Seniors – Adding Life to Years (SALTY) Project
Everyone wants to live well in their final years but this may be a challenge, particularly for people living in long term care settings. Seniors – Adding Life to Years (SALTY) is a four-year research project, developed by researchers, care providers, care administrators, policy makers and older adults and their families from across Canada. The project aims 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. SALTY’s research is organized into four interrelated streams: Monitor Care Practice, Map Promising Approaches to Care Relationships, Evaluate Innovative Practice, and Examine Policy Context. The project which employs diverse and multiple methods is being conducted in four Canadian provinces – British Columbia, Alberta, Ontario and Nova Scotia and will have relevance for jurisdictions across Canada.
SALTY was developed under the direction of Dr. Janice Keefe at the lead institution, Mount Saint Vincent University in Nova Scotia.
The project is 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, 2016 through to 2020.
Check back frequently to see updates on the progress of the project.
What’s the Latest News
While the SALTY project is now wrapping up having been funded by CIHR from April 2016 – March 2020, SALTY researchers are still busy. They are focused on writing up findings for publication and contributing to the conversations around needed changes to Canadian long-term care, brought to the forefront by the COVID-19 pandemic. The SALTY team’s expertise and learnings support a message that any plans to overhaul Canadian long-term care need to recognize that quality of life for residents and staff is essential. Four SALTY team members, Scientific Lead and Co-Lead Dr. Janice Keefe & Dr. Carole Estabrooks, Co-Investigator Dr. Pat Armstrong and Knowledge User Dr. James Silvius, sat on the Royal Society of Canada’s Working Group on Long-Term Care publishing the policy briefing “Restoring Trust: COVID-19 and the Future of Long-Term Care”. Dr. Pat Armstrong also recently co-authored the Canadian Centre for Policy Alternatives A Higher Standard: Setting federal standards in long-term care and continuing care”, and the Policy Context Stream under lead author Mary Jean Hande, published an article highlighting stream findings titled “COVID-19 highlights the urgent need for review of long-term care…and QoL must be central!” in the Fall issue of Canadian Nursing Home (pp 4-5). The findings
show that Kane’s quality of life domains safety, security and order are over-emphasized in Canadian long-term care policy and the authors suggests that a broader definition, which also includes relationships, dignity and physical comfort, is needed and vital for the well-being of long-term care residents. Many other reports, interviews, articles, op-eds and podcasts speaking to needed changes for Canadian long-term care have been published by team members and can be found on the “SALTY Team in the Media” page.
SALTY’s first manuscript, “Team-based integrated knowledge translation for enhancing quality of life in long term care settings: A multi-method, multi-sectoral research design”, was published in April 2020 by the International Journal of Health Policy and Management. This perspective paper describes the SALTY Project’s integrated knowledge translation method of research which engaged the voices of key stakeholders in the research process over the life of the project. A SALTY project video was also released earlier describing the integrated knowledge translation method and introducing some of the stakeholders that have been engaged with our research. We are also excited that one of the project’s Postdoctoral Fellows, Mary Jean Hande, has taken the lead in developing a book idea with our Advisory Group members, LTC resident, family, staff, persons living with dementia and LTC volunteers, around their reflections on engaging and advising the SALTY team as first voice representatives.
The Policy Context stream will have their findings focused on staff published as SALTY’s second manuscript in The Gerontologist in December 2020. We anticipate several other publications in the coming months, as many manuscripts from all our research streams are being finalized and submitted. Watch the Results and Dissemination page regularly for updates.
2020 was not good for conferences with most being cancelled due to the pandemic. SALTY was well represented however at the Gerontological Society of America (GSA) Virtual conference in November 2020. Monitoring Care Practice and Mapping Care Relationship streams each had two presentations. Mapping Care relationship research stream also participated at the Canadian HealthCare Workers Online conference in December 2020. Dr. Ivy Bourgeault presented their findings on how quality care work in long-term care is underrecognized skill work based on experience and knowledge of residents and the Policy Context stream presented findings in a June webinar hosted by the Canadian Foundation for Healthcare Improvement titled “Quality of Life in Long Term Care: What’s policy got to do with it?”. Future presentations will continue to be updated on the SALTY Results and Dissemination page.
“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. Hosts are joined for discussions by long-term care residents, volunteers, staff and family members, expert researchers and people with dementia, all affiliated with the Seniors – Adding Life to Year (SALTY) research project. Let’s Talk Care provides fresh perspectives from early emerging long-term care scholars and first voice accounts of quality of life in Canada’s long-term care homes. Episodes are available for listening on BuzzSprout and most popular podcast platforms including Spotify & Stitcher.
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-edm “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.