Antibiograms are challenging to construct in long-term care (LTC) homes in part due to low isolate counts and limited precision. Regional-local antibiograms offer a potential solution by using partial pooling, combining data from both the home and the broader LTC population. We developed regional-local urinary antibiograms and compared this approach to standard antibiograms. This cross-sectional study included urine cultures from LTC residents across Ontario. (i) Standard syndromic combined antibiograms were created for each LTC home with ≥30 total isolates. Homes with <30 isolates used the mean of susceptibility for each drug for the entire province. (ii) Partially pooled regional-local antibiograms were constructed using logistic mixed models with a random intercept for each home to ensure each LTC home could be provided a facility-specific antibiogram. We compared susceptibility and rank order of recommended antibiotics using each method. Among 627 LTC homes, 340 (54.2%) met the ≥30 isolate threshold. Regional-local methods allowed for the development of 627 LTC home-specific antibiograms. These methods narrowed susceptibility estimate ranges compared to standard methods (e.g., trimethoprim-sulfamethoxazole [TMP-SMX]: 57%-77% vs 37%-90%, respectively). A total of 119 (19.0%) homes had at least one antibiotic with over 80% susceptibility using the standard approach; only 11 (1.8%) homes met this threshold with the regional-local antibiogram. The antibiotic with the highest susceptibility varied based on methodology (amoxicillin-clavulanate for standard vs TMP-SMX for regional-local antibiogram). Regional-local antibiograms allow for the creation of facility-specific antibiograms, even among facilities with small isolate counts. This approach may provide more precise antibiotic susceptibility estimates by reducing misleading inter-facility variation.IMPORTANCELocal antibiograms can help inform empiric antibiotic treatment for long-term care residents with urinary tract infections. However, many facilities have too few isolates to create precise susceptibility estimates. A regional-local antibiogram is a novel strategy that uses a weighted approach: it prioritizes local data where available, but increasingly uses regional population-level data for homes with smaller sample sizes to improve statistical precision and reduce misleading inter-facility variation. This regional-local approach allows for the development of facility-specific antibiograms for a greater number of homes compared to traditional methods of developing antibiograms.
Delirium is a neuropsychiatric syndrome associated with serious complications. Residents of nursing homes are particularly vulnerable to developing delirium. Nurses play a key role in the prevention, detection, and management of delirium but often report a lack of specific knowledge and understanding. The aim of this study was to develop and evaluate a tailored e-learning programme on delirium for nurses working in German nursing homes. This pilot study employed a single-group pre-post design. Between January and March 2025, nurses from German nursing homes completed a delirium-specific e-learning program consisting of five modules on risk factors, causes, prevention, symptoms, diagnosis, and treatment. Participants completed a delirium knowledge questionnaire and rated their confidence in recognizing delirium before and after training. Evaluation questions assessed usability and relevance. A total of 80 nurses completed the e-learning program as well as the pre- and posttests. Delirium-specific knowledge improved from a median of 32 to 40 correct answers (interquartile range [IQR] = 9.25 vs. 7.5; p < 0.001). Subjective confidence in recognizing delirium increased from 5 to 7 (IQR = 2.25 vs. 1; p < 0.001) on a 10-point scale. Both improvements showed large effect sizes (knowledge: r = 0.86; subjective confidence: r = 0.92). Most nurses rated the training as highly relevant and usable. Residents of nursing homes are at increased risk of delirium, while nursing staff report a clear need for delirium-specific expertise. Findings from this pilot study suggest that the tailored e-learning program may enhance nurses’ knowledge and confidence in recognizing delirium. The program represents a promising foundation for structured delirium training in nursing homes and warrants further evaluation in larger and long-term studies. The online version contains supplementary material available at 10.1186/s12909-026-09297-2.
The health impacts of rising temperatures in care home settings are of growing concern. We seek to characterise the risk of heat-related mortality in nursing and residential care home settings in England and to assess potential modification of heat effects by Care Quality Commission (CQC) ratings. Heat episode analysis was used to assess excess mortality during the heatwave of 16-20 July 2022. Daily time-series regression analysis employing Distributed Lag Non-linear Models was used to assess short-term associations between daily mean temperature and daily number of deaths in care home residents during 2022-24, adjusting for season and day-of-week effects. Nursing home deaths increased by 34.1% (95% CI 21.1, 48.2) and residential care home deaths by 13.0% (0.1, 27.0) during the July 2022 heatwave. During 2022-24, the relative risk of death on a day of 25°C compared to a day of 16°C was 2.09 (95% CI 1.68, 2.60) among nursing home residents and 1.56 (1.24, 1.96) in residential care homes. There was a gradient of increasing heat-related mortality risk associated with poorer CQC rating, although almost all CQC categories were associated with raised risks. Heat-related mortality risk in care homes was greatest in the West Midlands and London regions. Our findings indicate a growing need for heat stress to be recognised as an important risk factor for care home residents. Urgent and wide-scale improvements in heat adaptation strategies are needed in care homes across England to help improve the resilience of the social care system to climate change.
Nursing homes are congregate settings for elderly individuals where infectious diseases can easily spread. The elderly are at high risk of contracting and dying from influenza, and the most effective way to prevent this is to receive the influenza vaccine. This study conducted a cross-sectional survey of elderly people in nursing homes to investigate the occurrence of influenza symptoms during the 2024-2025 flu season, as well as vaccination status and reasons for receiving or not receiving the vaccine. Bivariate logistic regression was used to determine the factors influencing the vaccination rate. Of the 1024 elderly people who participated in the survey, 25.39% reported experiencing flu-related symptoms in the previous flu season. While 16.21% of the elderly expressed willingness to receive vaccination, only 5.57% actually received it. Influenza vaccination was positively correlated with educational attainment (aOR 3.800, 95% CI 1.480-9.758 for middle school; aOR 5.138, 95% CI 1.738-15.191 for high school), monthly household income (aOR 0.216, 95% CI 0.072-0.644 for >8000), ability for self-care (aOR 0.269, 95% CI 0.123-0.591), and the scale of the nursing home (aOR 9.033, 95% CI 1.531-53.305 for 151-299; aOR 2.629, 95% CI 1.359-5.084 for ≥300). Willingness to receive the influenza vaccination was positively correlated with an unhealthy health status (aOR 0.398, 95% CI 0.204-0.779), symptoms of influenza (aOR 2.730, 95% CI 1.861-4.007), nursing home location (aOR 1.537, 95% CI 1.099-2.941 for outer suburbs), and the scale of the nursing home (aOR 1.991, 95% CI 1.154-3.435 for 151-299; aOR 2.158, 95% CI 1.374-3.390 for ≥300). Most elderly people who received the vaccine believed that vaccination could effectively prevent flu and that it could reduce the risk of complications, the rest were not vaccinated due to concerns about adverse reactions, mobility issues, or the distance to vaccination sites. Low awareness of flu vaccines and physical inability to travel to vaccination sites may be potential barriers to receiving the flu vaccine. It is worrying that the influenza vaccination rate is low among the elderly in nursing homes in Shanghai. As a result, it is crucial to prioritize targeted monitoring and intervention strategies for vulnerable populations living in collective institutions.
Providing high-quality advance care planning conversations for nursing home residents living with Alzheimer's Disease and Related Dementias is a persistent challenge, but implementation of advance care planning interventions remains limited. This study explored barriers and enablers to implementing the Goals of Care video with nursing home staff and identified strategies to implement the video intervention. Nursing home administrators identified staff members involved in ACP discussions with residents and families. A research team member contacted these individuals by email or telephone. Fourteen staff members across six Florida nursing homes participated in in-person or virtual semi-structured interviews. A summative content analysis quantified the frequency of each CFIR construct coded as an enabler or barrier, with frequencies calculated at the nursing home level. The primary enabler was the alignment of the Goals of Care video with nursing homes' organizational mission. The most identified barrier was the video's perceived length. Strategies to improve implementation included adapting materials, assessing readiness, and addressing site-specific challenges. Tailoring the Goals of Care video to the organizational context is essential. Addressing barriers, such as video concerns, while leveraging existing enablers can strengthen adoption and support more consistent advance care planning practices.
Unmet needs for activities of daily living (ADLs) are likely to increase with advancing age. This study explored the prevalence of unmet needs, its associated factors, and the perspectives regarding the care received by older adults living in their own homes in the Colombo District, Sri Lanka. A representative cross-sectional sample of community-based older adults (n = 723), aged ≥ 65 years, was obtained by multi-stage cluster sampling. Limitations in ADLs were measured using a validated Sinhala version of the 10-item Barthel Index, and the unmet needs were assessed using six specific questions. Simple and multiple logistic regression were used in data analysis. Mean(± SD) age of the older adults with unmet needs (n = 71) was 76.07 ± 8.44 years, with 84.5% males. Out of 723 older adults, 122 (16.8%) had limitations in activities of daily living (ADLs), among whom 71 (58.2%) reported unmet needs. The mean (± SD) ADL scores of the total sample, older adults with ADL limitations, and those with unmet needs were 94.42 ± 17.1, 67.17 ± 28.94 and 55.00 ± 30.16 (out of 100), respectively. The majority (63.4%) reported unmet needs for > 3 ADLs, while the prevalence of unmet needs for different ADLs ranged from 15.4% to 91.5%. The commonest unmet need was for walking and climbing steps (91.5%), followed by bathing (76%) and transferring (73.2%). Factors that showed significant (p < 0.001) positive associations with unmet needs in the adjusted model were male gender (odds ratio [OR] = 3.73, confidence interval [CI] = 1.80-7.7), age (75-84 years OR = 2.91, CI = 1.65-5.12; >85 years OR = 5.23, CI = 2.28-11.98) and disabling stroke (OR = 6.13, CI = 2.46-15.3). The majority were dissatisfied with the care they received (56.7%, n = 34) and with the caregivers' knowledge of caregiving (83.3%, n = 50). Older adults living in their own homes reported unmet needs, particularly in walking, climbing, bathing, and transferring. Factors that enhance the occurrence of unmet needs include advancing age, male gender and disabling stroke. The provision of assistive devices in mobilization and, capacity building of caregivers would help bridge this gap. Engaging nursing trainers in implementing structured home-based caregiver training programs and a multidisciplinary approach focused on mobility support is recommended.
This study analyzed technical directors' perceptions of swallowing in Residential Care Homes for Older Adults (ERPI). A qualitative study was conducted with 27 directors through semi-structured interviews addressing dysphagia knowledge, warning signs, risks, and management strategies. Data were thematically analyzed using ATLAS.ti. Participants recognized swallowing as clinically relevant for residents' health and safety but showed limited technical knowledge and resources for structured dysphagia management. Although risk awareness was evident, the absence of standardized protocols, multidisciplinary support, and continuous training constrained effective practice. Findings highlight the need for targeted training and organizational strategies to improve dysphagia care and support safer, higher-quality aging in residential settings.
Human settlements are increasingly being impacted by urban fires initiated by wildfires. Metrics such as area burned and number of structures destroyed are important, but research often overlooks the socio-ecological complexity of urban fires. We study the impacts of the 2025 Los Angeles fires on two communities at the neighborhood and residential parcel scales. Geospatial analyses and econometric modeling explore the relationships between urban morphology, socio-demographic factors, and home destruction. Here we show that socio-ecological characteristics and scale are key in parsing the dynamics of urban fires. Also, new socio-demographic populations are being affected and urban morphology metrics are more important than vegetation cover. Despite parallels with 19th and early 20th century urban conflagrations, understanding these re-emerging urban fires requires transdisciplinary approaches and unique metrics. Investigating the socio-ecological scales and dynamics of urban fires provides a valuable next step towards understanding and adapting to the risk associated with these disasters.
A restraint-free environment is a human right for people living in residential aged care (RAC). Yet restrictive practices continue to be frequently used in these settings. A scoping review of interventions is required to inform future practice and research. To identify and characterise interventions that have been implemented to reduce the use of restrictive practices on residents of RAC. A scoping review was conducted of peer reviewed articles that reported on interventions implemented in RAC to reduce restraint use. Databases searched included Ageline, CINAHL, Medline, PubMed, PsycINFO, Scopus, Embase. Bronfenbrenner's Socio-Ecological Model (SEM) was used to characterise and present the interventions. Seventy studies were included; 52 studies addressed one SEM level (macro-system, exo-system or micro-system) and 18 studies addressed two SEM levels (exo-system and meso‑system; exo-system and micro-system). No interventions were identified at the meso‑system level. Educational interventions were the most frequently recorded (31 studies), although there was a lack of detail in the reporting. Reductions in physical restraint were maintained over time, with varied outcomes regarding chemical restraint. Reduction in restraint use in RAC is complex, although most interventions focused on one SEM level of influence only. Positively, studies consistently reported reductions in physical restraint over time, reinforcing the benefits of implementing targeted interventions to reduce restraint use. Further research is needed to examine the benefits of interventions targeting multiple SEM levels and considering all forms of restraint. Findings from this review can inform future interventional studies to reduce restraint use in RAC. Open Science Framework https://osf.io/7v4b2.
Anticholinergic burden is an important risk marker in older adults, associated with cognitive decline, falls, and increased mortality. This study aimed to assess anticholinergic burden in institutionalized elderly individuals using two tools (ACB calculator and CALS-CRIDECO Anticholinergic Load Scale), as well as to analyze its relationship with pharmacotherapeutic variables like polypharmacy. A descriptive cross-sectional study was conducted by analyzing the pharmacotherapeutic profiles of institutionalized elderly individuals (≥65 years) utilizing individualized medication preparation services from a community pharmacy in Alentejo (Portugal). Participants agreed to the study and had complete, up-to-date pharmacotherapeutic profiles. The pharmacotherapeutic profiles of 75 institutionalized elderly people were analyzed; the sample comprised mostly women (72%) who had experienced excessive polypharmacy (≥10 medications) (56%) and had an average age of 85.62 ± 7.62 years. It was found that 90.7% (ACB) and 89.3% (CALS-CRIDECO) of the elderly had anticholinergic burden, with mean values of 3.60 ± 2.84 and 3.33 ± 2.51, respectively. Women exhibited higher anticholinergic burden in unadjusted analyses (p < 0.05). The burden correlated moderately with the total number of medications (p < 0.05). The results show high exposure to anticholinergic medications in the institutionalized elderly population, reinforcing the rationale for systematic therapeutic reviews focused on the pharmacological safety of institutionalized older adults in community pharmacies.
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Long-term care facilities are increasingly caring for persons living with dementia as this population grows. Frontline care workers provide most hands-on support, yet they often have limited access to formal dementia education and training. Traditional training formats frequently fail to support experiential learning or accommodate the linguistic, cultural, and demographic diversity of the long-term care workforce. This mixed methods pilot study examined the effects of the combined use of online learning, immersive virtual reality (VR) simulation, and facilitated group discussions on the training and preferred learning formats. In particular, this study tested whether training based on relationship-centered care (eg, emphasizing the importance of mutual respect, empathy, and shared humanity) in care relationships embodied in the immersive VR simulation allows staff to experience dementia-related cognitive and sensory changes from the perspective of persons living with dementia. A total of 21 certified nursing assistants from 1 US nursing home participated in a 3-month mixed methods intervention. Empathy and knowledge were measured using pre- and postintervention standardized tests; qualitative feedback was collected through open-ended surveys and group discussions. Participants were predominantly female, Black certified nursing assistants with approximately 68% reporting 8 years or more of care experience. Among the 76.2% (16/21) of the participants who completed the pre- and postintervention surveys, empathy scores increased from pretest (mean 5.31, SD 0.74) to posttest (mean 5.51, SD 0.61). The mean difference of 0.20 (SD 0.43) did not reach statistical significance (t15=1.88; P=.08), but the effect size was moderate (Cohen dz=0.47, 95% CI -0.03 to 0.43). Dementia knowledge scores also increased from pretest (mean 5.50, SD 2.37) to posttest (mean 5.94, SD 2.11), with a mean difference of 0.44 (SD 1.63), which was not statistically significant (t15=1.07; P=.30), and demonstrated a small effect size (Cohen dz=0.27, 95% CI -0.43 to 1.31). Qualitative findings revealed that participants perceived the VR training as engaging and emotionally impactful. Participants described reframing their understanding of dementia, reporting reduced stigma and increased empathy toward persons living with dementia. Many noted that experiencing dementia-related symptoms through VR helped them better understand residents' behaviors and respond with greater compassion. Participants expressed a strong preference for immersive VR and facilitated group discussions over online modules, and cultural differences in the VR scenarios were not perceived as barriers to learning. While preliminary, these findings suggest that combining relationship-centered care with immersive VR may enhance empathy and engagement among staff, particularly when paired with facilitated discussion and plain language explanations. This multimodal model appears particularly valuable for supporting empathic learning within diverse and experienced workforces. Larger, multisite studies with sustained follow-up are needed to determine long-term effects and optimize training for linguistically and culturally diverse workforces.
To describe trends in family physician (FP) attachment among assisted living (AL) residents and examine AL home-level characteristics associated with attachment and primary care visits. Repeated cross-sectional study. Licensed AL homes were linked to population-level health administrative data in Ontario, Canada, from January 1, 2013, to December 31, 2023. Our primary outcome was the proportion of AL residents with an attached FP, operationalized at the home level. Secondary outcomes included the type of FP practice model and frequency of primary care visits. Home-level exposures included AL home size, services offered, rurality, colocation with a nursing home, and area-level marginalization. We used autoregressive integrated moving average models to forecast the proportion of residents rostered, binomial regression with generalized estimating equations (GEEs) to model the proportion of attached residents, and Poisson regression with GEEs to model the number of primary care visits. From 2013 to 2023, the proportion of AL residents attached to FPs remained stable (∼82%). Attachment was lower in homes with on-site medical services and those located in marginalized areas. AL homes in rural communities, smaller homes, and those providing medical services had higher visit rates, whereas FP attachment and homes with pharmacist services were associated with fewer visits. Despite ongoing challenges with primary care access in the community, trends in FP attachment of AL residents have remained unchanged. Facilitating FP access and incentivizing on-site care in AL homes may improve access to primary care among this population.
The Australian National Aged Care Mandatory Quality Indicator Program (QI Program) requires government-subsidized residential aged care service providers to report quarterly data on a set of quality indicators. These indicators measure provider performance across specific domains of care and are intended to support continuous quality improvement. Health care dashboards can enhance the use of indicators by presenting data in interactive and intuitive formats that enable actionable insights. This mixed methods study aimed to develop an electronic dashboard to assist service providers' use of QI Program data to measure, track, and improve the quality of resident care. A participatory design methodology was used to co-design and co-develop the dashboard. Initially, stakeholder participants for the co-design were identified. A combination of workshops, meetings, and email communications with co-design participants was then used to iteratively define and refine user requirements and to develop and improve the dashboard prototype. A 3-month pilot of the dashboard was conducted with a convenience sample of 30 end-users across 12 nursing homes and a post-pilot survey based on the System Usability Scale (SUS) was used to assess end-users' perceptions of the dashboard usability. The dashboard supports multiple user roles by enabling comparisons across homes and detailed views of all indicators for individual homes. A key feature is the ability to progressively view data at various levels of detail: groups of homes, individual homes, resident groups, and individual residents. The resident-level view enables more targeted, personalized care by helping staff identify and prioritize the specific indicators triggered by each resident. The average SUS score was 75.2 (SD 16.3), indicating good usability for the dashboard. Most survey respondents (12/14, 85.7%) were likely or extremely likely to recommend the dashboard to a colleague and agreed the dashboard would support the delivery of personalized care for residents. Almost all respondents (13/14) agreed or strongly agreed that the dashboard would assist with quality monitoring and improvement activities, and some pilot participants also made suggestions for incorporating the dashboard into those activities. This study demonstrates the potential value of a co-designed dashboard to support the use of quality indicator data in residential aged care. Limitations of the current prototype include short pilot duration, convenience sampling, and reliance on manual quarterly data uploads, which constrain generalizability and scalability. Future work should explore long-term integration of the dashboard into routine quality improvement processes and evaluate its impact on resident outcomes and care quality over time.
Occupational therapy plays a vital role in enhancing engagement and quality of life for people living in nursing homes. However, in Australia, funding for occupational therapy in nursing homes is limited, and its scope is restricted. The Enhancing Allied Health for Older People (EAHOP) trial aimed to assess the feasibility and impact of embedding a multidisciplinary allied health model, including occupational therapy, in a nursing home. This paper describes the occupational therapy implementation and outcomes of the EAHOP trial. A convergent mixed-evaluation was conducted. Twenty-seven residents at an Australian nursing home received occupational therapy by occupational therapists and occupational therapy students. The Canadian Occupational Performance Measure (COPM) was used to set goals and evaluate changes in occupational performance. Data included median therapy minutes per resident and service occasions. Qualitative data were gathered using semi-structured and unstructured interviews and analysed using content analysis. The EAHOP trial included a Stakeholder Committee that included residents of the nursing home who were participants in the trial. This group advised the research team on all aspects of the intervention throughout the trial. Residents received a median of 895 minutes of occupational therapy and 203 minutes from allied health assistants for a 1-to-36-week programme where the intervention period varied according to individual need. This equated to a median of 3.9 minutes/resident/day. COPM scores showed clinically meaningful improvements in performance and satisfaction. Interventions addressed diverse occupational performance issues across self-care, productivity, and leisure. Qualitative findings supported these outcomes, highlighting the benefits of the service and identifying barriers and implementation challenges. Embedding a comprehensive occupational therapy service within a multidisciplinary team model is both feasible and beneficial in a nursing home. The improvements in occupational performance and satisfaction, along with the diversity of interventions required, highlight the important contribution of occupational therapy in a nursing home. Occupational therapy may help older people in nursing homes manage daily tasks more easily and safely. In Australia, occupational therapy currently has only a small role in these homes. Researchers from the University of Canberra ran a study called Enhancing Allied Health for Older People to see if a team of health workers in a nursing home would help. The study was held in a nursing home in Australia, with 27 residents receiving occupational therapy to do activities that were important to them. Each person's progress was measured by listing key activities and rating how well they could do them before and after support. Each resident got 895 minutes of occupational therapy and 203 minutes of help from allied health assistants based on their need and wishes. Researchers also talked to family members, staff and students to understand if occupational therapy support was useful and to know of any challenges. The study showed that occupational therapy in a nursing home can make it easier for people to engage in occupations and improve their quality of life.
Freedom of movement for people with dementia has received increasing attention in recent years, particularly in nursing homes. Nursing home residents' families play an important role in supporting their freedom of movement. Therefore, this qualitative study examines how families interpret and experience the freedom of movement of nursing home residents with dementia. Exploratory in-depth interviews were held with 13 family members of nursing home residents living with dementia. Data were analyzed thematically, starting with open coding and iterative refinement of codes. These codes led to the formulation of subthemes, which were clustered into five central themes: physical environments that support or hinder freedom, freedom is embedded in social contexts, value tensions in shaping perspectives on freedom, navigating unclear roles and responsibilities, and strategies for limited outdoor access. These central themes showed how family members interpret and experience freedom of movement in nursing homes for people with dementia. The findings underscore the complex and multifaceted nature of freedom of movement as families see it. Importantly, they suggest that nursing homes should actively involve families in shared decision-making and daily practices that balance freedom and safety to better support the quality of life of residents with dementia.
Engagement in meaningful activities supports the well-being and quality of life of nursing home residents with dementia. This study evaluated the implementability of a toolkit to choose meaningful activities for residents with dementia. A process evaluation was conducted using the RE-AIM framework. Two nursing homes were involved in the implementation of the toolkit through a 6-month participatory action research approach, whereas 3 nursing homes followed an implementation track of equal duration without participatory action research. The toolkit was implemented within 5 Dutch nursing homes, involving health care professionals and family caregivers of residents with dementia. Demographics were collected at baseline, user experience questionnaires were administered monthly, and at the end of the study, activity logs were collected and interviews conducted. Qualitative data were analyzed using a thematic analysis, based on a combined inductive and deductive approach (Consolidated Framework for Implementation Research). In total, 64 residents, 26 family caregivers, and 84 health care professionals were reached. Reach involved a mix of relevant stakeholders; however, family caregivers were least involved. Adoption declined from 40.4% to 28.1% during the study, with most users selecting a perceived lack of necessity and time constraints as reasons for nonuse. Implementation barriers and facilitators were categorized into the following 6 themes: individual characteristics, intervention characteristics, inner setting, outer setting, implementation process, and resident factors. The toolkit was well received by end users and generally considered user-friendly. Prominent facilitators to implementation were leadership, peer support, and regular reminders, among others. Key barriers included staff turnover, workload, and limited perceived usefulness. Addressing these via task transfer, retraining and clear framing can improve toolkit implementation. This study provides practical insights to strengthen future implementation of the toolkit and similar innovations.
To understand how the COVID-19 pandemic created obstacles for nursing home staff to communicate effectively with family members of residents and how administrators navigated new communication methods. A qualitative analysis of 156 interviews with nursing home administrators in the United States. Nursing home administrators in the United States. Communication methods used during the pandemic, and their effectiveness, were identified and discussed in this study that included 156 qualitative interviews with administrators at 40 nursing homes across the United States. This analysis suggests that existing communication systems were often reactive and ineffective during the pandemic because of the added workload placed on staff, leading to many nursing homes adopting more proactive and mass communication strategies. In addition, some nursing homes were able to implement communication methods that included individualizing communication for residents and families. Proactive, mass communication methods lessened the burden on staff, whereas individualized communication increased staff burden. Communication methods should be adapted based on nursing home staffing levels. Future research should further examine individualized and mass communication methods to optimize communication strategies in informing families effectively and enhancing relationships, while also acknowledging staff capacity.
Food safety in the home kitchen has become a growing public health issue due to inaccurate food preparation processes in consumers' homes, as well as poor personal and/or environmental hygiene. This study evaluated the prevailing environment, cleanliness, and hygiene habits of selected household kitchens using on-site visits and swabbing for microbial examinations. Most food contact surfaces, touch points, and kitchen supplies showed high contamination with total aerobic bacterial count (TABC), coliforms, and Escherichia coli. Among the food contact surfaces, the highest contamination was recorded in kitchen sink walls (91.4%) with E. coli. Approximately 67.0% of food preparation surfaces were contaminated with E. coli. Among the frequently touched surfaces, kitchen tap knobs (87.5%) were highly contaminated with E. coli. Furthermore, among the frequently used supplies, 91% of sponges/dishcloths were found to be contaminated with E. coli. About 81.0% of detergent bars were found to be contaminated with E. coli. The majority of homes (93.3%-100.0%) lack access to hot water, soap, and sanitizers in the kitchen, and the presence of pets (cats; 6.7% of households) or pests (100% of homes) in the kitchen was evident, indicating the likelihood of microbial contamination and transmission from the outside environment. To reduce the risk of microbial contamination, people must improve their food handling practices through education.