Implementation Science in Long-Term Care

Updated: Mar 17

Researchers team up with long-term care staff and residents’ families to test strategies for reintegrating care partners during pandemic


By Greg Basky for SHRF


Gloria Evans sees the impact the pandemic is having on the spirits of her mother, who lives in an assisted living facility in Regina. Since October, Gloria and her sister Lynette have each been allowed only a single, hour-long weekly visit with Olive -- who turned 101 last fall.


“The thing that’s been really tough on her is not being able to have people come in and sit,” says Gloria. “She’s said many times that she just wants somebody to listen to her, or to visit with.”


Prior to the pandemic, Gloria and her sister would stop by Memory Lane almost daily, to surprise Olive with some of her favorite treats -- potato chips or cinnamon buns -- to water plants, tidy up her room, put away laundry, or just catch her up on the latest world news.


Lynette says that, while her mother seems to appreciate their visits through the window of her ground level suite, she too senses Olive misses in-person, face-to-face contact with her family: “I would say that it's affected her quite a bit. We'd go to the window and she'd say, ‘Well...you can't come in yet...can you? It would be good if you could come in so we can visit again.”

Long-term care homes have been hit hard by the COVID-19 pandemic. The virus has proven particularly ruthless in seniors -- who often have other chronic conditions and weakened immune systems. In order to protect residents, public health orders required facilities to eliminate in person visits from family members and friends. Evidence is emerging though that the same policies put in place to keep residents and staff physically safe have brought unintended harm to residents’ mental health, through increased feelings of separation and social isolation.


A new project getting underway this spring in a handful of care homes in Saskatchewan, Ontario, and New Brunswick will identify effective ways to safely reintegrate the people who play a critical role in both the physical and mental health of residents. The Canadian Foundation for Healthcare Improvement (CFHI) which -- along with the Canadian Patient Safety Institute (CPSI) -- is supporting the project, defines these individuals as “essential care partners” in recognition of the key role they play in the well-being of residents.


Saskatchewan care homes part of national project

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Bill Pratt, Chief Relationship, Research & Innovation Officer

Regina Lutheran Home (special care home) and Memory Lane (supportive independent living), two long-term care homes in Regina run by Eden Care Communities, are part of the project, which is being funded in this province by the Saskatchewan Health Research Foundation (SHRF), in partnership with the Canadian Institutes of Health Research (CIHR). Bill Pratt, chief of relationships, research, and innovation with Eden Care, says he’s seen first hand that residents are missing the important people in their lives. “I’ve witnessed among our elders a feeling of being left out, of missing people -- particularly when there’s been an outbreak and they’re restricted to their suites.”


Eden Care staff are doing what they can -- within the confines of public health rules -- to address loneliness and boredom, but Pratt says there’s no escaping the fact that social interaction is significantly reduced. “It’s still not the same as having those you love coming in to see you.”


Local teams testing, tweaking evidence-based tools

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Natasha Gallant, Assistant Professor in Clinical Psychology, University of Regina

Natasha Gallant, an Assistant Professor in Clinical Psychology at the University of Regina, is project lead. She says local teams in each province will be iteratively testing a series of tools and strategies identified by CFHI as best practices for more closely involving essential care partners in long-term care. The tools include such things as staff education on the role of essential care partners and communication strategies to ensure essential care partners are properly identified, screened, and educated around facility-specific safety protocols.


“While some homes may have some of these pieces in place already, our project is intended to help tailor the tools to their circumstances, and help out in areas where they’re struggling,” says Gallant. “For example, if they’re currently providing one-on-one training for caregivers, perhaps we can develop some standardized web-based training to take that off their plate.”


Along the way, Gallant and her colleagues will be using questionnaires, interviews, and focus groups to collect quantitative and qualitative data from residents, family caregivers, and staff, to see if the work is making a difference -- with an eye to scaling up the final versions of tools to make them available to other long-term care facilities.


Knowledge mobilization an important aspect of implementation science


The project will use a research approach called implementation science, which focuses on maximizing the probability that a project’s findings are actually put into practice. The long-term care environments that have signed on have committed to implementing the tools and strategies they help develop over the course of the project.

Headshot of Thomas Hadjistavropoulos
Thomas Hadjistavropoulos, Research Chair in Aging and Health and Professor at the University of Regina (Photo by Trevor Hopkin, U of R Photography)

Thomas Hadjistavropoulos, Research Chair in Aging and Health and Professor at the University of Regina, is one of the senior researchers involved in the project. He says the applied nature of implementation science is the right prescription for addressing this pressing issue -- since it can take an average of 17 years for regular health research to make its way into practice. “When we are looking at the long-term care environment, most of the people we work with are not going to be around in 17 years to benefit from solutions that are available today.”


Hadjistavropoulos -- who does much of his research in the long-term care setting -- wants to work with facilities that are committed to making permanent changes. “I am frustrated with the old cycle,” he says. “The study ends, the researchers leave, and the intervention leaves with them. What is the point of knowing that something is effective if it’s not going to be used.”


The team needs to employ creative approaches to get this new work put into practice, rather than relying exclusively on conference presentations and reports -- which people say they find useful but do not tend to actually apply, according to Hadjistavropoulos. He would like to see the team tap into the power of social media to target and spread the word. He cites the example of Christine Chambers, a pediatric psychologist in Nova Scotia who launched a wildly successful social media campaign called #ItDoesntHavetoHurt to highlight proven techniques for reducing pain in children undergoing medical procedures.


The campaign garnered millions of impressions on Twitter and its hashtag was used thousands of times around the world -- which he says led to a presentation on Christine Chambers’ work before the Canadian Senate. “That’s really penetrating into the system.” Hadjistavropoulos has started a similar campaign (#SeePainMoreClearly) to mobilize knowledge aimed at improving pain care in long-term care environments.


Project promises change locally and abroad


The project team expects to have ethics approval by the end of February and are working to get the necessary data sharing agreements in place. Gallant would like to see the project lead to more formal recognition of the critical role essential care partners play in the wellbeing of long-term care residents. “They need to be considered part of the team in facilities,” says Gallant.


In addition to improving quality of life for Eden Care residents, Bill Pratt hopes the project makes families and staff feel like they’re part of something bigger. “How does the saying go? “A rising tide lifts all boats? Everybody should be able to benefit from this project, if they want to.”


This work holds the potential to support a smooth and safe reintegration of visitation and engagement of families with their loved one, according to Hadjistavropoulos. I’m hoping this work will find the best way to do it smoothly, safely and at a wide scale,” he says. “We’ve seen and heard the stories of people being alone and without contact with loved one for months -- that’s a really devastating situation to put someone in.”


This project is one of 22 Implementation Science Teams of researchers from across the country have partnered with LTC and retirement homes, including homes that are part of the LTC+ Acting on Pandemic Learning Together program, to study the effectiveness of promising practices, interventions and policy options designed to keep residents, families, caregivers and staff safe from COVID-19. Learn more >


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