Healthcare Management Forum

Leadership in long-term care is a burgeoning field of research, particularly that which is focused on enabling point of care staff to provide high-quality and responsive healthcare. In this article, we focus on the relatively important role that leadership plays in enabling the conditions for high-quality long-term care. Our methodological approach involved a rapid in-depth ethnography undertaken by an interdisciplinary team across eight public and non-profit long-term care homes in Canada, where we conducted over 1,000 hours of observations and 275 formal and informal interviews with managers, staff, residents, family members and volunteers. Guiding our analysis post hoc is the LEADS in a Caring Environment framework. We mapped key promising leadership practices identified by our analysis and discuss how these can inform the development of leadership standards across staff and management in long-term care.

The use of robotics is becoming widespread in healthcare. However, little is known about how robotics can affect the relationship with patients during an emergency or how it impacts clinicians in their organization and work. As a hospital responding to the consequences of the COVID-19 pandemic “ASST dei Sette Laghi” (A7L) in Varese, Italy, had to react quickly to protect its staff from infection while coping with high budgetary pressure as prices of Personal Protection Equipment (PPE) increased rapidly. In response, it introduced six semi-autonomous robots to mediate interactions between staff and patients. Thanks to the cooperation of multiple departments, A7L implemented the solution in less than 10 weeks. It reduced risks to staff and outlay for PPE. However, the characteristics of the robots affected staff's perceptions. This case study reviews critical issues faced by A7L in introducing these devices and recommendations for the path forward.

The high rates of nursing home deaths in the wake of COVID-19 have led to calls for their elimination and their replacement by home care. Based on years of research in Canada and abroad, this article argues that nursing homes are not just necessary, they provide significant benefits for those living in, working in, and visiting in them. In developing this argument, the article begins by setting out why long-term residential care is necessary before moving on to consider the benefits of such care, benefits that go beyond the clinical. It concludes by identifying factors that can make nursing homes a positive option while helping to avoid pandemic horrors in the future.

The COVID-19 pandemic has created much-needed attention on long-term care in Canada. Public exposure of life in long-term care has generated tremendous public support for improvements that to a large extent focus on staffing and ageing infrastructure. However, the impact of visit restrictions on long-term care residents during the pandemic highlights the need for changes to how long-term care has traditionally viewed the role and value of family members. The Office of the Seniors Advocate of British Columbia published a report Staying Apart to Stay Safe that highlighted the impact of visit restrictions from the perspective of over 13,000 residents and family members directly affected. The results provide compelling evidence of the need for health leaders to re-evaluate current practice and embrace a more holistic role for family members of residents in long-term care.

A combination of factors during the SARS-CoV-2 pandemic led to a disproportionately high mortality rate among residents of long-term care homes in Canada and around the globe. Retrospectively, some of these factors could have been avoided or minimized. Many infection control approaches recommended by public health experts and regulators, while well intended to keep people safe from disease exposure, threatened other vital aspects of health and well-being. Furthermore, focusing narrowly on infection control practices does not address long-standing operational and infrastructural factors that contributed significantly to the pandemic toll. In this article, we review traditional (ie. institutional) long-term care practices that were associated with increased risk during the pandemic and highlight one transformational model (the Green House Project) that worked well to protect the lives and livelihood of people within congregate care settings. Drawing on this evidence, we identify specific strategies for necessary and overdue improvements in long-term care homes.

The expansive geography of Central Alberta presents many barriers to optimal care, including limited resources and access issues. In response to the COVID-19 pandemic, primary care networks (PCNs) within Central Alberta partnered with a technology provider to rapidly implement home health monitoring (HHM) for patients with chronic diseases. In the 37 patients evaluated in phase 1 (90 days), diabetes was most common (73%), followed by hypertension (38%), chronic obstructive pulmonary disease (27%), and heart failure (11%). Overall, patients were comfortable using the HHM technology, and >60% reported improved quality of life after follow-up. Patients also made fewer visits to their family physician/emergency department compared with the pre-enrolment period. In January 2021, the HHM initiative was expanded to a larger patient cohort (phase 2; n = 500). Interim results for 90 patients from eight PCNs up to the end of May 2021 show similar findings to phase 1.

COVID-19 has put a spotlight on the senior living sector. Transformational change is needed to address the challenges of an institutional model of long-term care. This article makes recommendations applying the Systems Transformation domain of the LEADS leadership capabilities framework to change the way older persons experience the ageing journey by creating a small home model of living. A literature review reinforces the spotlight on the capital investment needed to reinvent the nursing home into a centre for living.

The COVID-19 pandemic has accelerated the need for flexible arrangements, including asynchronous work and working from home. These arrangements may be necessary to comply with public health directives and are manageable when few other options exist. It can be difficult to lead in an environment when team members have divergent core working hours and are not available for collaboration. This can be compounded by the perception of inequitable treatment of employee needs or preferences by management, which can further strain team dynamics. As the pandemic eases, it may be difficult for all employees to revert to a fully on-site arrangement; some may be unable and others unwilling. Leaders will need to consider ethical issues in reaching organizational goals in this new reality. Equity, diversity, and inclusion principles will be critical when balancing the needs of the individual and the team. Supportive arrangements and a culture of inclusion will be key to retaining top talent.