Explore the vast range of titles available.

Recent public and policy interventions aim to recognise formally the contributions of family care-givers to long-term residential care in Canada, with some arguing family carers are more than visitors and should be recognised as essential care-givers. These developments call for reconsidering how family care roles are understood and operationalised. Drawing on ethnographic research conducted in three care homes in Ontario, Canada, we present an in-depth feminist rhetorical analysis of the narrated lives and work practices of 12 unpaid family carers. Specifically, we explore how unpaid family carers themselves draw on broader discursive ‘ruling metaphors’ to interpret their roles and activities (e.g. as essential care-givers, visitors, team members), and how these metaphors invoke, organise and/or give rise to particular practices, responsibilities and relations. We contrast the stories of a family member who positioned herself as an essential care-giver and expressed a more onerous sense of individual responsibility with the stories of people who enjoyed the pleasures of visiting, who contributed as team members in ways that went beyond caring for their own relatives' care needs, and who embraced the possibilities that came with volunteering and with being able to influence change. Our analysis situates and contextualises participants' stories of their involvement and unpaid work in relation to their everyday material conditions and circumstances. We elaborate how different ways of understanding caring roles shape the nature of carers' unpaid work, as well as their options to share responsibility or set limits on that work. We also raise questions about the organisational conditions needed to help enact care as a shared collective responsibility.

BackgroundDespite a global policy push toward the advancement of family- and community-based care, residential care for children and youth remains a relevant and highly utilized out-of-home care option in many countries, fulfilling functions of care and accommodation as well as education and treatment.ObjectiveAs part of a larger project involving five European countries (Finland, Germany, Italy, Lithuania, and Spain), the objective was “to map” the context and content of residential care in each country, thereby building a foundation for meaningful comparisons and deepened understanding of each system’s inherent logic. Within the context of global deinstitutionalization efforts, the study also aimed to understand factors that hinder or enhance the transformation of residential care.MethodUsing an embedded multiple-case design, data was gathered by each country on its residential care macro context as well as salient variables related to three units of analysis–residential care system/program features, residential care training and personnel, characteristics of youth. Cross-case synthesis was used to summarize and compare cases across relevant dimensions.ResultsThe analysis highlighted areas of overlap and singularity, particularly with regard to utilization rates, concepts and methods, workforce professionalization, and characteristics of youth.ConclusionsFindings provide a more nuanced understanding of how residential care continues to be viewed and utilized in some countries, challenging the ‘residential-care-as-a-last-resort-only’ rhetoric that is currently dominating the discourse on residential care. It further provides an understanding of historical and sociocultural factors that need to be considered when trying to transform services for children, youth, and their families.

Background The quality of palliative and end-of-life care (EOLC) in residential aged care (RACFs) is variable, and often suboptimal. The aim of IMPART is to improve palliative care in RACFs. IMPART provides online training and telehealth palliative-geriatric support to aged care staff and family physicians/general practitioners (GPs) to enable timely EOLC discussions, clinical support, and improve documentation of care preferences. This may lead to preference-based care, reduction of unplanned hospitalization, and improved quality of life and EOLC. This protocol describes a study to evaluate the effectiveness, cost, and implementation process of the IMPART intervention. Methods This study is a pragmatic, stepped-wedge, cluster randomized controlled trial across 10 RACFs to evaluate the IMPART intervention. Clusters are randomly assigned to intervention or control groups. The IMPART intervention group 1) receives timely end-of-life support from specialist In-Reach teams using telehealth; 2) engages RACF staff and GPs in a Planning Ahead Team to reflect on current practices and co-design an Action Plan to improve EOLC planning and processes; 3) receives an online interactive, needs-based EOLC education program for staff and GPs working in RACFs. The control groups receive the IMPART intervention in subsequent waves. The primary outcome measure is reduction of unplanned hospital admissions and avoidable hospital transfers for residents at end-of-life when appropriate care in their RACF is possible and consistent with residents’ wishes. Secondary outcomes include reduction of emergency department presentations and length of stay of unplanned hospital admissions, and improvement in residents’ quality of life, comfort, satisfaction, and quality of EOLC. Discussion RACFs are high-mortality settings, yet the quality of palliative and EOLC varies across facilities. There is an urgent need for timely and integrated high-quality palliative care delivered in this context. Implementing IMPART, as a novel telehealth intervention, aims to address this need. This large multisite trial will provide robust evidence about the impact of the intervention (efficacy, cost-effectiveness, and process evaluation), to inform future roll-out and scale-up into the residential aged care sector. Trial registration anzctr.org.au; ACTRN12622000760774. Prospectively registered on 27/05/2022.

Background Transitioning from independent living to a residential care facility often results in a significant loss of independence, autonomy, and connectedness, leaving new residents with profound feelings of loss and grief. In light of these challenges, this study explored the potential benefits of a tailored in-house exercise program for new residents. Methods The study took place in an Australian residential care facility and included four new residents (aged 72 to 88, 75% female), who participated in a 12-week tailored exercise program led by an exercise physiologist. A focused ethnographic approach was used to obtain a comprehensive data set, drawing on ongoing observation, informal discussions during the program, and semi-structured interviews conducted at its conclusion. Field notes documenting participants’ interactions, moods, and responses, together with interview transcripts, were compiled into case files and analysed using Braun and Clarke’s thematic analysis. Rigorous coding and collaborative team discussions ensured a thorough and nuanced understanding of transitional experiences. Results The detailed accounts provided by new residents of the profound sense of loss they experienced during their transition offer essential context for understanding the value that exercise programs can provide in residential care settings. Insights from vignettes and thematic analysis show that participation in exercise helped residents regain control, independence, and competence, while also fostering social connection. Two key themes were identified underscoring the transformative role of exercise in supporting the well-being of new residents: (1) fostering empowerment, independence and well-being through exercise engagement, and (2) enhancing overall community and social connectedness via exercise. Conclusion This study indicates that structured exercise programs are instrumental in helping older adults navigate their transition into residential care. By enhancing personal agency, independence, and overall well-being, and fostering a welcoming and friendly environment, an exercise program can assist new residents during their adjustment to supported residential care. Considering the transformative nature of exercise, future research should investigate the mechanisms through which exercise programs facilitate residents’ progression through the stages of transition, and if getting residents involved in exercise prior to moving can encourage earlier participation in exercise programs once they move into residential care.

Children and adolescents in residential care often present with emotional and/or behavioral problems associated to previous adverse experiences such as abuse and neglect. Consequently, child welfare systems have developed therapeutic residential care (TRC) programs to address the most complex needs of this population. The aim of this study is to explore the characteristics of youths in TRC comparing them with those of youth in general residential care (GRC), and to detect the factors predicting referral to TRC programs. The sample consisted of 900 adolescents aged 12–17 years old (M = 15.57; SD = 1.33; 66.2% boys), from General Residential Care (n = 554) and Therapeutic Residential Care (n = 346). Profile information was collected through official files and an ad hoc questionnaire. Mental health problems were evaluated using the youth self-report (YSR). Significant sociodemographic differences were found between groups. Also, a higher frequency of emotional abuse and neglect, worse mental health, more breakdowns in child welfare measures and risk behaviors were found among adolescents in TRC. Sociodemographic and familial characteristics, features of the protective process and risk behaviors were associated to referral to TRC programs. Youths in GRC and TRC present with mental and behavioral problems that make it necessary to implement prevention programs and early detection procedures. Screening and evaluation of youth’s mental health and establishment of concrete criteria are suggested to ensure appropriate referral to the most suitable resource according to the individual needs of adolescents.

Autonomy is important in every stage of life. However, little is known about how autonomy is enhanced for older adults living in residential care facilities (RCFs). This leads to the research question: which facilitators and barriers to autonomy of older adults with physical impairments due to ageing and chronic health conditions living in RCFs are known? The results will be organised according to the framework of person-centred practice, because this is related to autonomy enhancement. To answer the research question, a systematic literature search and review was performed in the electronic databases CINAHL, PsycINFO, PubMed, Social Services Abstracts and Sociological Abstracts. Inclusion and exclusion criteria were derived from the research question. Selected articles were analysed and assessed on quality using the Mixed Methods Appraisal Tool. Facilitators and barriers for autonomy were found and arranged in four themes: characteristics of residents, prerequisites of professional care-givers, care processes between resident and care-giver, and environment of care. The established facilitators and barriers are relational and dynamic. For a better understanding of the facilitators and barriers to autonomy for older adults with physical impairments living in RCFs, a description is based on the 35 included articles. Autonomy is a capacity to influence the environment and make decisions irrespective of having executional autonomy, to live the kind of life someone desires to live in the face of diminishing social, physical and/or cognitive resources and dependency, and it develops in relationships. The results provide an actual overview and lead to a better understanding of barriers and facilitators for the autonomy of older adults with physical impairments in RCFs. For both residents and care-givers, results offer possibilities to sustain and reinforce autonomy. Scientifically, the study creates new knowledge on factors that influence autonomy, which can be used to enhance autonomy.