**About the Editors**

#### **Reena Devi**

Reena Devi is a Senior Research Fellow working in care home related research at the University of Leeds. Reena works as a Linking Pin researcher in a partnership between care provider organisations and academia called Nurturing Innovation in Care Home Excellence in Leeds (NICHE-Leeds). The purpose of NICHE Leeds is to enhance the experience of older people living in care homes, their families and the staff who work in care homes (follow NICHE-Leeds here - @LeedsNiche). Reena's research interests are focused around improvement and implementation science in the care home setting, and supporting the care home workforce. She is currently leading a research project focusing on improving understanding around how to attract, recruit and retain care home staff (follow the study here - @REACH review).

Twitter: @ DrReenaDevi Email: R.Devi@Leeds.ac.uk Webpage: https://medicinehealth.leeds.ac.uk/healthcare/staff/1537/dr-reena-devi-

#### **Tom Dening**

Tom Dening MA MD FRCPsych, is Professor of Dementia Research, University of Nottingham; and Honorary Consultant in Old Age Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust.

Appointed to his current post in 2012, he leads the Centre for Dementia at the Institute of Mental Health. He is the deputy director for Mental Health & Clinical Neurosciences in the School of Medicine, and the clinical speciality lead for Dementia in the East Midlands Clinical Research Network.

His interests include a wide range of clinical topics and psychosocial aspects of dementia. He is one of the editors of the Oxford Textbook of Old Age Psychiatry, the leading international work in this field, third edition published in 2021.

Email: tom.dening@nottingham.ac.uk

Twitter: @TomDening

Webpage: https://www.nottingham.ac.uk/medicine/people/tom.dening

#### **Adam Gordon**

Adam Gordon is Professor of Care of Older People at the University of Nottingham, UK. He is a practising geriatrician and President Elect of the British Geriatrics Society. He has been conducting research in long-term care homes for over a decade, with his work comprising a mixture of health services research, randomised controlled trials and implementation studies. He has also developed an extensive track-record of collaborative improvement work with the care home sector, including benchmarking work using the International Prevalence Measure of Care Quality (Landel Prevlentiemetung Zorgkwalitiet; LPZ), and co-leads the LOTUS consortium for Improving Long-term Care Institutions in Brazil and Europe through Collaboration and Research.

### *Editorial* **Enhancing the Quality of Care in Long-Term Care Settings**

**Reena Devi 1,2,\*, Adam Gordon 3,4 and Tom Dening <sup>3</sup>**


The quality of care in long-term care settings is a concern felt across the world given the growing number of dependent older people [1]; a population whose health and care needs are increasing over time [2]. This Special Issue set out to attract research focused around enhancing the quality of care in this setting. Since 2019, we have received articles at a regular pace and this Special Issue offers a collection of 22 manuscripts focused on a wide variety of topics. This Special Issue will now close, and in this closing editorial we summarise the content and share our thoughts on future research in this area.

Research included took place around the world (UK, Australia, Taiwan, The Netherlands, Belgium, Korea, USA, Spain, Brazil, Germany, and Italy), used a range of methods, and examined quality of care from different angles. Five papers focused on workforce, adding important evidence around supporting staff with training [3], the influences on job competency, satisfaction, and intention to stay in work [4,5], staff burnout [6], and the relationship between staff and organisation with quality of care [7]. Evidence aimed at teams who work with the sector to improve quality of care was also included. One paper presented a tool containing questions designed to help initiate conversations between innovators and care home staff [8], and another paper outlined essential learning directed at teams applying a Quality Improvement Collaborative tool in this context [9]. This Special Issue also comprises intervention studies, with interventions aimed at addressing depressive symptoms in nursing home residents [10,11], adjustment for new residents [12], social and psychological support [13], and loneliness and isolation [14]. Other studies present evidence which developed and tested quality indicators [15,16], and tools which capture the experience of quality from a resident's perspective [17,18], and assess partnership working between staff and families [19]. We also included studies that investigated factors associated with older people's experiences, such as the association between length of stay and end of life care [20], dry eyes or ocular lubricants with medication use, dementia, frailty and dry eyes [21], resident characteristics and their palliative care service use and comfort in the last week of life [22] and causes of infection-related hospitalizations [23]. Finally, the issue also includes a systematic review describing the current evidence base of care home research conducted in Brazil [24].

The articles published in this Special Issue on enhancing care in long term care offer an array of insights, contributions and perspectives from different angles. This highlights that enhancing quality is a complex issue, one that requires relevant stakeholders to take into consideration different types of knowledge. For example, there is a need to understand causes and associations of poor and good quality, the needs of the workforce, effective interventions that have undergone robust testing, and tools which can help to effectively guide implementing evidence into practice and measure the effectiveness of change. As editors of this Special Issue, we would have liked to see more evidence uncovering how to stimulate and sustain change in care home practice. From our experience of working in this

**Citation:** Devi, R.; Gordon, A.; Dening, T. Enhancing the Quality of Care in Long-Term Care Settings. *Int. J. Environ. Res. Public Health* **2022**, *19*, 1409. https://doi.org/10.3390/ ijerph19031409

Received: 21 January 2022 Accepted: 24 January 2022 Published: 27 January 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

area, care homes within their day to day "business as usual" activities have made progress with initiating changes. This activity though is rarely captured in the academic literature. We suggest that future researchers bring to the centre stage evidence around the specific processes and organisational structures that help care homes to successfully initiate and sustain improved outcomes in this setting.

We are pleased to offer interesting papers from across the world in this important field and bring them together in this way. The regular pace at which we received submissions to this Special Issue indicates significant interest and relevance of the issue. We hope that readers will both enjoy and use these findings in their own research and practice.

**Author Contributions:** All authors played a key role in editing this special issue. R.D. wrote a first draft of this closing editorial, and T.D. and A.G. reviewed and edited the editorial. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding. Reena Devi is a Linking Pin researcher part funded by Nurturing Innovation in Care Home Excellence in Leeds (NICHE-Leeds) initiative (https://niche.leeds.ac.uk/). A.G. is funded in part by the NIHR Applied Research Collaboration-East Midlands (ARC-EM). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

