Background Adult day programs (ADPs) are a community-based continuing care service for older adults, including those living with dementia, and their family or friend caregivers. Evidence regarding the effect of ADPs on long-term care (LTC) home admission is inconsistent. Objectives To develop a realist program theory explaining how and why APDs influence LTC home admission for people living with dementia. Methods We searched CINAHL, EBM Reviews, JBI EBP Database, Embase, Medline, APA PsycInfo, and Social Work Abstracts (inception to January 6, 2026), and screened reference lists of relevant reviews and included studies. We included original studies of any design that reported details on contexts and mechanisms explaining how and why ADPs influence LTC home admissions for people living with dementia. We excluded studies not reporting results specific to persons living with dementia or focusing on settings other than ADPs. Pairs of research team members independently screened titles, abstracts, and full texts, completed a critical appraisal of included studies’ methodological quality, and extracted Context-Mechanism-Outcome (CMO) statements. Discrepancies were reconciled by consensus after each step. Results We included 17 studies, of which we extracted eight CMO statements. Six CMO statements were synthesized into a program theory. ADPs delay LTC home admission through relational processes involving attendees, caregivers, and ADP staff. Key mechanisms include staff observation and early identification of changing care needs, effective communication with caregivers, caregiver respite and support, and high-quality care. APDs that actively integrate and support caregivers, provide person-centered care, promote attendance, and are accessed early strengthen caregivers’ capacity to continue supporting persons living with dementia. Conclusions To reduce the risk of LTC admissions for individuals living with dementia, ADPs and ADP policies need ensure structures and processes that facilitate early, continued, and sufficient access, as well as high quality support of individuals living with dementia and their caregivers. Contexts and mechanisms associated with attendees’ and caregivers’ social determinants of health, and system-level contexts and mechanisms that influence ADPs are important knowledge gaps to be addressed by studies and to be incorporated in our program theory in the future. Registration PROSPERO, CRD42024504030

OBJECTIVES:There are high rates of turnover documented among frontline care work staff in long-term residential care (LTC). Turnover has been associated with negative organizational outcomes. This study examined turnover contemplation among LTC workers in several Canadian provinces. DESIGN:A questionnaire including closed- and open-ended questions was sent out to Canadian LTC workers. Workers received a hard copy of the survey through mail and were able to send the hard copy back or complete the survey online. SETTING AND PARTICIPANTS:Canadian LTC workers (N = 347) were surveyed about their work using open- and closed-ended questions. This included demographic information and variables related to working conditions, interactions with supervisors and colleagues, and resident care. METHODS:Data were analyzed in IBM SPSS Statistics. Descriptive statistics and a binary logistic regression were performed using turnover contemplation as the outcome variable. RESULTS:Among Canadian LTC workers, contemplating leaving their current position is significantly and positively associated with lower support from immediate supervisors, working in a non-government-owned facility, and having less autonomy to perform more social care tasks. CONCLUSIONS AND IMPLICATIONS:LTC facilities, and systems more broadly, could improve worker retention rates by improving supervisory support and allowing workers to spend more time meaningfully interacting with patients.

Persons with dementia, their family/friend caregivers, and health systems agree that the preferred place of dementia care is a person’s home. Health systems have struggled to provide sufficient community-based dementia care supports, negatively affecting the health and well-being of persons with dementia and their caregivers. Therefore, dementia care and support of dementia caregivers are critical public health priorities. Adult day programs aim to simultaneously support the health and well-being of persons with dementia and their caregivers, but research focusing on these day program outcomes is lacking. The primary objective of this study was to compare various outcomes of day program attendees with dementia and their caregivers over time to outcomes of non-attendees with dementia in the community (with care needs similar to those of attendees) and their caregivers. In each of four Canadian health regions (York Region, Ontario; Interior Health, British Columbia; Calgary, Alberta; Winnipeg, Manitoba), this study will recruit 250 day program attendees with dementia and their caregivers, and 500 community-based non-attendees with dementia and their caregivers. Applying criteria used by the health system to determine day program eligibility, we will identify non-attendees with care needs similar to those of attendees. We will combine participants’ longitudinal health administrative data with repeated (baseline, 1-year, and 2-year follow-up) surveys to include variables not routinely collected by healthcare systems. Primary study outcomes are quality of life of the person with dementia and their caregiver. Secondary study outcomes include mental health (older adults, caregivers), cognitive and physical decline (older adults), time to admission to congregate care (older adults), and emergency room, hospital, and primary care use (older adults, caregivers). Using a day program survey, we will also assess day program characteristics. Using covariate-adjusted general estimating equations and time-to-event models, we will compare these outcomes between groups of day program exposure (no, low, medium, high). Persons living with dementia, their caregivers, and health systems urgently need solutions to support living at home with a good quality of life. This study will generate provide evidence on the potential of day programs to address these critical public healt needs. ClinicalTrials.gov: NCT06496945.

BackgroundAdult day programs provide critical supports to older adults and their family or friend caregivers. High-quality care in the community for as long as possible and minimizing facility-based continuing care are key priorities of older adults, their caregivers, and health care systems. While most older adults in need of care live in the community, about 10% of newly admitted care home residents have relatively low care needs that could be met in the community with the right supports. However, research on the effects of day programs is inconsistent. The methodological quality of studies is poor, and we especially lack robust, longitudinal research. ObjectiveOur research objectives are to (1) compare patterns of day program use (including nonuse) by province (Alberta, British Columbia, and Manitoba) and time; (2) compare characteristics of older adults by day program use pattern (including nonuse), province, and time; and (3) assess effects of day programs on attendees, compared with a propensity score–matched cohort of older nonattendees in the community. MethodsIn this population-based retrospective cohort study, we will use clinical and health administrative data of older adults (65+ years of age) who received publicly funded continuing care in the community in the Canadian provinces of Alberta, British Columbia, and Manitoba between January 1, 2012, and December 31, 2024. We will compare patterns of day program use between provinces and assess changes over time. We will then compare characteristics of older adults (eg, age, sex, physical or cognitive disability, area-based deprivation indices, and caregiver availability or distress) by pattern of day program use or nonuse, province, and time. Finally, we will create a propensity score–matched comparison group of older adults in the community, who have not attended a day program. Using time-to-event models and general estimating equations, we will assess whether day program attendees compared with nonattendees enter care homes later; use emergency, acute, or primary care less frequently; experience less cognitive and physical decline; and have better mental health. ResultsThis will be a 3-year study (July 1, 2024, to June 30, 2027). We received ethics approvals from the relevant ethics boards. Starting on July 1, 2024, we will work with the 3 provincial health systems on data access and linkage, and we expect data analyses to start in early 2025. ConclusionsThis study will generate robust Canadian evidence on the question whether day programs have positive, negative, or no effects on various older adult and caregiver outcomes. This will be a prerequisite to improving the quality of care provided to older adults in day programs, ultimately improving the quality of life of older adults and their caregivers. Trial RegistrationClinicalTrials.gov NCT06440447; https://clinicaltrials.gov/study/NCT06440447 International Registered Report Identifier (IRRID)PRR1-10.2196/60896

This chapter reflects on the conceptual implications of Canadian feminist political economy for the study of health and healthcare. The analysis is organized as follows. The first section articulates Canadian political economy as a particular stream of political economy. The next section focuses on the distinctive path of Canadian feminist political economy and outlines some of its key intellectual insights. The chapter then turns to address some of the distinctive repercussions of this current for comprehending healthcare, and how it fills gaps in the existing literature on the topic. By doing so, I argue that health and care work is a rich empirical space within which to further refine and expand research in feminist political economy. The final section concludes by summarizing the primary points arising from the chapter.

Drawing on recent case-study data, this article explores innovative practices around harm reduction and housing for older people who use drugs. Although right-wing groups call for further criminalisation of drug use, in light of extraordinarily high levels of deaths from opioid overdose in Vancouver, Canada, the provincial government has quietly permitted the development of safe supply, the testing of illegal drugs to avoid poisonings and the provision of low-barrier, inclusive and supportive social housing, including housing specifically for older people. Drawing on crisis theory, the article analyses the provision of low-barrier harm reduction services for this marginalised and highly vulnerable group of older people and reflects on what we can learn about providing supports that are needs based and strengths based and embody meeting people where they are.

This article compares community services provided to older adults living in Bergen, Norway, and Toronto, Canada. We investigate the gaps that are left unattended in the respective jurisdictions and consequently maintained by the organizations. Our findings reveal the importance of community organizations in positively influencing the initial transition from independence to needing more supports. Our findings show differences between the jurisdictions in the experiences of care gaps for diverse groups of providers and clients, while the overall importance of community organizations for older adults is shared in both jurisdictions, particularly by filling gaps between the formal and informal care systems.

Dominant narratives about late life promote active aging, while anti-aging ones mobilize tropes of decline and irrelevance. In contrast, counter-narratives raise questions that spark new conversations about the promising practices that could foster more age-friendly cities. In this article, we describe our feminist and ethnographic approach to interviews and digital storytelling that aim to amplify the voices of marginalized older adults living with disability, violence, and colonialism, and share findings from this endeavor. We discuss the interviews with, and stories shared, by two disabled older adults - an Indigenous woman and a white paraplegic man - and the aging futures their counter-stories suggest. These stories reveal these participants' ongoing struggles to create meaning in their lives, and how their relationships to the physical, cultural, and social environment of the city, including its supports and services, can both support and hinder this becoming.

Since the pandemic, field work has been transformed by shifts in the political economy affecting the material conditions underpinning research. In this research note, a research team considers their challenges and learning in completing field studies conducted in 2022, including intensified strains on time, money, researchers’ bodies, and risks associated with illness and infection spread. We argue that a neoliberal “research super-hero” norm operates within the research community, rooted in a conception of high productivity that mingles uneasily, for many researchers, with feminist, anti-racist, and anti-colonial social justice aims and responsibilities. Our 2022 fieldwork experience led us to notice how this norm has circulated within our explicitly feminist research team and nudged us to challenge it, while raising questions about how a “research-worker” norm can best be supported.

Exploring long-term residential care (Ontario, Canada), we argue that within the context of late neoliberalism, care time is political, contested, and multi-scalar. Multi-scalar time captures the way that time commodifies, disciplines, and delimits workers' experience of care, and fractures human relations and solidarities. Drawing on data from nonprofit nursing homes in Canada, the article explores how the larger policy context of care work shapes and hinders workers' abilities to spend time caring and building relationships with residents, how workers negotiate care provision in austere environments, and how workers use borrowed time to de-commodify care and find spaces for solidarity.