Our research focuses on advancing knowledge and improving care for adults through innovative day programs and studies. Key projects include the ADAPT-DemCare realist review, EXPEDITE and AIDA-DemCare cohort studies, and COVCARES research on the impact of COVID-19. Our multidisciplinary team evaluates program objectives, outcomes, and quality of life through mixed methods, peer-reviewed publications, policy briefs, and public presentations. For more details, explore our protocols and published findings linked throughout the page.
Links to research projects:
Adult Day Programs
Adult day programs provide vital support for older adults with dementia and their caregivers, yet there is a lack of large-scale studies, particularly in Canada, examining their impacts. Our research program addresses these knowledge gaps through a realist review, environmental scans, and cohort studies that assess the effects of day programs on health outcomes, caregiver experiences, and cost-effectiveness. Additionally, we conduct interviews and focus groups to explore the perspectives of attendees, caregivers, staff, and decision-makers, ensuring a comprehensive understanding of these programs.
Program objectives:
> Conduct a realist review to identify and synthesize the available literature on the positive and negative effects (or the lack of effects) of day programs on older day program attendees, and their family/friend caregivers, – including an evaluation of what does or does not work for whom under what circumstances.
> Conduct an environmental scan of all day programs in (1) the York Region, Ontario, (2) the Winnipeg Regional Health Authority, Manitoba, (3) the Calgary Health Zone, Alberta, and (4) the Interior Health Region, British Columbia, to assess the number and characteristics of these settings.
> Conduct a retrospective cohort study, using de-identified clinical and administrative healthcare data from Western Canada (Alberta, British Columbia, Manitoba), along with semi-structured interviews and focus groups with key informants to help further contextualize our quantitative findings. This will help us understand how to best support older adults, including those living with dementia, and their family/friend care-givers to enable care in the community for as long as possible (aging in place).
> Conduct a prospective cohort study among older day program attendees and their family/friend caregivers in the (1) the York Region, Ontario, (2) the Winnipeg Regional Health Authority, Manitoba, (3) the Calgary Health Zone, Alberta, and (4) the Interior Health Region, British Columbia, to link primary data (e.g., type of day programming received, social determinants of health, out-of-pocket expenses, caregiver burden, client and caregiver quality of life) to their health administrative data to assess the effects of day programs on older adults with dementia, their family/friend caregivers, and the healthcare system.
> Conduct semi-structured interviews and focus groups with day program attendees, their family/friend caregivers, day program staff/managers, and health system/government decision makers, before and after each of the previously mentioned projects to inform each of the projects, to further contextualize project findings, and to assess how these key informants perceive and experience day programs.
Study Design:
This sequential, multi-phase, mixed method evaluation applies an integrated knowledge translation approach, and is informed by a realist lens which seeks to answer the following questions::
- What does or does not work?
- For whom (and to what extent)?
- In which circumstances does it work or not?
- How and why does it work or not?
The realist model expands the traditional causal model in which intervention X leads to a given outcome O. Realism asks what contexts C and mechanisms M allow X to lead to O, so the XO model becomes a CMO model. This CMO model allows the realist evaluation process to be contextually sensitive and exploratory. This is necessary when a topic is under-theorized and under-researched, as in evaluating older adult day programs. To address complex problems pragmatically in the real world, focus on context is essential. Context refers to the social conditions in which mechanisms operate, including social, economic and political structures; healthcare settings; organizational settings or social conditions (e.g. leadership, team interactions, team-client-relationships); program participants (e.g. clients and their families); program staffing and experience; and geographical and historical context. Mechanisms refer to the entities, processes or (social) structures that operate in particular contexts to bring about the outcomes. Mechanisms are not directly observable, but are accessible through theory building and theory testing.
In the context of older adult day programs, examples of mechanisms might be the various activities that individuals with dementia are involved in in these settings and that help them to achieve certain outcomes (e.g., slowing down cognitive or physical decline, feeling meaningfully occupied and valued, increased quality of life, etc.). Another example could be the respite provided to the clients’ family/friend caregivers, which is thought to lead to the outcome of reduced caregiver burden and improved mental health. The outcomes this research program will include are day program attendee outcomes (e.g., quality of life, risk of institutionalization, acute care and primary care use, cognitive and physical decline), family/friend outcomes (e.g., caregiver burden, depression, anxiety, quality of life, physical health, acute care and primary care use, out-of-pocket expenses), day program staff outcomes (e.g., quality of work-life, turnover, use of best practices), and health system outcomes (e.g., number of days older adults lived in the community instead of congregate care settings and associated costs and savings).
The realist review is funded by a CIHR Knowledge Synthesis and Mobilization Grant. It will identify and synthesize available literature on the positive and negative effects of day programs (or lack thereof) on day program attendees with dementia, and their family/friend caregivers. The goal is to develop a program theory to unpack under what circumstances (contexts) day programs may have an effect (outcomes) on older adults living with dementia and their caregivers, and how and why these effects come about (mechanisms). This realist synthesis will inform the other parts of this program of research (e.g., variable selection in the two cohort studies or sampling of participants and focus of questions in the semi-structured interviews and focus groups). Hypotheses developed in the realist review will be tested in the two cohort studies. This project also provides timely evidence for health system and government decision makers and program administrators to consider where and how to allocate resources so that day programs are optimally utilized. Program directors may consider reviewing their designs and partnerships to best benefit their clients. Also, findings can support older individuals with dementia and their family/friend caregivers to make a decision of whether they join a day program. Researchers may use the developed program theories to inform design and objectives of their future studies.
In this retrospective population-based, cross-provincial cohort study, we propose to use health administrative data from Alberta, British Columbia, and Manitoba with the purpose of understanding of how to best support older adults including those living with dementia, and their family/friend caregivers to enable care in the community for as long as possible.
This will be the first Canadian retrospective, population-based, cross-provincial cohort study, assessing patterns of use/non-use, user/non-user characteristics, and effects of adult day programs on older adults, including those living with dementia. We will apply an intersectionality lens to understand how overlapping social identities, such as age, gender, socioeconomic status, or disability, interact in experiences of discrimination and privilege.
Study objectives:
> Explore patterns of day program use (e.g., variations in time to first attendance, monthly hours of attendance, ongoing vs interrupted attendance, total time of day program exposure), using latent class analyses (LCA), and compare the frequency of each latent use class between provinces and over time.
> Compare social determinants (age, sex, physical/cognitive disability, area-based deprivation indices, caregiver availability/distress) by attendees’ day program use/non-use class, province, and over time.
> Assess whether day program attendees compared to a propensity score matched control group of non-attendees enter care homes at later points in time, use emergency, acute, or primary care less frequently, experience less cognitive and physical decline, have better mental health, and less distressed caregivers, and assess whether these day program effects vary by older adults’ social determinants.
This prospective cohort study is funded by a CIHR Implementation Science Team Grant. We will recruit a total of 1,000 older adults attending a day program and each attendee’s primary caregiver in (1) the York Region, Ontario, (2) the Winnipeg Regional Health Authority, Manitoba, (3) the Calgary Health Zone, Alberta, and (4) the Interior Health Region, British Columbia (i.e., 250 day program attendees and their caregivers in each region). We will also recruit a comparison cohort of older adults not attending a day program and their family/friend caregivers, aiming for two non-attendees and their caregivers for every attendee.
To ensure care needs of non-attendees are comparable to those of attendees, we will apply criteria used by health systems to determine day program eligibility to identify non-attendees in the community. Eligible non-attendees must: 1) have a primary caregiver, 2) have at least mild cognitive impairment (RAI CPS score of 2 or higher), 3) be at least 55 years old, and 4) meet regional day program eligibility critiera, including: 4.1) the ability to cope with activities of daily living to some extent, 4.2) no or minimal need for assistance to ambulate/transfer, 4.3) continence or requiring minimal assistance in managing continence needs, 4.4) no unmanageable behaviour problems, and 4.5) being alone for long periods within the day, or having a caregiver who needs respite.
We complete surveys with caregivers and - if possible - with persons in need of care at baseline and after 1 and 2 years. Surveys will assess older adults' socio-demographic characteristics, care needs, health and well-being, and quality of life, as well as caregivers' socio-demographic characteristics, tasks they help the older adult with, challenges encountered, health and well-being, caregiver burden, and quality of life. We will also complete a survey with the attendee's day program to assess structural characteristics of these settings. Examples of day program characteristics assessed include staffing numbers and mix, number of spaces, types of programming provided (e.g., arts-based, recreational), special focus of the program (e.g., dementia), etc. This study will provide a rich picture of how social determinants of health and day program characteristics are associated with effects of day programs on attendees, family/friend caregivers, and the healthcare system.
Throughout each of the projects outlined above, we will conduct semi-structured interviews and focus groups with key informants (older adults, their caregivers, day program staff/managers, representatives of Alzheimer societies and caregiver organizations, and health system/government policy makers). We will explore these individuals’ perspectives on why older adults do or do not use a day program, and on how and why day programs have positive, negative, or no effects on different groups of attendees and caregivers, especially those with multiple, intersecting vulnerabilities.
Ontario Team:
Matthias Hoben NPA, YorkU
Saleema Allana PA, UWO
Colleen Maxwell PA, UWaterloo
Whitney Berta Co-I, UofT
Jennifer Bethell Co-I, UHN Toronto
Tamara Daly Co-I/Collab., YorkU
Liane Ginsburg Co-I, YorkU
Alberta Team:
Zahra Goodarzi PA/Co-I, UofC
Holly Symonds-Brown PA/Co-I, UofA
Sienna Caspar CO-I, ULethbridge
Greta Cummings Co-I, UofA
Kaitlyn Tate Co-I, UofA
Adrian Wagg Co-I, UofA
David Hogan Co-I/Collab., UofC
Manitoba Team:
Malcolm Doupe PA, UMB
Lori Mitchell Collab., UMB
BC Team:
Kim McGrail PA/Co-I, UBC
Jennifer Baumbusch Co-I, UBC
Peer-reviewed papers:
Nguyen, H., Rahman, A., Ubell, A., Goodarzi, Z., Maxwell, C. J., Allana, S., ... & Hoben, M. (2024). Adult day programs and their effects on individuals with dementia and their caregivers (ADAPT-DemCare): a realist synthesis to develop program theories on the how and why. Systematic Reviews, 13(1), 265. https://doi.org/10.1186/s13643-024-02683-1
Hoben, M., Maxwell, C. J., Ubell, A., Doupe, M. B., Goodarzi, Z., Allana, S., ... & McGrail, K. (2024). EXploring Patterns of Use and Effects of Adult Day Programs to Improve Trajectories of Continuing Care (EXPEDITE): Protocol for a Retrospective Cohort Study. JMIR Research Protocols, 13(1), e60896. doi: 10.2196/60896
Presentations:
Hoben, M., Ubell, A., Nguyen, H., Rahman, A. (2024). Evaluating Adult Day Programs: The Helen Car-swell Chair in Dementia Care Program of Research. Five Days in May, British Columbia Research Day, Apr 23, 2024, virtual presentation.
Hoben, M. (2024). Evaluating Adult Day Programs: The Helen Carswell Chair in Dementia Care Program of Research. Canadian Association of Gerontology Student Connection, Apr 07, 2024, virtual presentation.
Hoben, M. (2023). Evaluating Adult Day Programs: The Helen Carswell Chair in Dementia Care Program of Research. Ontario Caregiver Coalition Annual General Meeting, Dec 14, 2023, virtual presentation.
Hoben, M. (2023). Between home care and long-term care: Appreciating adult day programs and assisted living communities as important, yet under-valued care settings. Invited keynote presentation at the 22nd Biennial Canadian Gerontological Nurses Association Conference, Apr 21, 2023, Niagara Falls, Ontario.
Hoben, M. (chair), Ubell, A (co-chair). (2024). Adult Day Programs: Introducing a Program of Research Evaluating Their Effects on Persons With Dementia and Their Family/Friend Caregivers. Symposium at the CAG 2024 conference, Edmonton, Alberta, Canada, Oct 24-26.
Hoben, M., Ubell, A., Doupe, M., Allana, S., Baumbusch, J., Goodarzi, Z., Maxwell, C., McGrail, K., Symonds-Brown, H., Berta, W., Bethell, J., Cada, A., Caspar, S., Cummings, G., Daly, T., Ginsburg, L., Hogan, D., Nguyen, H., Rahman, A., Tate, K., Wagg, A., Weeks, L. (2024). A Program of Research Comprehensively Evaluating Effects of Adult Day Programs on People With Dementia and Their Caregivers. Presentation 1 of a symposium at the CAG 2024 conference, Edmonton, Alberta, Canada, Oct 24-26.
Nguyen, H., Rahman, A., Goodari, Z., Ubell, A., Cada, A., Hoben, M. (2024). Day Program Effects on Individuals With Dementia and Their Caregivers: Developing Realist Program Theories on the How and Why. Presentation 2 of a symposium at the CAG 2024 conference, Edmonton, Alberta, Canada, Oct 24-26.
Rahman, A., Nguyen, H., Baumbusch, J., Doupe, M., Goodarzi, Z., McGrail, K., Maxwell, C., Allana, S., Symonds-Brown, H., Ubell, A., Cada, A., Hoben, M. (2024). Evaluating day program use patterns, user/non-user characteristics, and effects on persons living with dementia and their caregivers. Presentation 3 of a symposium at the CAG 2024 conference, Edmonton, Alberta, Canada, Oct 24-26.
Ubell, A., Cada, A., (2024). The Reality of Adult Day Program Practice and How the Proposed Program of Research Aligns With This Reality. Presentation 4 of a symposium (chaired by Hoben, M.) at the CAG 2024 conference, Edmonton, Alberta, Canada, Oct 24-26.
Reports, policy briefs, media:
Hoben, M., Nguyen, M. H., Ubell, A. (2024). Improving support for adult day programs caring for persons living with dementia in the York Region: A policy brief targeting health authorities. York University.
Ontario Caregiver Coalition. (2024). Policy brief 1: Building a better Ontario by listening to the voices of caregivers. June, 2024.
Ontario Caregiver Coalition. (2024). Policy brief 2: Building a better Ontario by alleviating the financial hardship of caregiving. September, 2024.
Ontario Caregiver Coalition. (2024). Policy brief 3: Building a better Ontario for caregivers by providing mental health supports. December, 2024
YFile (2024). York U researchers receive CIHR funding to study dementia care. Newsletter article from June 12, 2024, announcing a successful CIHR research grant ($750,000, 3 years), led by Prof. Hoben.
The B.R.A.I.N.S. Project (2023). Let’s Get Real with Matthias Hoben. Podcast episode on dementia. https://www.instagram.com/p/CzmaIdaOVIV/, November 13, 2023.
Jankowski, N. (2023). Caregiver: Professor Matthias Hoben inaugurates a new endowed Chair in Dementia Care. York University Magazine, 2023(summer). Article featuring Prof. Hoben's program of research.
YFile (2022). Professor Mattias Hoben named Helen Carswell Chair in Dementia Care. Newsletter ar-ticle from November 25, 2022 featuring Prof. Hoben's program of research on evaluating day pro-grams for persons with dementia.
Impact of COVID-19
COVID-19 has severely impacted vulnerable older adults in long-term care (LTC) and assisted living (AL)/designated supportive living (DSL) homes, where chronic underfunding and staffing challenges contributed to high mortality and negative health outcomes. Although LTC residents have received considerable research attention, there has been limited investigation into AL/DSL residents, despite their similar vulnerability to the virus. These residents often face additional risks due to fewer on-site healthcare services, lower staffing levels, and greater reliance on family caregivers, which exacerbates caregiver stress. This study analyzes the effects of COVID-19 on DSL and LTC residents in Alberta, using clinical and administrative data to assess preparedness, infection control, staffing, and resident outcomes.
About:
Across Canada and internationally, COVID-19 has had a particularly devastating impact on the quality of care and lives of vulnerable older adults, especially those with complex chronic conditions and frailty who are living in congregate care settings. So far, much research and media attention has been paid to the impacts of COVID-19 and its associated physical distancing restrictions and policies on older clients living in long-term care (LTC) homes. However, far less attention has been paid to older adults living in Designated Supportive Living (DSL) homes or Assisted Living (AL) homes, despite people living in LTC and DSL/AL exhibiting similar vulnerabilities to COVID-19 infection and negative health outcomes.
Similar to LTC, people living in DSL/AL homes are of advanced age (average 84 years), and typically have significant health needs, including high rates of dementia (≥60%), mental health conditions (34% with depression) and multimorbidity (average of 5 conditions), increasing the older adult’ frailty and risk for infection with COVID-19. LTC and DSL/AL homes also have similar structural and operating conditions that unfortunately facilitate widespread transmission of COVID-19, such as heavy reliance on poorly paid part-time staff who provide essential and intimate care across many different facilities.
Although older clients living in LTC and AL/DSL homes exhibit similar vulnerabilities to the negative consequences of COVID-19, DSL/AL homes offer fewer services and have lower staffing levels (including fewer skilled staff members per person in need of care and no onsite 24-hour nursing care). This results in an increased expectation for significant family involvement in care (e.g., assistance with activities of daily living, monitoring of health status, social engagement and support) compared to LTC, increasing stressors experienced by family caregivers. Though the immediate and longer-term effects of COVID-19 on older clients living in DSL/AL homes and their families across Canada are expected to be significant, they remain to be investigated.
Study design and objectives:
Our observational study builds directly on the standardized interviews and methods utilized in a large prospective cohort study of 1,089 older clients living in DSL/AL homes and 1,000 older clients living in LTC homes and their family caregivers conducted across 113 DSL/AL and LTC homes in AB during 2006-2010 by Co-Principal Investigator Maxwell and colleagues (termed ACCES). We aim to recruit 1,000 eligible family caregivers of older clients.
Our overall aim of this study is to illuminate and understand the impact of COVID-19 (and associated social distancing restrictions and policies) on the care and oversight provided by family caregivers within a diverse array of DSL/AL homes, and the resulting consequences for the health and psychosocial well-being of these essential (though often invisible) care providers.
COVCARES - AB/BC study objectives are:
- Examine the effects of COVID-19 and related DSL/AL home restrictions, on the types/amount of health and social care provided to older clients living in DSL/AL homes by key family caregivers.
- Explore whether changes in these care patterns differ across characteristics of (a) family caregivers (e.g., age, gender, ethnicity, income, relationship to older clients); (b) older clients living in DSL/AL homes (e.g., age, sex, functional impairment); and (c) DSL/AL homes (e.g., size, region, for-profit status, visiting policies, COVID-19 testing & outbreak status).
Our findings will directly inform the development and conditions for scale-up of policy and practice interventions to (i) ensure timely communication with, and engagement of, family caregivers in DSL/AL homes during emergencies; and, (ii) permit rapid and enhanced emergency preparedness, staffing and services in DSL/AL homes. Interventions targeting both are essential for mitigating the adverse consequences of future outbreaks and restrictions on older clients’ and family caregivers’ health and psychosocial well-being.
Methods:
The first stage involve a random sample of DSL/AL homes within 10 strata (defined by 5 health zones & large vs. small bed size. These factors were used to define strata given their association with health system factors, urban-rural region, and DSL/AL home characteristics (including staffing, quality of care and pandemic preparedness). The second stage consists of working with identified DSL/A home administrators to have them select eligible older client-caregiver dyads. Eligible family caregivers are those identified as the person most involved in the care and/or informed about the client, and who are primary caregivers of clients who are at least 65+ years of age and who have been in the DSL/AL home for 3 or more months as of March 1, 2020.
For the family/friend caregiver survey (that closed at the end of March 2021) we have a sample size of 690 respondents and for the DSL/AL home [facility] survey (that closed April 6, 2021) we have a sample of 104 respondents. Our baseline surveys had a primary focus on the impact of the first wave of the COVID-19 pandemic covering the period from 3 months prior to and post March 1, 2020. During our baseline data collection, we received significant correspondence from our family/friend caregiver and home [facility] administrator respondents asking us to consider a follow-up version of our surveys to ensure we capture relevant changes associated with the second wave of the pandemic (covering the period from Oct 1, 2020 to Feb 28, 2021). Therefore, we invited the family/friend caregiver participants and DSL/AL home key contacts who completed our initial surveys to complete a follow up survey.
About:
COVID-19 has had a devastating impact on vulnerable older adults living in long-term care (LTC) and assisted living (AL) homes. Healthcare reforms have neglected these settings for decades, setting them up for the tragedy that unfolded during COVID-19 – including rates of death and suffering that were disproportionately higher than those in the general older adult population. Several Canadian studies have assessed the impact of COVID-19 on LTC residents, focusing on rates of infection and death, hospitalizations before death, medication prescribing practices, and increased behavioural and mental health issues. Far less attention has been paid to AL, a rapidly expanding residential setting intended for people with similar but generally less advanced needs than in LTC. US research suggests that excess mortality rates in AL during the COVID-19 pandemic were consistent with those in LTC. A study on AL homes in the US and one on retirement homes in Ontario, found that being located in communities with higher rates of COVID-19 infections, larger bed size, and higher proportions of visible minorities among residents in the facility or the surrounding community increased the risk for COVID-19 outbreaks. However, no comprehensive investigation of the impact of the pandemic on Canadian AL residents is available.
Building upon our original work in COVCARES AB/BC this retrospective cohort study will use DSL and LTC resident population-level clinical data (Resident Assessment Instrument, RAI) linked with health administrative data collected 01/2017–12/2021. We will examine and compare the impact of the COVID-19 pandemic on DSL vs LTC residents in Alberta. Further, we will link unique, comprehensive facility-level survey data collected from our 64 randomly sampled DSL homes and from 35 randomly sampled LTC homes participating in the Translating Research in Elder Care (TREC) program. We will assess how facility-reported COVID-19 preparedness, infection prevention/control measures, outbreak status, staffing/care challenges, and communication with family/friend care partners were associated with resident outcomes.
Study design and objectives:
This retrospective cohort study will use DSL and LTC resident population-level clinical data (Resident Assessment Instrument, RAI) linked with health administrative data collected 01/2017–12/2021. We will examine and compare the impact of the COVID-19 pandemic on DSL vs LTC residents in Alberta. Further, we will link unique, comprehensive facility-level survey data collected from our 64 randomly sampled DSL homes and from 35 randomly sampled LTC homes participating in the Translating Research in Elder Care (TREC) program. We will assess how facility-reported COVID-19 preparedness, infection prevention/control measures, outbreak status, staffing/care challenges, and communication with family/friend care partners were associated with resident outcomes. Our objectives are to:
- Assess how DSL residents’ physical and mental health, quality of care indicators, and healthcare use have changed during the course of the pandemic, compared to the 3 years prior to the pandemic
- Explore differences in the outcome trajectories assessed in objective 1, as well as, COVID-19 infections and deaths between DSL and LTC residents
- Evaluate how the novel, potentially modifiable, facility-level measures captured by our DSL and LTC facility surveys are associated with resident’s COVID-19 infections & death, and other resident outcomes
Methods:
The proposed study builds on the standardized interviews and methods utilized in our Alberta Innovates funded COVID-19 study and an earlier large prospective cohort study (ACCES, 2006-2010) led by Co-PI Maxwell. In the first phase of our COVID-19 study, we randomly selected 64 DSL homes (3,756 spaces), stratified by health zone (North, Edmonton, Central, Calgary, South) and size (small/large, based on zone median bed-size). They accounted for 32% of the 201 DSL homes (11,853 spaces) in Alberta. TREC, led by team member Estabrooks, has done similar work in LTC since 2007. Funded by CIHR and the Alberta government, TREC has collected data on the impact of COVID-19 in a representative cohort of 35 randomly selected urban LTC homes in Alberta (5,180 spaces), stratified by health zone (Edmonton, Central, Calgary), size (small: <80 beds, medium: 80-120 beds, large: >120 beds), and ownership (private for-profit, public or voluntary not-for-profit). For this study we conducted two population-based, retrospective cohort studies using linked clinical (RAI) and health administrative data available for all DSL and LTC residents in Alberta. We will also link our existing unique COVID-19 facility survey data to clinical and health administrative resident data.
i) Facility Characteristics: We examine the following characteristics that are publicly available for all DSL and LTC homes in Alberta: bed number, for-profit vs not ownership, chain affiliation, health zone, urban/rural location, and services provided. Utilizing the comprehensive baseline and follow-up COVID facility surveys completed for the 64 DSL homes participating in our previous study, and the COVID facility survey collected from 35 TREC LTC homes, we also examine the following additional characteristics: staffing levels, COVID-19 testing and outbreak status, extent and timing of infection prevention/control measures, staff education/training, and staffing/care challenges encountered during the pandemic. Both surveys are based on tools used in previous DSL/LTC research in Alberta, designed with input from our stakeholder partners. The research team conducted these surveys via video calls with directors of care. The DSL baseline survey captured the COVID-19 experiences and practices in the 3 months prior to and post March 2020, while the follow-up survey captured changes between wave 1 (March–July 2020) and wave 2 (Oct 2020–Feb 2021). The LTC facility survey (collected in summer/fall 2021) captures facilities’ COVID-19 experiences overall.
ii) Resident COVID-19 Testing, Clinical, and Health Administrative Data: We work with our collaborators to obtain RAI, COVID-19 testing and health administrative data. Specifically, our collaborator Dr. Jeff Bakal, Alberta Health Services Program Director for Provincial Research Data Services, helped facilitate our data access process. We requested the following data covering the period from 01/2017 to 12/2021:
- CDOM. The Communicable Disease and Outbreak Management (CDOM) system will provide information on COVID-19 infections, testing and vaccination for all DSL and LTC residents.
- RAI-HC and RAI-MDS 2.0. The RAI – Home Care (RAI-HC) and the RAI – Minimum Data Set (MDS) 2.0 are standardized, valid, reliable clinical assessment tools. They will provide data on residents’ medical conditions, functional dependence, pain, cognitive impairment, mood, and behavioural problems. These data will also provide risk-adjusted quality of care indicators, based on well-validated algorithms.
- DAD. The hospital Discharge Abstract Database (DAD) will provide information on all resident inpatient hospital stays, including diagnoses, length of stay and treatments received.
- NACRS. The National Ambulatory Care Reporting System (NACRS) will provide data on all resident emergency department visits, diagnoses and treatments received.
- PIN. The Pharmaceutical Information Network (PIN) will provide information on residents’ medications filled through a community pharmacy.
Research Principal Investigators
Dr. Matthias Hoben (Principal Investigator)
Associate Professor & Helen Carswell Chair in Dementia Care
School of Health Policy and Management
Associate Member, YorkU Graduate Program in Nursing
Adjunct Assistant Professor, Faculty of Nursing, University of Alberta
Alzheimer Society of Canada New Investigator (2020-2023) Policy Research
301E Stong College - SC
Keele Campus | Toronto | ON | M3J 1P3
Dr. Colleen Maxwell (Co-Principal Investigator)
Professor
University Research Chair
University of Waterloo, School of Pharmacy
PHR 4013 | Waterloo | ON | N2L 3G1
[Adjunct Professor, Community Health Sciences, University of Calgary, Calgary, AB]
Co-Investigators
Dr. Joseph Amuah
Adjunct Professor
University of Ottawa
Dr. Andrea Gruneir
Assistant Professor
University of Alberta
Dr. David Hogan
Professor
University of Calgary
Dr. Natasha Lane
Resident Physician
University of British Columbia
Dr. Lauren Griffith
Assistant Professor
McMaster University
Dr. Stephanie Chamberlain
Postdoctoral Fellow
University of Alberta
Dr. Jennifer Baumbusch
Associate Professor
University of British Columbia
Dr. Kimberlyn McGrail
Professor
University of British Columbia
Family Caregiver Associations
Sandy Serada
Caregivers Alberta
Barb MacLean
Family Caregivers of British Columbia
Collaborators
Heather Cook
Ministry of Health
British Columbia
Hude Quan
University of Calgary
Alberta
Study Coordinator
Kyle Corbett
Research Coordinator
York University
kylecorb@yorku.ca
Survey Research Centre
The Survey Research Centre (SRC) at the University of Waterloo has been conducting telephone, online, mail and face-to face surveys for academic research purposes since 1999. The SRC has worked with universities and colleges across Canada, and with organizations such as the Centre for Addiction and Mental Health (CAMH), Health Canada and Statistics Canada. The SRC adheres to the standards and protocols developed by the American Association for Public Opinion Research (AAPOR) and employs highly-trained undergraduate and graduate post-secondary students to conduct telephone interviews.
Peer-reviewed papers:
Hoben, M., Shrestha, S., Dampf, H., Hogan, David B., McGrail, K., Knopp-Sihota, J., Maxwell, C. J. (accepted). Association between organizational context and resident pain in assisted living: A repeated cross-sectional study. Int J Geriatr Psychiatr, 39(11), e70005.
Hogan , D. B., Maxwell, C. J., Dampf, H., McGrail, K., Estabrooks, C. A., Poss, J. W., Bakal, J. A., Hoben, M. (2024). Excess Deaths in Assisted Living and Nursing Homes During the COVID-19 pandemic in Alberta, Canada. JAMDA, 25(7), 105032.
Hoben, M., Li, W., Dampf, H., Hogan, D. B., Corbett, K., Chamberlain, S. A., McGrail, K., Grif-fith, L., Gruneir, A., Lane, N. E., Baumbusch, J., Maxwell, C. J. (2023). Caregiver Involvement and Concerns with Care of Residents of Assisted Living Before and During the COVID-19 Pandemic. Gerontology, 69(7), 839-51 .
Maxwell , C. J., Dayes, L., Amuah, J. E., Hogan, D. B., Lane, N. E., McGrail, K. M., Gruneir, A., Griffith, L. E., Chamberlain, S. A., Rutter, E. C., Corbett, K., Hoben, M. (2022). Coping behav-iours and health status during the COVID-19 pandemic among caregivers of assisted living residents in western Canada. J Am Med Dir Assoc, Available online 22 December 2022.
Lane, N. E., Hoben, M., Amuah, J. E., Hogan, D. B., Baumbusch, J., Gruneir, A. Chamberlain, S. A., Griffith, L. E., McGrail, K., Corbett, K., Maxwell, C. J. (2022). Prevalence and Correlates of Anx-iety and Depression in Caregivers to Assisted Living Residents During COVID-19: A Cross-sectional Study. BMC Geriatr, 22(1):662.
Hoben, M., Baumbusch, J., Hogan, D. B., Gruneir, A. Chamberlain, S. A., Corbett, K., Griffith, L. E., McGrail, K., Amuah, J. E., Lane, N. E., Maxwell, C. J. (2022). Family/friend caregivers’ concerns about assisted living residents’ mental health during the COVID-19 pandemic: A cross-sectional sur-vey study. J Fam Nurs, online ahead of print (Sep 20, 2022).
Presentations:
COVCARES - AB/BC webinar
This is a recording of a webinar in which we shared results of the COVCARES-AB/BC study with the general public. COVCARES-AB/BC stands for COVID-19 and Caregivers of Assisted living Residents: their Experiences and Support needs. The study surveyed 673 family/friend caregivers of residents living in assisted living homes in Alberta and British Columbia. We also surveyed directors of care of 104 assisted living homes in these provinces.
COVECARES - AB summit
Maxwell, C., Hoben, M. (2021). COVCARES-AB/BC – COVID-19 and Caregivers of Assisted living Residents: their Experiences and Support needs. Canadian Consortium on Neurodegeneration in Aging (CCNA) Partners Forum & Science Days, October 12-15, 2021, virtual conference.
Hoben, M (chair), Maxwell, C. J. (co-chair), Beeber, A. S (discussant) (2023). The impact of COVID-19 on residents and family/friend caregivers in assisted living homes. Symposium at the GSA 2023 Annual Scientific Meeting, Tampa, FL, USA, Nov 11, 2023.
Hoben, M., Maxwell, C. J. (2023). COVID-19 and the care of assisted living residents: The COVCARES program of research. Presentation 1 of the COVCARES symposium at the GSA 2023 Annual Scientific Meeting, Tampa, FL, USA, Nov 11, 2023.
Hoben, M., Dampf, H., Hogan, D. B., Corbett, K., McGrail, K., Griffith, L. E., Gruneir, A., Maxwell, C. J. (2023). Caregiver involvement and concerns with resident care in assisted living before and during COVID-19. Presentation 2 of the COVCARES symposium at the GSA 2023 Annual Scientific Meeting, Tampa, FL, USA, Nov 11, 2023.
Maxwell, C. J., Dampf, H., Alkabbani, W., Cotton, C. J., Gamble, J. M., Hogan, D. B., Gruneir, A., Hoben, M. (2023). COVID-19 and psychotropic drug use in assisted living residents: Variation by wave and setting type. Presentation 3 of the COVCARES symposium at the GSA 2023 Annual Scientific Meeting, Tampa, FL, USA, Nov 11, 2023.
Hoben, M., Maxwell, C. J., Dampf, H., Devkota, R. (2023). Association of assisted living homes’ preparedness for and responses to the COVID-19 pandemic with resident pain. Presentation 4 of the COVCARES symposium at the GSA 2023 Annual Scientific Meeting, Tampa, FL, USA, Nov 11, 2023.
Baarbé, J., Maxwell, C. J., Dampf, H., Shrestha, S, Hoben, M. (2023). Association of assisted living homes’ preparedness for and responses to the COVID-19 pandemic with resident loneliness. Presentation 5 of the COVCARES symposium at the GSA 2023 Annual Scientific Meeting, Tampa, FL, USA, Nov 11, 2023.
Hoben, M., Dymchuk, E., Banerjee, S., Estabrooks, C. A. (2023). The association of COVID-19 outbreaks and other factors with nursing home residents’ quality of life. Presentation at the GSA 2023 Annual Scientific Meeting, Tampa, FL, USA, Nov 10, 2023.
Hoben, M., Dymchuk, E., Chamberlain, S. A., Beeber, A. S. (2023). The impact of COVID-19 on relationships between care teams and family caregivers in congregate care. Presentation at the GSA 2023 Annual Scientific Meeting, Tampa, FL, USA, Nov 10, 2023.
Hoben, M., Poss, J., Dampf, H., Corbett, K., Amuah, J., Baumbusch, J., Chamberlain, S. A., Estabrooks, C. A., Griffith, L., Gruneir, A., Hogan, D. B., McGrail, K., Maxwell, C. J. (2023). Comparing population-based risk adjusted rates of resident outcomes in assisted living and long-term care settings in Alberta before and after the start of the COVID-19 pandemic. CAHSPR Annual Conference 2023, May 29-31, 2023, Montreal, Canada.
Hoben, M., McArthur, E., Dampf, H., Hogan, D., Poss, J., Amuah, J., Bronskill, S., Maxwell, C. J. (2023). COVID-19 and rates of hospitalization events among older residents of assisted living vs. long-term care homes in Alberta, Canada. CAHSPR Annual Conference 2023, May 29-31, 2023, Montreal, Canada.
Reports, policy briefs, media:
Stolte, E. (2021). Alberta needs to know if staffing crunch, profit motive made outbreaks worse. Arti-cle in the Edmonton Journal that featured Prof. Hoben’s research. Edmonton Journal, January 26, 2021
Rutherford, G. (2021). COVID-19 restrictions may be even harder on people in assisted living than those in long-term care: U of A nursing researcher – New study seeks input from family members and facilities to understand impact, plan for next pandemic. Article in Folio that featured M. Hoben’s research. Folio, January 13, 2021.
Hoben, M., Maxwell, C., Baumbusch, J., Hogan, D. (2020) Opinion: COVID's impact on assisted-living homes is being overlooked. Edmonton Journal, November 19, 2020.
Hoben, M., Maxwell, C., Baumbusch, J., Hogan, D. (2020) Opinion: COVID's impact on assisted-living homes is being overlooked. Calgary Herald, November 19, 2020, re-print of the Edmonton Journal OpEd from November 19, 2020.
Hoben, M., Maxwell, C., Baumbusch, J., Hogan, D. (2020) Opinion: COVID's impact on assisted-living homes is being overlooked. Vancouver Sun, November 19, 2020, re-print of the Edmonton Journal OpEd from November 19, 2020.
How are COVID restrictions impacting those living in long-term care? Radio interview with CFAX 1070, Adam Stirling, November 23, 2020.
Quality of Life
Quality of life (QoL) is a critical but often overlooked goal of care for people with dementia in long-term care (LTC) and designated supportive living (DSL). Social factors, such as race, social support, and financial situation, can significantly impact QoL, yet these outcomes are rarely measured, especially for marginalized groups, leading to health disparities. Since no cure for dementia exists, maximizing QoL through supportive care is essential, and this study aims to develop a feasible system for routine QoL measurement to improve care and outcomes for residents with dementia in DSL and nursing homes.
About:
50 million people worldwide are living with dementia. Population aging is expected to more than triple numbers by 2050. Dementia encompasses multiple degenerative brain disorders that are progressive, cannot be cured, continuously diminish cognitive and functional abilities, cause neuropsychiatric symptoms, and ultimately lead to death. Yet even in the face of profound impairment, people with dementia can maintain QoL with appropriate supports in place. With no dementia cure or disease-modifying treatment available, maximizing QoL is the one thing we can do for people with dementia. Therefore, persons with dementia and agencies that advocate for them demand that maximizing QoL is a priority goal in Canada and worldwide. Before we can implement system-wide routine measurement, we have to test whether it is feasible to do so. Therefore the ultimate benefit of this study will be establishing a feasible approach to routine QoL measurement in designated supportive living (DSL) and nursing home (NH) sites. This study will be the prerequisite to actually monitoring and improving QoL in DSL and NH residents with dementia.
Funded by:
Alzheimer Society Research Program Quality of Life New Investigator grant: Grant/award #21-16
Study design and objectives:
This convergent mixed methods study uses 1) standard QoL assessments (DEMQOL-CH), 2) routinely collected clinical data from DSL and NH residents, 3) semi-structured cognitive interviews with care staff using the DEMQOL-CH, and 4) focus groups with administrators and decision makers. It is intended to be a feasibility pilot for a larger study. Our research will apply an integrated knowledge translation (iKT) approach, partnering researchers and stakeholders in a non-hierarchical way on jointly-determined priorities.
We carry out this feasibility study in DSL facilities and in NHs in Alberta. Our collaboration with senior policy makers and citizens aligns closely with Alberta’s strategic priority on quality of life in dementia and the goal of routinely assessing QoL for NH residents.
Study objectives:
1: Determine the feasibility of care staff administering the DEMQOL-CH
2: Assess quality of the DEMQOL-CH data collected by care staff in objective 1
3: Build strategies to facilitate implementation of the DEMQOL-CH in Alberta's DSL and NH facilities, in collaboration with decision makers and stakeholders
Methods:
In order to achieve the first study objective 60 care staff completed the DEMQOL-CH on 400 residents between two sites, using programmed iPads. Comparison of DEMQOL-Proxy results to DEMQOL-CH results is a major validity source. Research assistants conducted cognitive interviews with each of the 20 of the 60 care providers to assess response process validity of the DEMQOL-CH and care staff-perceived feasibility of completing it. Research assistants conducted semi-structured interviews with administrators to assess feasibility from their perspectives. To avoid burden on resident care and care staff, we backfilled participating care staff with casual care staff to facilities during this project and refunded related costs.
We assessed time for care staff to complete the DEMQOL-CH (time automatically recorded for electronic surveys), patterns of missing data by resident cognition, floor/ceiling effects, tendency to the mean, lack of variance and other response patterns. Our analysis followed best practice guidelines for psychometric testing of assessment tools.
All cognitive and semi-structured interviews were audio recorded and transcribed verbatim. Our content analysis helped identify themes reflecting care staff understanding of tool items and instructions and participant perceptions of feasibility to collect DEMQOL-CH data.
For the second objective we assessed test-retest reliability, we randomly selected 80 residents (20%) from our sample of 400 residents. The same care staff member who assessed these residents with DEMQOL-CH re-assessed them within 24–48 hours. This time frame is long enough for care staff to not remember their initial ratings and short enough for resident QoL to not change substantially. To assess inter-rater reliability, we randomly selected another 8 residents (20%) from our sample. One of our 6 recruited and trained care staff other than the one who conducted the first assessment completed the DEMQOL-CH a second time within the same work shift as the first assessment.
We assessed internal consistency reliability (Cronbach’s alpha) using data on all 400 residents. This sample size exceeds the minimum for this measure. We assessed test-retest reliability by intra-class correlation with a 2-way mixed effects model of absolute agreement and inter-rater reliability by a 1-way random effects model.
In order to assess criterion validity (agreement between DEMQOL-CH and interviewer-administered DEMQOL-Proxy), we compared tools item by item with weighted Kappa statistics and sensitivity/ specificity analyses. We also compared overall scores of the 2 tools with paired t-tests. A 4-factor model was identified in previous exploratory factor analysis. In this study, we evaluated this hypothesized structure with confirmatory factor analysis. Our sample size of 400 residents was sufficient for Kappa statistics, and paired t-tests and confirmatory factor analyses. Research suggests that residents’ physical function, cognitive function, pain and depression are linked to QoL. To assess construct validity, we assessed whether QoL (measured by DEMQOL-CH) is associated with each of these clinical outcomes (measured by RAI-HC). We ran multiple regression models with QoL as the outcome variable and each clinical outcome as the predictor variable, controlling for resident characteristics (e.g. age, sex, diagnoses), care unit (e.g. unit type, staffing) and facility (e.g. size, ownership model).
To explore the third study objective we collected data for this objective at our final webinars. For this webinar, we generated a tailored report on our findings for each facility, and a summative report with findings on feasibility, barriers and facilitators of our data collection. We developed the feedback reports in collaboration with our stakeholders. In the first half of the webinar, we presented and discuss the tailored QoL reports and the summative report on recommendations and challenges for wider implementation. The second half of the summit convened focus groups to collect additional data on a) more specific experiences of participants in this project at their sites, b) tailored site reports and c) the summative report.
We audio recorded focus groups, transcribed them verbatim and conducted thematic content analysis. We then prepared a report on the focus groups for a final webinar with all available summit attendees in the last 3 months of the study. In this webinar, we presented and discussed focus group findings, received input and then generated a final set of recommendations.
About:
Quality of life (QoL) is the ultimate goal of care for people living with dementia in long-term care (LTC). Nine out of 10 LTC residents have dementia or significant memory problems – and often they have poor QoL. Social factors, such as a person's social support, race/ethnicity or financial situation are as critical for an individual's QoL as their health or functional abilities. US research suggests that there may be disparities in QoL among marginalized populations such as LTC residents who are members of visible minority communities. Although maximizing QoL and fighting health disparities in LTC are key priorities in Canada, health authorities do not regularly measure these outcomes and we lack research on these issues. This is a serious problem. If we do not measure QoL and its reasons for frail, vulnerable, and often disadvantaged people living in LTC, these issues remain invisible and so we cannot improve them.
Study design and objectives:
In this study, we assess QoL of LTC residents with dementia. We also assess important resident and facility characteristics that may influence a resident’s QoL – such as a resident’s health, social support, or financial situation; and a facility’s size, ownership, or quality of care provided. We include almost 4,000 residents in 78 LTC Homes in Alberta, British Columbia, Manitoba, New Brunswick, and Nova Scotia. We share our findings with LTC homes, government decision makers, people in need of care and their family/friend care partners. We meet with them to discuss possible reasons for poor QoL, reasons for differences in QoL among groups of residents (e.g. male or female gender, low income), and strategies to improve QoL and disparities in QoL for LTC residents with dementia. This study is an important first step to prepare for intervention studies aiming to improve QoL and disparities in QoL for LTC residents with dementia.
Our study aims to compare QoL among subgroups of older adults living with dementia in LTC settings, who have various intersecting vulnerabilities – including residents at advanced stages of dementia who cannot self-report and who have no family member or friend to provide a proxy assessment. Three specific research objectives will address these pressing issues:
1. Assess QoL and associated social determinants, using mixed effects regression models, adjusted for resident, care staff, and LTC home covariates known to influence QoL, in a representative sample of ~6,350 residents in 127 LTC homes in Alberta (AB), British Columbia (BC), Manitoba (MB), Ontario (ON), and Nova Scotia (NS).
2. Identify, using covariate-adjusted multi-level latent class analyses, clusters of intersecting social determinants that perpetuate and reinforce QoL inequities among LTC residents.
3. Evaluate, through focus groups and knowledge users’ interpretations, the perceived usefulness and intended uses of data on LTC residents’ QoL and its social determinants.
Social determinants and other factors (covariates)
influencing LTC resident QoL
Methods:
In this explanatory sequential mixed methods study, we use an integrated knowledge translation (iKT) approach to co-produce knowledge with knowledge users in all project phases. We first collected quantitative data on LTC residents’ QoL and its social determinants, from a representative sample of LTC homes in AB, BC, MB, ON, NS (objective 1). We then assess whether different clusters of intersecting factors can be found in those with the highest and lowest QoL (objective 2). Lastly we conduct feedback webinars with embedded focus groups with knowledge users (objective 3), to help us interpret our findings, discuss how results can be used to enhance care practices, and identify strategies to maximize QoL and minimize QoL inequities among LTC residents with dementia.
Our theoretical framework integrates 4 perspectives. 1) Social determinants of health – the idea that living conditions primarily shape the health and well-being of individuals, not just medical treatments or lifestyle choices. 2) A health equity framework that outlines important social factors sup-porting or impeding health equities. 3) Intersectionality – an analytical framework to understand how intersecting, overlapping social identities combine to create different modes of discrimination and privilege. 4) The Wilson & Cleary QoL framework adapted for LTC, which guided our selection of social determinants and model covariates. In alignment with our iKT approach, our collaborators participated in study conceptualization. For this first quantitative, large-scale evaluation of multiple intersecting social determinants of LTC resident QoL, we prioritize a focused set of social determinants that our stakeholders deemed highest priority. Data on these had been collected from residents and families by care teams, using items from validated Statistics Canada population survey.
Dr. Amit Arya
Dr. Carole Estabrooks
Dr. Hannah O'Rourke
Dr. Jordana Salma
Dr. Kelli Stajduhar
Dr. Malcolm Doupe
Dr. Pamela Jarrett
Dr. Melissa Ristau
Dr. Anna Beeber
Dr. Christine Kelly
Dr. Janice Keefe
Dr. Katie Aubrecht
Dr. Laura Hughes
Dr. Sube Banerjee
Dr. Stephanie Chamberlain
Study Coordinator:
Emily Dymchuk
Research Coordinator
York University
edymchuk@yorku.ca
Peer-reviewed papers:
Hoben, M, Dymchuk, E., Doupe, M. B., Keefe, J., Aubrecht, K., Kelly, C., Stajduhar, K., Banerjee, S., O’Rourke, H. M., Chamberlain, S. A., Beeber, A. S., Salma, J., Jarrett, P., Arya, A., Corbett, K., Devkota, R., Ristau, M., Shrestha, S., Estabrooks, C. A. (2024). Counting What Counts : As-sessing Quality of Life and its Social Determinants Among Nursing Home Residents with Dementia. BMC Geriatrics, 24(1), 177.
Dymchuk, E., Mirashemi, B., Chamberlain, S. A., Beeber, A. S., Hoben, M. (2023). The impact of COVID-19 on relationships between family/friend caregivers and care staff in continuing care facilities: A qualitative descriptive analysis. BMC Nursing, 22(1):121.
Hoben, M., Dymchuk, E., Corbett, K., Devkota, R., Shrestha, S., Lam, J., Banerjee, S., Chamberlain, S. A., Cummings, G. G., Doupe, M. B., Duan, Y., Keefe, J., O'Rourke, H. M., Saeidzadeh, S., Song, Y., Estabrooks, C. A. (2023). Factors associated with the quality of life of nursing home residents during the COVID-19 Pandemic: A cross-sectional study. J Am Med Dir Assoc, 24(6), 876–84.
Hoben, M., Banerjee, S., Beeber, A. S., Chamberlain, S. A., Hughes, L., O’Rourke, H. M., Stajduhar, K., Shrestha, S., Devkota, R., Lam, J., Simons, I., Dymchuk, E., Corbett, K. Estabrooks, C. A. (2021). Feasibility of Routine Quality of Life Measurement for People Living With Dementia in Long-Term Care. J Am Med Dir Assoc, 23(7):1221-6.
Presentations:
Hoben, M., Baarbé, J. (2023). Counting What Counts: Assessing Quality of Life and its Social Determinants Among People Living With Dementia in Nursing Homes. Interior Health Research Week, Oct 18, 2023, virtual conference.
Hoben, M. (2022). Quality of Life of Individuals With Dementia Receiving Continuing Care: The influence of COVID-19 outbreaks, care staff burnout, and several other factors. Presentation at the Alberta Association of Gerontology Futures Policy Forum, webinar, Sep 7, 2022.
Hoben, M. (2022). Quality of life of older adults living in nursing homes: how can we measure it and how can we improve it? Five Days in May. British Columbia Island Health research month, virtual conference, May 3, 2022.
Hoben, M. (2021). Quality of life in nursing home residents with moderate to severe dementia: Feasibility of routine measurement. Presentation to members of the Alberta Gerontological Nurses Association. Edmonton, Alberta, Canada, January 25, 2021.
Shieu, B., Schwartz, T., Hoben, M., Toles, M., Beeber, A., Anderson, R. A. (2022). Age Related Differences in Health-Related Quality of Life Among Western Canadian Nursing Home Residents. GSA 2022 Annual Scientific Meeting, Indianapolis, IN, USA, November 2-6, 2022.
Hoben, M. (2022). The impact of COVID-19 outbreaks and personal support workers' burnout on long-term care resident quality of life (QoL). This is Long Term Care 2022, Ontario Long Term Care Association (OLTCA) annual conference, virtual, October 24-26, 2022.
O’Rourke, H. M., Swindle, J., Chacinski, D., McGilton, K., Lee, H., Boscart, V., Hoben, M., Barsan, K., Dal Pizzol, F. L. F. (2022). Connecting Today: Feasibility and acceptability of a remote visiting program for people living with dementia in long-term care homes. Canadian Association on Gerontology (CAG) 51st Annual Scientific and Educational Conference, Regina, SK, Canada, October 20-22, 2022.
Duan, Y., Iaconi, A., Song, Y., Hoben, M., Norton, P., Estabrooks, C. (2022). Organizational Context and Quality Indicators in Long-Term Care Homes: A Microsystem Look. 2022 Annual CAHSPR Conference “The Power and Promise of Canadian HSPR”, May 31-June 2, 2022.
Reports, policy briefs, media:
Long Term Care Quality Initiative (LTC-QI) Update (June 2024). The LTC-QI is a collaborative partnership between Michael Smith Health Research BC, the BC Ministry of Health, health authori-ties, and research and academic communities. The Counting What Counts project was mentioned in the Jun 2024 newsletter.
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