Empowering Staff to Overcome Challenges in Long-Term Care

In this issue of Annals of Long Term Care: Clinical and Aging® (ALTC), our feature articles discuss unique challenges faced in the long-term care (LTC) facility and present strategies for overcoming them. A common theme is the importance of effective communication, training, and empowering of staff members to ensure the effective integration of new practices and procedures into the daily activities of the facility.

Amy Wilson, MS, RT(R), RDMS, RVTv, and colleagues examined the benefits, challenges, and costs associated with implementation of bladder ultrasound scanners into the nursing home setting. The authors present qualitative and descriptive findings of a 14-month study of four nursing homes, in collaboration with a Midwestern university, that implemented bladder ultrasound scanning technology in their facilities. Knowledge and attitudes of nursing home staff and residents about urinary incontinence were assessed through pre- and post-intervention surveys and patient questionnaires. The authors also collected feedback about the challenges involved with integrating bladder scanning technology into routine practice. Within the context of this study, the authors discuss implementation science alongside the constructs necessary for the incorporation of new technology and evidence-based research into established practice. In addition, the cost impact of new technology integration is addressed in order to arrive at strategies for optimizing health-related quality-of-life outcomes for residents in the nursing home setting. The data reported should serve to help researchers and practitioners better understand integration of evidence-based research and technology into nursing homes and begin to fill a gap in the literature as pertains to implementation science in nursing homes. The authors stress a focus on education, process, culture, and cost when integrating new technology or evidence-based research into nursing home settings, while ensuring that residents are given a greater voice in their care.

In another report, researchers investigated the outcomes of a transformation in dining culture at a LTC community from traditional, institutional meals to resident-centered meals and relational dining. Kate Ducak, MA, CPG, et al. conducted dining room observations; interviews with leadership, staff, residents, and family members; and review of relevant resident-related documents. The authors report three themes that arose from their evaluations: that a ‘recipe for success’ comprised of key approaches are needed to make changes in LTC toward a social model of care; that LTC facilities must go beyond resident-centered dining to relational meals in order to make residents truly feel at home; and that change is not without its challenges, but practical solutions can be implemented to overcome them. The lessons from this case study can be used in other LTC homes to improve the health and quality of life of persons living, working, and visiting by enhancing the mealtime experience.

A unique challenge faced in LTC is sexually disinhibited behaviors, which can occur in up to 25% of patients with dementia. This behavior is extremely disruptive not only to the caregivers of the patient but to other residents as well. Anand Beri, MBBS, MRCPsych, MSc (Lon), and coworkers report a case of an elderly patient with dementia who exhibited inappropriate sexual behavior in an LTC setting and review several classes of drug that have been used to control these behaviors as well as the risks that are associated with these treatments, especially in older adult populations. The authors also review the approaches that can be taken by LTC staff in response to inappropriate sexual behaviors.

This issue also features Part 2 of our “Ask the Expert” with epilepsy specialist Robert T. Wechsler, MD, PhD, FAAN. Dr. Wechsler discusses how prescribers choose which drug to start in older adults with epilepsy, the surgical options available for treating epilepsy, what to do when medical management has failed, and the current limitations and challenges of treating epilepsy in older adults. This two-part series serves as a useful resource for caretakers working with older adults with epilepsy in the LTC setting.

The articles in this month’s issue highlight the importance of a shared vision among facility leadership and staff to ensure consistency and quality of care, especially when launching new program initiatives and implementing strategies to tackle challenges in LTC.