This project, in common with all research endeavours, had a number of limitations that we wish to make explicit. This was a qualitative study that can not be argued to be representative of the institutionalcare population of Ireland. However, the purpose of the study was not to yield generalizable information (for that, a large-n quantitative study utilising probability sampling would have been necessary), but rather to explore lives in institutionalcare, and to make a contribution to theorising on the (met and unmet) needs of institutionalcare residents. While the methods utilised by us were carefully documented and are therefore replicable, our research findings are of uncertain transferability as the context in which a study of this kind is carried out inevitably has a strong impact on the research findings.
On the other hand, home care is often a more expensive way of managing severe needs than institutionalcare, but some older people prefer to remain in the community even with relatively severe needs, leading to a trade-off between controlling public expenditure and offering choice and independence to LTC users . Due to the large variation between demented and non-demented, and physically dependent and non-dependent persons, it is not sufficient to use average cost for all residents when analyzing costs of care in institutions . The support of informal caregivers to institutionalized elderly may have an impact on both quality of life but also on the costs of institutionalcare .
Methods: The Groningen Observational instrument for Long-Term InstitutionalCare (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen ’ s kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T -test verified if the difference between observers differed significantly from zero. Results: The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa ’ s were found for interventions in the domains basic (0.67 – 0.92) and complex (0.70 – 0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa ’ s ranged from fair to almost perfect (0.30 – 1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48 – 0.99) and poor to excellent for the other domains (0.00 – 1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers ( p > 0.05) were found.
The decision of choosing a career is a crucial one. Since early career choices like the selection of academic streams have far-reaching effect on one’s career path, it is essential that the students engage in the process of career decision- making (CDM) at the earliest. Such choices are more crucial for adolescents living in institutionalcare because if these adolescents do not find productive employment later in life, the danger of them being drawn to delinquency looms large. A family provides natural environment for upbringing of children. But unfortunately, adolescents living in institutionalcare are deprived of this natural environment. They do not receive the same sort of encouragement which well-versed parents supporting their own child would provide for studying well and for moving ahead in career- related endeavours. A wide array of studies spanning over time have found that all aspects of children’s development are negatively impacted by institutionalization . Thus, it is expected that adolescents in institutionalcare face greater career indecision. In view of the intricate nature of career indecision, prior studies in the field of CDM had proposed that different forms of career indecision may exist . The difference between indecision and indecisiveness has been studied by many theorists in the field of vocational and educational research [3,4]. The word developmental indecision commonly refers to a normative stage in career development which is resolved with comparative ease for a majority of people . Unlike developmental indecision which is viewed as a temporary phase of indecision, career indecisiveness is understood as a more persistent, severe and continuous difficulty in making career decisions . Indecisiveness represents a chronic incapacity to take decisions which may manifest itself in varied circumstances . It may be understood as extreme anxiety, self-doubt or overwhelming pressure caused by the act of making a decision regarding career . Some researchers even call it generalized indecision . As career counsellors consider problems regarding career indecisiveness as one of the most severe and one that calls for the longest intervention , taking notice of them can aid teachers and counsellors to plan and customize interventions more effectively by working on the sources of such difficulties.
The percentage of children in institutional long-term social care in Europe ranges from 0.8 percent of the total children population under 18 years of age in Iceland to 2.3 percent in Latvia, with the medium of 1.22 percent in the European Union . There can be many reasons why children have been separated from their parents, e.g., poverty, deprivation, neglect of children, alcohol or drug abuse in family, domestic violence, psychological or sexual abuse, etc. [2, 3]. Some of those children live with guardians or in foster families while some are sent to long-term social care institutions. Institutionalcare is one of alternatives where children and youth under 18 live when they cannot stay in the family for various reasons – neglect, deprivation, violence, abuse etc. Those children are called “social orphans” [4, 5].
The participative way of development of KPI’s calls for dialogues with the employees from the primarily process to gather information which eventually can lead to a bottom-up development. Thus, it provides the possibility to have dialogues about the figures with the management (Evers et al., 2011). Evers et al,. (2011), based their research on the five leading principles of Wouters and Wilderom (2008) for the participative development of KPI’s. The first leading principle of Wouters and Wilderom (2008) is that the employees from the primarily process are using their own experiences and knowledge to come up with relevant KPI’s. Research of Groen, Wouters and Wilderom (2011) showed that employees, part group interventions, in which they can come up with possible KPI’s, are more proactively involved in the development process. The second principle of Wouters and Wilderom (2008) is that the management needs to provide the time and space to develop participative KPI’s. This is important for the employees in order to find out what exactly is being expected from them. Eventually the behavioural norm will be clear because of different professional insights which is the third leading principle. Employees consider the self-developed KPI’s as a credible instrument and will accept it more above imposed KPI’s. These bottom-up developed KPI’s are being used to continuously improve the work process. The KPI’s are providing important feedback to the employees which eventually to more knowledge about the work processes (Evers et al., p.65). The last leading principles according to Wouters and Wilderom (2008) are team-trust and openness (fourth principle) and transformational leadership (fifth principle). When these findings are being compared with the Rhineland way of organizing, it can be stated that the participative way of development of KPI’s suits best. This, because the employees are involved in the determination process based on their own findings, knowledge and experiences (Evers et al., 2011). KPI’s can be developed for the institutionalcare in the same way, with participation of the employees themselves.
The purpose of this research was to elicit the perceptions of older people about effective relationships in an institutional residential setting by means of positively framed questions. Research into relationships in settings for older people generally focuses on what is not working or what is problematic (Anthony, Suchman, & Penelope, 2011; Grenade & Boldy, 2008). Studies have found that older people in organised care institutions typically experience depression and loneliness (Grenade & Boldy, 2008; Roos & Malan, 2012; Shabangu & Roos, 2012; Taube et al., 2013; Victor, Scambler & Bond, 2009). Older people tend to reminisce about relationships that have ended as a result of different kinds of losses: relational losses, the loss of activities they had engaged in previously or environmental changes (Lalive d’Epinay, Cavalli & Spini, 2003; Roos & De Jager, 2010; Roos & Klopper, 2010; Roos & Malan, 2012). Research conducted in South Africa confirms that relationships in institutional settings for older people can contribute to unhealthy group dynamics, isolation and rejection (Roos & Malan, 2012; Roos & Nel, 2010; Shabangu & Roos, 2012).
Levels of self-esteem were not significantly different between the two group, although there was a trend in the direction of the ex-institutional group having higher levels of self-esteem than the comparison group. This could fit a picture of self- reliant and self-sufficient individuals that has emerged from the results so far. It is interesting that after a history o f being given up for adoption and being later adopted, with all the feelings that this knowledge will generate, the ex-institutional group tend to have higher self-esteem. This may well have been boosted and encouraged by proud parents whom the child may perceive as having specially selected their child out o f many others to make up their family, and from then on encouraging the children to feel special, valued and well-loved, putting a lot o f time and energy into building a bond with the child, perhaps more so than parents o f ordinary families with children brought up by their natural parents. The evidence from the past stages of the study states that adoptive parents often provide a very rich, motivated and enthusiastic environment for the child, more so at 8 years of age than non-adoptive parents and certainly more than the parents o f ‘restored’ children (Tizard and Hodges, 1978). This quality of their environment has already been seen to have very positive consequences for the child’s IQ and attachment and bonding with their new parents, and may therefore also exert a good influence on their children’s self esteem.
Shelter is a last resort in cases of suspected or threatened violation of rights in the Statute of the Child and Adolescent. The literature suggests that quality of care offered to children is one of the factors necessary to ensure the protective nature of the institutionalcare. This study aimed to investigate the profile and care practices of educators in the state of Pará, comparing two contexts, the metropolitan region of Belém (RMB) and the interior region of the state (IE). Data were collected by semi-structured interviews with 110 educators from 11 shelters in the state of Pará. The results show that the RMB educators have higher average service time than IE group, and significant differences were detected in 14 care practices between the groups. Our findings corroborate the literature on the importance of training and valuing the educator in order to provide a higher quality service.
On the other hand, formal care can be delivered either in the community in the form of home-and community- based care (HCBC), or in the institutional settings in the form of institutionalcare. To ease the caregiving burden on the younger generation, and to share the responsibil- ity of elderly support between government and family members, several laws and regulations related to elderly care have been promulgated in China, including a new law on social insurance, and a proposed revision of the law on protecting the rights and benefits of older people . In China, formal care is gaining ground [4, 18]. For institutionalcare, developed countries have already built up relatively advanced service delivery systems for older people’s institutionalcare, and there are also compre- hensive government policies and regulations to monitor the quality of service delivery, for example, the White Paper “Caring for Our Future: Reforming Care and Support” in England, the Act on Prevention of Elderly Abuse and Support for Attendants of Elderly Persons in Japan, the Omnibus Budget Reconciliation Act of 1987 in the US. In China, institutionalcare is still in short supply compared with that in the developed countries. Nursing homes can provide beds for only 2.72% of the total number of older people . For HCBC, although the lack of adequate and affordable institutionalcare and the weakening of traditional family care have made HCBC an appealing option, in China, HCBC is still at the early stages compared with that in developed countries. China is facing challenges regarding how to address mount- ing service needs with limited social resources in a young, developing civil society . With the more recent develop- ments in formal LTC provision, older Chinese people now have wider choices in LTC modes. In response to this situation, to optimize older people’ s arrangements for LTC services and improve the quality of later life, this study sets out to explore and make theoretical sense of older people’s LTC needs, and to clarify influencing factors.
complementary areas that should be able to interact in a manner that eases the transitions between the home and institutionalcare for the older persons in need of care. Informal carers are still taken for granted, and provided with little monetary recognition of their work: the carer’s allowance retains its safety-net and residual character as it is means-tested rather than paid out to all who undertake informal care work (Timonen and McMenamin 2002). State legislative efforts remain focused on institutionalcare, and it is arguable that the most important reason for this lies in the implicit assumption that home care is still largely a private matter that the State should not interfere with: in other words, the echoes of Catholic social thinking, and the subsidiarity principle play a role in bringing about a bifurcated system where institutionalcare is increasingly regulated but formal home care remains the poor relation that is left unregulated in the mistaken belief that the ‘traditional’ channels and networks of family and community are still in position to perform effectively the role of ‘regulator’ in the new and more complex world where private, public and voluntary sector providers are working alongside family carers.
impact of residents’ attributes on length of stay. The developed model captures the survival and movement patterns of LTC residents placed in institutionalcare (e. g. residential care, nursing care) and funded by the local authority. The model also extends a model developed previously by the authors  by handling left-truncated in addition to right-censored data. A continuous time Markov model of the flow of elderly residents within and between residential and nursing care assumes that residents may go through two conceptual states (i.e. not observable) - short-stay and long-stay states - before dis- charge, predominately by death  (see, Figure 1). For example, at any given time we could observe that a per- son is in residential home care but we do not know whether s/he is in a short or long stay sate. This intui- tive assumption was also validated with empirical evi- dence using the Akaike information criterion (AIC) and the Bayesian information criterion (BIC) to select the model which gives best fit with least complexity [num- ber of states]. Residents admitted to residential care might stay for a short period of time (short-stay state) and could either be discharged or moved to nursing care. Otherwise, they would stay for a longer period of time (long-stay state) and then be discharged or moved to nursing care. Similarly, Faddy et al used in  a Mar- kov model to represent the process of hospital stay. They demonstrated that the resulting distribution pro- vides a good fit to the patients’ length of stay data unlike gamma and log normal distributions.
On the other hand, despite literature reports that institutionalcare has a pivotal role in long-term care expenditures, we demonstrated that institutionalcare interacting with higher care needs level is a relevant fac- tor in explaining the highest LTC expenditures in our model. The association between institutionalcare utili- zation and higher care needs level or, in other words, the utilization of facility services by elderly with severe disability status, is a critical set of conditions related to LTCI expenditures in City A. The importance of these findings supports the need for a critical evaluation of the role of facilities services in the LTCI system. Some obvious questions include whether, these institutions should be considered as a final residence for the severely disabled elderly?, how much do the facilities services contribute to improving the disability status of their elderly residents?, and do the economic incentives in the institutionalcare sub-system operate to retain their users, or to reintegrate them as soon as possible into the community? This would seem to be a crucial issue for policymakers to examine the scope of these ques- tions when the projected expenditures of the LTCI sys- tem threaten the sustainability of this system in Japan.
The system of long term care (LTC) in the Czech Republic, as in other countries of Central and Eastern Europe, is not considered a specific sector of the social security system. Rather, services are provided within the medical and social sectors, and are not regulated by a unified legal arrangement nor administered by one central and/or regional institution. They covers a wide range of supportive health and social services provided to people who are not self-sufficient. The latter category includes not only the elderly, but individuals who need assistance for reasons other than age, such as long term illness, physical and mental disabilities and to persons in vulnerable groups (drug abusers, people in mental crisis). Despite the fact that LTC is not unified as a separate sector, an operational definition of LTC can be found in the document of the Ministry of Labour and Social Affairs - the Preliminary National Report on Health and Long-term Care in the Czech Republic . LTC is referred to as “(…) a wide range of health and social activities to people who are no more self-sufficient – either because of their age, disability or for any other serious reason – and thus require constant assistance with self-service, personal hygiene, housework and providing links to social environment” (MoLSA 2005). The philosophy of the LTC system is to provide care within the family in a natural, home environment. The principles behind the design of LTC are expressed as “ accessibility”, “quality”, and “fiscal tenacity” and express EU policy in the field ( Potůček et al. 2006). This attitude is also underlined in the National Programme of Preparation for Ageing 2008 – 2012, which is the most important strategic document expressing the direction of the LTC policy. Family care is supported by the state in the form of home care and home nursing care. As a result, the LTC system is targeted towards the social activation of the elderly and disabled. Nowadays, it is estimated that approximately 80% of care to the elderly in need is provided by the family, mostly by children, but also spouses (MoLSA 2005). Informal care within the family is estimated to last 4 to 5 years on average. The results of the Eurobarometer survey show that the Czech population believes that support by the family is the best way to provide assistance to the elderly who need support due to poor physical or mental condition. 66% of the survey respondents indicated that the elderly should be provided with help by a family member who either lives in the same household or visits the person in need and provides care on a regular basis (European Commission 2007). Another important aspect of the LTC provision is institutionalcare, which is partly provided within the health care system (in hospital departments or aftercare, rehabilitation and LTC departments) and partly within the social services system (in pensioners’ homes).
This article presents the results of a systematic litera- ture review of institutional elderly care management re- search. The purpose of the review is to compare how institutionalcare management research matches the long-term care challenges currently emphasized in inter- national long-term care policy for elderly people. Defin- ing the concepts of management, long-term care and institutionalcare is complex, from the perspectives of both research and practice see [6,7]. In this review, man- agement is seen from a manager-centered perspective, in which organizational level management is in the focus. Long-term care refers to formal care of elderly people needing support in many functions for a prolonged period of time, and includes care both in home or insti- tutional settings. Institutionalcare refers to care which is given in institutions such as nursing homes. So, insti- tutional care is only a part, but often the most resource intensive, of long-term care and was thus chosen for the focus of the literature review. However, because inter- national policy documents concerning only institutional elderly care were not available, the policy documents were searched for in the field of the broader concept of