Working Conditions Supporting Person-Centered Care of Persons Living with Dementia in Long-Term Care Homes

Abstract The COVID-19 pandemic has underscored the importance of person-centered dementia care and working conditions that support such care in long-term care (LTC) home settings. Personal support workers (PSWs), known also as certified nursing assistants, provide the most direct formal care for persons living with dementia. However, little is known about the working conditions that enable person-centered care. Accordingly, the purpose of this study was to examine the working conditions and the impact of those conditions on PSWs in LTC homes. PSWs (N=39) employed at one of five LTC homes in southwestern Ontario, Canada participated in a series of one-hour focus groups before, during, and after Be-EPIC, a person-centred communication training program for formal caregivers of persons living with dementia. Using an interpretive description investigative framework, textual data from focus group conversation transcripts were open-coded into categories. Overarching themes were interpreted inductively. Study credibility was enhanced through investigator triangulation. Three themes emerged related to working conditions of PSWs: dementia care is complex, lack of trained staff to provide person-centered dementia care, and residents’ families are not situated in the residents’ care circle. Four themes emerged related to the impact of current working conditions of PSWs: occupational burnout, poor resident care, frustrated and disengaged families, and PSWs leave their role. The findings offer opportunities for employers to ameliorate working conditions to support person-centered care. We conclude with specific workplace recommendations that respond to the complexity of dementia care and the associated occupational stresses PSWs experience in the current LTC environment.

touchscreen tablet has great potential to support personcentred care. We aimed to support the adoption of tablets for hospitalized people with dementia to connect with families and friends. A patient-oriented research approach was employed to co-produce the toolkit. We are a transdisciplinary team, including a medical student, physicians, nurses, patients, and family partners. We facilitated staff focus groups (n=3), and conducted stakeholders' interviews (n=4) to gain a more comprehensive understanding of users' needs. The sample included ten patients, ten family members, 40 staff members, nurses, care workers, physicians, and unit clerks (n=40). The Consolidated Framework for Implementation Research (CFIR) guided the research design and qualitative analysis. A toolkit was developed based on participants' perspectives on what needs to be in place to support successful adoption. We developed a mobile tablet with one mechanical arm and one leg on wheels. Participants reported impacts: (a) it puts a smile on the patient's face, (b) it alleviates anxiety and worries on both sides, and (c) it reduces responsive behaviors. The conceptual framework CFIR provides helpful guidance in identifying barriers to implementation. Working with users including patient and family partners to explore possible solutions was key to our success. Future research should engage patient and family partners to seek proactive strategies to address obstacles to advance the science of technology implementation.

VOICES FROM THE FRONTLINES IN LONGTERM CARE DURING COVID-19: NARRATIVES OF DIRECT CARE WORKERS Christin Wolf, Andrea Freidus, and Dena Shenk, University of North Carolina at Charlotte, Charlotte, North Carolina, United States
Our study draws from the narratives of 30 staff caring for residents in congregate care communities in central North Carolina from June-September 2020. It is part of phase 2 of an on-going 3-phase rapid qualitative appraisal of workers providing longterm care to older adults with the purpose of disseminating findings to key stakeholders to inform policy, programming, and funding decisions. The 3-phase project involves semi-structured interviews with 60+ participants that were videorecorded using a web-based platform. We report on the emotional and visceral experiences of these direct care workers providing care during the pandemic. We organize the data into four affect categories: fear/anxiety, sadness/grief, anger/frustration, and trauma/stress. The 30 participants include nurses, activities staff, med techs, CNAs, housekeepers, dining staff, chaplains and administrators at nursing homes, assisted living communities, memory care units and continuing care retirement communities. We amplify the voices of these formal caregivers in order to demonstrate how their sensorial and emotive experiences can speak to the human suffering they bore witness to, the underlying ageism that permeates our culture, and the social hierarchy that devalues their labor and their worth as they serve on the frontlines during this unprecedented global pandemic.

WORKING CONDITIONS SUPPORTING PERSON-CENTERED CARE OF PERSONS LIVING WITH DEMENTIA IN LONG-TERM CARE HOMES
Marie Savundranayagam, 1 Susan Docherty-Skippen, 2 and Shalane Basque, 1 1. Western University, London, Ontario,

Canada, 2. Sam Katz Community Health and Aging Research Unit, London, Ontario, Canada
The COVID-19 pandemic has underscored the importance of person-centered dementia care and working conditions that support such care in long-term care (LTC) home settings. Personal support workers (PSWs), known also as certified nursing assistants, provide the most direct formal care for persons living with dementia. However, little is known about the working conditions that enable personcentered care. Accordingly, the purpose of this study was to examine the working conditions and the impact of those conditions on PSWs in LTC homes. PSWs (N=39) employed at one of five LTC homes in southwestern Ontario, Canada participated in a series of one-hour focus groups before, during, and after Be-EPIC, a person-centred communication training program for formal caregivers of persons living with dementia. Using an interpretive description investigative framework, textual data from focus group conversation transcripts were open-coded into categories. Overarching themes were interpreted inductively. Study credibility was enhanced through investigator triangulation. Three themes emerged related to working conditions of PSWs: dementia care is complex, lack of trained staff to provide person-centered dementia care, and residents' families are not situated in the residents' care circle. Four themes emerged related to the impact of current working conditions of PSWs: occupational burnout, poor resident care, frustrated and disengaged families, and PSWs leave their role. The findings offer opportunities for employers to ameliorate working conditions to support person-centered care. We conclude with specific workplace recommendations that respond to the complexity of dementia care and the associated occupational stresses PSWs experience in the current LTC environment.

NATIONAL EARLY WARNING SCORES AND COVID-19 DEATHS IN CARE HOMES: AN ECOLOGICAL TIME SERIES STUDY
Daniel Stow, 1 Robert Barker, 2 Fiona Matthews, 3 and Barbara Hanratty, 3 1. Institute of Health and Society,Newcastle upon Tyne,United Kingdom,2. Newcastle University,Newcastle upon Tyne,United Kingdom,3. Newcastle University,Newcastle upon Tyne,England,United Kingdom Tracking COVID-19 infections in the care home population has been challenging, because of the limited availability of testing and varied disease presentation. We consider whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes. We analysed NEWS measurements from care homes in England (December 2019 to May 2020). We estimated pre-COVID (baseline) levels for NEWS and NEWS components using 80th and 20th centile scores for measurements before March 2020. We used time-series to compare the proportion of above-baseline NEWS to area-matched reports of registered deaths in care home residents from the Office for National Statistics We analysed 29,656 anonymised NEWS from 6,464 people in 480 care home units across 46 local authority areas. From March 23rd to May 20th, there were 5,753 deaths (1,532 involving COVID-19, 4,221 other causes) in corresponding geographical areas. A rise in the proportion of above-baseline NEWS was observed from