There is widespread scholarly recognition that migrant long-term care (LTC) workers experience relatively poorer work conditions than local LTC workers. We focus here on the ways in which migration and employment regulation intersect in formal LTC markets to produce working conditions for migrant workers. Drawing on cross-national comparisons between Australia, the Netherlands and the United Kingdom we explore: firstly, the forms of employment regulation that can protect migrant LTC workers or expose them to additional risks; and secondly, how migration regulation can work to amplify employment protection gaps for certain groups of migrant workers. We find that while historically there have been better employment protections in Australia and the Netherlands, the reshaping of work in all three LTC systems creates a context within which migration regulation can exacerbate the risks of precarious work for migrant workers and for those on temporary visas in particular.

Older adults who have reduced decision-making capacity and no family or friends to compensate for these deficiencies are known as unbefriended and require a public guardian. The purpose of this study was to review the peer-reviewed and grey literature to determine the scope of available research on unbefriended older adults in Canada and the United States. We found limited research examining unbefriended older adults. No Canadian studies or reports were located. Unbefriended older adults were childless or had fewer children, were more cognitively impaired, and were older than older adults who were not unbefriended. These findings demonstrate a stark scarcity of studies on unbefriended older adults. Research is urgently needed using standardized data collection of guardianship status in order to enable studies of the prevalence of public guardianship in Canada.

Introduction: In light of recent local initiatives aimed at improving emergency department (ED) patient flow, we sought to characterize how patients aged 65 and older who reside in long term care (LTC) facilities utilize the services of the EDs in Regina, Saskatchewan as compared to an age-matched comparison of community dwelling individuals. Methods: A retrospective chart review was performed with a convenience sample of the first 50 patients who presented to each ED at both hospitals in Regina starting January 1, 2012 for each population. Two separate patient populations were included: those who reside in the health region run LTC facilities and those who live in the community. We abstracted data from a variety of different clinical, demographic and administrative parameters. Results: The charts of 100 patients were reviewed for the LTC population (54 females, mean age 82.6) and 99 patients for the community dwelling population (55 females, mean age 77.3). The CTAS distribution for the LTC patients was found to be CTAS 1: 5%, CTAS 2: 9%, CTAS 3: 43%, CTAS 4: 33% and CTAS 5: 10%. For the community dwelling individuals, the distribution was CTAS 1: 1%, CTAS 2: 21%, CTAS 3: 44%, CTAS 4: 22%, CTAS 5: 10%. This is a significantly different distribution (p = 0.047). From the LTC population, we found that 50% of patients were admitted, with 46% being discharged and 4% leaving without being seen. Furthermore, we also noted that 75% of patients were brought to the ED by EMS. From the community dwelling population, we noted that 43% of patients were admitted, with 55% being discharged and 1% leaving without being seen. This population used EMS services 41% of the time. With respect to length of stay, LTC patients had a mean duration of 5.7 (±4.3 hours) compared to 4.8 (±4.0) hours for the non-LTC population (p=0.111). Conclusion: Our findings suggest that the highest volume of acuity for the LTC patients falls within the CTAS 3 or 4 categories whereas there is a higher proportion of CTAS 2 acuity patients in the community dwelling population. Exactly half of our LTC sample was admitted as compared to 43% of the community population. The LTC population also required EMS services for a considerably higher proportion of their presentations to the ED (75% compared to 41%). It is our intent that the findings of this study will help guide future quality improvement initiatives.

Heart failure (HF) is common among long-term care (LTC) residents, and may account for 40 per cent of acute-care transfers. Canadian Cardiovascular Society HF guidelines endorse standard therapies; yet LTC residents are less likely to receive treatment. This qualitative study employed focus groups to explore perceptions, from 18 physicians and nurse practitioners in three Ontario homes, on HF care practices and challenges. For example, participants reported challenges with HF diagnostic skills and procedural knowledge. They also identified the need for interprofessional collaboration and role clarification to improve HF care and outcomes. To address these challenges, multimodal interventions and bedside teaching are required. Leadership was viewed as essential to improve HF care. Several concerns arose regarding knowledge gaps and clinical deficits among primary-care providers who manage heart failure in LTC residents. Multimodal, clinically focused educational and interprofessional solutions are needed to improve HF care in long-term care.

Background: The study was designed to examine the 30- and 90-day mortality and hospitalization rates among nursing facility (NF) residents in the affected areas of Louisiana and Mississippi following Hurricane Katrina and to assess the rate of significant posthurricane functional decline.

Methods: A secondary data analysis was conducted using Medicare claims merged with NF resident data from the Minimum Data Set. Thirty- and 90-day mortality and hospitalization rates for long-stay (>90 days) residents residing in 141 at-risk NFs during Hurricane Katrina were compared to rates for residents residing at the same facilities during the same time period in prior nonhurricane years (2003 and 2004). Functional decline was assessed as a 4+ drop in function using a 28-point Minimum Data Set Activities of Daily Living Scale.

Results: There were statistically significant differences (all P < .0001) in mortality, hospitalization, and functional decline among residents exposed to Hurricane Katrina. At 30 days, the mortality rate was 3.88% among the exposed cohort compared with 2.10% and 2.28% for residents in 2003 and 2004, respectively. The 90-day mortality rate was 9.27% compared with 6.71% and 6.31%, respectively. These mortality differences translated into an additional 148 deaths at 30 days and 230 deaths at 90 days. The 30-day hospitalization rate was 9.87% compared with 7.21% and 7.53%, respectively. The 90-day hospitalization rate was 20.39% compared with 18.61% and 17.82%, respectively. Finally, the rate of significant functional decline among survivors was 6.77% compared with 5.81% in 2003 and 5.10% in 2004.

Conclusions: NF residents experienced a significant increase in mortality, hospitalization, and functional decline during Hurricane Katrina.

(Disaster Med Public Health Preparedness. 2010;4:S28-S32)

In 2010, approximately 500,000 Canadians suffered from a dementia-related illness. The number of sufferers is estimated to double in about 25 years. Due to this growing demographic, dementia (most frequently caused by Alzheimer’s disease) will increasingly have a significant impact on our aging community and their caregivers. Dementia is associated with challenging behaviours such as agitation, wandering, and aggression. Care providers must find innovative strategies that facilitate the quality of life for this population; moreover, such strategies must value the individual person. Social commitment robots – designed specifically with communication and therapeutic purposes – provide one means towards attaining this goal. This paper describes a study in which Paro (a robotic baby harp seal) was used as part of a summer training program for students. Preliminary conclusions suggest that the integration of social commitment robots may be clinically valuable for older, agitated persons living with dementia in long-term care settings.

Survivorship of patients placed into long-term care facilities within the Regional Municipality of Hamilton-Wentworth was studied over a seven-year period from 1980 to 1987. All patients had been assessed prior to placement by the Placement and Coordination Service and their computer files served as the data base for this study. Over the seven years, 25 per cent of patients died in each of nursing homes, homes for the aged and lodging homes and over 50 per cent of patients died after being placed in chronic care hospitals. Approximately 10 per cent of the deaths occurred in the first year after placement in the lodging homes, homes for the aged and nursing homes, whereas 25 per cent died in this time in chronic care beds. Survivorship rates of all patients combined differed significantly for males compared with females, but were not significantly different for variables such as age at time of placement, marital status, ambulation, living arrangement, previous location of community versus institutions, and agreement between recommended and final placement. Client's memory at time of placement was associated with survivorship in a nursing home: males with “no recall” and females with “marked confusion” and “no recall” survived longer than those with “normal” memory.

On January 1, 1978, a new Long Term Care Program was introduced in British Columbia. Five levels of care are offered, any one of which may be provided at home or in a facility. This paper presents data from a longitudinal study of Program clients (N = 3516) in two health unit areas, one urban, one semi-rural. The period of analysis is five years from admission. By the end of the five years, 40.2 percent of clients had died; 35.0 percent were still in the Program; 24.7 percent had been discharged alive and were still alive. This paper focuses on the decedents.

It was established that approximately half of the males and half of those aged 75 or over at admission were deceased within five years of admission. Regardless of level of care at admission, at least one-third had died in the five year period. More than one-third of decedents did not change level or location of service prior to death.

While these data may assist care providers in identifying high risk clients, probably the most provocative finding was the similarity in the proportion and pattern of deaths among new clients admitted to care at home and those admitted to facility.

A survey conducted amongst 2,3 72 patients of Quebec chronic care hospitals and nursing homes confirms a high rate of restraints usage. There are differences between those centres in their utilization rate and models employed. It seems that acute care hospitals are also using frequently those coercive methods for their patients aged 65 years and older. Restraints are currently used without any written prescription in the patient's chart.