Exploring how care home staff manage responsive behaviours, associated with dementia, in care homes in Ireland, during the COVID-19 pandemic

Introduction: Care home residents with dementia often exhibit responsive behaviours including agitation, aggression and wandering. Psychotropic drugs are often prescribed to manage responsive behaviours but contravene guidance as they increase the risk of serious adverse events and death in people with dementia. Aim: This thesis aims to understand how care home staff manage responsive behaviours to identify the barriers and facilitators to implementing a non-pharmacological approach to behaviour management. Methods: This thesis was underpinned by the transformative paradigm and critical theory. A review of qualitative studies was conducted to synthesise understanding of the facilitators or barriers to implementing non-pharmacological strategies to behaviour management (PROSPERO protocol registration CRD42020165948). The findings from the review, in addition to a qualitative survey and patient and public Involvement informed the design of the qualitative interview study to understand how responsive behaviours are managed by care home staff in the Republic of Ireland (ROI) prior to, and during the Covid-19 pandemic. In total, 25 interviews were conducted with staff from 21 care homes across Ireland. Reflexive thematic analysis of qualitative data was informed by Braun and Clarke (2019). All participants provided written informed consent. Ethical approval was obtained from Lancaster University. Findings: The findings from the systematic review and qualitative study found the barriers to taking a non-pharmacological approach to manage responsive behaviours included inadequate staff training and multidisciplinary collaboration. The qualitative study extends current knowledge by showing that a power hierarchy exists between healthcare assistants and nurses that posed a barrier to taking a non-pharmacological approach to behaviour management. Facilitators to taking a non-pharmacological approach included effective leadership and family involvement in resident care. Conclusion: This thesis extends knowledge by conceptualising how responsive behaviours are managed using both pharmacological and non-pharmacological approaches to identify the facilitators and barriers to implementing non-pharmacological strategies to behaviour management. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Managing DNACPR Recommendations in Residential Care: Towards Improved Training for Social Care and Capacity Professionals

The use of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) recommendations has come under scrutiny during the COVID-19 pandemic, and the Care Quality Commission (CQC) has issued a call for new standards, guidance and training. One group for whom new training is required is 'capacity professionals' working in and with residential care facilities. These professionals (including Independent Mental Capacity Advocates and Best Interests Assessors) typically have a social work background and have specialist training regarding the 2005 Mental Capacity Act, the provisions of which have a direct relevance to DNACPR recommendations. We report on a survey and focus groups that probed the experiences of this professional group during the pandemic. We recruited 262 participants by approaching civil society organisations in which capacity professionals are well represented;twenty-two participated in follow-on focus groups. We used manifest content analysis and descriptive statistics to analyse the results. Our findings contribute to an emerging picture of what transpired in residential care homes during the first year of the pandemic and help to provide an empirical and normative basis for the development of the new guidance and training for which the CQC has called. The use of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) recommendations during the COVID-19 pandemic has been a topic of continuing interest and concern. We report on the experiences of a distinctive group of professionals who worked in and with residential care homes during the pandemic. The results contribute to an emerging picture of what happened in care homes during the first year of the pandemic and help provide an empirical and normative basis for the development of the new guidance and training for which the Care Quality Commission has called. Participants reported on blanket applications of DNACPRs, failure of adequate consultation, inadequate or inadequately documented grounds for DNACPR recommendations, and reliance on DNACPR recommendations beyond their designated use. We identify five areas in need of clarification in relation to existing guidance and training and recommend modifications to the procedures used to record and review DNACPR recommendations.

'Home-Likeness' in English and Italian care homes' websites: From countering stereotypes to wading through the COVID-19 pandemic

Care homes often have to face negative stereotypes depicting them as dreaded places where older and/or disabled patients are brought to spend the last period of their life. These institutions may thus use their websites to communicate a more positive self-description;this often entails depicting the care homes as real homes for their residents. The present paper aims to understand more precisely the characteristics of this 'home-likeness', by carrying out a corpus-assisted discourse analysis focusing on Italian websites of care homes situated in Lombardy, compared with a corpus of English websites of care homes based in London. Moreover, it discusses the implications of this 'home-likeness' during the coronavirus pandemic, where the concept of sheltering at home was variably used by governments and health institutions alike (both in Italy and in the UK) to gather consensus around lockdown restrictions. It concludes that the metaphor of home used in long-term residential seniors care is diffuse, but is often culture-bound, as the comparison between Italian and English websites shows both some similarities and some differences. However, in both cases it appears sometimes paradoxical and insufficient to ensure adequate patient-centred care, especially during pandemics. © Peter Lang Group AG, International Academic Publishers, Bern 2023. All rights reserved.

Developing the Resident Measure of Safety in Care Homes (RMOS): A Delphi and Think Aloud Study.

OBJECTIVE: This study aimed to develop a measure of contributory factors to safety incidents in care homes to be completed by residents and/or their unpaid carers. INTRODUCTION: Care home residents are particularly vulnerable to patient safety incidents, due to higher likelihood of frailty, multimorbidity and cognitive decline. However, despite residents and their carers wanting to be involved in safety initiatives, there are few mechanisms for them to contribute and make meaningful safety improvements to practice. METHODS: We developed 73 evidence-based items from synthesis and existing measures, which we presented to a panel of stakeholders (residents/carers, health/social care professionals and researchers). We used two online rounds of Delphi to generate consensus (80%) on items important to include in the Resident Measure of Safety in Care Homes (RMOS); a consensus meeting was later held. The draft RMOS developed through the Delphi was presented to participants during 'Think Aloud' interviews using cognitive testing techniques. RESULTS: The 29-item RMOS was developed. Forty-three participants completed Delphi round 1, and 27 participants completed round 2, 11 participants attended the consensus meeting and 12 'Think Aloud' interviews were conducted. Of the 73 original items, 42 items that did not meet consensus in Delphi round 1 were presented in round 2. After the consensus meeting, it was agreed that 35 items would comprise the RMOS questionnaire and were presented in the 'Think Aloud' interviews. Participants suggested numerous changes to items mostly to improve comprehension and ability to answer. CONCLUSION: We have a developed an evidence-based RMOS, with good face validity, to assess contributory factors to safety in care homes from a resident/carer perspective. Future work will involve psychometrically testing the items in a pilot and developing a complementary simplified, dementia-friendly version to promote inclusivity. PATIENT OR PUBLIC INVOLVEMENT: Four patient and public contributors worked with researchers to develop the online questionnaires. Patients (residents) and carers participated on the consensus panel. One member of the research team is an expert by lived experience and was involved in design and analysis decisions. The item list and instructions for the questionnaires were reviewed for face validity, understanding and acceptability by a patient and public involvement group and modified.

Caring from a distance: carers? experiences of keeping in touch with care home residents during COVID-19 closures

In response to COVID-19, many care homes closed to visitors and new ways for carers and residents to stay in touch were tried. This UK study employed an online survey to explore carer experiences of staying in touch from a distance. The research highlighted: the importance of ongoing connections (through visits and remotely);diverse approaches to maintaining contact;and concerns about safeguarding and well-being. Findings underscore the importance of developing personalised approaches to staying in touch during future care home closures and for those who require an ongoing approach to remote contact due to distance, illness or additional caring responsibilities.

Care Homes in Spain in the COVID-19 Pandemic: Lessons Learned from an Intervention by Médecins Sans Frontières

When the COVID-19 pandemic struck in early 2020, it rapidly became apparent that older individuals were at greater risk of serious illness and death. The risk was even greater for residents in care homes, who live in close proximity and may be suffering other comorbidities. Such facilities also saw a high turnover of staff and visitors, meaning an increased risk of transmission. Data has suggested that care home residents may account for up to a half of all COVID-related deaths in Spain. As morbidity and mortality for COVID-19 was increasing in March 2020, MSF offered support to Spanish care homes during the first wave of infections. Our intervention included different axes: advocacy, knowledge sharing, training and implementation of measures for a reduction in transmission and for infection prevention and control (IPC). The situation for care home residents was dire, with many people dying alone, away from loved ones and without access to palliative care. Staff were overwhelmed and ill-equipped to deal with the scale and complexity of this tragedy. Although technical interventions to reduce transmission were crucial, it became clear that other people-centred activities that supported residents, their families and staff, were of equal importance, including facilitating contact between families, providing emotional support and offering adequate pain management and palliative care. Residents in care homes have the same rights as everyone else. In the event of future crises, the most vulnerable should not be neglected.

The role of identity in the experiences of dementia care workers from a minority ethnic background during the COVID-19 pandemic: A qualitative study.

BACKGROUND: Care home staff working during the COVID-19 pandemic experienced higher levels of stress and increased workloads. People from diverse ethnic backgrounds were disproportionately affected by the COVID-19 pandemic. This study explored the identity experiences of care home staff from diverse ethnic backgrounds in the context of working during the COVID-19 pandemic. METHODS: Fourteen semistructured interviews were conducted between May 2021 and April 2022 with ethnic minority care home staff in England, who worked during the pandemic. Participants were recruited using convenience and theoretical sampling. Interviews were conducted via telephone or online platforms. A social constructivist grounded theory methodology was utilised in analysing the data. FINDINGS: Participants described five key processes which facilitated or hindered the impact that their experiences had on their identity: dealing with uncertainty and transitioning into a COVID-19 world; difficult emotions; experiences of discrimination and racism; the response from the care home and societal systems; and the personal vs collective responsibility. When participants' physical and psychological needs went unmet by support structures within the care home and/or society, they experienced a sense of injustice, lack of control and being unvalued or discriminated against by others. CONCLUSIONS: This study highlights the importance of recognising the unique needs of staff from diverse ethnic backgrounds working in care homes and adapting working practices to improve impact on identity, job satisfaction and staff retention. PATIENT AND PUBLIC INVOLVEMENT: One care home worker was involved in developing the topic guide and helping to interpret the findings.

The management of elderly patients with COVID out of the hospital: The Italian experience

Even though COVID infection-19 mainly affected older adults (average age of 80 years according to data from the ISS-National Institute of Health), most of them were managed outside the hospital setting within services of Primary Care Department of Health Authority and Services of Modena and through the activation of specific care models. In this chapter, we discuss the possibility of care for older patients with COVID-19 in primary care settings such as Community Hospital, Nursing Home or Long-Term Care Facility (including special care unit for people with dementia) and home care through the experiences of the Special Continuity of Care Unit (USCA). Many people with COVID-19 who do not require hospitalisation may need home care, and those who are hospitalised with the virus will need home care post-discharge. Some older adults, less willing to move into nursing homes given many deaths in these settings, may opt for home care. The experience described with the care pathway for COVID-19 in a nursing home has allowed us, after the first even more severe cases which causes deaths, also not only to contain the spread of infection (in our network only n° 16 out of a total of n° 52 Nursing Homes has cases of COVID-19) but also to be able to treat and monitor the older people within these services. © Springer Nature Switzerland AG 2020.

Ethnocultural long-term care homes in Canada: a place for cultural inheritance and community building

This article discusses the overlooked role of recreation programmes in the ethnocultural and cultural-specific long-term care home from my standpoint as a recreation worker. First, the policy during the pandemic that prohibited visits by family members and volunteers revealed that they are important informal caregivers to fill in for the limitations of workers. Second, recreational programmes can also be considered as a practice of cultural inheritance: staff and volunteers learn their history and reconstruct them as collective memory. Third, the interaction between residents, volunteers, families and workers generates a sense of belonging to the ethnic community. Therefore, it can be considered a practice of community building for minority ethnic groups. By presenting the significant role of recreation workers in a long-term care home, I aim to question the meaning and value of care work in long-term care facilities.

Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes.

BACKGROUND: The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. AIM: To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. METHODS: A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. FINDINGS: In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. CONCLUSION: The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine.

Enhancing diabetes care for the most vulnerable in the 21st century: Interim findings of the National Advisory Panel on Care Home Diabetes (NAPCHD).

Older adults with diabetes may carry a substantial health burden in Western ageing societies, occupy more than one in four beds in care homes, and are a highly vulnerable group who often require complex nursing and medical care. The global pandemic (COVID-19) had its epicentre in care homes and revealed many shortfalls in diabetes care resulting in hospital admissions and considerable mortality and comorbid illness. The purpose of this work was to develop a national Strategic Document of Diabetes Care for Care Homes which would bring about worthwhile, sustainable and effective quality diabetes care improvements, and address the shortfalls in care provided. A large diverse and multidisciplinary group of stakeholders (NAPCHD) defined 11 areas of interest where recommendations were needed and using a subgroup allocation approach were set tasks to produce a set of primary recommendations. Each subgroup was given 5 starter questions to begin their work and a format to provide responses. During the initial phase, 16 key findings were identified. Overall, after a period of 18 months, 49 primary recommendations were made, and 7 major conclusions were drawn from these. A model of community and integrated diabetes care for care home residents with diabetes was proposed, and a series of 5 'quick-wins' were created to begin implementation of some of the recommendations that would not require significant funding. The work of the NAPCHD is ongoing but we hope that this current resource will help leaders to make these required changes happen.

Provision of palliative and end-of-life care in UK care homes during the COVID-19 pandemic: A mixed methods observational study with implications for policy.

Introduction: Little consideration has been given to how the provision of palliative and end-of-life care in care homes was affected by COVID-19. The aims of this study were to: (i) investigate the response of UK care homes in meeting the rapidly increasing need for palliative and end-of-life care during the COVID-19 pandemic and (ii) propose policy recommendations for strengthening the provision of palliative and end-of-life care within care homes. Materials and methods: A mixed methods observational study was conducted, which incorporated (i) an online cross-sectional survey of UK care homes and (ii) qualitative interviews with care home practitioners. Participants for the survey were recruited between April and September 2021. Survey participants indicating availability to participate in an interview were recruited using a purposive sampling approach between June and October 2021. Data were integrated through analytic triangulation in which we sought areas of convergence, divergence, and complementarity. Results: There were 107 responses to the survey and 27 interviews. We found that (i) relationship-centered care is crucial to high-quality palliative and end-of-life care within care homes, but this was disrupted during the pandemic. (ii) Care homes' ability to maintain high-quality relationship-centered care required key "pillars" being in place: integration with external healthcare systems, digital inclusion, and a supported workforce. Inequities within the care home sector meant that in some services these pillars were compromised, and relationship-centered care suffered. (iii) The provision of relationship-centered care was undermined by care home staff feeling that their efforts and expertise in delivering palliative and end-of-life care often went unrecognized/undervalued. Conclusion: Relationship-centered care is a key component of high-quality palliative and end-of-life care in care homes, but this was disrupted during the COVID-19 pandemic. We identify key policy priorities to equip care homes with the resources, capacity, and expertise needed to deliver palliative and end-of-life care: (i) integration within health and social care systems, (ii) digital inclusivity, (iii) workforce development, (iv) support for care home managers, and (v) addressing (dis)parities of esteem. These policy recommendations inform, extend, and align with policies and initiatives within the UK and internationally.

A realist evaluation of the feasibility of a randomised controlled trial of a digital music and movement intervention for older people living in care homes.

BACKGROUND: Low physical activity in care home residents brings about negative mental health consequences, such as higher levels of depression and loneliness. With advancements in communication technology, particularly during the COVID-19 pandemic, the feasibility and effectiveness of a randomised controlled trial (RCT) of a digital Physical Activity (PA) resource in care homes deserve more research attention. A realist evaluation was used to uncover influencing factors of a feasibility study implementation to inform how a digital music and movement programme would work and under what circumstances this would be most effective. METHODS: Participants were 49 older adults (aged 65 years +) recruited across ten care homes in Scotland. Surveys were administered at baseline and post-intervention comprising psychometric questionnaires on multidimensional health markers validated in older adults with possible cognitive impairment. The intervention comprised 12 weeks of four prescribed digitally delivered movement (n = 3) and music-only (n = 1) sessions per week. An activity coordinator delivered these online resources in the care home. Post-intervention focus groups with staff and interviews with a sub-sample of participants were conducted to gain qualitative data on the acceptability of the intervention. RESULTS: Thirty three care home residents started the intervention, but only 18 residents (84% female) completed both pre- and post-intervention assessments. Activity coordinators (AC) offered 57% of the prescribed sessions, with an average residents' adherence of 60%. Delivery of the intervention did not go as planned due to Covid restrictions in care homes and delivery challenges, including (1) motivation and engagement, (2) changes in cognitive impairment and disabilities of the participants, (3) death or hospitalisation of the participants and (4) limited staffing and technology resources to deliver the programme as intended. Despite this, group participation and encouragement of residents supported the delivery and acceptance of the intervention, with ACs and residents reporting improved mood, physical health, job satisfaction and social support. Improvements with large effect sizes were found for anxiety, depression, loneliness, perceived stress and sleep satisfaction, but no changes in fear of falling, domains of general health or appetite. CONCLUSION: This realist evaluation suggested that this digitally delivered movement and music intervention is feasible. From the findings, the initial programme theory was refined for future implementation of an RCT in other care homes but future research exploring how to tailor the intervention to those with cognitive impairment and/or lacking capacity to consent is needed. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov NCT05559203.

"Because if I don't hold his hand then I might as well not be there": Experiences of Dutch and UK care home visiting during the COVID-19 pandemic.

OBJECTIVES: To explore and compare the experiences of care home visits during the pandemic in the UK and the Netherlands. DESIGN: Qualitative semi-structured interview studies. SETTING AND PARTICIPANTS: Family carers of relatives residing in care homes in the UK and the Netherlands were interviewed remotely. METHODS: Family carers were asked about their experiences of care home visits during the pandemic, and specifically in the Netherlands after care homes had reopened. Transcripts were analyzed in each country separately in the native language using thematic analysis, before discussing findings at multiple analysis meetings. RESULTS: Across 125 interviews, we developed four themes: (1) different types of contact during lockdown; (2) deterioration of resident health and well-being; (3) emotional distress of both visitors and residents; and (4) compliance to guidelines and regulations. Visiting in both the UK and the Netherlands was beneficial, if possible in the UK, yet was characterized by alternative forms of face-to-face visits which was emotionally distressing for many family carers and residents. In the Netherlands, government guidance did enable early care home visitation, while the UK was lacking any guidance leading to care homes implementing restrictions differently. CONCLUSIONS AND IMPLICATIONS: Early and clear guidance, as well as communication, is required in future pandemics, and in this ongoing pandemic, to enable care home visits between residents and loved ones. It is important to take learnings from this global pandemic to reimagine long-term care, highlighting the value of socializing for care home residents.

The impact of COVID-19 restrictions and care home strategies on residents with dementia as experienced by family carers in Italy.

OBJECTIVES: The COVID-19 pandemic and public health measures caused serious consequences for several population cohorts, including people with dementia in care homes and their families. The aim of this study was to explore the impact of COVID-19 on care home residents with dementia as experienced by family carers in Italy. Specifically, strategies implemented to overcome the pandemic's constraints, their influence upon care, and consequences for everyday life of residents with dementia and carers were investigated. METHODS: Semi-structured interviews explored participants' experiences of the pandemic, its restrictions and the services' status during lockdown. Transcripts were analysed via thematic analysis. RESULTS: 26 family carers were interviewed. Three themes emerged: (1) COVID-19 restrictions negatively affected both residents with dementia and family carers, (2) Changing policies in care homes during COVID-19, and (3) Technology use in care homes during COVID-19. COVID-19 restrictions severely affected care home residents with dementia, disrupted their daily living, and accelerated their cognitive decline. Consequently carers' emotional burdens increased. Care home response strategies (safe visiting and digital solutions) were critical, though they were not enough to compensate for the lack of close in-person contacts. CONCLUSIONS: Mixed evidence emerged about the feasibility of care home strategies and their associated benefits. To meet arising needs and possible future pandemic waves, there is a need for updated health strategies. These should prioritise a continuity of therapeutic activities and minimize negative effects on residents' quality of life, whilst incorporating feasible and accessible digital solutions to provide remote communication and psychological support for family carers.

'This is no country for old (wo)men'? An examination of the approach taken to care home residents during the Covid-19 pandemic.

This article discusses the human rights of residents in care homes in England who were affected by restrictions that were imposed during the first months of the COVID-19 pandemic in order to safeguard health and life at a time of public health emergency. It focuses on the potentially adversarial relationship between the need to protect the health of these residents and the possible adverse interferences with their human rights in the initial phase of the pandemic. The scope and application of these rights to the healthcare context is not straightforward due to the exigencies of the pandemic. Consideration is given to whether their rights, as protected by the European Convention on Human Rights (ECHR) and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) are vindicated or breached by the actions taken in the context of the COVID-19 pandemic. The article questions whether the restrictions that were applied were justified, given the limitations that exist within some ECHR Articles. It deliberates upon what can be done to ensure that relevant bodies and care homes, themselves, are better enabled to respond to a public health emergency in an individualistic, rights-based manner, based upon both principlism and pragmatism.

A Disruption, Not an Interruption: The Impact of COVID-19 on Child Care in Iowa.

Background: In March 2020, when public health stay home orders began in order to halt the spread of COVID-19, child care as an industry was drastically and abruptly impacted. This public health emergency highlighted the weaknesses in the child care system in the United States. Objective: This study investigated the changes in operations cost, child enrollment and attendance, and state and federal support that occurred during the first year of the COVID-19 pandemic among both center-based and home-based child care programs. Methods: A total of 196 licensed centers and 283 home-based programs across Iowa participated in an online survey as a part of the 2020 Iowa Narrow Costs Analysis. This mixed method study utilizes qualitative analysis of response as well as descriptive statistics and pre- post comparison testing. Results: Analysis of qualitative and quantitative data revealed that the COVID-19 pandemic had a marked impact on child care enrollment, the operational cost of child care, the availability of child care, and a variety of other areas including staff workload and mental health. In many instances, participants shared that state and federal COVID-19 relief funds were critical. Conclusion: Although state and federal COVID-19 relief funds were critical for child care providers in Iowa during the pandemic, results suggest similar financial support will be necessary beyond the pandemic to sustain the workforce. Policy suggestions are made for how to continue to support the child care workforce in the future.

Decent work in care homes: lessons and implications of the pandemic experience from Scotland

Purpose: The purpose of this paper is to identify lessons and implications on the theme of decent work in social care. This has long been highlighted as integral to improving social care for the elderly. The COVID-19 pandemic experience reveals lessons and implications about the systemic absence of decent work in one place, Scotland, in care homes. The main lesson and implication is a need for change beyond the focus on levels of pay and systemic advocacy of decent work as it is conventionally understood. Design/methodology/approach: Data was collected using qualitative, semi-structured interviews with 20 care workers in care homes.[AQ4] A range of care system institutional stakeholders was also interviewed. A range of care system institutional stakeholders was also interviewed. Findings: Decent work in social care may only be progressed to the extent that a culture change is achieved, transcending the institutional stasis about who owns and engages with progressing decent work. Research limitations/implications: This is a study in one place, Scotland, with a small sample of frontline care workers in care homes and representatives from a range of institutions. Practical implications: Effective culture change for decent work in care homes needs to be a higher research priority. More explicit culture policies can be a mechanism by which overall decent work and system change may be catalysed and sustainably secured together. Explicit culture change is here set out with respect to operational, institutional and national domains. Social implications: There needs to be social policy and political support for situating decent work to be part of a broader culture change around care work with the elderly. A culture-oriented change plan as well as new resourcing and structures can together ensure that the nadir of the pandemic experience was a historical turning point towards transformation rather than being just another low point in a recurring cycle. Originality/value: The situating of systemic decent work progress within a broader culture change, and modelling that culture change, are original contributions. © 2022, Emerald Publishing Limited.

Supporting person-centred dementia care following the COVID-19 pandemic.

In recent years, nurses have experienced increased workplace pressures in part due to the coronavirus disease 2019 (COVID-19) pandemic, which exacerbated challenges in the delivery of person-centred dementia care. This article examines how people with dementia were affected by the COVID-19 pandemic, as well as exploring the ongoing effects on nurses and the care they provide for people with dementia. The author discusses the importance of dementia awareness and education for nurses that supports them to promote the needs of people with the condition. The article also outlines how nurse leaders can promote person-centred care for people with dementia through reflection and clinical supervision.