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      Who is Looking After Mom and Dad? Unregulated Workers in Canadian Long-Term Care Homes*

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          Abstract

          Older adults living in residential long-term care or nursing homes have increasingly complex needs, including more dementia than in the past, yet we know little about the unregulated workforce providing care. We surveyed 1,381 care aides in a representative sample of 30 urban nursing homes in the three Canadian Prairie provinces and report demographic, health and well-being, and work-related characteristics. Over 50 per cent of respondents were not born in Canada and did not speak English as their first language. They reported moderately high levels of burnout and a strong sense of their work’s worth. Few respondents reported attending educational sessions. This direct caregiver workforce is poorly understood, has limited training or standards for minimum education, and training varies widely across provinces. Workplace characteristics affecting care aides reflect factors that precipitate burnout in allied health professions, with implications for quality of care, staff health, and staff retention.

          RÉSUMÉ

          Les personnes âgées recevant soins de longue durée ou soins infirmiers résidentiels ont des besoins de plus en plus complexes, y compris exhibitant plus de la démence que dans le passé, mais on ne connait que peu en ce qui concerne la population non réglementée qui fournit leurs soins. Nous avons interrogé 1 381 aides dans un échantillon représentatif de 30 maisons de soins infirmiers en milieu urbain dans les trois provinces des Prairies canadiennes afin de signaler des caractéristiques démographiques, la santé et le bien-être, et des caractéristiques liées au travail. Plus de 50 pour cent des répondants ne sont pas nés au Canada et ne parlaient pas l'anglais comme leur première langue. Ils ont signalé des niveaux d'épuisement modérément élevés et un sentiment fort de la valeur de leur travail. Peu de répondants ont déclaré avoir participé à des séances de formation. Cette main d'oeuvre composée de fournisseurs de soins directs est mal comprise, leur formation et les normes pour l'emploi sont limitées, et la formation varie considérablement d'une province à l'autre. Les caractéristiques du lieu de travail qui touchent aux aidants reflètent des facteurs qui favorisent l'épuisement professionnel dans les professions connexes de la santé, avec des implications pour la qualité des soins, pour la santé du personnel et pour leur rétention.

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          Most cited references21

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          Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population

          Background The validity of survey-based health care utilization estimates in the older population has been poorly researched. Owing to data protection legislation and a great number of different health care insurance providers, the assessment of recall and non-response bias is challenging to impossible in many countries. The objective of our study was to compare estimates from a population-based study in older German adults with external secondary data. Methods We used data from the German KORA-Age study, which included 4,127 people aged 65–94 years. Self-report questions covered the utilization of long-term care services, inpatient services, outpatient services, and pharmaceuticals. We calculated age- and sex-standardized mean utilization rates in each domain and compared them with the corresponding estimates derived from official statistics and independent statutory health insurance data. Results The KORA-Age study underestimated the use of long-term care services (−52%), in-hospital days (−21%) and physician visits (−70%). In contrast, the assessment of drug consumption by postal self-report questionnaires yielded similar estimates to the analysis of insurance claims data (−9%). Conclusion Survey estimates based on self-report tend to underestimate true health care utilization in the older population. Direct validation studies are needed to disentangle the impact of recall and non-response bias.
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            Systematic review of studies of staffing and quality in nursing homes.

            To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes. Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified. There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing. A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.
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              Beyond the 'iron lungs of gerontology': using evidence to shape the future of nursing homes in Canada.

              Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.
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                Author and article information

                Journal
                Can J Aging
                Can J Aging
                CJG
                Canadian Journal on Aging
                Cambridge University Press (New York, USA )
                0714-9808
                1710-1107
                March 2015
                : 34
                : 1
                : 47-59
                Affiliations
                [1 ]Faculty of Nursing, University of Alberta
                [2 ]Ottawa Hospital Research Institute and School of Nursing, University of Ottawa
                [3 ]Department of Family Medicine, University of Calgary
                Author notes

                The authors thank the care aides for their participation and their managers for providing the time to participate. We also thank Youn Young Choi and Sung Hyun Kang for data management and analysis, Christian Rochefort for assistance with interpreting Quebec data, and Ferenc Toth for assistance with preparation of the manuscript.

                []La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Carole A. Estabrooks, R.N., Ph.D. Faculty of Nursing University of Alberta 11405 87 Avenue Edmonton (AB) T6G 1C9 ( carole.estabrooks@ 123456ualberta.ca )
                Article
                S0714980814000506 00050
                10.1017/S0714980814000506
                4413363
                25525838
                0acdca9b-9b89-49df-9a33-9f80fb2464bc
                © Canadian Association on Gerontology 2014

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 August 2013
                : 17 March 2014
                Page count
                Pages: 13
                Categories
                Articles

                aging,care aides,long-term care,nursing homes,personal care workers,unregulated healthcare workforce,vieillissment,aides de soins,soins a longue durée,main d'oeuvre de services de santé non-règlementé

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