Approximately 25% of older adult residents who experience an acute change in health status are transferred from Long-Term Care (LTC) to Emergency Departments (ED). We explored the use of an intervention (i.e., LTC to ED) care and referral pathway, INTERACT® Change in Condition cards, and STOP AND WATCH tool, in informing decision making regarding resident transfers. We conducted 22 semi-structured interviews with Health care Providers (HCPs) involved in the LTC to ED care pathway in Western Canada. Thematic analysis of the qualitative interviews was used to evaluate the use of the pathway and tools. We identified six themes influencing decision making around resident transfers including interprofessional practice and conflict, ambiguous and clear medical cases, ageism, health care providers’ goals, family involvement in resident care, and intervention tools. The intervention may be useful in streamlining, documenting, and increasing transparency in complicated LTC resident care and transfer decisions.

The COVID-19 pandemic highlighted significant vulnerabilities in long-term care (LTC) homes, severely impacting residents and care partners. This study investigates how care partners of older adults living in Ontario LTC homes perceived residents’ experiences during the COVID-19 pandemic, and how those perceptions shaped their own caregiving experiences. Using critical ethnography, we identified four key themes: (a) masks and miscommunication, (b) loneliness and loss, (c) from interaction to isolation, and (d) loss of the advocacy role. Supportive actions included transparent masks, increased allied health professionals, and enriching daily programs. These findings emphasize the need for policies that balance infection control with the emotional and social needs of LTC residents, addressing power imbalances, ageism, and systemic inequities.

Understanding the process of seeking long-term care (LTC) in old age helps identify what contributes to delays and inequalities in accessing it. Current research highlights the roles of individual and policy factors, but pays little attention to how these factors interact. This qualitative study aims to fill this gap by identifying facilitating factors and mechanisms in the initial approaches to LTC policies. It examines care-seeking in two towns in northern Italy, where a demand-based approach, high fragmentation and poor coordination pose significant challenges. In a bottom-up approach to policy implementation, the experiences and perspectives of both care-seekers and professionals are integrated. Indeed, the data collection (April 2023–May 2024) triangulates 100+ hours of participant observation and semi-structured or vignette-based interviews. The study finds that care-seeking entails three interrelated steps: recognising care needs, being willing to receive LTC, and reaching an entry point. At each stage, three mechanisms operate at intrapersonal and interpersonal levels and can be promoted by LTC policies to facilitate care-seeking, especially for those experiencing barriers. The mechanisms are (1) taking the initiative to raise awareness of care needs and share information about available solutions; (2) fostering trust between professionals and care-seekers, who often rely on confidential relationships to discuss care arrangements; and (3) combining primary information with tailored guidance on the local offer, enabling care-seekers to make informed decisions. The findings provide actionable insights into policies and practices that facilitate care-seeking, and offer a conceptual framework that explains the driving factors behind this process and its mechanisms.

As the population ages, the provision of adult long-term care (LTC) is one of the major challenges facing the UK and other developed nations. LTC funding for the elderly is complex, reflecting the range and level of services provided, with the total cost depending on the duration of LTC required. Institutional care settings (e.g., nursing/residential care homes) represent the most expensive form of LTC. Planning and funding for institutional LTC requires an understanding of the factors affecting the mortality (and hence duration and cost of care) of such LTC recipients. Using data provided by Bupa, one of the largest LTC providers in Britain, this paper investigates factors affecting the mortality of residents of institutional LTC facilities over the period 2016-2019. Consistent with existing research, most residents were female and had a higher average age profile compared with male residents. For those residents who died during the investigation period, the average length of stay was approximately 1.6 times longer for females relative to males. For both males and females, new residents experienced higher mortality in the first-year post admission compared to existing residents. Variations in the mortality of the residents were analysed by condition, funding status and care type on admission.

Reforms to the means tests in England for state-financed long-term care were planned for implementation in 2025. They included a lifetime limit (cap) on how much an individual must contribute to their care, with the state meeting subsequent care costs. We present projections of the costs and distributional impacts of these reforms for older people, using two linked simulation models which draw on a wide range of data. We project that by 2038 public spending on long-term care for older people in England would be about 14% higher than without the reforms. While the main direct beneficiaries of the lifetime cap would have been the better off who currently receive no state help with their care costs, the reforms also treated capital assets more generously than the current system, helping people with more modest incomes and wealth. When analysing the impacts of the reforms it is therefore important to consider the whole reform package. Our results depend on a range of assumptions, and the impacts of the reforms would be sensitive to the levels of the cap and other reformed parameters of the means test on implementation.

The aim of the article is to examine the efficiency of Long-Term Care Sector in Poland. Detailed analysis of the level of dependency was carried out, measured by the number, structure and sequence of ADL loss among residents based on data collected between 2021 and 2022 in Polish private rest homes, social residential homes and nursing homes. We have used 3 scenarios based on care and home modernization vouchers to calculate alternative public LTC costs. In the 5 years’ perspective, it seems that solutions based on care vouchers: home care vouchers for 0–2 ADL group without cognitive impairment or mental disorders and inpatient care vouchers for 0–2 ADL group with mentioned impairments, lead to the highest public savings. Better allocation of people with a low level of dependency and without cognitive impairment results in lower public spending on LTC and increased access for people with a higher level of dependency.

Relationship-centred mealtimes can support care home residents, who are at high risk for loneliness. However, care home staff do not consistently promote relationship-centred mealtimes. This secondary analysis examined the impact of factors (selected based on the Theory of Planned Behaviour) upon care home staff interest in making mealtimes more relationship-centred. Data were from a cross-sectional, quantitative survey of 670 care home staff from North America. We used multivariable logistic regression to test hypotheses. The model was statistically significant, and explained 13 per cent of the variance in staff members’ interest in making mealtimes more relationship-centred. Respondents who were more satisfied with current mealtime practices, had used collaborative change strategies in the past, and who perceived organizational support for relationship-centred care were more likely to have interest in making mealtimes more relationship-centred. These are modifiable factors to target in interventions designed to promote care home staff interest in making mealtimes more relationship-centred.