Out of the Loop: Social Network Isolation in Long-Term Care in Nova Scotia

Abstract

The purpose of this study is to better understand the nature, characteristics and reasoning as to why some directors of care in nursing homes are isolated from the social network of their peers. Using data from the Translating Research in Elder Care (TREC) project “Advice Seeking Networks in Long-Term Care”, this study sought to explore the descriptive characteristics of Directors of Care (DOC) who are social network isolates in Nova Scotia and what factors contribute to their isolation within the network. Furthermore, it addressed the question: what are the implications of social network isolation at an individual level, facility/organization level, and for the network as a whole?

The research is embedded in the diffusion of innovation theoretical framework that explains how and why new innovations and interventions are spread throughout a network. In this case of social network isolates, one might assume that with limited connectivity to the network, opportunities for spreading new innovations and best practices will be limited.

The project utilized findings from the quantitative survey of the TREC project for the selection of social network isolates (n=10), identified by visually observing the network maps and using low centrality scores. Semi-structured interviews were conducted with the social network isolates (n=6). Interviews addressed demographic factors that may lead to network isolation and the implications of a limited social network.

Overall, few commonalities exist among the characteristics of social network isolates. The nursing homes where isolates are employed vary in size and ownership model; however, nine of the ten isolates are in rural locations. Participants are unaware of their isolation and did not perceive any difficulty when accessing information regarding best practices and innovations in long-term care. They reported that rurality or proximity to other network actors is not influential on their advice seeking behaviours or access to information. However, it has been determined that the innovations they implement within their facilities are not considered to be particularly novel in the sector. This finding confirms their lack of access and opportunities to learn about new innovations in longterm care, reinforcing that social network isolates are laggards when adopting innovations. These DOCs feel largely disconnected from the Department of Health and Wellness, who are responsible for licensing and funding long-term care. Participants state that recent budget cuts and a lack of funding have negatively impacted the quality of care they are able to provide.