An ethnographic exploration of user engagement in long-term care

The devastating impact of COVID-19 on older adults in long-term care (LTC) facilities across Canada has drawn public attention to systemic problems across the sector. As governments, researchers and the public contemplate policy reform, there is an urgent need to ensure that residents and family carers can meaningfully engage in policy and service design. User engagement initiatives refer to involving people with lived experience in service or policy development. While some mechanisms to support user engagement in LTC facilities exist, such as resident and family councils, advisory committees, and consumer groups, it is unknown how these forums promote user engagement. My postdoctoral research will address this research gap through an ethnographic study examining how policies and institutional practices facilitate and constrain user engagement in LTC. Using a combination of document analysis, semi-structured interviews, and participant observation, I will explore the extent to which current mechanisms for user engagement enable residents and carers to exercise their rights and influence change. First, I will conduct a document analysis of LTC policies and legislation to examine how residents and their rights are portrayed in document materials. Next, I will interview stakeholders involved in user engagement within LTC, health services and community organizations to examine user engagement practices and constraints. Finally, I will conduct participant observation with family and resident councils in two LTC facilities to explore the experiences of residents and carers attempting to influence change. To enhance the relevancy of the research, the study will be guided by a knowledge user advisory committee made up of residents and carers. This research will support an in-depth understanding of the factors that shape user engagement in LTC and inform the development of user engagement initiatives that promote the rights of residents and family carers.