholarPubMed
Kane, R. A., Lum, T. Y., Cutler, L. J., Degenholtz, H. B. and Yu, T. C. M. H. A. (2007). Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial Green House Program. Journal of the American Geriatrics Society, 55, 832–839.CrossRefGoogle ScholarPubMed
Karlsson, S., Edberg, A. K., Westergren, A. and Hallberg, I. R. (2008). Functional ability and health complaints among older people with a combination of public and informal care vs. public care only. Scandinavian Journal of Caring Sciences, 22, 136–148.CrossRefGoogle ScholarPubMed
Lakdawalla, D. N. and Schoeni, R. F. (2003). Is nursing home demand affected by the decline in age differences between spouses? Demographic Research, 8, 279–304.CrossRefGoogle Scholar
Lewin, G. et al. (2008). The Home Independence Program. Geriaction, 26, 13–21.Google Scholar
Macdonald, A. J. D. and Woods, R. T. (2005). Attitudes to dementia and dementia care held by nursing staff in UK “non-EMI” care homes: what difference do they make? International Psychogeriatrics, 17, 383–391.CrossRefGoogle Scholar
Martikainen, P. et al. (2009). Gender, living arrangements, and social circumstances as determinants of entry into and exit from long-term institutional care at older ages: a 6-year follow-up study of older Finns. The Gerontologist, 49, 34–45.CrossRefGoogle Scholar
Matsui, T. et al. (2006). Determinants of the quality of life in Alzheimer's disease patients as assessed by the Japanese version of the Quality of Life-Alzheimer's Disease Scale. Dementia and Geriatric Cognitive Disorders, 21, 182–191. doi: 10.1159/000090744.CrossRefGoogle ScholarPubMed
McCarthy, M., Addington-Hall, J. and Altman, D. (1997). The experience of dying with dementia: a retrospective study. International Journal of Geriatric Psychiatry, 12, 404–409.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
McCormack, B. and McCance, T. V. (2006). Development of a framework for person-centred nursing. Journal of Advanced Nursing, 56, 472–479. doi: 10.1111/j.1365-2648.2006.04042.x.CrossRefGoogle ScholarPubMed
Ministry of Health and Social Affairs (2001). Social Services Act (SFS: 453). Stockholm: Ministry of Health and Social Affairs.Google Scholar
Mitchell, S. L., Morris, J. N., Park, P. S. and Fries, B. E. (2004). Terminal care for persons with advanced dementia in the nursing home and home care settings. Journal of Palliative Medicine, 7, 808–816.CrossRefGoogle ScholarPubMed
Mor, V. et al. (2007). Prospects for transferring nursing home residents to the community. Health Affairs, 26, 1762–1771.CrossRefGoogle ScholarPubMed
Morrison, R. S. and Siu, A. L. (2000). A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. Journal of Pain and Symptom Management, 19, 240–248.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (2007). Dementia: The NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care. National Clinical Practice Guideline Number 42. London: Alden Press.Google Scholar
NSW Department of Health (2006). Guidelines for Working With People With Challenging Behaviours in Residential Aged Care Facilities – Using Appropriate Interventions and Minimizing Restraints. North Sydney: NSW Department of Health. Available at: http://www.health.nsw.gov.au/policies/gl/2006/GL2006_014.html.Google Scholar
OECD (2005). The OECD Health Project Long-term Care for Older People. OECD Social Issues/Migration/Health, 11, 1–140.Google Scholar
OECD (2007). Society at a Glance: OECD Social Indicators 2006. OECD Social Issues/Migration/Health, 3, 1–118.Google Scholar
Ploeg, J. et al. (2007). Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders. Worldviews on Evidence-Based Nursing, 4, 210–219. doi: 10.1111/j.1741-6787.2007.00106.x.CrossRefGoogle ScholarPubMed
Polivka, L. (2001). Globalization, population, aging, and ethics. Journal of Aging and Identity, 6, 147–163.CrossRefGoogle Scholar
Polivka, L. and Borrayo, E. A. (2002). Globalization, population aging, and ethics. Part II: toward a just global society. Journal of Aging and Identity, 7, 195–211.CrossRefGoogle Scholar
Prabhu, R. D. (1996). Mushrooming nursing homes [Letter]. National Medical Journal of India, 9, 48–49.Google ScholarPubMed
Rachlis, M. (2000). The Hidden Costs of Privatization: An International Comparison of Community and Continuing Care. Vancouver: Canadian Centre for Policy Alternatives, BC Office. Available at: http://cupe.ca/updir/Hidden%20Costs%20of%20Privatization%20.doc.Google Scholar
Raikkonen, O., Perala, M. L. and Kahanpaa, A. (2007). Staffing adequacy, supervisory support and quality of care in long-term care settings: staff perceptions. Journal of Advanced Nursing, 60, 615–626. doi: 10.1111/j.1365-2648.2007.04443.x.CrossRefGoogle ScholarPubMed
Ransom, S. (2000). Eden Alternative: The Texas Project. San Marcos, TX: Institute for Quality Improvement in Long-Term Health Care, Southwest Texas State University.Google Scholar
Richardson, S. and Martin, B. (2004). The Care of Older Australians: A Picture of the Residential Aged Care Workforce. Adelaide: National Institute of Labour Studies, Flinders University. Available at: http://nils.flinders.edu.au/assets/publications/Final_Report_ISBN_inc.pdf.Google Scholar
Sachs, G. A., Shega, J. W. and Cox-Hayley, D. (2004). Barriers to excellent end-of-life care for patients with dementia. Journal of General Internal Medicine, 19, 1057–1063.CrossRefGoogle ScholarPubMed
Sampson, E. L., Ritchie, C. W., Lai, R., Raven, P. W. and Blanchard, M. R. (2005). A systematic review of the scientific evidence for the efficacy of a palliative care approach in advanced dementia. International Psychogeriatrics, 17, 31–40.CrossRefGoogle ScholarPubMed
Sandberg, J., Lundh, U. and Nolan, M. R. (2001). Placing a spouse in a care home: the importance of keeping. Journal of Clinical Nursing, 10, 406–411.CrossRefGoogle Scholar
Sandberg, J., Nolan, M. R. and Lundh, U. (2002). “Entering a New World”: empathic awareness as the key to positive family/staff relationships in care homes. International Journal of Nursing Studies, 39, 507–515.CrossRefGoogle ScholarPubMed
Shin, H. Y. (2006). A preliminary study on the Korean version of Quality of Life-Alzheimer's Disease (QOL-AD) scale in community-dwelling elderly with dementia. Journal of Preventive Medicine and Public Health, 39, 243–248.Google Scholar
Sikorska-Simmons, E. and Wright, J. D. (2007). Determinants of resident autonomy in assisted living facilities: a review of the literature. Care Management Journals, 8, 187–193.CrossRefGoogle ScholarPubMed
St. John, P. D., Montgomery, P. R., Kristjansson, B. and McDowell, I. (2002). Cognitive scores, even within the normal range, predict death and institutionalization. Age and Ageing, 31, 373–378.CrossRefGoogle ScholarPubMed
Street, D., Burge, S., Quadagno, J. and Barrett, A. (2007). The salience of social relationships for resident well-being in assisted living. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 62, S129–134.CrossRefGoogle ScholarPubMed
Thomas, W. H. (2004). What are Old People For? Acton, MA: Vander, Wyk and Burnham.Google Scholar
United Nations (1991). Principles for Older Persons. New York: United Nations. Available at: http://www.integranet.un.org/esa/socdev/ageing/un_principles.html.Google Scholar
United Nations (2002). Madrid International Plan of Action on Aging (MIPAA). New York: United Nations. Available at: http://www.un.org/esa/socdev/ageing/madrid_intlplanaction.html.Google Scholar
United Nations (2003). Major Trends Affecting Families: a Background Document. New York: United Nations. Available at: http://www.un.org/esa/socdev/family/Publications/mtrendsbg.htm.Google Scholar
Weiner, M. F. et al. (2000). The Quality of Life in Late-stage Dementia (QUALID) scale. Journal of the American Medical Directors Association, 1, 114–116.Google ScholarPubMed
Wikler, D. and Hirschfeld, M. (2002). Ethical Choices in Long-Term Care: What Does Justice Require? Geneva: World Health Organization. Available at: http://www.who.int/mediacentre/news/notes/ethical_choices.pdf.Google Scholar
World Health Organization (1997). Organization of Care in Psychiatry of the Elderly: A Technical Consensus Statement. Geneva: World Health Organization. Available at: http://www.who.int/mental_health/media/en/19.pdf.Google Scholar
World Health Organization (2002). Active Ageing: A Policy Framework. Geneva: World Health Organization. Available at: http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf.Google Scholar
Wu, B., Mao, Z. and Xu, Q. (2008). Institutional care for elders in rural China. Journal of Aging and Social Policy, 20, 218–239.CrossRefGoogle ScholarPubMed
Wu, B., Carter, M. W., Goins, R. T. and Cheng, C. (2005). Emerging services for community-based long-term care in urban China: a systematic analysis of Shanghai's community-based agencies. Journal of Aging and Social Policy, 17, 37–60.CrossRefGoogle Scholar
Zimmerman, S. et al. (2005). Attitudes, stress, and satisfaction of staff who care for residents with dementia. The Gerontologist, 45 (Special Issue 1), 96–105.CrossRefGoogle ScholarPubMed