Improving Quality of Long-Term Care in Nursing Homes – Embedding Scientific Research in Everyday Practice (Hilde Verbeek) May 2014
Improving Quality of Long-Term Care in Nursing Homes – Embedding Scientific Research in Everyday Practice
Hilde Verbeek, PhD, Assistant Professor, Department of Health Services Research, Maastricht University and Coordinator of the Academic Collaborative Centre on Care for Older People.
Structural multidisciplinary collaboration between research, policy, education and practice is essential to improving quality of long-term care in nursing homes. In the southern part of the Netherlands, the Academic Collaborative Centre on Care for Older People (ACC-COP) serves as a model to achieve this. Recently, we published an editorial in the Journal of the Medical Directors Association1 explaining its structure and organization. In this article I would like to highlight our model’s key issues to successful research in nursing homes.
Especially in long-term care, new care models and person-centered care philosophies are being developed focusing on quality of life, increasing patient’s autonomy, meaningful activities, and enabling patients to sustain their own lifestyle for as long as possible. There is, however, still a gap between this knowledge and current practice, and as a result, health care professionals, policy makers, patients and their families do not benefit sufficiently from new advancements and best evidence.
The complexity of long-term care has increased tremendously over the last decades, not only due to aggregated care needs of patients but also because of technological and related health care innovations. On the other hand, the number of well-trained and educated staff is decreasing. This challenge requires leadership, bringing together expertise from a transdisciplinary perspective.
Academic Collaborative Centre on Care for Older People
The ACC-COP is a formal multidisciplinary network consisting of Maastricht University, five large long-term care organizations and Zuyd University of Applied Sciences, all located in the southern part of the Netherlands. The model was developed in 1998 as collaboration between Maastricht University and one long-term care organization. Now we cover five long-term care organizations, including 85 care locations and about 13,000 long-term care staff.
The model has two vital characteristics. First, it is a multidisciplinary partnership with the core disciplines being nursing science, gerontology, old age medicine, psychology and physiotherapy. Collaborating partners are practitioners (such as nurses, physicians, psychologists, physiotherapists and occupational therapists), managers, researchers and teaching staff. Second, we have joint appointments of ACC-COP staff working both at the university and within a long-term care organization. Senior researchers work on a structural basis and at least one day a week within the long-term care organizations. They help to identify relevant issues for practice and policy, translate these into scientific research projects and enable the translation of evidence-based knowledge in daily practice. Furthermore, they initiate and coordinate research and teaching activities within the long-term care organizations. Moreover, long-term care staff (nurses, physicians, physiotherapists, psychologists) participate in research projects. They may be posted to the university to conduct their PhD projects, on average two days weekly for about a four-year period.
Financing for projects is mainly provided via external research funding earned in competition. The long-term care organizations finance the structural placement of the senior university staff, whereas the university covers coordination costs of the ACC-COP and provide workplaces for posted long-term care staff at the university.
Illustration of activities
Activities within the ACC-COP focus on improvement of quality of life and quality of care of older people receiving long-term care. We address both clinical topics (such as malnutrition, pain in dementia, falls) and organizational topics (e.g. redesign of nursing home care, work environment, employee health and well-being). Successful projects include, for example, the development, evaluation and implementation of an intervention to reduce physical restraints in nursing homes, evaluation of innovative dementia care design such as small-scale, homelike care environments for older people with dementia, development of a pain assessment tool for people with dementia and a large-scale European study involving 2,000 people with dementia and their family caregivers during the transition phase from home care towards institutional nursing care.
The model and its activities are attractive to external funding agencies, which have added to our earning power. For example, in January 2014 the ACC-COP received a grant of €1,000,000 to investigate innovations in long-term care improving independence of residents in long-term care. Four research projects are being conducted: 1) encouragement of physical activity among residents in nursing homes; 2) increasing independence by facilitation of informal and formal care networks; 3) prevention of physical restraints at home and 4) laborsaving technological and social innovations. Other new projects focus on strategies to empower evidence-based practice in nursing staff; nurse qualifications, competencies and leadership in future nursing home care and the effects of green care farms for people with dementia in providing 24-hour nursing care. These are a new type of small-scale, homelike care environments, in which next to agriculture activities 24-hour nursing care is provided as an alternative to traditional nursing homes.
In our opinion, there are certain features of the ACC-COP that makes it a successful example of embedding scientific research into every day care practice. Long-term care organizations themselves gave rise to the main research questions, and their staff have been involved in the development and implementation of interventions from the start throughout the whole project. Moreover, a project does not stop when funding ends, but practitioners, directors and researchers look further for better solutions and improvements in joint collaboration. Finally, it facilitates education and can make young people enthusiastic to consider careers in long-term care. For example, healthcare professionals and policy makers give lectures to students in our Bachelor’s and Master’s programs (e.g., health care science, medicine, nursing) and we organize internships and work visits during their courses.
In the Netherlands, several collaborative networks have been established between universities and nursing homes (i.e. Amsterdam, Nijmegen, Leiden, and Groningen). As one size does not fit all, there is no fixed scheme to set up such a structural collaboration. Both within and between countries organizational culture, structure and financing of health care and research may differ. The multidisciplinary character and joint appointments of staff working in our ACC-COP are two unique aspects, however, that are in our opinion responsible for its success over the past years. To improve long-term care quality, an infrastructure is necessary in which scientists and educators can jointly work to develop, implement and test innovative care approaches.
- Verbeek, H., Zwakhalen, S.M.G., Schols, J.M.G.A., Hamers, J.P.H. Keys to successful embedding scientific research in nursing homes: a win-win perspective. Journal of the American Medical Directors Association. 2013; 14: 855-857.