Efficacy of the TIMES route
Elderly care in residential care facilities is under pressure due to increasing complexity and moral distress among caregivers. This research aims to break the vicious cycle of task‑oriented care and missed emotional support. Through the TIMES route, we help teams consciously create space for person‑centered care that benefits both residents and caregivers.
Time for emotional care for people with dementia
It is vital that people with dementia are able to preserve their identity and sense of self‑worth. By being aware of residents’ feelings and emotions and by involving them in meaningful activities, caregivers in residential care facilities provide indispensable support in this regard.
However, due to limited time and staffing shortages, emotional care for people with dementia appears to be under pressure. Research shows that when minimum staffing levels are ensured, teams are in fact able—within the currently available resources—to give greater priority to the psychosocial well‑being of residents with dementia.
Drawing on the experiences of these teams, we aim to inspire caregivers to think differently about the use of available time and resources. We seek to support them in making emotional care for people with dementia a higher priority. To this end, we are developing a tool that encourages reflection on time use and care processes, as well as creative thinking focused on possibilities.
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The complexity of care for residents in residential care facilities (RCFs) is increasing. Whereas residents previously were primarily physically frail and experienced reduced mobility, we now see a growing number of residents with complex medical conditions, cognitive impairments, and psychiatric vulnerabilities. This challenges caregivers in managing behavioral and mood changes such as aggression, anxiety, and depression (Helvik et al., 2018; Gillis et al., 2023). To address these challenges, it is essential to have competent caregivers who invest sufficient time in holistic care (Lund et al., 2024).
Caregivers in RCFs experience their work as highly meaningful, maintain high standards of care, and strive to provide person‑centered care. However, current working conditions—characterized by increasing care complexity, staff shortages, and a culture in which residents’ basic needs are overlooked—create a conflict between their professional standards and the care they are actually able to deliver (Lund et al., 2024). To cope with this tension, caregivers tend to prioritize efficient care focused on routine physical tasks carried out quickly and efficiently. This approach alleviates moral distress because these goals feel achievable and therefore satisfying.
Emotional distancing is another well‑known coping strategy used by caregivers when confronted with morally stressful situations and is one of the contributing causes of neglect in residential care. There is growing evidence that residents’ basic needs in RCFs are frequently overlooked—not only physical care needs such as oral care, but also the management of residents with challenging or aggressive behavior and residents who need social contact (Lund et al., 2024). A lack of social contact and connectedness increases feelings of loneliness among residents, which can in turn lead to depression (Afrashteh et al., 2024).
While emotional distancing may function as a short‑term coping strategy, in the long term it leads to feelings of guilt and emotional and physical stress, resulting in increased absenteeism and turnover intentions. Lund and colleagues (2024) describe how residential elder care has consequently entered a negative spiral, with an increasing focus on a caregiver‑centered culture rather than a resident‑centered one. Although this culture originates as a survival strategy and coping mechanism for caregivers dealing with stress, neither residents nor staff ultimately benefit from it.
This research proposal aims to break this negative spiral and to restore balance in care for both residents and caregivers.
The “missed care” model of Kalisch et al. (2009) identifies three key elements that influence the quality of care and quality of life in RCFs: the work environment, the quality of clinical decision‑making, and caregivers’ beliefs. This study focuses on caregivers’ beliefs. Their decisions to provide, delay, or omit aspects of care are influenced by four factors: team norms, priorities, personal values and beliefs, and habits and routines. Each team has a set of implicit norms regarding acceptable behavior among team members, and these norms are relatively quickly adopted by new staff. Care decisions are therefore not made solely at an individual level, but also within the social system to which caregivers belong.
Over the past year, with the support of the Alzheimer Research Foundation, we explored these norms, priorities, habits, and routines among caregivers in residential care facilities. We sought inspiration from teams that do succeed in collectively dedicating more time and attention to emotional support for residents with dementia. This work formed the basis for the development of a thematic toolbox—the TIMES route—designed to help teams reflect differently on time use and their care choices.
Because it is crucial that new, evidence‑based tools effectively find their way into practice, this study aims to test the applicability or efficacy of the TIMES route in four care teams. The results will provide essential insights to refine and better target the TIMES route, thereby increasing its potential to influence norms, priorities, and routines effectively.
The main research question is:
What are the essential conditions for implementing the TIMES route, and which content‑related and practical adaptations are needed to increase the likelihood of behavioral change—specifically, greater attention to and time for emotional support—among caregivers?
