Thriving in long-term care: Harnessing international comparative data to improve care of older adults
By Michael Lepore and Kirsten N. Corazzini
The majority of us will require long-term care services and supports at some point during our later years, many in residential care settings. Historically, residential long-term care in North American and many Western European countries has included a range of options such as nursing homes and assisted living facilities. Considerable consumer, policy, and research efforts have focused on how to improve the quality of care that someone receives in such settings, as well as how to move from more medicalized and institutionalized approaches, to more person-centered and empowering approaches and home-like environments. This is particularly true for care of long-stay residents, who may live their final years in a nursing home, and who commonly live with neurocognitive disorders, such as Alzheimer’s Disease. Simultaneously, the need for residential long-term care is increasing worldwide, including in low- and middle-income countries, driven by unprecedented population aging and the declining availability of unpaid care at home, as adult children may migrate for employment opportunities, and more women enter the paid labor force, among other factors. A critical issue, therefore, is how to sustain and grow residential care environments that honor the personhood and support the thriving of older adults and those who care for them, even in the context of complex, co-morbid illnesses, and neurocognitive disorders.
Information sharing across countries provides a valuable tool to tackle this issue. Specifically, data on high priority long-term care policies, regulations, financing, staffing, care practices, and quality outcomes can help governments design and refine their long-term care systems, help practitioners improve the quality of their services, and help citizens make informed long-term care decisions. However, such international data remains limited. Worldwide Elements To Harmonize Research In long-term care liVing Environments (WE-THRIVE) is a growing, global consortium of long-term care researchers, including researchers from low-, middle-, and high-income countries, to identify priority measures, in ways that acknowledge cultural differences and do not lose focus on the importance of resilience and the potential for thriving among residents, families and staff. Working in intentionally inclusive teams of international researchers, we have had the opportunity to identify key factors of the diverse contexts of long-term care, have examined how the meaning of person-centered care is culturally embedded, and have begun to recommend measures that hold promise for broad-based adoption in data collection and data sharing, such as measures of well-being and personhood, and staff intent to stay.
Changing cultures of aging and long-term care, whether in high-income countries where there is an effort to deinstitutionalize care, or in low- and middle-income countries where there are increasing efforts to grow formal long-term care without losing family and community involvement, requires investing in data infrastructures where we can learn from one another across countries. Our work as part of WE-THRIVE contributes to this effort.
SPECIAL COLLECTION DETAILS:
Special Collection on International Common Data Elements for Residential Long-term Care
Read the Published Special Collection
Guest Editors: Michael Lepore, PhD and Kirsten N. Corazzini, PhD, FGSA
Michael Lepore, PhD, is Senior Health Policy and Health Services Researcher with RTI International’s Aging, Disability and Long-Term Care Program and an Adjunct Assistant Professor of Health Services, Policy and Practice at the Brown University School of Public Health. Dr. Lepore earned his doctoral degree in sociology and a certificate in gerontology from Georgia State University and completed a postdoctoral fellowship in health services research at Brown University’s Center for Gerontology and Health Care Research. His research examines long-term care policy, financing, and regulation, workforce and staffing, and innovation, including person-centered care and quality measurement. Since 2015, Dr. Lepore has co-chaired WE-THRIVE to identify common data elements for measuring high-priority long-term care issues internationally. He also serves as Chair of the American Public Health Association’s Aging and Public Health policy committee and as Associate Editor of the Gerontological Society of America’s Public Policy & Aging Report.