Association of long-term care organizational context, facilitation, and their interactions with resident pain: a cross-sectional study

Background We examined whether organizational context (work environment), facilitation (support for evidence-based practices), and their interaction are associated with pain among long-term care (LTC) home residents. Methods This cross-sectional study analyzed data from 8,313 residents (≥65 years) on 281 units in 86 LTC homes across three Canadian provinces, using covariate adjusted generalized linear mixed models. Resident pain (≥moderate intensity in the past week) was measured using the Resident Assessment Instrument–Minimum Data Set 2.0. Unit surveys assessed organizational context, using the Alberta Context Tool, care hours per resident day, and staffing mix. Availability of geriatric services reflected facility-level facilitation. Unit managers’ organizational citizenship behavior (OCB) and care aides suggesting improvement reflected unit-level facilitation. Results Pain prevalence was 11% (n=921). More care aides suggesting improvements was linked to less resident pain (odds ratio [OR]=0.573, 95% confidence interval [CI]: 0.345-0.951, p=0.0312). In units with lower social capital scores, higher manager OCB was associated with reduced pain, but not in units with higher social capital scores (OR=4.245, 95% CI: 1.209-14.905, p=0.0240). Additionally, in units with lower informal interaction scores, more care hours per resident day were associated with lower odds of pain, with this effect being stronger than in units with higher informal interaction scores (OR=1.428, 95% CI: 1.057-1.929, p=0.0202). Conclusions Encouraging care aides to suggest improvements may help reduce resident pain. Tailored interventions, such as boosting manager OCB in units with low social capital and increasing care hours where informal interaction is low, may help address resident pain in LTC homes.