As the sector moves forward, policy-making, especially on infection control and prevention, needs to become more comprehensive. This means residents, their families, and direct care staff should be seated at the table when it comes to broader policy decisions.
It all starts with a cultural shift in long-term care, according to a report published by RAND Corporation, a nonprofit organization focused on helping improve policy and decision-making through research and analysis.
Researchers suggest that operators value resident and staff autonomy and are referring to a small-scale policy-making model that can be scaled for wider adoption.
In addition to administrators, consumer advocates, and the Long Term Care Association, 23 stakeholders informed the project, including residents, direct care staff, clinicians, and researchers.
Co-author of the report, Lori Frank, said she wanted to expand on the idea of cultural change and policymaking after the National Academy of Sciences and Engineering (NASEM) report was released in April.
“There has been a huge ripple effect across the healthcare ecosystem,” added Frank. “By expanding the points on culture and adding some of what we have found through our research, we can really expand the potential transformative impact of that report.”
According to researchers, participatory governance, or a hybrid of selected stakeholders and operational leadership, is the policy-making model necessary for policies to meet the needs of the population.
Researchers have outlined three policy-making models. Representation by petition is more traditional, with managers and owners bringing concerns to the authorities. Participatory representation is at the other end of the spectrum, with all stakeholders bringing concerns to government officials.
“If you have different opinions as part of that governance structure, you may see different things, think about things differently, and reach richer conclusions in policy-based decisions,” Frank said. .
The hybrid model sits somewhere in between, with a mix of selected stakeholders, families and residents, and managers and staff coming together to make policy recommendations.
“Perhaps there might be an intermediate way in which we could start collecting this information directly from residents and families, using some of the infrastructure already in place. There is a meeting, and it can be an advantage.”
The sector has already seen an increase in the participation of families and community groups during the pandemic, when visitors were non-existent or severely limited during the COVID-19 surge.
Policy-making also needs to take system-wide pressures into account, researchers say. Regulatory realities, financial controls, and staffing “must be recognized” in cultural change.
Leadership is important for moving the needle in cultural change, setting the tone for staff behavior and resident well-being, researchers added.
“There was a real consensus in all of so many people we spoke to about the importance of leadership within the facility,” Frank said. “A lot of this was facilitated by my own experience with assisted living with my mother-in-law. It was fascinating to hear… [everyone] Point out the importance of leadership within the facility to set the mood and allow for the different kinds of conversations that can support this kind of decision and this kind of cultural change. “
According to the report, operators must spend more time on leadership training and “financing” communications between staff and management.
Through such tests, age, gender, race, and ethnicity can be assessed in relation to shared decision-making, researchers say.
Other tests will need to consider balancing individual preferences for infection prevention and community-level needs and requirements for people in long-term care, researchers note.
In other words, it is necessary to take into consideration the autonomy of residents when it comes to infection control.
“If lockdown comes, or if this is the last few years of my life and I choose to have this birthday party with my family, how can I have my preferences entered into that conversation? Do you have any?” asked Frank.
