Seniors – Adding Life to Years (SALTY) Project SALTY logo

Project funded from April 2016-March 2021

Everyone wants to live well in their final years but this may be a challenge, particularly for people living in long term care settings. The Seniors – Adding Life to Years (SALTY) research study, aimed to add quality to late life for people living in long term care and for their caregivers, including family, friends, volunteers and care workers who support their care. Researchers did work through four interrelated streams – (see overview below): Monitor Care Practice, Map Promising Approaches to Care Relationships, Evaluate Innovative Practice, and Examine Policy Context. They used diverse and multiple methods across four Canadian provinces – British Columbia, Alberta, Ontario and Nova Scotia.

The study was led by Dr. Janice Keefe, Mount Saint Vincent University and Dr. Carole Estabrooks, University of Alberta with the participation of leading researchers and representatives from long-term care including decision makers, clinicians, care aides, family caregivers and residents (see SALTY Team). For an overview of the study click here to watch Seniors-Adding Life to Years project video (7 mins).

The study was funded through a Late Life Issues grant from the Canadian Institutes of Health Research (FRN145401), in partnership with Michael Smith Foundation for Health Research (FRN16738), Research Nova Scotia (formerly Nova Scotia Health Research Foundation) (FRN2016-870) and Alzheimer Society of Canada.

Funding for the project has ended but team members are available for presentations and continue to work on publications. For more information contact salty@msvu.ca


What’s the Latest News

  • New Publication: Bourgeault, I., Daly, T., Aubrecht, C., Armstrong, P., Armstrong, H., Braedley, S. (2022). Leadership for quality in long-term care. Healthcare Management Forum. 35(1):5-10. doi: 10.1177/08404704211040747.
  • New Publication: Taylor, D. & Keefe, J. (2021). How residents’ quality of life are represented in long term care policy: A novel method to support policy analysis. Journal of Long-Term Care. 375–385. http://doi.org/10.31389/jltc.79
  • Two briefs released as part of Knowledge Translation Series:

Volunteer Role Largely Absent in Provincial Long-Term Care Policy

Staff Flexibility is Key to Improving Highly Regulated Long-Term Care Sector

Overview of Study Activities

The Monitoring Care Practice team (stream 1) led by Dr. Carole Estabrooks and Dr. Matthias Hoben at the University of Alberta have identified and prioritized care quality measures, burdensome symptoms and potentially inappropriate care practices, at the end of life for residents living in long-term care. The team is finalizing their analysis of narratives and summaries collected from residents and family using an action project method. Priority setting data was completed for decision makers however, unfortunately, focus groups to capture staff perspective and priorities are on hold indefinitely due to the COVID-19 pandemic and the inability to access long-term care facilities. Several papers are planned to report on methodologies and findings from their work. With the support of a CIHR project grant stream 1 researchers are expanding the work proposed in the SALTY project team grant specifically around data collection with residents, the addition of national data analysis and data visualization, and final consultation with stakeholders. The results from this work will test the ability to create and communicate longitudinal measures of quality of care.

Mapping Care Relationships team (stream 2) led by Dr. Tamara Daly, Dr. Ivy Bourgeault and Dr. Katie Aubrecht aim to identify how promising approaches to late life long-term care can enhance care relationships and quality of work. The team is developing and finalizing several manuscripts reporting stream 2 findings and methodology around their intensive ethnographic fieldwork. Many papers will expand on op-eds the leads have published in response to the COVID-19 pandemic, including topics such as putting the qualitative back in quality, looking at alternative measures of quality, recognizing the skill in long-term care work and the intersectionality of person centred dementia care. The team will provide alternative approaches and promising practices that have emerged from their work. Stream findings have been presented at the 2020 virtual Gerontological Society of America (GSA) and Canadian Healthcare Workers (CHWC) conferences. In addition, three SALTY Trainees are working with stream 2 data for PhD, Master’s and undergraduate theses.

Evaluating Innovative Practice (stream 3) led by Dr. Kelli Stajduhar, Dr. Denise Cloutier and Dr. Leah MacDonald evaluated the implementation of a quality improvement project – the integration of a palliative approach to care in long term care in Island Health, BC. The team is finalizing manuscripts reporting their evaluation findings including papers on emotional geographies of providers caring for long-term care residents and the implementation of integrating palliative approaches to care in long-term care. The stream 3 team has also contributed to the conversation around needed reforms to Canadian long-term care with an op-ed “Not Scared of Dying but of Dying Scared” in healthydebate and are finalizing another around the need to apply a palliative approach to care to long-term care.

Examining Policy Context (stream 4) led by Dr. Janice Keefe, Dr. Dee Taylor and Heather Cook examined the legislative and regulatory level long-term care policy landscape in the project jurisdictions NS, ON, AB & BC. The team completed policy analyses focusing on resident, family, staff and volunteer. All but one of eight planned key informant interviews (2 per jurisdiction) were completed despite delays due to the COVID-19 pandemic. The final key informant interview is expected to be completed by January 2021. A manuscript reporting the results of the staff analysis will be published in The Gerontologist in December 2020, and the team are finalizing manuscripts reporting their novel policy analysis method and results of the volunteer, family, and resident focused analyses.

The SALTY Trainee Network.

Over the lifespan of the SALTY project there have been 24 trainees (Postdoctoral Fellows, PhD candidates and Master’s and undergraduate students) engaged over all research streams and in all aspects of the project. Currently, during this wrap-up phase of the project, there are 6 trainees actively supporting dissemination and knowledge translation work and 3 trainees analyzing SALTY data for their own academic theses.

The SALTY Trainee Network recently launched a Podcast mini-series “Let’s Talk Care” hosted by Postdoctoral Fellow Mary Jean Hande, and Master’s students Emly Hubley and Marco Redden. They host current and former SALTY trainees as well as other members of the SALTY team in discussions exploring timely topics such as working, dying, caring, and COVID-19 in today’s long-term care system. The podcast provides fresh perspectives from early emerging scholars and first voice accounts of quality of life in Canada’s long-term care homes. Episodes of the mini-series can be found on BuzzSprout and other popular podcast platforms. Current and past trainees are also developing a manuscript reflecting on how the network was organized, the types of activities and how enagement with the project helped to further trainee careers. And finally, Mary Jean Hande has taken the lead on developing the concept for an edited book highlighting the many voices of our advisory group committee with their reflections on their involvement and engagement over the lifespan of the project.

The SALTY Advisory group, has helped shape SALTY research since concept and development of the project and remained actively engaged through all research phases. The group, composed of a long-term care resident, persons living with dementia, family care givers, volunteer representatives and care aides, has provided feedback and input to SALTY researchers from first voice perspectives – those who will be most impacted by SALTY findings. Members continue to remain actively involved and enthusiastic to contribute as co-authors on a book of their reflections on facilitating and maintaining meaningful engagement of first voice perspectives in a large research project.

The SALTY KT Advisory Group provided input and advice to researchers regarding knowledge exchange, translation and dissemination activities with the aim to increase the uptake and impact of SALTY outputs. The group, composed of decision makers, clinicians and knowledge users from the long term care sector across project jurisdictions, has met regularly with researchers providing input and feedback on methodology, and interpretation of insights and findings. They were active in the planning and organization of team meetings to maximize knowledge exchange and planning for dissemination and mobilization of project findings and key messages.

Project Milestones

2021

• November-Symposium at Gerontological Society of America Annual Scientific Meeting, virtual—Leveraging promising policies to support long-term care resident’s quality of life post-pandemic.

• October-Policy Stream researchers hosted workshop at North American Integrated Care Conference on First voices in long term care research: Critical reflections on meaningful engagement, voice, and representation

• October-Policy Stream researchers published in Journal of Long-Term Care “How residents’ quality of life are represented in long term care policy: A novel method to support policy analysis”.

• July- Scientific Lead, Dr. Janice Keefe, gave presentation to AGE-Well APPTA Policy Rounds “How attention to provincial long-term care policies can support or inhibit resident quality of life.”

• July-Marco Redden successfully completed thesis Meaningful Engagement among Care Home Residents with Dementia and Family Members: A Critical Ecological Analysis.

• May-Dr. Mary Jean Hande presented at Canadian Association of Health Services Policy Research Conference on Canadian long-term care policy guidance for staff to support resident quality of life.

• March-Evaluating Innovation Practice stream researchers published in Social Science & Medicine “We are to be like machines. Fill the bed before it gets cold”: Exploring the emotional geographies of healthcare providers caring for dying residents in long-term care facilities.

• February-Policy stream researchers published in Canadian Journal of Aging The Role of Volunteers in Enhancing Resident Quality of Life in Long-Term Care: Analyzing Policies that May Enable or Limit this Role.

• January-Policy stream researchers published in The Gerontologist Long-term residential care policy guidance for staff to support resident quality of life.

2020

• December-Emily Hubley successfully completed thesis Integrating a Palliative Approach to Care in Long-Term Care: A Comparative Case Study of Three Provinces.

• December – Dr. Ivy Bourgeault presented at Canadian Healthcare Workers Conference on how quality care work in long-term care is underrecognized skill work based on experience and knowledge of residents.

• November – “COVID-19 highlights the urgent need for review of long-term care…and QoL must be central!”, an article by policy context stream authors Mary Jean Hande, Janice Keefe, & Dee Taylor, published in Canadian Nursing Home, Vol 31, No. 3, October/November 2020.

• November – “Let’s Talk Care: Fresh Perspectives on Long-Term Care” a podcast co-hosted by SALTY trainees Mary Jean Hande, Emily Hubley and Marco Redden was launched on November 24, 2020. This podcast mini-series explores the challenges and possibilities of quality of life in long-term care in Canada through episodes that delve into timely topics such as working, dying, caring, and COVID-19 in today’s long-term care system.

• November – Mapping Care Relationships oral presentation by stream lead Katie Aubrecht “Intersectionality: Mapping Critical Relations for Quality in Long-Term Care Research” and poster presentation by trainee Andie Marquez ““When you are working in this environment, you’re more likely to get sick”: Mapping Care Relationships in LTC” at the Virtual Gerontological Society of America conference.

• November – Poster presentations “The Action Project Method Applied in Nursing Home Settings” & “Priorities for End of Life Reporting in Nursing Homes: Results from a Mixed Methods Study” by Monitoring Care Practice stream Co-Investigator Andrea Gruneir.

• October – Janice Keefe presented SALTY project findings at Nova Scotia Health Authority Geriatric rounds

• June – The Canadian Foundation of Healthcare Improvement (CFHI) hosted a webinar of the Examining Policy Context stream 4 findings presented by the stream leads on June 9th. The recorded webinar can be viewed at: here A summary of the webinar is also available.

• May – Full Team videoconference to share stream level findings from Policy Context and Mapping Care Relationships researchers. Scientific Lead Janice Keefe hosted the virtual meeting of 26 SALTY team members including researchers, knowledge users and trainees.

• April – SALTY’s 1st manuscript published “Team-based integrated knowledge translation for enhancing quality of life in long term care settings: A multi-method, multi-sectoral research design” in the International Journal of Health Policy and Management.

• February – SALTY Project video released providing overview of the project from Scientific Lead Janice Keefe and other team members including SALTY advisory group members and knowledge users.

2019

October – Dr. Dee Taylor, stream 4 Co-Lead Investigator and advisory group members Sandra Bauld, Faye Forbes and Corrine Schalm held a workshop at the Canadian Association on Gerontology (CAG) 2019 conference titled “The rewards and pitfalls of authentic inclusion of stakeholders in the analysis of nursing home policies”. SALTY Trainee, Emily Hubley, also presented a Stream 4 poster on the role of volunteers in enhancing resident quality of life in long term care.

• October – Two oral presentations by stream 3 Co-Lead Dr. Denise Cloutier at the Canadian Association of Gerontology 2019 conference. One on the evaluation of a palliative approach to care in long term care, and the other on the challenges of implementing palliative approaches in long term care.

October – Dr. Katie Aubrecht, stream 2 Co-Lead Investigator presented “A room with a view: unpacking decision maker perceptions and assumptions about the meaning of quality long-term care” at the Canadian Association on Gerontology (CAG) 2019.

September – Oral presentation on integrating a palliative approach in long-term care homes and poster presentation on the development and integration of a palliative approach to care strategy by Kailyn Roland, stream 3 Research Associate, at the Canadian Hospice Palliative Care conference in Ottawa.

September – Workshop presentation to the Ontario Long Term Care Association: This is Long Term Care 2019 Conference in Toronto by Dr.

Janice Keefe & Dr. Mathias Hoben on how SALTY research informs quality of life for older adults living in residential long-term care.

June –Featured panel presentation at the Northwood Research Symposium on the cross stream emerging evidence to support quality of life in long term care by Janice Keefe and Katie Aubrecht in-person, and Denise Cloutier and Matthias Hoben via video technology.

May – Poster presentations at the Canadian Association of Health Services and Policy Research (CAHSPR) conference by: Ivy Bourgeault on criteria for selecting quality long term care homes with promising social approaches, and Dee Taylor on the interaction of resident quality of life with policies that govern staff.

May – Oral panel presentations on embodying qualities of everyday lives in long term care by Tamara Daly, Susan Braedley, Katie Aubrecht, Prince Owusu and Vasuki Shanmuganathan at the Trent Aging joint conference of North American and European Networks on Aging

May – In-person team meeting – Halifax, NS May 27th – 28th.

May – SALTY Trainee workshop – in-person Halifax, NS May 26th.

May – Oral presentation at the Qualitatives Conference on insider/outsider dilemmas in late life long term care ethnographic research by Katie Aubrecht.

April – BrainXchange webinar hosted by the Alzheimer Society of Canada sharing findings and insights from Monitoring Care Practice (stream 1) and Evaluating Innovative Practice (stream 3).

February – full team video conference meeting to share and discuss project stream finding

2018

November – oral presentation by Janice Keefe at the Gerontological Society of America scientific meeting on the findings of policy differences between jurisdictions when considering family/fiend caregiver involvement in resident quality of life

October – Poster presentation on the innovative method used to integrate key stakeholders in SALTY research on end-of-life in nursing homes using web-based Delphi panels by Matthias Hoben at the Canadian Association on Gerontology Scientific Meeting

October – Oral presentation of the findings from the comparison of long-term care policy across project jurisdictions from a resident perspective by Dee Taylor at the Canadian Association on Gerontology Scientific Meeting

August – SALTY Trainees Prince Owusu and Lily Lu attended the Knowledge Mobilization Master Class at the International Federation on Aging (IFA) conference in Toronto on August 7th.

June – 2nd full team meeting via video conference, June 18

May – panel presentation by stream leads at Canadian Association of Health Services and Policy Research Conference, Montreal

April – meeting of team leads and knowledge user representative from each province to review progress and plan for remainder of project

January – In-person meeting of stream 1 to discuss stream activities.

January – Stream 2 team training in ethnographic methodology at a pilot site in Ontario.

2017

November – Dr. Janice Keefe, Dr. Katie Aubrecht, Dr. Matthias Hoben, Dr. Della Roberts and Dr. Dee Taylor hosted a NS provincial sector workshop at Mount Saint Vincent University for key decision makers and stakeholders from the Nova Scotia long term care sector.

July – Dr. Dee Taylor presented “Finding rabbit holes without falling in: Navigating palliative care policy in Canadian Long-term Care” poster at the International Association of Gerontology and Geriatrics (IAGG) 2017 World Congress in San Francisco.June – “Seniors – Adding Life to Years: A Canadian Project Focusing on Late Life Long Term Care” poster displayed at Northwood Research Symposium. June – Stream 4 completed the policy document retrieval and coding. June – In person meeting of Stream 2 to discuss stream activities.

May – Dr. Katie Aubrecht presented “Seniors – Adding Life to Years: A Canadian Project Focusing on Late Life Long Term Care” poster at the Canadian Disability Studies Association 2017 conference in Toronto.

May – Full team meeting via video conference technology, May 9.

2016

April – Project received funding from the Canadian Institutes of Health Research, Michael Smith Foundation for Health Research and Nova Scotia Health Research Foundation.

May – 2 project trainees participated in the 2016 CIHR Institute of Aging’s Summer Program in Aging in Toronto focused on the theme of “Recognizing Frailty and Improving Care”.

September – First in-person team meeting – Halifax, Nova Scotia, September 18th – 20th.

September – Dr. Janice Keefe and Dr. Matthias Hoben presented a webinar entitled Improving End of Life care in Long term care on September 27, 2016. This was an integrated KTE webinar event by brainXchange in partnership with the Alzheimer Society of Canada and the Canadian Consortium of Neurodegeneration in Aging (CCNA). View the archived webinar here.
December – Meeting of Stream 4 Team to discuss policy document selection and analysis approach.
January – In-person meeting of Stream 1 Team to discuss data collection and other stream activities