Teamwork and Nurse Care Coordination in Home Healthcare.

Home healthcare agencies provide interdisciplinary care to millions of individuals annually. Care is typically led by registered nurses who often determine additional disciplines need to be included in the plan of care. We found that, although persons living with dementia represent about 30% of the home healthcare population, data from our home healthcare system showed that over a 1-year period with 36,443 home care episodes, only 29.6% had one or more social worker visits. Recognizing Alzheimer's disease-related dementia as a terminal condition and shifting toward a palliative care approach can be a challenge in home healthcare where care is focused on restorative care or rehabilitative goals with a primary focus on improvement in condition. The goal of this article is to present insights into nurse-led care coordination and teamwork and provide implications for practice.

Dementia Arts Mapping: observational methods for documenting impacts of poetry and recreation in care settings.

BACKGROUND: Long-term care homes for older and disabled adults, including those who are living with dementia, facilitate a diversity of recreational activities and program as social interventions. The relationships between interventional elements and participant impacts are not well understood. METHODS: This paper explores a poetry methodology and reports the findings from a pilot test of Dementia Arts Mapping, a novel ethnographic observational technique, to better understand impacts of poetry and recreation on people living with dementia in long-term care settings. Between 2017 and 2020, at 17 skilled nursing facilities throughout Wisconsin, researchers situated within care homes observed participants during diverse activities. RESULTS: We found poetry workshops surpassed other activities in eliciting self-expression. CONCLUSIONS: Dementia Arts Mapping is an effective instrument for generating insights about dementia care and may be further enhanced for future use in research to inform care provision to foster meaningful engagement with people with dementia.

NASW's Supervisory Leaders in Aging: One-year practice change outcomes of an innovative training program for social work supervisors.

Social work supervision addresses professional development, staff support, and management of direct service workers. It is important in aging-services settings because of the impacts of complex and evolving biopsychosocial forces in clients' lives. This article presents findings of the Supervisory Leaders in Aging (SLA) study based on data available one-year post completion. SLA is a 30-hour certificate program for supervisors from aging-services settings addressing best practices in supervision of gerontological practice. The study compares participants' self-assessment of use of supervisory best practices before attending a 3-month workshop series and at two times following graduation. This article reports findings from the analysis of data provided by 114 out of 129 supervisors who completed the program. Participants increased the frequency of use of best practices at both three and 12 months after graduation. These increases were conceptually meaningful and statistically significant among participants who were low users of best practices prior to the program. SLA has led to significant adoption and maintenance of supervisory best practices among participating social work supervisors and especially among those who have not previously adopted routine use of best practices. The interactive small-group learning activities of SLA's educational model should be promoted and the curriculum of best practices should be further refined and tested as SLA is implemented in other communities.

"Doing the Right Thing": Family Caregivers Managing Medical and Nursing Tasks in the Postacute Home Health Care Setting.

Family caregivers often manage complex medical and nursing tasks (MNTs) for older adults transitioning from hospital to home. To explore caregivers' experiences managing MNTs in the postacute home health care (HHC) setting, we interviewed by phone 20 caregivers of older adults who received HHC following a hospitalization. Interviews were recorded, transcribed, and analyzed using directed content analysis. Caregivers highlighted the technical complexity and emotional impact of performing MNTs, as well as social (e.g., family, friends) and environmental (e.g., neighborhood, housing) resources they leveraged to meet the older adults' care needs. Caregivers also identified challenges coordinating care and services within HHC and the larger health care system. Caregiver engagement in the postacute HHC setting should incorporate tailored training and support, assessments of socioenvironmental context and resources, and facilitated navigation of the health care system. Future research should elucidate factors associated with successful collaborative relationships among HHC providers, older adults, and their caregivers in the postacute HHC setting.

John A. Hartford Foundation Centers of Excellence Program: History, Impact, and Legacy.

The John A. Hartford Foundation (JAHF) created the Centers of Excellence in Geriatric Medicine and Geriatric Psychiatry in 1988 with the goal of establishing academic training environments to increase geriatrics-trained faculty. The initiative identified medical schools with the necessary components for training academic geriatricians. JAHF grants provided the resources to create a cadre of physicians whose research, teaching and practice leads to substantial contributions in geriatrics. Results from two evaluations show that the program has successfully increased geriatrics-prepared faculty who have achieved promotion and institutional retention, success in winning competitive research grants, and positions of leadership. The initiative strengthened the national network of geriatrics programs and served as a major driver of increased prestige for the fields of geriatric medicine and psychiatry.

Aging in Place vs. Relocation for Older Adults with Neurocognitive Disorder: Applications of Wiseman's Behavioral Model.

Some older adults are more vulnerable to housing concerns due to physical and cognitive challenges, including those with a neurocognitive disorder who need extensive support. Environmental gerontology frameworks, including Wiseman's 1980 Behavioral Model of Elderly Migration, have informed scholarship on aging in place and relocation. Understanding Wiseman's model, including considerations for working with families confronting a neurocognitive disorder, can help practitioners ensure that older clients live in settings that best meet their wants and needs.

Primary care providers' bereavement care practices: recommendations for research directions.

OBJECTIVE: Bereaved patients are often seen in primary care settings. Although most do not require formal support, physicians may be called upon to provide support to some bereaved, particularly those with bereavement-related mental health disorders like complicated grief and bereavement-related depression. Research evidence on physician bereavement care is scant. We make recommendations for future research in this area. DESIGN: Literature review focuses on studies conducted between 1996 and 2013 in the United States. Searches of Medline and PsychInfo, along with hand searches of reference sections, were conducted. RESULTS: The limited existing research indicates substantial gaps in the research literature, especially in the areas of primary care physician skill and capacity, patient-level outcomes, and the quality of research methodology. No US studies have focused specifically on care for bereavement-related mental health disorders. We provide recommendations about how to improve research about primary care bereavement care. CONCLUSIONS: The primary care sector offers ample opportunities for research on bereavement care. With greater research efforts, there may be improvements to quality of bereavement care in primary care, in general, and also to the accurate detection and appropriate referral for bereavement-related mental health conditions.

Relocation remembered: perspectives on senior transitions in the living environment.

The experience of aging may necessitate transitions in living environments, either through adaptations to current residences or through relocations to more supportive environments. For over a half century, the study of these transitions has informed the work of researchers, health and mental health providers, policymakers, and municipal planners. In the 1970s and 80s, knowledge about these transitions advanced through Lawton and Nahemow's ecological theory of competence and environmental press, Wiseman's behavioral model of relocation decision making, and Litwak and Longino's developmental perspective on senior migrations. This article revisits influential theoretical frameworks that contribute to our understanding of senior transitions in living environments. These seminal works are shown to inform recent studies of relocation and gerontology. This article concludes with a call for a view on housing transitions that reflects the contemporary context.

The transformative potential of social work's evolving practice in dementia care.

Social workers in diverse service systems throughout the United States encounter many opportunities for improving quality of life for people with dementia and their families. Yet practice with this population is unclearly defined and a core set of competencies for such practice does not yet exist. Instead, it is shaped by roles within aging and health systems. These roles are informed by a biomedical disease model of dementia. This article examines social work practice and its connection to evolving views on aging and senility throughout the 20th century. New directions for practice are recommended to improve services for individuals with dementia.