Management challenges faced by administrators at dementia care nursing homes in China

Abstract Currently, more than 10 million Chinese older adults have been diagnosed with dementia, a number that is expected to increase as the population in China rapidly ages. Yet, little research exists on dementia care in Chinese long-term care facilities. Our research addresses this gap in the knowledge-base by examining the challenges nursing home directors encounter as well as the coping strategies they employ to deal with these challenges. Twenty-one facility directors employed by faith-based nursing homes across 14 provinces in China participated in this study. Semi-structured interviews were conducted in respondents’ native language via phone or in person. Most respondents reported a religious affiliation, and about half were female and had been facility directors for more than four years. Two researchers fluent in Mandarin and English coded interview transcripts; thematic analysis was conducted to identify patterns in the data. The results indicated four primary challenges, which pertained to recruiting and retaining nursing staff, funding, lacking support from the government, and conflicts with family members. The coping strategies included obtaining and using external resources such as volunteer visitors, operationalizing personal spiritual beliefs, and providing training to improve skills and empathy among employees. This study contributes to nursing home practice by expanding our knowledge of culturally relevant dementia management strategies in China. Suggestions to address management challenges from a policy and practical perspective include clear and sustainable financial support from the government, staff training, and staff-resident ratio regulations, seeking external resources, and integrating spiritual strategies into problem management and service quality improvement.


LEVERAGING MEDICAL CLAIMS TO PREDICT LONG-TERM CARE TRANSITIONS AMONG OLDER ADULTS IN THE UNITED STATES
Megan Backhaus, 1 An-Ting Jhuang, 1 Ben Griffith, 1 and Lauren Bangerter, 2 1. UnitedHealth Group,Minnetonka,Minnesota,United States,2. OptumLabs,Eden Prairie,Minnesota,United States Most older adults prefer to age in place rather than moving to a long-term care (LTC) facility, but little is known about the factors that predict entry into LTC.This study sought to utilize administrative claims data to understand the predictors of LTC transitions using de-identified claims data from Medicare Advantage members in the UnitedHealth Group Clinical Discovery Database.We investigated LTC transitions of 250,587 adults (Mean age = 77, standard deviation = 7.75) between January 1, 2016 and December 31, 2019.Types of predictors for these transitions include aggregated medical data surrounding chronic conditions and frailty indices, as well as healthcare utilization and demographics in 2016 and 2017.We then fit data of these types to an extreme gradient boosting (XGBoost) model to predict long-term care transitions in 2018 and 2019 (ROCAUC = 0.84, accuracy = 0.84, precision = 0.68, and recall = 0.42).Frailty indicators, such as falls and fractures, mobility problems, dementia, and delirium, as well as osteoporosis are strong predictors of LTC transitions.These findings can be used to design interventions aimed at preventing LTC transitions and enabling older adults to age in place.

LONG-LASTING EFFECTS OF THE PANDEMIC ON OLDER ADULTS' FOOD INSECURITY: THE URGENT NEED FOR ENHANCED SNAP BENEFITS
Lauren Popham, 1 Jane Tavares, 2 and Marc Cohen, 3 1.National Council on Aging, Arlington, Virginia, United States, 2. LeadingAge LTSS Center @UMass Boston, Boston, Massachusetts, United States, 3. University of Massachusetts Boston, University of Massachusetts Boston, Massachusetts, United States Despite the start of COVID-19 pandemic recovery in the U.S., food insecurity remains at elevated levels with 10% of American adults reporting food insecurity nearly three times higher than pre-pandemic (Census Bureau's Household Pulse Survey, June 2021).To gain insight into the long-term impacts of the pandemic on older adults, we examined food insecurity patterns during the last economic recession and the role that the Supplemental Nutrition Assistance Program (SNAP) played in mitigating food insecurity and skipped meals.We analyzed data on adults age 60+ from the Health and Retirement Study, looking at the Great Recession (2008) as a predictor of what to expect in the next decade of pandemic recovery.A key finding was that food insecurity more than doubled among older adults during the Great Recession and remained elevated even 10 years later.Regression analyses showed that SNAP use among older adults weakened the relationship between poverty and food insecurity, but didn't eliminate it-17% of older adults still reported food insecurity two years after enrolling in SNAP.The data indicates that a growing share of older SNAP users' benefits have not kept up with rising food costs.In fact, 85% of beneficiaries had monthly benefit amounts below the USDA 'Thrifty Plan" budget.Congress recently passed the American Rescue Plan which increases SNAP benefits temporarily, yet these enhancements are about to run out.This study underscores the need for permanent SNAP enhancements to help prevent long-lasting hunger facing millions of older Americans.Currently, more than 10 million Chinese older adults have been diagnosed with dementia, a number that is expected to increase as the population in China rapidly ages.Yet, little research exists on dementia care in Chinese long-term care facilities.Our research addresses this gap in the knowledgebase by examining the challenges nursing home directors encounter as well as the coping strategies they employ to deal with these challenges.Twenty-one facility directors employed by faith-based nursing homes across 14 provinces in China participated in this study.Semi-structured interviews were conducted in respondents' native language via phone or in person.Most respondents reported a religious affiliation, and about half were female and had been facility directors for more than four years.Two researchers fluent in Mandarin and English coded interview transcripts; thematic analysis was conducted to identify patterns in the data.The results indicated four primary challenges, which pertained to recruiting and retaining nursing staff, funding, lacking support from the government, and conflicts with family members.The coping strategies included obtaining and using external resources such as volunteer visitors, operationalizing personal spiritual beliefs, and providing training to improve skills and empathy among employees.This study contributes to nursing home practice by expanding our knowledge of culturally relevant dementia management strategies in China.Suggestions to address management challenges from a policy and practical perspective include clear and sustainable financial support from the government, staff training, and staffresident ratio regulations, seeking external resources, and integrating spiritual strategies into problem management and service quality improvement.

thly benefit amounts below the USDA 'Thrifty Plan" budget.Congress recently passed the American Rescue P
an which increases SNAP benefits temporarily, yet these enhancements are about to run out.This study underscores the need for permanent SNAP enhancements to help prevent long-lasting hunger facing millions of older Americans.Currently, more than 10 million Chinese older adults have been diagnosed with dementia, a number that is expected to increase as the population in China rapidly ages.Yet, little research exists on dementia care in Chinese long-term care facilities.Our research addresses this gap in the knowledgebase by examining the challenges nursing home directors encounter as well as the coping strategies they employ to deal with these challenges.Twenty-one facility directors employed by faith-based nursing homes across 14 provinces in China participated in this study.Semi-structured interviews were conducted in respondents' native language via phone or in person.Most respondents reported a religious affiliation, and about half were female and had been facility directors for more than four years.Two researchers fluent in Mandarin and English coded interview transcripts; thematic analysis was conducted to identify patterns in the data.The results indicated four primary challenges, which pertained to recruiting and retaining nursing staff, funding, lacking support from the government, and conflicts with family members.The coping strategies included obtaining and using external resources such as volunteer visitors, operationalizing personal spiritual beliefs, and providing training to improve skills and empathy among employees.This study contributes to nursing home practice by expanding our knowledge of culturally relevant dementia management strategies in China.Suggestions to address management challenges from a policy and practical perspective include clear and sustainable financial support from the government, staff training, and staffresident ratio regulations, seeking external resources, and integrating spiritual strategies into problem management and service quality improvement.


MANAGEMENT CHALLENGES FACED BY ADMINIS-TRATORS AT DEMENTIA CARE NURSING HOMES IN


MOTIVATION TO LEARN AND MULTILINGUALISM ACROSS THE ADULT LIFE STAGES IN THE U.S.

Shalini Sahoo, 1 Takashi Yamashita, 2 Roberto Millar, 3  Lifelong learning or continuing education over the life course has become necessary to navigate a rapidly changing technological landscape.Motivation to learn (MtL) is essential for facilitating lifelong learning.In the U.S., most of the educational opportunities are available in English.Moreover, little is known about associations between being multilingual and MtL across the life stages.This study analyzed nationally representative data from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted use file (RUF).Using a previously established latent MtL construct, structural equation models were estimated by four age groups ---25-34 (n = 2,310); 35-44 (n = 1,610); 45-54 (n = 1,670); and 55 and older (n = 2,620).Results showed that being multilingual was associated with greater MtL among younger age groups, including age 25-34 (b = 0.20, p = 0.01) and 35-44 (b = 0.28, p < 0.001), after adjusting for the demographic, socioeconomic and health characteristics of individuals.Multilingualism was not associated with MtL among older age groups, including 45-54 (b = 0.06, p = 0.50) and 55 and older (b = 0.13, p = 0.19).Findings suggest that education policies that target younger multilingual adults are likely to be effective while enhancing MtL of monolingual (i.e., English-speaking only) adults seems to be a necessary first step.Yet, a similar approach may not be effective for older adults, arguably due to more diverse life circumstances, educational needs, and learning style preferences.More detailed interpretations of empirical results and theoretical explanations are needed.


MOTIVATIONS AND EXPERIENCES OF OLDER ADULT VOLUNTEERS IN A TELEHEALTH NURSING SIMULATION ACTIVITY

Jennifer Crittenden, 1 and Kayla Thompson, 2 1.University of Maine, University of Maine, Maine, United States, 2. University of Maine, Bangor, Maine, United States

The COVID-19 pandemic has posed challenges to safely engaging older adults in volunteer activities.This research explored a unique partnership between a Retired Senior and Volunteer Program (RSVP) and a school of nursing to administer a telehealth virtual simulation training for nurse practitioner students.Semi-structured interviews were carried out with nursing simulation coordinators and volunteers after the telehealth simulation exercise.The purpose of this research was to identify principles of successful virtual volunteer engagement for telehealth simulations.This initial pilot study encompassed debriefing interviews

MOTIVATION TO LEARN AND MULTILINGUALISM ACROSS THE ADULT LIFE STAGES IN THE U.S.
Shalini Sahoo, 1 Takashi Yamashita, 2 Roberto Millar, 3  Lifelong learning or continuing education over the life course has become necessary to navigate a rapidly changing technological landscape.Motivation to learn (MtL) is essential for facilitating lifelong learning.In the U.S., most of the educational opportunities are available in English.Moreover, little is known about associations between being multilingual and MtL across the life stages.This study analyzed nationally representative data from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted use file (RUF).Using a previously established latent MtL construct, structural equation models were estimated by four age groups ---25-34 (n = 2,310); 35-44 (n = 1,610); 45-54 (n = 1,670); and 55 and older (n = 2,620).Results showed that being multilingual was associated with greater MtL among younger age groups, including age 25-34 (b = 0.20, p = 0.01) and 35-44 (b = 0.28, p < 0.001), after adjusting for the demographic, socioeconomic and health characteristics of individuals.Multilingualism was not associated with MtL among older age groups, including 45-54 (b = 0.06, p = 0.50) and 55 and older (b = 0.13, p = 0.19).Findings suggest that education policies that target younger multilingual adults are likely to be effective while enhancing MtL of monolingual (i.e., English-speaking only) adults seems to be a necessary first step.Yet, a similar approach may not be effective for older adults, arguably due to more diverse life circumstances, educational needs, and learning style preferences.More detailed interpretations of empirical results and theoretical explanations are needed.

MOTIVATIONS AND EXPERIENCES OF OLDER ADULT VOLUNTEERS IN A TELEHEALTH NURSING SIMULATION ACTIVITY
Jennifer Crittenden, 1 and Kayla Thompson, 2 1.University of Maine, University of Maine, Maine, United States, 2. University of Maine, Bangor, Maine, United States The COVID-19 pandemic has posed challenges to safely engaging older adults in volunteer activities.This research explored a unique partnership between a Retired Senior and Volunteer Program (RSVP) and a school of nursing to administer a telehealth virtual simulation training for nurse practitioner students.Semi-structured interviews were carried out with nursing simulation coordinators and volunteers after the telehealth simulation exercise.The purpose of this research was to identify principles of successful virtual volunteer engagement for telehealth simulations.This initial pilot study encompassed debriefing interviews with volunteers (N = 3) and interviews with simulation coordinators (N = 2).Three major themes emerged within the response coding: 1) the benefits of virtual simulation volunteering, 2) technology as a facilitating factor and challenge, and 3) unique volunteer management considerations.Both volunteers and coordinators noted that volunteers derived positive emotional benefits and new insights from their participation.Coordinators discussed the "authenticity" factor that older adults brought to the simulation experience as a benefit to engaging older adult volunteers.Technology sub-themes included accessibility considerations, experience with the online format, and other logistical considerations in conducting telehealth simulation.Volunteer management sub-themes encompassed volunteer skills and motivations, the perceived successful aspects of training, and improvements for future simulations.Volunteers discussed an interest and connection to healthcare and education as a motivating factor for their participation in the telehealth simulation.This small scale pilot research will be expanded through future simulation activities to continue to identify principles of practice for engaging older adults in virtual volunteerism.

a facilitating factor and challenge, and 3) unique volunteer management considera
ions.Both volunteers and coordinators noted that volunteers derived positive emotional benefits and new insights from their participation.Coordinators discussed the "authenticity" factor that older adults brought to the simulation experience as a benefit to engaging older adult volunteers.Technology sub-themes included accessibility considerations, experience with the online format, and other logistical considerations in conducting telehealth simulation.Volunteer management sub-themes encompassed volunteer skills and motivations, the perceived successful aspects of training, and improvements for future simulations.Volunteers discussed an interest and connection to healthcare and education as a motivating factor for their participation in the telehealth simulation.This small scale pilot research will be expanded through future simulation activities to continue to identify principles of practice for engaging older adults in virtual volunteerism.


NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM PARTICIPANTS' RECOMMENDATIONS TO BOOST CAREGIVER SUPPORTS

Heather Menne, 1 Natalie Mulmule, 2 Angela Gasdaska, 2 Emily Costilow, 2 and Kristen Robinson, 3 1.RTI International,Washington,District of Columbia,United States,2. RTI International,RTI International,North Carolina,United States,3. DLH/SSS,Silver Spring,Maryland,United States For more than 20 years, family caregivers have been supported through the National Family Caregiver Support Program (NFCSP) of the Older Americans Act (Title IIIE).The NFCSP provides information to caregivers about available services; assistance in gaining access to services; counseling, support groups and caregiver training; respite care; and supplemental services.In the 2019 National Survey of Older Americans Act Participants, 1,909 NFCSP caregivers were asked "What recommendations do you have for improving the service?"The resulting 748 open-ended responses were thematically coded.The thematic analysis yielded six major themes: Additional Resources, Staffing, Communication, Care Coordination, Quality of Services, and Eligibility.Sub-themes were identified for Additional Resources and Staffing.The most common sub-themes for Additional Resources were requests for more help or services (e.g., grocery shopping), increased funding or financial assistance, and more service hours (e.g., overnight or holiday care).The most common sub-theme for Staffing was the need for



CHINA Lin Jiang, 1 Fei Sun, 2 Robin Bonifas, 3 and David Hodge, 4 1.The University of Texas Rio Grande Valley, Edinburg, Texas, United States, 2. Michigan State University, East Lansing, Michigan, United States, 3. Indiana State University, Terre Haute, Indiana, United States, 4. Arizona State University, Phoenix, Arizona, United States

Innovation inAging, 2021, Vol. 5, No. S1

NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM PARTICIPANTS' RECOMMENDATIONS TO BOOST CAREGIVER SUPPORTS
Heather Menne, 1 Natalie Mulmule, 2 Angela Gasdaska, 2 Emily Costilow, 2 and Kristen Robinson, 3 1.RTI International,Washington,District of Columbia,United States,2. RTI International,RTI International,North Carolina,United States,3. DLH/SSS,Silver Spring,Maryland,United States For more than 20 years, family caregivers have been supported through the National Family Caregiver Support Program (NFCSP) of the Older Americans Act (Title IIIE).The NFCSP provides information to caregivers about available services; assistance in gaining access to services; counseling, support groups and caregiver training; respite care; and supplemental services.In the 2019 National Survey of Older Americans Act Participants, 1,909 NFCSP caregivers were asked "What recommendations do you have for improving the service?"The resulting 748 open-ended responses were thematically coded.The thematic analysis yielded six major themes: Additional Resources, Staffing, Communication, Care Coordination, Quality of Services, and Eligibility.Sub-themes were identified for Additional Resources and Staffing.The most common sub-themes for Additional Resources were requests for more help or services (e.g., grocery shopping), increased funding or financial assistance, and more service hours (e.g., overnight or holiday care).The most common sub-theme for Staffing was the need for CHINA Lin Jiang, 1 Fei Sun, 2 Robin Bonifas, 3 and David Hodge, 4 1.The University of Texas Rio Grande Valley, Edinburg, Texas, United States, 2. Michigan State University, East Lansing, Michigan, United States, 3. Indiana State University, Terre Haute, Indiana, United States, 4. Arizona State University, Phoenix, Arizona, United States