recent projects

Arts in Long Term Care

Funded by The Hulda B. and Maurice L. Rothschild Foundation

Principal Investigators: Jennifer A. Brush MA, CCC/SLP and Margaret P. Calkins, PhD in partnership with the Society for arts in Healthcare

The purpose of this current project is to develop a print and resource that helps recreation staff engage elders in meaningful activities, with a particular focus on involving outside arts groups that visit the home. This resource will have a wealth of information to assist activity/recreation therapy professionals, artists and volunteers to engage residents in a deeper and more meaningful way with art. Three main goals guide this project: 1). To identify current model programs in long term care homes that demonstrate how the arts play a key role in moving toward person-centered care by engaging elders in the art process; 2). To build awareness and understanding on how the active engagement in the arts can be incorporated into long term care homes; and 3). To support community partnerships and cross-industry connections to increase the availability and effectiveness of arts programs in long term care homes.

The focus of Phase I of this four-part project was to collect information from long-term care communities, artists, creative arts therapists, and arts organizations with the goal of creating resources to help these professionals better incorporate arts programming into long-term care. The partners of this project developed and disseminated a survey that examined the extent to which long-term care homes and arts organizations are providing arts programs led by professional artists or creative arts therapists that facilitate resident engagement--a cornerstone to quality of life.

The information from the first phase of the project has highlighted the need for a more coordinated approach to providing arts engagement activities in long-term care communities. This assessment of the existing “state of the arts in long-term care” suggests that both long-term care communities and artists/arts organizations identify a number of challenges that need to be overcome to more effectively support active arts engagement by nursing home residents. In particular, the lack of overlap of existing resources reflects an unmet opportunity. The next phases of the project will involve the creation of a National Advisory Council, whose members will assist the Society for the Arts in Healthcare and IDEAS Institute in the development of a primer on starting and sustaining arts engagement programs for residents of long-term care communities. The primer will integrate the informational needs of both artists and staff, with a clear focus on active arts engagement activities.

Contribution of the Designed Environment to Fall Risk in Hospitals

Funded by Research Coalition, Center for Health Design

This project will assess the impact of a set of environmental design features that relate to falls in hospitals, specifically patient bedrooms. Features that will be assessed include (among other variables): visibility to the bathroom, access to a continuously supported walking path from bed to bathroom, amount of light at night between bed and bathroom, amount of contrast on the floor between bedroom and bathroom, visibility from a staff work area to the bed, dynamic coefficient of friction of flooring, and more

Communication Toolkit-Improving people’s lives-one conversation at a time

Funded by the Retirement Research Foundation

Principal Investigator: Jennifer A Brush, MA, CCC/SLP

The purpose of this project is to examine the impact of low cost environmental interventions on the communication skills of clients with dementia living in long term care settings. 60 speech-language pathologists, occupational therapists, and physical therapists will participate. The participating rehabilitation professionals will receive a Communication Toolkit Resource Guide about the therapeutic use of the physical environment and how to incorporate environmental modifications into speech therapy treatment sessions, Communication Toolkit Environmental Assessments to evaluate how supportive the environment is of communication, and sound and light meters to assess is sound and light levels throughout the care community are appropriate. The participants will receive pre and post tests to evaluate their knowledge about environmental modifications before and after reading the resource guide, and will complete a questionnaire evaluating the Communication Toolkit.

Meal Time Matters at Home

Funded by the Home Instead Senior Care Foundation

Principal Investigator: Jennifer Brush, MA, CCC/SLP

This project addressed the need for educational programs that build skills for professional home caregivers in the area of dysphagia, oral care, recognizing and preventing dehydration, meal preparation, and safe feeding techniques.  IDEAS Institute developed Meal Time Matters at Home, a two-hour training program that includes everything a trainer needs to provide education on this important topic. As a result of this project, over 160 home caregivers received free training, and an additional 140 home care agencies were mailed complimentary copies of the complete training curriculum.

Creating Home and Building Community II: The Urban Experience

Funded by the Hulda B. & Maurice L. Rothschild Foundation

Principal Investigator: Margaret Calkins, PhD.

Creating Home & Building Community II: The Urban Experience was a grant opportunity designed to assist a nursing home in exploring new approaches to creating more resident-centered, relationship-based models that are appropriate for an urban setting. This project provided one urban nursing facility that was considering a process of restructuring their environment/culture with assistance to move the process forward in this new direction.

IDEAS Institute coordinated, for the Hulda B. & Maurice L. Rothschild Foundation, the development of the Request for Proposals, the process of identifying the top tier proposals (both internally and with an outside panel), conducted site visits, and assisted in making the final award final decision.

Environmental Modifications to Improve Continence at Home, in Nursing Homes, and in Assisted Living

Funded by the Alzheimer’s Association

Principal Investigator: Margaret Calkins, PhD.

This project examined the impact of different color changes in the bathroom on the ability of an individual with Alzheimer’s disease to use the bathroom independently. The study was conducted in 9 waves with 65 participants, and featured a representative sample of individuals from the community, assisted living facilities, and nursing home facilities. One wave was conducted with individuals from the community (n=2), four waves at four different assisted living facilities (n=31), and four waves at four different nursing home facilities (n=32). Participants included individuals with a diagnosis of Alzheimer’s Disease or related dementia, who had a history of incontinence, but who could still use the toilet with moderate (i.e. may require physical assistance after verbalizing need to use toilet) to no assistance (i.e. did not require assistance with transferring or managing clothing). Community-dwelling participants were recruited with the assistance of the Cleveland Chapter of the Alzheimer’s Association. The intervention consisted of three separate environmental modifications: increased toilet to floor contrast, increased toilet to wall contrast, and increased visibility.

Each Wave began with participant recruitment, consent process, and assessment (weeks 1-3). A small battery operated motion sensor was installed in the primary bathroom of each participant. It was positioned on the wall or ceiling to capture movement within close proximity of the toilet. In facilities that used tank toilets rather than tank less toilets, a battery operated flush sensor was inserted inside the toilet tank to count the number of times the toilet was flushed. The wireless motion and flush sensor devices sent data to a base station unit that communicated the data to a secure internet database. The sensors also detected caregiver movements, but the researchers assumed that their patterns remained stable over the course of the research.

The motion and flush sensing devices were used to collect baseline data for three weeks, before any environmental modifications were implemented. After three weeks the first environmental modification was implemented. The order of implementation of modifications was randomly altered and changed at each facility, so that 1/3rd of the participants received Environmental Modification 1 first, 1/3rd received Environmental Modification 2 first, and 1/3rd received Environmental Modification 3 first. This process was repeated for the other 2 environmental modifications, randomly altering the order of modification implementation, and conducting readings for 3 weeks (Figure 1). A modification was removed from the randomization if a participant declined the modification (i.e. lack of comfort with a privacy curtain temporarily installed). The process was then repeated in the other settings (Figure 2).

Meal Time Matters

Funded by the Mt. Sinai Healthcare Foundation

Principal Investigator: Jennifer Brush, MA, CCC/SLP

Patient malnutrition and dehydration is a serious problem in long term care.  Reports have shown that inadequate staff training is one of the main factors that leads to malnutrition and dehydration of patients.  Research has confirmed that that many STNAs lack dysphagia and feeding knowledge despite current training curriculum.  Therefore, nursing assistant education is needed in the area of feeding and swallowing. 

This project addressed the need for educational programs that build skills for nursing and dining assistants and promote safe feeding techniques.  IDEAS Institute developed and distributed Meal Time Matters, a training program that includes a CD with a 45-minute slide presentation, trainer’s speaking text for each slide, three inter interactive exercises, an 8-minute DVD, participant handouts, nursing assistant skills checklist, and learning assessment.

Creating Home and Building Community

Funded by the Hulda B. & Maurice L. Rothschild Foundation

Principal Investigator: Margaret Calkins, PhD.

Approaches to the delivery of long term care are changing dramatically. Traditional institution-centric models are giving way to resident-centered models, delivered in more home-like settings.  To support these changes, the Hulda B. & Maurice L. Rothschild Foundation decided to offer a grant of $100,000 to a nursing home that was engaged in the process of redesigning its physical environment to become more person centered.  IDEAS Institute worked with the Foundation to develop and administer the grant application process, and continues to work with the Rothschild Foundation overseeing the implementation of grant-based activities. 

The award was given to Garfield County Memorial Hospital and Long-Term Care, in Pomeroy Washington.  They are implementing rapid-cycle process analysis techniques to evaluate care processes from both an efficiency and resident-experience perspective.  The nursing home is being redesigned and substantially added to, based on lesson learned from re-engineering their care processes.

Exploring the Value of Private Bedrooms in Nursing Homes

Funded by The Commonwealth Fund

Principal Investigator: Margaret Calkins, PhD.

IDEAS Institute explored the benefits and detriments of private versus shared rooms in nursing homes, with a focus on factors that impact costs.  The results suggest older adults overwhelmingly prefer a private room over a shared room.  Increasingly, residents and families are choosing facilities based on availability of a private room.  Anxiety and aggression are significantly lower in facilities with greater bedroom privacy and more personalization in the bedrooms. Pneumonia, the leading cause of death among nursing home residents (with overall mortality rates reported between 20% -50%, and as high as 80% in some studies), is the second most frequent nosocomial infection in nursing homes. There is some limited evidence of higher ongoing operational costs of shared rooms, including greater time to clean rooms, more frequent resident relocation, more staff time spent managing roommate conflict and increased marketing costs. A construction costs analysis suggests average cost of construction plus debt (30 years @ 7%) of a private room is $36,515, and $22,814 for a shared room (per person).  However, the cost of this difference can be recouped in less than 2 years (596 days) assuming a $23 differential in room charge (figure based on national averages for nursing home room rates).  This assumes all beds are occupied.  If a bed in a shared room remains unoccupied, the time to recoup the difference in cost construction is less than 3 months (82 days). Click here to read the Shared versus Private Bedroom summary article. The full report can be pruchased on our prodcuts page.

IDEAS for a Better Visit

Funded by the Mt. Sinai Healthcare Foundation 

Principal Investigator: Jennifer Brush, MA, CCC/SLP

Visiting in a long-term care facility can be difficult for family and friends.  Facilities need resources and guidance to support meaningful and enjoyable interactions between older adults and their visitors.  IDEAS Institute facilitated successful visiting by the creation and distribution of IDEAS for a Better Visit, a 20-page large print booklet that includes information about the sights and sounds to expect, how to visit with someone who has hearing, vision, or memory loss, what to say, do, or bring during a visit, bringing children during the visit, and more.

Using the Environment to Improve Intake for People with Dementia

Funded by the Extendicare Foundation

Principal Investigator: Jennifer Brush, MA, CCC/SLP

Physical and social environments are important but often not actualized resources that can have a significant impact on the overall goals of food consumption and quality of life. The purpose of this pilot study, was to examine the effect of improved lighting and table setting contrast on residents’ meal consumption, communicative interaction, independence, and behaviors during meals in both assisted living and long term care environments serving people with dementia.

After a lighting and contrast intervention, there were significant improvements in both oral intake and functional abilities at both facilities. There were statistically significant increases from baseline to posttest in the frequency with which the residents engaged in and started conversations with staff, and answered questions with on topic responses. This result suggests that nursing home staff and designers should consider modifying the barriers in the dining environment, such as dim lighting and poor contrast, to increase clients’ ability to participate in meals. Doing so will facilitate favorable therapeutic outcomes by supporting independence.