title: A qualitative study of the views of residents with dementia, their relatives and staff about work practice in long-term care settings.
abstract: BACKGROUND
  Most people living in 24-hour care settings have dementia, and little is known about what makes long-term care a positive experience for them.
  
  
  METHODS
  This carer-led qualitative study examined working practices in 24-hour long-term care-settings, including hospitals, nursing and residential homes, with the aim of finding out and making recommendations about such settings. Using semi-structured interviews, managers, nurses and care assistants were asked about work practices, such as how they coped with difficult behavior, about shifts, staffing levels, staff retention and training. Relatives of residents with dementia were asked about their role and perceptions of the care provided, and residents were asked for their opinions of their care.
  
  
  RESULTS
  Staff reported that residents presented with increasingly challenging behavior compared to the past, and that sometimes staffing levels and skills were inadequate. Of all the settings, hospitals had the most problems with staffing levels and retention, staff-relative relationships and staff support systems. Relatives saw their own role as positive. People with dementia of varying severity could usefully evaluate some of the services they received.
  
  
  CONCLUSIONS
  Dementia-specific training and education of staff in all long-term care-settings, including induction, should address the management of problem behavior in dementia and thereby improve staff fulfilment and relatives' satisfaction. The long-stay hospital may not be appropriate as a "home for life" for those with dementia, and we recommend that long-stay care settings should be able to cater flexibly for a range of resident needs.
authors.affiliation: Royal Free and University College Medical School, Department of Mental Health Sciences, University College London, Archway Campus, Holborn Union Building, Highgate Hill, London N19 5NL, UK.
authors.forename: Georgina
authors.initials: G
authors.lastname: Train
authors.forename: Shirley
authors.initials: S
authors.lastname: Nurock
authors.forename: Ginnette
authors.initials: G
authors.lastname: Kitchen
authors.forename: Monica
authors.initials: M
authors.lastname: Manela
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000523:psychology*; D001291:Attitude of Health Personnel; D003704:Dementia / Q000523:psychology* / Q000628:therapy; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D011368:Professional-Family Relations; D012112:Residential Facilities; D012114:Residential Treatment; D016526:Workload