Janice Keefe

• PhD
• Professor (Full) at Mount Saint Vincent University

Background: Among community dwelling older adults, social vulnerability increases with age. Advanced age alone does not fully explain how or why older adults become more socially vulnerable; frailty may offer a better explanation. Objective: We aimed to understand how change in frailty relates to change in social vulnerability over time. Design...

Pandemic-related restrictions in nursing homes have undermined the critical role that family and friend caregivers play in enhancing resident quality of life. Objective We examined how family caregiver access restrictions in nursing homes were implemented and how they impacted the mutual well-being of and relationships between residents and their...

Home care policies, programming, and services in Canada are designed to support older adult clients to age well in their homes and communities. Because the medical model dominates programming and policy decisions about home care services, the delivery of home care services is rarely viewed as relational and intra-active, in which interdependent rel...

Despite efforts to acknowledge diversity among unpaid caregivers, research, advocacy, practice and policy tends to be based in, and to reproduce, normative expectations and assumptions about who provides unpaid care and what this support looks like. The objective of this analysis is to generate unique insights into unpaid caregiving by exploring th...

This study assesses the quality of work life for Nova Scotian continuing care assistants (CCAs) (n = 266), nurses (n = 144) and managers (n = 45) from 10 long-term care (LTC) homes in late 2021. CCAs scored significantly worse than nurses and managers on measures of mental health and anxiety. All groups reported high levels of cynicism and emotiona...

Despite efforts to acknowledge diversity among unpaid caregivers, Canadian research, advocacy, practice, and policy tend to be based in and to reproduce dominant social and institutional expectations and assumptions about who provides unpaid support and why, and what this support looks like. The objective of this analysis is to generate unique insi...

The COVID-19 pandemic exposed long-standing inequities in Canada’s long-term residential care (LTRC) sector with life-threatening consequences. People from marginalized groups are overrepresented among those who live in, and work in LTRC facilities, yet their voices are generally silenced in LTRC research. Concerns about these silenced voices have...

Background Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants...

Background Staff in long‐term care (LTC) homes have long‐standing stressors, such as short staffing and high workloads. These stressors increased during the COVID‐19 pandemic; better resources are needed to help staff manage stress and well‐being. The purpose of this study was to evaluate the effect of a simple stress management strategy (coherent...

The public home care (PHC) system in Canada is heavily reliant on family caregivers to enable clients to stay in the community. When caregivers are present, there are concerns formal home care aide (HCA) services are less available. Using data from the Resident Assessment Instrument for Home Care (RAI-HC), we examined caregiver and client character...

A new paradigm for continuing care policy has emerged that is based on assumptions about the benefits of caring partnerships and client-centred care delivery. Such assumptions place the interface between formal and informal care squarely on the policy agenda. The authors describe how existing research can contribute to the debate stimulated by the...

Older adults who age at home independently are often celebrated as having anticipated and planned for their care needs in the later stages of life, whereas those who receive assistance from home support services are often stigmatised as dependent and characterised as a ‘drain on the system’. However, this thematic analysis of interview data from 12...

More research is needed into how “person-centered care” (PCC) manifests in home care (HC) worker-client relationships. Qualitative data were collected at three time points from twelve HC workers and others to better understand how approaches to care shape the pathways of older adult HC clients with chronic conditions in two Canadian health jurisdic...

Background Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants...

Background: Social vulnerability is the accumulation of disadvantageous social circumstances resulting in susceptibility to adverse health outcomes. Associated with increased mortality, cognitive decline, and disability, social vulnerability has primarily been studied in large population databases rather than frail hospitalized individuals. We exa...

Nursing homes were profoundly affected by the COVID-19 pandemic, influencing work outcomes of care aides who provide the most direct care. We compared care aides' quality of work life by conducting a repeated cross-sectional analysis of data collected in February 2020 and December 2021 from a stratified random sample of urban nursing homes in two C...

The COVID-19 pandemic has taken a devastating toll on long-term care (LTC) residents, families, and staff. In an effort to keep residents safe from COVID-19, public health measures were implemented early in the pandemic to restrict visitation with residents in many countries, with subsequent adjustments made over the course of the pandemic. It is c...

Background In Canada, publicly-funded home care programs enable older adults to remain and be cared for in their home for as long as possible but they often differ in types of services offered, and the way services are delivered. This paper examines whether these differing approaches to care shape the pathway that home care clients will take. Older...

Background The precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents’ quality of life. In deference to the risk mitigation measures in Canadian long-term care settings dur...

Objectives: Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL. Design: Cross-sectional study (July to Decembe...

Background Nursing home (NH) residents’ experiences are embedded within their relationships to others. Our objectives were to describe how residents and care partners (family or staff members) jointly construct, discuss, and act on care priorities. Methods We used Action-Project Method, a qualitative method focused on action within social context....

Background: The precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents’ quality of life. In deference to the risk mitigation measures in Canadian long-term care settings du...

Family caregivers play a vital role in supporting the physical and mental health of long-term care (LTC) residents. Due to LTC visitor restrictions during the COVID-19 pandemic, residents (as well as family caregivers) showed significant adverse health outcomes due to a lack of family presence. To respond to these outcomes, eight implementation sci...

Background and objectives: COVID-19 pandemic visitor restrictions to long-term care facilities have demonstrated that eliminating opportunities for family-resident contact has devastating consequences for residents' quality of life. Our study aimed to understand how public health directives to support family visitations during the pandemic were na...

Objective: To evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada. Design: Repeated cross-sectional survey. Setting and participants: A random sample of nursing homes (n = 35) in urban ar...

Family members are essential contributors to the quality of life (QoL) of persons living in residential long-term care (RLTC). This paper analyzes how the system enables or inhibits family involvement with residents in RLTC. Our analysis of 21 policies that regulate long-term care in four Canadian Provinces reveal differences in their portrayal of...

Background Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on...

The capacities of home care programs to respond to clients’ holistic, everyday needs and changing circumstances can shape trajectories of clients and family caregivers. This analysis examines how such flexibility emerges in relations between home care actors within the constraints of policies, regulations and funding contexts. A relational lens bro...

Background Social vulnerability occurs when individuals have been relatively disadvantaged by the social determinants of health. Complex interventions that reduce social vulnerability have the potential to improve health in older adults but robust evidence is lacking. Objective To identify, appraise and synthesize evidence on the effectiveness of...

Improving Nursing Home Care Through Feedback On perfoRMance Data (INFORM) was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015–2016, we successfully implemented two theory-based feedback strategies (compared to a standard approach to feedback) to increase nursing home (NH) care aides’ involvement in formal communicatio...

Policies favouring safety, security, and order are expressed in preference to those oriented towards person-centred resident quality of life in Canadian long-term care settings. Factors impacting the expression of these latent (under-utilised) rules were uncovered through an analysis of long-term care related policies in four provinces. 84 policies...

Family members are essential contributors to Q0L of LTC residents. This paper analyzes how the system views family’s role in residents’ QoL and enables or inhibits family involvement. Our analysis of 21 policies that regulate LTC in four Canadian Provinces reveal differences in their portrayal of residents’ families. In many policies, family roles...

Long-term care (LTC) is highly regulated and often the policy language is complex and in tension with residents’ quality of life goals. Prior to COVID-19, LTC policy levers prioritized safety over other quality domains such as privacy, dignity, spirituality, and comfort. During the pandemic, this focus on safety regulations, while important, intens...

Context: In one’s final years, quality of life (QoL) is a fundamental desire. In Canada, a publicly-funded long-term care (LTC) system is governed provincially through multiple policies about housing and care provision. A pan-Canadian research team investigated federal and provincial policies’ influence on the QoL of older people living in resident...

Background: The Translating Research in Elder Care (TREC) program is a partnered health services research team that aims to improve the quality of care and quality of life for residents and quality of worklife for staff in nursing homes. This team includes academic researchers, trainees, research staff, citizens (persons living with dementia and f...

Publicly funded home care in Canada supports older adults in the community to delay institutional care, which results in complex care populations with multimorbidity that includes mental health problems. The purpose of this study is to examine prevalence of psychiatric diagnoses and other mental health symptoms among older clients in two publicly f...

Background Numerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors...

Research has shown that long-term care (LTC) volunteers play important roles in enhancing the quality of life (QoL) of older LTC residents, often through providing unique forms of relational care. Guided by Kane’s QoL domains, we used a modified objective hermeneutics method to analyze how unique volunteer roles are represented and supported in pro...

Background Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to ‘age in place’ in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Num...

Background and Objectives Amidst a complex policy landscape, long-term residential care (LTRC) staff must navigate directives to provide safe care while also considering resident-preferred quality of life (QoL) supports, which are sometimes at odds with policy expectations. These tensions are often examined using a deficit-based approach to policy...

The action-project method (APM), developed in counselling psychology and used in various disciplines, has been shown to be useful for understanding major life transitions in different contexts. We argue that the APM is beneficial for studying the impact of nursing home (NH) home admission and daily life of residents and their families/friends. The...

The aim of the “Trajectories” project is to compile measures of nursing home (NH) quality to better characterize the final year of life for residents. In the first phase, we worked with various stakeholder groups to identify their priorities to focus the selection of possible outcomes relevant to end-of-life needs. Policy- and decision-makers from...

This presentation shares the methodology and early findings from a policy scan conducted to understand and assess the impact of COVID-19 policies on dementia care in the community for diverse populations in the province of Nova Scotia, Canada. The scan provided baseline information on: 1) Provincial legislative and regulatory policies related to de...

Background: Long-term care facilities offer shelter and care for Canadian seniors; however, there are great variances in the quality of care that is provided to older adults across facilities. One factor that could contribute to this variation in quality is the diffusion and implementation of advice and innovations within this sector. This study s...

The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to infor...

Background: Enhancing non-clinical home care supports and services for older adults to live well is a strategic priority in developed countries, including Canada. Underpinning these supports and services are structures of care that are reflected in home care policies, programs and practices within jurisdictions. These approaches to care exist at m...

This article examines provincial policy influence on long-term care (LTC) professionals’ advice-seeking networks in Canada’s Maritime provinces. The effects of facility ownership, geography, and region-specific political landscapes on LTC best-practice dissemination are examined. We used sociometric statistics and network sociograms, calculated fro...

Background: The Translating Research in Elder Care (TREC) program is a longitudinal partnered program of research in Western Canada that aims to improve the quality of care and quality of life for residents and quality of worklife for staff in long-term care settings. This program of research includes researchers, citizens (persons living with dem...

Background: Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of interventions are rare. This is a protocol for the Sustainment, Sustainability and Spread Study (SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment (sustaine...

Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making...

Background The number of people living with dementia (PWD) is increasing worldwide, corresponding with an increasing number of caregivers for PWD. This study aims to identify and describe the literature surrounding the needs of caregivers of PWD and the solutions identified to meet these needs. Method A literature search was performed in: PsycInfo...

Background Interpersonal relationships among professionals drive both the adoption and rejection of consequential innovations. Through relationships, decision-makers learn which colleagues are choosing to adopt innovations, and why. The purpose of our study was to understand how and why long-term care (LTC) leaders in a pan-Canadian interpersonal n...

Canada has one of the most policy-dense long-term care (LTC) systems in the world. These policies intend to frame best quality of care practices for people living in care. Unfortunately, the high volume of and gaps within policies create ambiguity for care providers in how to enact sometimes contradictory policy in keeping with the quality of end o...

“All behaviour has meaning” is one of the central tenants of dementia care research and education. Yet, the question, “What is behaviour?” is often left unasked within dementia care research, education, practice and policy. Drawing from perspectives in cultural gerontology, interpretive sociology and critical disability studies, this presentation t...

BACKGROUND More than 15 million Americans provide unpaid care for persons with Alzheimer’s disease or other related dementias (ADRD). While there is good evidence to suggest that caregivers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group-formats. Alternatively, offering eHealth inter...

Background: More than 15 million Americans provide unpaid care for persons with Alzheimer disease or other related dementias (ADRD). While there is good evidence to suggest that caregivers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group format. Alternatively, offering electronic heal...

Frailty has many social and societal implications. Social circumstances are key both as contributors to frail older adults' health outcomes and as practical facilitators or barriers to intervention and supports. Frailty also has important societal implications for health systems and social care policy. In this discussion paper, we use a social ecol...

This article is based on a study that used a validated care-giver assessment instrument known as ‘The C.A.R.E. (Caregivers’ Aspirations, Realities, and Expectations) Tool’ to understand its usefulness in working with older adults caring for a spouse with cognitive impairment. It draws on data collected as part of a larger, quasi-experimental pre- a...

L’une des conséquences du vieillissement démographique est le ralentissement de la croissance du nombre des actifs sur le marché du travail, voire même une décroissance. Il apparaît dès lors tout indiqué d’adopter des politiques qui inciteraient les travailleurs à repousser le moment de leur retraite, d’autant plus que l’espérance de vie ne cesse d...

This chapter uses a disability studies perspective to deconstruct the relationship between personhood and domestication, as this relationship has been made to appear in interviews with older adults residing in a nursing home in Canada. Our analysis illustrates how assumptions about dementia shape the self-perceptions, experiences of home, and meani...

Purpose The purpose of this paper is to explore the concept of homelikeness from the perspective of family members and friends of nursing home residents across different models of nursing homes. Design/methodology/approach This mixed-methods study examined survey data collected from 397 family members and friends of residents living in 23 nursin...

Identifying how to enhance the quality of life for older adults living in nursing homes can contribute to transforming health care institutions into person-centered homes, an approach to care that places residents’ relationships, life experiences, abilities, preferences and dignity at the forefront. One component of a federally-funded study of 23 n...

The Advice Seeking Networks in Long Term Care Study used social network analysis to understand the informal advice networks of senior leaders in Canadian long term care (LTC), with the goal of using this knowledge to inform future efforts to more effectively disseminate quality improvement innovations. In this abstract we describe one main componen...

Canada has one of the most regulated policy-laden long-term care (LTC) systems in the world. While there is noble intent, the high volume of policies creates ambiguity for knowledge users on how to provide quality end of life care for residents. More importantly, the desires of residents and/or their families for quality of life often get lost in t...

The Advice Seeking Networks in Long Term Care Study used social network analysis to understand the informal advice networks of senior leaders in Canadian long term care (LTC), with the goal of using this knowledge to inform future efforts to more effectively disseminate quality improvement innovations. In this abstract we describe one main componen...

The Advice Seeking Networks in Long Term Care Study used social network analysis to understand the informal advice networks of senior leaders in Canadian long term care (LTC), with the goal of using this knowledge to inform future efforts to more effectively disseminate quality improvement innovations. In this abstract we describe one main componen...

Background: A number of long-term care homes in Nova Scotia, Canada, have been built or redesigned with new models of care with expanded care aide scope of practice and neighborhood-style layouts. Our objective was to examine what physical characteristics (bed size, owner-operator), model of care, and relational (family–staff relationship, perceive...

In 2006, Nova Scotia began to implement its Continuing Care Strategy which was grounded in a vision of providing client-centered care for continuing care clients, including residents of nursing homes. Considerable evidence pointed to the benefits of the “household” model of care—which led the province to adopt the smaller self-contained household m...

Background Initiatives to accelerate the adoption and implementation of evidence-based practices benefit from an association with influential individuals and organizations. When opinion leaders advocate or adopt a best practice, others adopt too, resulting in diffusion. We sought to identify existing influence throughout Canada’s long-term care sec...

RÉSUMÉ Cette étude, utilisant des méthodes mixtes, a permis de déterminer les caractéristiques personnelles et professionnelles qui déterminent la satisfaction au travail des travailleurs de soutien à domicile (TSD) qui offrent de l’aide aux personnes âgées. Les données étaient fondées sur une mesure normalisée de la satisfaction au travail ainsi q...

Background: Missing values are commonly encountered on the Mini Mental State Examination (MMSE), particularly when administered to frail older people. This presents challenges for MMSE scoring in research settings. We sought to describe missingness in MMSEs administered in Long Term Care Facilities (LTCF), and to compare and contrast approaches to...

In light of the global, unprecedented and enduring phenomenon of population ageing, cities and communities across the world have committed themselves to establishing and implementing age friendly community designs, programs, services and practices. In Canada, there has been a particular interest in promoting ‘age friendliness’ in rural and remote c...

It's time to take the needs of caregivers seriously; doing so will benefit both those providing and receiving care. This is the thrust of the argument by Williams et al. and we couldn't agree more. Our commentary offers elaboration on the sixth and final assumption - that caregivers' needs should be considered apart from cared-for persons and forma...

Workshop presented at the 76th Annual Canadian Psychological Association Convention, Ottawa, ON, June 4-6, 2015. Researchers are often faced with the problem of missing data. To deal with this problem they commonly use ad hoc methods, such as listwise deletion or mean imputation, that have been shown to reduce power and produce biased estimates. Mu...

Coastal climate change is challenging communities to adapt. More frequent and extreme weather events leading to coastal area flooding and other hazards can present a risk for residents and the infrastructure and services they rely on. This is particularly the case for vulnerable populations such as seniors. Nova Scotia is experiencing this confluen...

Coastal climate change in the form of rising sea levels and more frequent and extreme weather events can threaten community assets, residences, and infrastructure. This presents a particular concern for vulnerable residents - such as seniors aged 75 years and older. Our spatial study combines census area cohort population model projections, communi...

This study explores the factor structure of the interRAI self-report nursing home quality of life survey and develops a measure that will allow researchers to compare predictors of quality of life (QOL) across resident, family, and staff perspectives. Nursing home residents (N = 319), family members (N = 397), and staff (N = 862) were surveyed abou...

The purpose of this sequential, two-phase mixed-methods study was to examine the health of male and female nurses who provided care to older relatives (i.e., double duty caregivers). We explored the experiences of 32 double duty caregivers, which led to the development of an emergent grounded theory, Negotiating Professional-Familial Care Boundarie...

Background Numerous social factors, generally studied in isolation, have been associated with older adults’ health. Even so, older people’s social circumstances are complex and an approach which embraces this complexity is desirable. Here we investigate many social factors in relation to one another and to survival among older adults using a social...

An emergent grounded theory was used to examine Professionalizing Familial Care, the processes by which registered nurses enact professional care work within the familial care domain. A sample of registered nurses (n = 32) were interviewed by telephone at multiple time points over a 6- to 12-month period. The findings revealed that the professional...

As the first of the Boomers reach age 65 in 2011, it is of great interest to identify trends in disability to better predict future needs and resources within community care. This paper uses data from four national datasets to investigate trends in disability rates and examine socio-demographic characteristics associated with disability. Results sh...

Having a greater understanding of what influences the older adults decisions to move and the characteristics of older adults who are more likely to move is valuable to help plan for the housing needs of the expanding older adult population. The authors examined how contextual, push and pull factors influence preferences of older adults to relocate....

In this article current knowledge on changes in nursing home approach to care (i.e., staffing models) and physical design were reviewed with a view to the impact of change on residents and their families. A comprehensive search of English- language, peer-reviewed and gray literature concerning nursing home care published during the period of 1989 t...

The evolution of family networks of older men and women in Canada is projected for the coming decades. By disaggregating help coming from informal sources, in certain family networks, the contribution of adult children is equal to that of a spouse. Given the reduced availability of adult children in future decades, the implications for the future d...

This article examines the influence that intrinsic and extrinsic job values have on the turnover intention of continuing care assistants (CCAs) who work either in home care or facility-based care in Nova Scotia (n = 188). Factor analysis of job values identified three latent job values structures: "compensation and commitment," "flexibility and opp...

Using the concept of retirement congruency (RC), which takes into account greater variation in retirement decisions (low, moderate, or high RC) than a dichotomous conceptualization (forced versus chosen), multinomial logistic regression was conducted on a sample of caregivers from the 2002 Canadian General Social Survey who were retired from employ...

This paper is a synthesis of research on recruitment and retention challenges for home support workers (HSWs) in Canada. Participants: Home support workers (HSWs) provide needed support with personal care and daily activities to older persons living in the community. Literature (peer reviewed, government, and non-government documents) published in...

Home care is considered an essential pillar of the health care systems in many industrialized countries. With an increased demand for home health workers, there has been growing interest in examining recruitment and retention of these workers. With a focus on recruitment of home support workers, in this study we draw on data from interviews with 57...

RÉSUMÉ L’ensemble des sociétés occidentales connaissent actuellement une croissance considérable des personnes âgées de 75 ans et plus. De nombreux changements familiaux affectant ces sociétés, il est pertinent de se demander qui prendra en charge les aînés de demain en cas de besoin d’assistance. Cet article compare les projections démographiques...

In order to gain an understanding of double duty caregiving (DDC), defined here as the provision of care to elderly relatives by practising health professionals, a DDC scale has been developed. This study tests the psychometric properties of the scale. Survey data were collected from a random sample of 187 female registered nurses who were employed...

In order to gain an understanding of double duty caregiving (DDC), defined here as the provision of care to elderly relatives by practising health professionals, a DDC scale has been developed. This study tests the psychometric properties of the scale. Survey data were collected from a random sample of 187 female registered nurses who were employed...

Résumé À l’aide de résultats issus du modèle de microsimulation LifePaths, développé par Statistique Canada, nous estimons l’évolution de la situation matrimoniale et de la proportion d’individus sans enfant survivant des futures personnes âgées selon l’âge et le sexe pour le Canada en 2001 et 2031. Ces projections permettent de montrer comment l’é...