Project Background
Why we did this research?
In Nova Scotia, the continuing care sector has been undergoing significant changes. As part of the Continuing Care Strategy, a number of new and replacement homes have been opened over the last five years. These homes include shifts in staff scope of practice and incorporate innovative physical designs (e.g., home-like settings replacing hospital-like wards). In addition to these system-level changes, individual facilities are adopting philosophies that emphasize resident-centered care.
Prompted by these changes, a team of researchers and sector representatives came together to develop a research project to examine the impact of these changes. A review of the literature identified that a transition to resident-centered care, through the use of more home-like environments and new staffing approaches, has the potential to improve delivery of care and address important resident concerns. However, the impact of these innovations on resident quality of life had not been thoroughly assessed, specifically within a Canadian context. To address this gap, the team put together a research proposal to examine the impact of different models of care in Nova Scotia’s publicly funded nursing homes on resident quality of life from the perspectives of residents, family members, and staff.
The proposal was successful and in April 2011 the Care and Construction project began with 4 years of funding from the Canadian Institutes of Health Research (CIHR) and the Nova Scotia Health Research Foundation (NSHRF).
What is This Research About?
The Care and Construction study examines the impact of different models of care, as defined by differences in physical design and staff scope of practice, on resident quality of life within Nova Scotia nursing homes.
The four objectives of this project are:
1) To examine resident quality of life through the residents’ experience with different models of care.
2) To examine resident quality of life through the family’s experience with different models of care.
3) To examine resident quality of life through staff experiences with different models of care.
4) To facilitate the dissemination of knowledge and application of research to strengthen continuing care sectors throughout Canada.
Resident Quality of Life
In developing the research questions for this project, the team chose to focus on resident quality of life as the main outcome. Quality of life can include a number of elements such as perceptions of autonomy, comfort, safety. It can also encompass elements of resident satisfaction and perceptions of quality of care. As a measure of resident quality of life, residents, family, and staff completed the interRAI Survey on Nursing Home Quality of Life ©. The survey was tailored to the different perspectives. Residents responded from their own perspective, family responded based on their perceptions of the experience of the resident (their family member) and staff responded based on their perception of the experiences of all residents living in the home.
Through analysis of the responses, the team identified four components of quality of life that are shared between residents, family, and staff in their assessments of resident quality of life. These factors are:
• Care and Support: Residents have privacy and safety when receiving care, receive service when needed, are treated with dignity and respect, and are supported to live the way they want.
• Autonomy: Residents have the privacy they want, decide when to do things and how to spend their time, and have control over who is in their room.
• Activities: Residents have enjoyable activities to take part in and that keep them mentally active.
• Food: Residents enjoy mealtimes and have variety in their meals.
Models of Care
The project team categorized the differences within the nursing homes as the model of care. The three models of care for the project are New-Full-scope, New-Augmented, and Traditional. These are based on differences in physical design (new household design vs. traditional) and staff approach (based on the variations in scope of practice of the Continuing Care Assistants (CCAs)).
Overview of the model of care
|
|
Physical |
Staff |
|
New – Full-scope
|
New Small, self-contained households |
Full-Scope |
|
New – Augmented |
New Small, self-contained households |
Augmented |
|
Traditional |
Traditional floors/units |
Traditional |
How we did this research?
A variety of data collection methods were used to assess resident quality of life from the three different perspectives. The mix of data collection methods allows the team to balance the inclusion of a large numbers of participants while also examining more in-depth contextual factors. The two main components of the project are the survey of residents, family, and staff and the case study. These components included surveys, interviews, focus groups, participant observation, and activity monitoring.
Twenty-three nursing homes served as study sites for the project. Case studies, surveys with residents and family, follow up interviews with residents, and follow up focus groups with family took place at these study sites. The staff surveys took place at these study sites but were also open to staff from all nursing homes in the province. An additional 36 nursing homes participated in the staff surveys. Most data collection took place throughout 2012, with a follow up staff survey completed in late 2013/early 2014.
|
Survey |
Follow up |
Case study |
Nursing Home Profile |
|
|
23 Study Sites |
||||
|
Residents |
319 |
15 |
6 |
– |
|
Family member |
397 |
21 |
6 |
– |
|
Staff |
442 |
60 |
6 |
– |
|
Senior Administration |
23 |
– |
– |
23 |
|
36 Additional sites |
||||
|
Staff |
420 |
41 |
– |
– |
|
Senior Administration |
– |
– |
– |
34 |
Project Milestones
2011
April: Project received funding from the Canadian Institutes of Health Research & Nova Scotia Research Foundation
June: 1st in-person meeting of the research team at Mount Saint Vincent University (June 17th, 2011)
August: Project receives ethical clearance to conduct staff focus groups
August: Rosecrest communities joins project as collaborator
October: Focus groups with staff completed
2012
January: Project receives ethical clearance to conduct case studies and recruitment begins for the case study
March: Project receives ethical clearance to conduct resident, family member and staff surveys, interviews and focus groups
March: Pretesting of the surveys with residents, family members and staff
April: Research trainee and assistants are hired and trained to support survey data collection and analysis
May – June: Presentations and recruitment of residents, family members and staff to participate in the survey
July: Dr. Janice Keefe interviewed about the project on CTV Morning Live with Heidi Petracek.
August: Data analysis begins
October: First in-depth interviews with residents and focus groups with families
November: Care and Construction Project highlighted for its research partnership at the MSVU Open Doors, Open Knowledge AUCC Luncheon. Click here to see highlights from the event.
November: Presentations of preliminary results from the survey and case study at the NSCA’s Aging Conference in Halifax
November: In-depth interviews with residents and focus groups with families completed.
December: 2nd in-person meeting of the research team at Mount Saint Vincent University
2013
June: Presentation of family perspective on resident quality of life at the Northwood Research Symposium
June: 3rd in-person meeting of the research team at Mount Saint Vincent University
October: Presentation on comparing the resident, family and staff perspectives of resident quality of life at the Canadian interRAI Conference in Ottawa
October: Many presentations on results from the project shared at the Canadian Association on Gerontology Conference in Halifax
October: Presentation on the Case Study methodology presented at the Qualitative Health Research Conference in Halifax
November: Presentation of results at the Gerontological Society of America Conference in New Orleans, LA
November: Workshop for sector representatives held in Halifax in collaboration with Health Association Nova Scotia. Click here to see the final report of the workshop.
November: 1st presentation of results for nursing home residents, family and staff at Ivany Place in Bedford.
December: Recruitment of staff to participate in a follow up survey on nursing home resident quality of life
December: Presentation of results at Windsor Elms Village in Falmouth, NS
2014
January: Presentation of results at The Sagewood in Lower Sackville, NS
February: Presentations of results at Cedarstone and Vimy Court in Truro, NS; at Tideview Terrace in Digby, NS; at Alderwood Rest Home in Baddeck, NS; at Harbourstone in Sydney,
March: Presentations at the Walk with Me…Changing the Culture of Aging in Canada Conference held in Toronto, ON
June: Release of video with study results
June: Presentation of results to union representatives, Dartmouth, NS
June: Panel presentation, Northwood Research Symposium, Dartmouth, NS
September: Keynote address at Excellence in Aging Care Symposium, Fredericton, NS
November: Promoting Employee Engagement and Healthy Workplaces in Long-Term Care workshop held in Truro, NS
December: Article published in Long Term Care Today
December: Celebration Reception and Final In-Person Team Meeting, Halifax, NS
2015