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

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

FAll issue Canadian Nursing Home covershow 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.

SALTY podcast mini series graphic

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.



Study activities
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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.

Project Milestones

2020

• November – SALTY Trainee podcast “Let’s Talk Care” launched. · 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 – 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

  • OctSALTY-Photo_CAG_Strm4_wrkshp_2019-10-25_1016_croppedober – 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.

    SALTY-Photo_CAG_Strm2_AubrechtK_1344136_cropped
  • 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.




  • SALTY-Photo_CHPC_2019-09-21_RolandK_cropped (002)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.



  • SALTY-Photo_OLTCA_2019-09-18_oltca203_HobenM (002)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.




  • JunSALTY presentation at Northwoode – Featured panel presentation at the Northwood Research Symposium on the cross stream emerging evidence to support quality of life in long term careby 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 SALTY oral presentation Trent Universitylives 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
  • DSC_1483May – 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
    videoconference






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
    Matthias Hoben

 

  • 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

 

  • DSC_0646August – 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
  • CHASPER conferenceMay – panel presentation by stream leads at Canadian Association of Health Services and Policy Research Conference, Montreal





  • SALTY 5April – 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

  • SALTY 4November – 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.


  • SALTY 3July – 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.

    SALTY 2

    • 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”.
  • SALTY teamSeptember – 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