PWO SG GZHZ Efficacy of the TIMES route

The complexity of caring for residents in residential care centres (RCCs) is increasing. Whereas previously it was mainly residents with physical vulnerabilities and reduced mobility, we now see more residents with complex medical conditions, cognitive problems and psychiatric vulnerabilities. This challenges care providers in dealing with behavioural and mood changes such as aggression, anxiety and depression (Helvik et al., 2018; Gillis et al., 2023). To this end, it is important to have competent care providers who invest sufficient time in holistic care (Lund et al., 2024). Care providers in residential care centres find their work very meaningful, have high standards for the care they provide and also want to offer person-centred care. Current working conditions – with more complex care needs and a shortage of care providers – and a culture in which residents' basic needs are ignored lead to conflict between their standards and the care they actually provide (Lund et al., 2024). To cope with this, they prefer efficient care that focuses on routine physical care and performing tasks quickly and efficiently.This approach alleviates feelings of moral stress because they can achieve this, which is satisfying. Emotional distancing is another well-known coping strategy for care providers when they find themselves in morally stressful situations and is one of the causes of neglect in the care of residents in residential care centres. There is increasing evidence that the basic needs of residents in residential care centres are regularly ignored. This applies not only to basic physical care such as oral care, but also to dealing with residents who display challenging or aggressive behaviour and with residents who need social contact (Lund et al., 2024). A lack of social contact and a lack of connection reinforce feelings of loneliness among residents, which in itself can lead to depression (Afrashteh et al., 2024). Emotional distancing may be a short-term coping strategy, but in the long term it leads to feelings of guilt and emotional and physical stress, resulting in increased absenteeism and turnover. Lund and colleagues (2024) describe how residential elderly care has consequently entered a negative spiral in which the focus is increasingly on a care provider-oriented culture rather than a resident-oriented culture. And even though this culture stems from a survival strategy for care providers and a coping mechanism in dealing with stress, neither residents nor staff benefit from it. This research proposal focuses on breaking this negative spiral and aims to restore balance in the care provided to residents and staff.

The “missed care” model developed by Kalisch et al. (2009) describes three major elements that influence the quality of care and quality of life in residential care homes: the working environment, the quality of clinical decision-making, and the beliefs of care providers. This study focuses on the beliefs of care providers. Their choices to perform, postpone or not perform elements of care for residents are influenced by four factors: team norms, the priorities they set, their personal values and beliefs, and their habits and routines. Each team has a set of standards regarding acceptable behaviour among team members. These standards are implicit and are relatively quickly accepted by new team members. Care providers do not make decisions solely on an individual basis, but also within the social system to which they belong. Over the past year, with the support of the Alzheimer's Research Foundation, we set out to identify these standards, the priorities set by care providers in residential care homes, their habits and their routines. We sought inspiration from teams that do succeed in working together to offer more attention and time for emotional support to residents with dementia. This forms the basis for the development of a box with themes (the TIMES route) that we want to use in teams to encourage them to look at time and their choices in a different way. We want to bring their unconscious processes to a conscious level. Examples of themes are: How can you provide emotional support? From problem to opportunity, Reflecting on priorities we set as a team and as individuals, when do we call in specialist help? A first version of the TIMES route will be developed in terms of content and graphics by September 2025, when the funding from the Alzheimer's Research Foundation expires.

Because it is important that new and scientifically based tools also find their way into practice effectively, we want to use this research to test the applicability or efficacy of the TIMES route in practice in four teams.

The results of this research will provide the necessary information to adapt the TIMES route where necessary and to use it in a more targeted manner, thereby increasing the chance of effectively influencing norms, priorities and habits.The main research question is: What are the essential conditions for implementing the TIMES route, and what substantive and practical adjustments to the TIMES route are desirable in order to increase the likelihood of behavioural change (more attention and time for emotional support) among healthcare providers?