Barriers and Facilitators to Implementing Homelike Models in Long-Term Care: A Scoping Review Using the Updated...

Area of Science:

• Gerontology
• Healthcare Management
• Implementation Science

Background:

• Home-like models in long-term care (LTC) aim to enhance resident well-being, autonomy, and daily experiences.
• Inconsistent implementation and sustainability across settings highlight the need to understand influencing factors.

Purpose of the Study:

• To systematically identify and explain multilevel barriers and facilitators impacting the implementation of home-like models in LTC.
• To provide insights for improving the adoption and sustainability of person-centered care environments.

Main Methods:

• A comprehensive scoping review was conducted, analyzing 36 peer-reviewed studies and 13 Canadian grey literature documents.
• Implementation factors were extracted and systematically mapped using the updated Consolidated Framework for Implementation Research (CFIR 2022).

Main Results:

• Fifty-two implementation factors were identified: 23 barriers and 29 facilitators.
• Inner Setting factors (staffing, culture, leadership, resources) were most influential, often constrained by Outer Setting determinants (regulation, funding).
• Adaptive leadership, staff engagement, supportive culture, and flexible regulations emerged as key facilitators.

Conclusions:

• Successful implementation relies on addressing internal organizational factors while navigating external regulatory and funding landscapes.
• Incremental or pilot-based implementation strategies are effective for managing complexity and sustaining culture change in LTC settings.
• Fostering adaptive leadership and staff engagement is crucial for overcoming barriers and realizing the benefits of home-like models.