The Experiences of Skilled Nursing Staff in Memory Care Units During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: The novel coronavirus disease 2019 (COVID-19) resulted in the need for multiple mitigation strategies. The impacts of these safety measures were felt more extremely by healthcare providers. This qualitative study focused on the experiences of staff in skilled nursing facilities, specifically in locked memory care units, during the first year of the COVID-19 pandemic. RESEARCH DESIGN AND METHODS: This study used a basic interpretive methodology. In-depth interviews were conducted with skilled nursing staff members who worked in a locked memory care unit during the 2020 calendar year. Thematic analysis was used to organize and interpret the data. RESULTS: A total of 11 participants provided data that resulted in themes around reasons for working on a locked memory care unit, experiences working with people who have behavioral and psychological symptoms due to dementia, training, outcomes of shared experiences, outcomes of policy changes, management support, and suggestions for a future pandemic. DISCUSSION AND IMPLICATIONS: The results of this study may have implications for skilled nursing facilities with locked memory care units that continue to grapple with the realities of providing care during a pandemic. Providing appropriate training, social support, and appropriate protective equipment are among the suggestions.

New Mothers With Postpartum Depression: A Qualitative Exploration of Healthcare Decision-Making.

Postpartum depression (PPD) is a significant health issue for many new mothers in the weeks and months following a child's birth. Quantitative data suggest that a mother's PPD negatively impacts healthcare decision-making for the child via routine well-baby visits and pediatric care. However, little is known from a qualitative perspective about the factors that challenge or facilitate these healthcare decisions. The purpose of this descriptive qualitative study was to understand the perceptions of new mothers about factors contributing to their healthcare decision-making, for themselves and for their children, while living with PPD. The researchers used purposive sampling to recruit eight women from clinics, community organizations, and social media support groups who met the study's inclusion criteria. Individual semi-structured interviews were carried out with eight participants about their PPD experiences, motherhood, and healthcare decision-making influences. Transcribed interviews and initial themes were shared with participants to verify researcher interpretations and aid in the analysis process. The researchers analyzed interview data using thematic analysis to cultivate an understanding of the phenomenon by identifying and interpreting patterns in the data. Three primary themes were drawn from the data analysis: (1) Importance of Clinician Trust and Support; (2) Balancing the Health of the Mother and Child; and (3) Other Support Structures That Facilitate Healthcare Decision-Making for the Mother and Baby Dyad. Participant experiences underscored the need for cohesive approaches by clinical providers of pre- and postnatal care. Group model approaches to postnatal care appear to mitigate or reduce the impact of PPD.

Exploring Beliefs about Aging and Faith: Development of the Judeo-Christian Religious Beliefs and Aging Scale.

This paper reports on the development of a novel 10-item scale that measures beliefs about aging as well as religious-based beliefs about aging. The Religious Beliefs and Aging Scale (RBAS) shows acceptable internal consistency (α = 0.74) and is bolstered by a strong correlation (r = 0.70) with the Brief Multidimensional Measure of Religiousness/Spirituality. Exploratory factor analysis elucidated two belief subscales: Afterlife (i.e., how age is experienced in the afterlife; α = 0.897) and Punishment (i.e., aging and dementia as a punishment for sin; α = 0.868). This scale can be used in research regarding end-of-life planning, ageism, and self-care practices.

Social Lives and Cliques Within Senior Housing Communities.

A better understanding of social environments will benefit facilitation of social cultures within senior housing communities. Social cliques naturally form among groups of people, particularly those living in close proximity. Research has shown that often older adults experience stigma based upon their health status and are excluded from social groups. This study examined residents' perceptions of life in senior housing, social stigma, and cliques. Forty-eight residents from two types of senior housing communities participated in the study. Qualitative thematic coding was used to analyze responses to open-ended interview questions. Overall, residents reported satisfaction with the community and their privacy and reported difficulties with distance from family, caregiving, and bereavement. The majority were able to identify cliques, defining them based upon common interests, health status, and shared histories. The most salient finding was that while social cliques existed they were not a source of dissatisfaction or stigma.

Defining doctoral gerontologists: Who are they and how are they contributing to the field of gerontology?

More than 300 individuals have earned doctoral degrees in gerontology since 1993, yet little is known about their training, professional placement, and contributions to the field. Given this lack of information, the authors sought to define the emerging mass of doctoral gerontologists. In this study, the authors analyzed results from the 2014 Gerontology Education Longitudinal Study survey sample of 84 individuals who earned a doctoral degree in gerontology between 1993 and 2013. Results revealed doctoral gerontologists completed training requirements that were consistent across eight programs offering doctorates in gerontology. The authors also found doctoral gerontologists have been successful in securing jobs in academic and nonacademic organizations, creating gerontological knowledge, and translating their work into other fields. The authors concluded by considering how the successful integration of doctoral gerontologists might continue, and they propose directions for future research.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services.

Background: The majority of older adults prefer to remain in their homes, or to "age-in-place." To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults' residential environment is associated with their health status and HCBS utilization. Building upon the Person-Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.

The rote administrative approach to death in senior housing: Using the other door.

Understanding death in long-term care (LTC) facilities and the preexisting standards and policies pertaining to the death experience in LTC is essential. Qualitative interviews were conducted with 10 administrators of CCRCs and data analyzed through content analysis. Results of the current study reveal that administrators spoke of approaching death in their facility similar to any other procedural task, removal of the residents' bodies varied by community, and coordination responsibilities ranged from maintenance crews to management. Notification practices for residents and staff were also inconsistent. Differences existed in internal cultures on providing forms of respect. These practices were standard for some facilities while others were flexible to accommodate family requests. The majority of the sites did not offer additional training on death and dying for staff members. Findings suggest the need for consistency regarding how senior housing administrators approach the death of a resident and provide support for staff members.

Institutional Bereavement Care for Fictive Kin: Staff Grief in CCRCs.

PURPOSE: The purpose of this study was to explore approaches used by administrators to respond to grief and bereavement among staff after the death of a resident. METHODS: Continuing care retirement community (CCRC) facilities (n = 10) were randomly selected from a larger study of 31 facilities. Open-ended interviews were conducted using a structured interview protocol. Qualitative methods, specifically thematic analysis, were used to analyze the interview data. FINDINGS: Emergent themes suggest that LTC facilities have freedom in how to provide support for staff members, family members, and other residents after the death of a loved one. However, results show variations in methods for notifying staff of a resident's death, inclusion of direct care staff in caring for the deceased, providing memorial services, and offering grief/bereavement support. When speaking of the loss of a resident and ways to provide grief/bereavement support, only 3 of the 10 administrators discussed the importance of extending such services to the staff. IMPLICATIONS: Causes of staff burnout in the CCRC workplace is an unresolved issue. Research has shown that inadequate grief and bereavement support for staff contributes to factors associated with staff burnout and retention. Although administrators hold formal services after a resident has died, there are differences among facilities. It may be that organizations could improve bereavement services for staff.

A portrait of resilience in caregiving.

The current study investigated biopsychosocial resilience in an older adult caregiver. A case study was selected for in-depth exploration of resilience in caregiving identified through biopsychosocial (i.e., salivary cortisol) methods. An exemplar of a woman caring for an adult child dying from a genetic disease is presented in the context of multiple stressors. Significant stress was found to be buffered by cognitive reframing and acceptance of interpersonal limits. Early experiences in caregiving for others with terminal illnesses provided a frame of reference, and difficult family dynamics added a layer of complexity. During periods identified as stressful, cortisol levels rose outside of normal bounds. The study implications are that mixed-methods (i.e., biopsychosocial) studies yield important results on individual differences within similar contexts.

Application of the model of allostasis to older women's relocation to senior housing.

OBJECTIVES: Adjustment to senior housing entails significant lifestyle changes and is a stressful process. The adaptation process is dynamic and has yet to be studied using the conceptual model of allostasis. This article presents exemplars of women whose profiles represent three allostatic states: successful adaptation (homeostasis), ongoing adaptation (allostasis), and maladaptation (allostatic load). METHOD: Older women who had relocated to senior housing participated in three interviews and monthly saliva sample collection over a 6-month period. Saliva was assayed for diurnal cortisol secretion. Triangulation of mixed methods was used to analyze data, and psychosocial data were mapped onto the cortisol graphs to illustrate changes in stress reactivity and well-being. RESULTS: Coping abilities, perceptions of stressors, and cortisol measures provide a detailed picture of the interplay among events and perceptions and the effects of both on well-being. DISCUSSION: The case exemplars provide detailed information on the complexity of psychosocial and physiological components of the model of allostasis. This study also fills a gap in knowledge on negative relocation outcomes using the allostatic model.

What can I do with a doctoral degree in gerontology? Expanding your options.

An endless number of career trajectories are possible for gerontologists. With a growing aging population, our skills and areas of expertise are of high value to numerous industries. The purpose of this study is to describe the professional development and career trajectories of alumni of U.S. doctoral gerontology programs obtained through the Gerontology Education Longitudinal Study (GELS). Specifically, the authors examine how professional identification, doctoral program career preparation, and perception of job prospects affect alumni decisions to pursue "traditional" (i.e., academic) versus "nontraditional" (i.e., non-academic) careers. Results from the GELS revealed a fairly even split in the alumni sample of careers in traditional and nontraditional settings. The decision to pursue a traditional versus nontraditional career was not significantly associated with personal identification, doctoral program career preparation, or perception of employment options. These results suggest that the skill set obtained in doctoral gerontology programs is useful and is in demand in a variety of careers; therefore, doctoral programs may want to consider tailoring training to meet students' future career goals in both academic and non-academic settings.

Influence of Late Life Stressors on the Decisions of Older Women to Relocate into Congregate Senior Housing.

Late-life stressors often require individuals to make substantial alterations in behavior and lifestyle and can affect their overall health and well-being Relocation is a significant life stress regardless of age. The primary aim of this study is to elucidate the push-pull factors associated with moving into congregate senior housing. The secondary aim is to investigate the decision-making processes and stresses associated with moving into a congregate living environment. Interviews were conducted with 26 women who were new residents in congregate senior housing. Relocation, as expected, was considered to be stressful although individual differences were found among perceptions of relocation stresses. Women who had made the decision to relocate on their own showed evidence of better psychosocial well-being at the time of the move. One-quarter of the sample chose to move in order to provide care to another person. As the options for senior housing continue to evolve and the numbers of adults reaching advanced age continue to increase, it is important to understand the factors that contribute to successful adaptation. This knowledge will enable facility administrators to implement programs and procedures to assist incoming residents with acclimating to their new homes.

Tomorrow belongs to those who prepare for it today: gerontology doctoral students career aspirations.

This research seeks to examine the characteristics and goals of students enrolled in gerontology doctoral education. The authors seek to identify the unique characteristics of scholars enrolled in the interdisciplinary study of aging and elicit discussion on the ways in which these scholars will contribute to the growth and development of the field. This article describes results from an ongoing longitudinal study examining the relationship between gerontology doctoral education and overarching frameworks that define and advance the field. Four cohorts of first-year doctoral students were invited to participate in an online survey. Results reveal three distinct typologies of gerontology doctoral students: traditional academics, applied specialists, and general educators. Traditional academics are seeking postdoc and tenure-track faculty positions upon completion of the doctoral degree whereas the applied specialists intend to pursue careers in allied health fields or within a government setting. Educators plan to seek academic positions within teaching intensive or balanced teaching-research institutions. Gerontology doctoral students are being trained to serve as leaders in practice and research by linking and integrating multiple perspectives. Doctoral education will continue to facilitate applications of research to practice, identify the meaning of being a "gerontologist," and to advance the field of gerontology. However, students are entering with diverse academic and professional backgrounds and have varied career goals.

Globalization of gerontology education: current practices and perceptions for graduate gerontology education in the United States.

The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level degree programs. The authors conducted qualitative interviews with representatives of the Association for Gerontology in Higher Education, the major national organization supporting higher education in gerontology, graduate program directors, and students. Although all respondents expressed their interest in globalizing gerontology education, actual practices are diverse. The authors discuss suggested conceptualization and strategies for globalizing gerontology education.

Death in the nursing home: an examination of grief and well-being in nursing assistants.

The grief that nurses experience when patients and residents die can be complex and has been linked to both problematic (e.g., depression) and beneficial (e.g., gains in coping) outcomes. In this study, 380 nursing assistants working in the nursing home setting were surveyed to gain an understanding of the relationship between grief and well-being. Findings indicated that participants experienced both distress and growth in their grief. Those who experienced greater distress from grief reported significantly higher levels of burnout and lower levels of psychological and physical well-being. Conversely, participants who experienced greater growth from their grief reported significantly lower levels of burnout, higher levels of psychological and physical well-being, and higher levels of job satisfaction. These findings suggest that grief may be an important determinant of well-being in nursing assistants, which, in turn, may impact quality of care in the nursing home.

The Grief Support in Healthcare Scale: development and testing.

BACKGROUND: Social support is an important factor to consider in understanding the grief process. However, existing measures of social support fail to account adequately for the unique characteristics of grief experienced by healthcare workers in relation to the deaths of patients or nursing home residents. OBJECTIVE: The purposes of this study were to develop and to test a grief support measure specific to the experiences of healthcare workers. METHODS: Using a cross-sectional design, 380 nursing assistants completed self-administered surveys focusing on grief and loss in the nursing home setting. Exploratory factor analysis and regression analysis were conducted to test the psychometric properties of the Grief Support in Healthcare Scale (GSHCS) and to investigate the scale's relationships with grief outcomes. RESULTS: Reflective of the theory of disenfranchised grief, the 15 items of the GSHCS were loaded onto three distinct factors: recognition of the relationship, acknowledgement of the loss, and inclusion of the griever. Reliability was acceptable to high across these factors (Cronbach's α of .89, .86, and .78, respectively). Regression analysis indicated that the three subscales of the GSHCS were related significantly to both distress from grief and growth from grief, yet these relationships were unique for each factor. DISCUSSION: This research demonstrated that the GSHCS has acceptable reliability and face validity for understanding grief in healthcare workers and may aid in the development of interventions targeted at enfranchising grief in this population. Additional testing is needed to estimate the validity and the reliability of the scale with other groups of healthcare workers.

Mentoring in gerontology doctoral education: the role of elders in mentoring gerontologists.

This study examined elder mentors' and students' roles, functions, and satisfaction with the Elder Mentorship program at the Graduate Center for Gerontology, University of Kentucky. The Elder Mentorship program matches gerontology doctoral students with older adults in the community. Parallel surveys were constructed to evaluate the program from the perspectives of elder mentors and student mentees. Data were analyzed using descriptive frequency analyses, with open-ended questions analyzed thematically. Results show that students and elder mentors were mostly satisfied with their experiences. Elder mentors perceived their participation more positively than did student mentees. Future programs utilizing the elder mentorship model may benefit from matching students and elder mentors in terms of shared interests.

Building relationships in residential long-term care: determinants of staff attitudes toward family members.

The objective of this study was to identify staff-, family-, facility-, and resident-level predictors of staff attitudes toward family members. Data were used from 41 care staff members recruited from 5 nursing homes, 5 assisted living facilities, and 16 family care homes. A multiple regression model found that staff who reported greater quality in their relationships with residents also tended to indicate more positive perceptions of family members. The findings emphasize the need to consider family, resident, and staff relationships in concert when designing and implementing nursing interventions to improve quality of life and care in residential settings.