As the U.S. population ages, the demand grows for long-term care.
An estimated two-thirds of those who reach age 65 will eventually need long-term care, for short stays or ongoing assistance. Collectively, the number of people living in nursing homes or other residential care facilities, or using home care services is expected to nearly double, from 15 million in 2000 to 27 million by 2050.
Nurses are essential to ensuring quality of care and quality of life for older adults in long-term care settings.
To prepare the nursing workforce for our current and future needs, nursing schools often use innovative approaches to engage students with geriatrics course content and practice experiences involving older adults. In doing so, nursing schools challenge the ageism that’s prevalent in our society, as well as perceptions that long-term care is not a desirable work environment.
The results so far suggest that shifting students’ attitudes towards working with older adults is easier than encouraging them to work in long-term care. Still, the lessons learned can strengthen today’s efforts.
Perhaps the most ambitious approach is the teaching nursing home (TNH). More widespread in the 1980s and 1990s, when they were financially supported by the National Institute on Aging and the Robert Wood Johnson Foundation, TNHs bring together nursing homes and schools of nursing, plus medical schools in some cases.
Through multifaceted collaborations, TNHs seek to better prepare students to work with older adults, to foster gerontology and geriatrics research, and to improve outcomes for nursing home residents. Studies have found that TNHs can stabilize or enhance resident outcomes, improve student attitudes towards older adults, strengthen nursing curricula, and increase research relevant to frail elders. Whether TNHs lead more nursing students to work in long-term care is unknown.
A 2005 summit on TNHs encouraged wider use of this model, while noting that an understanding of and accountability to program goals must be shared by the nursing home and nursing school. In the TNH model, nursing home staff benefit from educational opportunities, which promote evidence-based practice and person-centered care. TNHs also facilitate the translation of research into practice, and practice into research.
TNH summit participants concluded that future programs are more likely to be successful and sustainable if they involve multiple nursing homes and academic centers, and engage students and faculty across disciplines. They also recognized technology use as important, identifying the limited access in some nursing homes as a barrier to TNH efforts.
Nursing schools’ more targeted approaches to promote working with older adults and in long-term care have focused on students’ clinical experiences.
The University of Minnesota School of Nursing carefully designs clinical experiences with nursing home sites. To become a clinical site, nursing homes must support evidence-based and person-centered care, have high RN staffing and low nursing staff turnover, and support the clinical learning objectives. Clinical faculty must have geriatric expertise, be familiar with the nursing home environment, and be willing to develop a partnership with the nursing home.
Once this solid foundation has been established, the University of Minnesota model stresses creative teaching strategies. For example, one assignment introduces the concept of resident-directed care by having students interview a resident and develop a care plan for them in the resident’s voice. Students then help carry out the care plan, gaining experience with implementing, evaluating and modifying it.
The Wisconsin Long-Term Care Clinical Scholars Program, developed by the Edgewood College and University of Wisconsin–Madison Schools of Nursing, couples a paid summer internship in a nursing home or assisted living setting with weekly workshops on topics including nursing home systems, medication use in older adults, and nursing leadership in long-term care. Students work at least three shifts per week, with a preceptor. The program also includes training for two nurse preceptors from each facility.
After participating in the program, most students had a more positive view of nursing home care and were more likely to take a job in a nursing home or assisted living facility. Nearly all felt more prepared to work in long-term care settings. Students appreciated the program’s intensive focus. One said, “It was really helpful to go more often than a clinical where you are only there two days a week. I felt like I always had to relearn things in clinical.”
A mutually beneficial relationship between long-term care providers and nursing schools is required for each of these innovative approaches. Improving care and readying the nursing workforce for an aging population are priorities for both. To make progress, nursing schools and long-term care providers must work together to create learning opportunities that challenge students’ negative perceptions of long-term care.
Given the growing need and shared goals, more pioneering partnerships are likely to develop.
–Diane Farsetta