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United Kingdom, 4. University of Leeds, Leeds, England, of severe disability amongst residents has increased from United Kingdom 56% to 80% over a 20 year period, driven by increases This multi-method research explores the challenges family in difficulties in bathing and dressing. The prevalence of practitioners and long-term care facilities face when they multimorbidity also increased from 29% to 56% between work together. It seeks to understand how different responses 2006 and 2014. A growth in the number of people with de- to these challenges may influence the delivery of care. Whilst mentia, cardiovascular and cerebrovascular diseases con- different services have their own values, aims, structures and tributed to this. We conclude that residents in LTCFs have processes, all are contending with constrained resources and become a selected subset of the population, characterised by frequent organisational change. Our findings from a large increasing needs for support. This poses an important chal- qualitative study and analysis of routine health data are or- lenge for future care provision. ganised around the micro (individual), meso (organisational) and macro (system) factors that influence the organisation RELATIONSHIP BETWEEN CARE HOME STAFFING and delivery of resident care. In this presentation, we draw AND QUALITY OF CARE: A MIXED-METHODS out the interplay between these levels, and how each shapes APPROACH and is shaped by the changing demands and nature of care. Karen Spilsbury,1 Andy Charlwood,2 This presentation will bring new insights into primary care Danat Valizade,2 and Kirsty Haunch2, 1. University of for long-term care facilities, through the perspectives of those Leeds, Leeds, United Kingdom, 2. University of Leeds, who experience and provide care in that setting. Leeds, England, United Kingdom Beyond broad recognition that ‘staff influence quality’, FACILITATORS OF DEPENDENCY IN THE VERY OLD: little is known about the care home workforce and its re- RESULTS FROM THE NEWCASTLE 85+ STUDY lationship to quality. Our study examines this relationship A Kingston,1 Louise A. Robinson,2 for the first time in the UK. Quality is a complex, con- Rachel Duncan,3 and Carol Jagger3, 1. Newcastle tested and dynamic concept: we have operationalised this University, Newcastle upon Tyne, United Kingdom, 2. concept using data collected at national and organisational University of Newcastle, Newcastle upon Tyne, England, levels to measure quality, as well as considering the views United Kingdom, 3. Newcastle University, Newcastle upon of quality of different stakeholders. We will present interim tyne, England, United Kingdom findings from this study’s work packages (due to complete In order for governments to plan health and social care in July 2020), including: (1) our review which has devel- strategies to help people maintain independence, evidence is oped theoretical explanations of how, why and in what required to show how risk factors are associated with pro- circumstances staffing promotes quality for residents and gression in dependency. We use a transparent measure of relatives; and (2) our observational study using routine ad- dependency, based on help needed with activities of daily ministrative data sets at national and provider level. Key living, incontinence and cognitive impairment, categorised findings include the importance of experience and stability as: high (24-hour care); medium (daily care); low (less than of care hoe staff, as well as how care is delivered (indi- daily) and independent, then characterise changes over ten vidual commitment, team reciprocity and organisational years (age 85-95) using the Newcastle 85+ Study while ex- mandate). ploring how eight disease groups, multimorbidity and im- pairments interact to increase care needs. Stroke and diabetes NEW MODELS OF CARE FOR LONG-TERM CARE confer an increased risk of low-level dependency. Complex FACILITIES: WHAT DOES THE EVIDENCE TELL US? multimorbidity, or three or more falls engendered the greatest Katie Brittain,1 Dawn Craig,2 Karen Spilsbury,3 risk of transitions to substantial dependency. There should be Paul Wilson,4 Katie Brittain,5 and John Vines5, 1. a focus on prevention of, and appropriate and efficient ser- Northumbria University, Newcastle, United Kingdom, 2. vice provision for those with complex multimorbidity with University of Newcastle, Newcastle upon Tyne, England, emphasis on stroke, diabetes and falls, to maintain the inde- United Kingdom, 3. University of Leeds, Leeds, England, pendence of older people United Kingdom, 4. University of Manchester, Manchester, England, United Kingdom, 5. Northumbria University, HEALTH AND WELL-BEING OF OLDER ADULTS IN Newcastle upon Tyne, England, United Kingdom LONG-TERM CARE FACILITIES: LESSONS FROM Models of care are evolving to meet the demands of an LONGITUDINAL STUDIES. ageing population in long-term care facilities. Syntheses of Robert O. Barker,1 Andrew Kingston,2 current evidence are an essential to inform future change. Fiona Matthews,2 and Barbara Hanratty2, 1. Newcastle In this project we conducted a rapid synthesis of evidence University, Newcastle upon Tyne, United Kingdom, 2. relating to enhancing health in long term care facilities Newcastle University, Newcastle upon Tyne, England, across technology and evaluation. Mapping reviews were United Kingdom conducted on the uses, benefits and challenges of tech- Older adults in long-term care facilities (LTCF) have nology in care homes and approaches to evaluation of new complex needs for health care and support. There is a percep- models of care. Systematic evidence syntheses addressed tion that residents’ needs are increasing over time, but little the questions of which technologies have a positive impact research evidence to back this up. In this study we brought on resident health and well-being and which measurement together data on 1640 residents in LTCFs from three longi- tools have been validated for use in UK care homes. Key tudinal studies, and conducted repeated cross-sectional ana- findings will be presented in animated format, including lyses across a 25 year period. We found that the prevalence that the most promising interventions appear to be games GSA 2019 Annual Scientific Meeting Innovation in Aging, 2019, Vol. 3, No. S1 243 that promote physical activity and enhance mental health. have been common, most were just brief audio or video lags. This presentation will highlight the benefits and import- Expansion of HIPAA compliant telemedicine software op- ance of evidence synthesis to the development of models tions across devices is increasing the population of caregivers of care. who are able to participate in home video visits. (127 words)

SESSION 1295 (SYMPOSIUM) CAREGIVER EXPERIENCE OF TELEHEALTH- DELIVERED HOME SAFETY EVALUATIONS 1 USING ACCESSIBLE TECHNOLOGY TO SUPPORT Megan Gately , 1. Bedford VA Medical Center Geriatric CAREGIVERS OF PERSONS WITH DEMENTIA Research, Education & Clinical Center, Bedford, Chair: Katie Maslow, Gerontological Society of America, Massachusetts, United States Washington, District of Columbia, United States People with dementia are living in the community, Co-Chair: Scott A. Trudeau, American Occupational necessitating in-home supports for their day-to-day needs. Therapy Association, Bethesda, Maryland, United States Given geriatrics work force shortages, innovative strategies Discussant: Sara J. Czaja, Weill Cornell Medicine, New that increase the reach of extant providers while maintaining York, New York, United States quality are needed. Home-based video telehealth may increase There is widespread enthusiasm about the potential of access to specialty care such as a dementia-focused home safety technology in general to support persons living with dementia evaluation by an occupational therapist; however, little is and their families and other caregivers. At the same time, re- known about the technological demands and caregiver experi- commendations from the 2017 National Research Summit ence of a home safety evaluation delivered by telehealth. Our on Care, Services, and Supports for Persons with Dementia study employed video telehealth to deliver a dementia-focused and their Caregivers emphasize the need for research to de- home safety evaluation compared to in-person evaluation for velop, evaluate, and disseminate specific technologies that caregivers (n=10) of veterans with dementia. Most video visits can achieve meaningful benefits for well-defined subgroups of encountered technological problems. Caregiver experience be- persons living with dementia and their caregivers, including tween the video and in-person evaluations differed. Our find- individuals from diverse populations and individuals who ings reflect the highly dynamic, complex nature of in-home live and receive care in various settings. This symposium video telehealth which requires maximal collaboration with focuses on specific home-based technologies to help family caregivers. By explicating the resource demands and potential caregivers of community-living persons with dementia. Our burden of video telehealth for caregivers, development of ef- three speakers will talk about research results for three dif- fective in-home telehealth evaluation is enhanced ferent technology-related interventions, including: use of home video telehealth visits to help family caregivers provide IMPLEMENTING HOME SAFETY TOOLKIT TO effective dementia care and provide medical management; CAREGIVERS OF VETERANS WITH DEMENTIA 1 use of home video assessments by occupational therapists to Scott A. Trudeau , 1. American Occupational Therapy help family caregivers increase home safety for community- Association, Bethesda, Maryland, United States living persons with dementia; and approaches for making a The purpose of this project was to study the processes self-paced Home Safety Toolkit available to family caregivers necessary to make a Home Safety Toolkit (HST) for Veterans of community-living veterans with dementia. Each speaker with dementia accessible to veterans and their caregivers. will report both positive outcomes, including family care- This Type 3 Implementation–Effectiveness Hybrid Research giver satisfaction, and barriers encountered in delivering the Design, included diagnostic analyses of the current pro- interventions. Such barriers include difficulties with the tech- cesses by which Veterans receive home safety items, and nologies as well as caregiver reluctance to change and costs identification of modifications necessary in order to provide that were not covered by health care insurance or health sys- the HST to Veterans with dementia. Two Veterans Health tems. Our discussant will respond to the presentations and Administration Networks, one in the Northeast and one in solicit audience questions and discussion. the Mid-Atlantic region, participated. A formative evaluation used semi-structured interviews with key staff informants and caregivers identified facilitators and barriers to suc- DEMENTIA CAREGIVER EMBRACE OF HOME VIDEO cessful acquisition and use of home safety items. Qualitative TELEHEALTH VISITS data analysis reveals key barriers of time and cost, selection 1 Lauren Moo , 1. Geriatric Research Education & Clinical of best items, and caregiver reluctance to change. There was Center, Bedford, Massachusetts, United States resounding support from caregivers regarding the potential Bringing people with dementia to in-person medical benefits of self-paced toolkit including education and home visits can be logistically challenging for family caregivers, safety items to implement for their veteran. especially when they themselves are older adults with their own health or mobility challenges, when they live far from the clinic, or when they have to combat inclement weather. SESSION 1297 (SYMPOSIUM) Our dementia management clinic has successfully trialed video visits into the home. Video sessions have been wel- EAST MEETS WEST: IMPROVING HEALTH AND comed by many dementia caregivers citing reduced travel LONG-TERM CARE FOR OLDER ADULTS IN THE U.S. and less disruption of daily routine as the primary benefits AND CHINA of participating. Caregivers report equivalent visit satisfac- Chair: Bei Wu, New York University, New York, New York, tion compared to in-person visits. While technical issues United States

GSA 2019 Annual Scientific Meeting