Relationship-Centered Care for Older Adults in Long-Term Care Homes: A Scoping Review

Abstract

This scoping review, following Levac et al.’s methodology, examines the implementation and impact of relationship-centered care (RCC) in long-term care (LTC) settings for older adults. Peer-reviewed articles from AgeLine, CINAHL Complete, MEDLINE, PsycINFO, and Web of Science were included if published after 2000, involved older adults in LTC homes, focused on RCC, and conducted in Australia, Europe, New Zealand, or North America. Key findings were organized using inductive content analysis, and 41 empirical studies with qualitative, quantitative, and mixed-methods designs were included. Three categories emerged: (1) Core Practices of RCC—relationship building and reciprocal exchange; (2) Transformative Impacts of RCC—improved care quality and collaboration; and (3) Pathways and Roadblocks to RCC—individual and organizational factors. By understanding the key elements, facilitators, and barriers of RCC, policymakers and practitioners can develop targeted strategies to improve care experiences and outcomes for residents, families, staff, and all others involved in LTC.

What this paper adds

• • Deepens understanding of RCC in LTC through practical examples, connecting theory to practice.

• • Presents a comprehensive synthesis of empirical studies, highlighting RCC’s benefits and challenges.

• • Provides a framework to develop strategies for enhancing care experiences and outcomes in LTC.

Applications of findings

• • Guides LTC practitioners on RCC strategies to build meaningful relationships and improve care quality.

• • Advises policymakers on supportive policies that overcome RCC barriers, promoting holistic geriatric care.

• • Identifies gaps in RCC research, such as its impact on diverse populations, suggesting future research directions.

Introduction

The global population over 60 is projected to double from 12% to 22% between 2015 and 2050 (WHO, 2022). As people age and experience physical or cognitive decline, they may require daily assistance with tasks like bathing, dressing, housekeeping, meal preparation, and medical support (WHO, 2024). Long-term care (LTC) services address these needs, helping individuals with significant physical or cognitive challenges maintain their functional abilities and dignity. LTC services also support social participation and manage chronic conditions through community-based nursing, physical therapy, and palliative care. The World Health Organization emphasizes incorporating person-centered care (PCC) principles into all LTC services to respect and meet individuals’ unique needs, ultimately enhancing overall care quality (Perracini et al., 2022; WHO, 2024).

PCC, a model that emphasizes the holistic needs and preferences of those receiving care, became prominent with culture change movement, advocating a shift from strictly biomedical models to biopsychosocial approaches that prioritize residents’ autonomy and quality of life (QoL) in LTC settings (Bhattacharyya et al., 2022; Fazio et al., 2018; Kitwood, 1997). While the culture change movement encourages strong, cooperative bonds among residents, families, caregivers, and the community (Cornelison, 2016), PCC sometimes overemphasizes residents’ independence, potentially overlooking the essential interconnections vital to effective care relationships. To address these limitations, relationship-centered care (RCC) builds on the principles of PCC by placing a stronger emphasis on interpersonal bonds and positive, reciprocal relationships as fundamental to quality care (Hirschmann & Schlair, 2020; Nolan et al., 2004).

Introduced by Tresolini and the Pew-Fetzer Task Force (1994) after a review of the US healthcare system, RCC promotes a shift from disease-focused care to an approach that considers social, economic, environmental, and cultural contexts (Nolan et al., 2006, 2008). RCC emphasizes personal experiences with illness and relationship-building as core to therapeutic and healing processes. It views care as a relationship-building process rooted in trust and reciprocity. Key elements include clinical expertise for compassionate care, effective teamwork and interdisciplinary communication for respect and clarity, and continuity of staff and family relationships to support a positive LTC environment (Nolan et al., 2008).

Foundational Frameworks

The concept of RCC in LTC is grounded in well-established theoretical perspectives that emphasize the value of interpersonal relationships in care environments. Frameworks like Nolan et al.'s Senses Framework (2004, 2006, 2008) and Dewar's Caring Coversations (2011) advocate for enhancing care quality in LTC homes through meaningful relationships.

Developed by Nolan and colleagues in 1997 and refined over 20 years, the Senses Framework enhances RCC by addressing the needs of all involved in care, focusing on both subjective and perceptual elements (Nolan et al., 2006, 2008). The framework’s six principles are creating a sense of safety (Security), valuing personal histories (Continuity), fostering community (Belonging), encouraging purposeful activity (Purpose), supporting personal goals (Fulfillment), and recognizing individual contributions (Significance). These principles make the Senses Framework a valuable tool for fostering an inclusive and effective LTC environment.

The Caring Conversations framework supports RCC by promoting compassionate, dignified interactions among staff, older adults, and families (Dewar, 2011; Dewar & Nolan, 2013). It includes seven components: addressing sensitive topics (Be Courageous), showing empathy (Connect Emotionally), demonstrating interest (Be Curious), respecting differing viewpoints (Consider Other Perspectives), collaborating (Collaborate), finding mutually acceptable solutions (Compromise), and acknowledging efforts (Celebrate). These elements are vital for skilled interactions, supporting the six senses and advancing RCC (Dewar, 2011; Dewar & Nolan, 2013). The Senses Framework and Caring Conversations highlight the importance of compassionate interactions and holistic support, framing RCC as essential to high-quality care. Both emphasize relationship-building as central to quality care, reinforcing RCC’s focus on this review.

Current Gaps

To date, scoping reviews on RCC have predominantly focused on broader healthcare contexts. Lamph et al. (2023) examined relational practices in health, criminal justice, education, and social work, noting definitional ambiguities among practitioners, policymakers, and academics. A recent review by Fox et al. (2024) focused on relational collaboration within healthcare teams, emphasizing the need for a supportive team culture and organizational support to enhance worker well-being. Another scoping review emphasized the central role of relationships in delivering quality care, with the concept of RCC being influenced by theories of sociology, social psychology, and psychiatry (Soklaridis et al., 2016). However, a major gap remains in understanding RCC specifically in LTC for older adults, especially in personal areas like continence care. Bhattacharyya, Morgan, and Burgess (2022) developed a framework showing that resident satisfaction in nursing homes is driven by autonomy, meaningful activities, and social interaction—factors essential to quality of life, yet often overlooked in LTC assessments. Their findings stress that resident satisfaction extends beyond clinical care, involving environmental, psychological, and relational aspects. Thus, further investigation is needed to map RCC-specific practices and resident-centered perspectives in LTC settings and address current knowledge gaps.

This review aims to fill these gaps by focusing specifically on RCC in LTC, examining current practices, challenges, and limitations to provide a comprehensive view of RCC’s role in enhancing well-being. By assessing RCC’s contributions to LTC, this study enriches the literature, identifying key relational practices and the facilitators and barriers affecting RCC implementation.

Objective and Research Questions

This scoping review aims to explore the scope and depth of existing knowledge on RCC in LTC settings for older adults, examining its implications, benefits, and challenges. The following questions guide this review:

• 1. What practices constitute RCC in the context of LTC for older adults?

• 2. What are the outcomes of RCC in LTC settings?

• 3. What are the facilitators and barriers of implementing RCC in LTC settings?

Methods

Scoping review, a form of knowledge synthesis, explores research questions by systematically reviewing, selecting, and summarizing relevant literature to map key concepts, a variety of evidence, and research gaps (Colquhoun et al., 2014). This study follows the framework developed by Levac et al. (2010), to investigate RCC for older adults in LTC settings. The following steps are included in the framework: (i) developing the research question, (ii) establishing pertinent studies, (iii) selecting the studies, (iv) charting the data, (v) synthesizing and reporting the results, and (vi) consulting stakeholders to enhance the review’s relevance and applicability (Levac et al., 2010, 3).

Developing the Research Question

The three primary research questions guiding this scoping review have been outlined earlier. The target population for this review is older adults residing in LTC homes, and the concept is RCC approaches. As introduced earlier, RCC is an approach that views relationships as essential to therapeutic and high-quality care, emphasizing interactive and reciprocal exchanges among residents, their relatives, and care staff (Nolan et al., 2006; Ryan et al., 2008).

Establishing Pertinent Studies

The research questions focus on exploring RCC for older adults in LTC settings. Other care approaches that predate RCC, such as PCC, which focuses on the overall needs and individual preferences of care recipients, were considered beyond the scope of this review. With the guidance of supervisor who has content (e.g., RCC research) and methodological (e.g., review and analysis) expertise, this scoping review was conducted as part of a dissertation project. An experienced social science librarian provided expertise in refining search terms and strategy for selecting the studies.

The following databases were searched from March to May 2024: AgeLine, CINAHL Complete, MEDLINE, PsycINFO, and Web of Science. Keywords included target population (e.g., older adults), concept (e.g., RCC, relational care), and context (e.g., LTC, nursing home) (Joanna Briggs Institute, 2020). Table 1 lists the keywords and search strings used.

Table 1.

Search Terms and Search Strings.

Target Population	Concept		Context
Older adults OR senior OR senior citizens OR elder OR aging population	AND	Relationship-centered care OR relationship-centered care OR relational care OR care relationships	AND	Long-term care OR nursing home OR aged care facility OR aged care home OR home for the aged OR residence for senior citizen

Selecting the Studies

Following the database searches, relevant study citations were collated and uploaded into Covidence, which is an online software program to manage systematic reviews efficiently (Babineau, 2014). After removing the duplicates, the first and second author independently screened titles and abstracts based on inclusion/exclusion criteria. To ensure consistency and clarity, the researchers reviewed the inclusion and exclusion criteria together regularly, discussing any points of potential ambiguity. The full text articles were then retrieved and assessed in detail against the inclusion criteria. Any unresolved conflicts or concerns that arose at each stage of the study selection process were resolved through discussions between the lead researcher and the second author. Reasons for exclusion of studies at each stage are recorded in Covidence and reported in the scoping review. The search results and the study selection process are detailed using a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram (Tricco et al., 2018) (see Figure 1 below).

Figure 1.

Flow diagram of study identification and selection.

The inclusion criteria for peer-reviewed journal articles were (i) population: older adults in LTC homes; (ii) concept: RCC or related concepts, such as care relationships and relational care; (iii) publication date range: 2000–2024; (iv) language: English; and (v) empirical research only. The term “older adults” allowed broader inclusion, while the 2000–2024 range captured relevant, contemporary RCC research in LTC. Diverse study designs—quantitative, qualitative, and mixed methods—were included to map the full breadth of evidence in this interdisciplinary field (Arksey & O’Malley, 2005; Joanna Briggs Institute, 2020).

Exclusions were (i) studies in acute care hospitals, ambulatory care, assisted living, or community-dwelling settings; (ii) research conducted outside Australia, Europe, New Zealand, or North America; and (iii) non-empirical or non–peer-reviewed studies. LTC settings were chosen to focus on high-dependency care, excluding assisted living facilities (ALFs) due to their lower care levels. Including ALFs could have broadened RCC insights across the care continuum, but the exclusion enabled targeted analysis of RCC in intensive care contexts. Reference lists of included studies were also hand-searched to identify additional relevant studies.

Data Charting

After identifying the final set of relevant research studies, data were extracted and charted into Table 2, which includes details such as authors and country, sample characteristics, methods used, study objectives, and key findings relevant to the review questions. This table separates articles on RCC from those on related concepts, like care relationships and relational care, that align with RCC principles. The data extraction and charting process was iterative and continuous, aimed at effectively reporting findings aligned with the research questions and study objectives.

Table 2.

Data Chart of Articles Included in the Scoping Review.

Authors and Country	Sample	Method	Objective	Relevant Findings
Relationship-centered care
Allison et al. (2019), United States of America	n = 19 interviews with special care unit careers	Qualitative, ethnographic case study (observation and interviews)	To explore the functioning of a dementia special care unit as a caring community	Relationships were developed using a family-centered approach. The caring community included staff, volunteers, friends, and family members.
Aveyard and Davies (2006), United Kingdom	n = 18 staff and 7 relatives	Qualitative, semi-structured interviews	To evaluate the implementation of an action group based on RCC and the Senses Framework in a dementia nursing home	The project fostered a sense of security, significance, belonging, purpose, continuity, and achievement in the care home. Participants in the action group gained mutual understanding, appreciation for each other, a strong collective voice, and commitment to short- and long-term goals.
Compton et al. (2022), Canada	n = 141 residents and 67 family members	Quantitative design with descriptive and inferential statistics	To understand the QoL outcomes reported by residents and families in LTC settings with a focus on RCC	The study highlights the impact of RCC on QoL and provides practical guidance for its implementation in LTC settings.
Dewar and MacBride (2017), Scotland and United Kingdom	n = 37 staff, 20 residents and 18 relatives	Qualitative, observations and interviews	To detail dignity-promoting interactions in care homes and evaluate an educational intervention to improve them using the Caring Conversations framework	Findings showed that participants’ communication aligned with the Caring Conversations framework. Staff then piloted small ‘tests of change’ based on these insights to enhance effective practices.
Dewar et al. (2019), Scotland and United Kingdom	n = 119 nursing home managers	Mixed method design, pre- and post-questionnaires and group discussions	To examine the impact of the My Home Life (MHL) initiative on leadership and care practices from the managers’ perspective	Managers reported positive changes in personal development and care home environment after the MHL intervention, including better self-awareness, leadership, relationships, and culture.
Eyers et al. (2013), United Kingdom	n = 14 residents and 13 care staff for interviews	Mixed method, semi-structured interviews and questionnaires	To explore how technology can enhance nighttime RCC in care homes	Despite care staff’s distrust in technology and limited understanding of sleep’s importance, appropriately used technology can enhance RCC.
	n = 87 staff for questionnaires
Jablonski-Jaudon et al. (2016), United States of America	n = 46 residents	Quantitative, MOUTh intervention	To describe a tailored practice designed to intercept and reduce resistant behavior during mouth care for residents with dementia	Results indicated that the MOUTh intervention evolved into a relationship-centered approach, requiring caregivers to understand residents better to build trust and adjust their care.
Jones and Moyle (2016), Australia	n = 39 care staff and 12 community organizations for interviews	Qualitative, pragmatic exploratory interviews	To explore aged care staff’s perspectives on their relationships with other staff, families, and residents	Care duties and concerns about professional boundaries prevented staff from forming therapeutic relationships with residents and families. Excessive care needs, family expectations, and staff conflicts due to hierarchy and shifts hindered positive relationships among staff and between staff and families.
Keller et al. (2021), Canada	n = 1036 care providers	Quantitative, online survey	To explain modifications in mealtime practices in residential setting and providers outlook on issues concerning dining practices due to the COVID-19 pandemic	Care providers struggled to balance RCC and safety during COVID-19 pandemic. Challenges included reduced social interaction, staff shortages, limited volunteer/family help, and assisting residents with eating.
Keller et al. (2021), Canada	n = 27 and 19 residents and 39 and 29 staff	Quantitative, modified stepped-wedged design	To demonstrate the effectiveness of the CHOICE + intervention in improving the mealtime experience over 12 months	The CHOICE+ intervention significantly improved the physical and social environments, RCC practices, and overall mealtime atmosphere in three diverse dining rooms.
Ploeg et al. (2013), Canada	n = 35 residents and family members	Qualitative, individual and focus group interviews	To understand how residents and family members perceive the role of nurse practitioners in care homes	Residents and family members saw nurse practitioners as providing resident- and family-centered care and enhancing overall care quality.
Rutten et al. (2022), Netherlands	n = 29 care staff	Qualitative, semi-structured and face-to-face focus groups	To comprehend the work experience of Dutch nursing home staff during the COVID-19 pandemic	Findings emphasized work routine disruptions, impacts on front-line care staff’s job and personal life, the importance of team and leader support, and effects on RCC.
Sion et al. (2020), Netherlands	n = 10 clients and 9 staff for focus groups, 24 client and staff for world café	Qualitative, focus group and world café	To find a method to assess how clients perceive the quality of care they experience in nursing homes	Findings highlighted the importance of relationships, where quality care was largely shaped by client, family, and staff engagement.
Talbot and Brewer (2016), United Kingdom	n = 8 care assistants	Qualitative, semi-structured interviews	To comprehend the experiences of care assistants providing dementia care in LTC settings	Care assistants were considering the viewpoints of residents with dementia to promote RCC.
Trinca et al. (2021), Canada	n = 639 residents (58 general and 24 dementia care units)	Quantitative, secondary analysis—Mealtime Scan	To investigate the correlation between the presence of residents and staff during mealtimes and the implementation of RCC	The research indicated that relationship-focused care might decrease with more residents at mealtimes, but having more staff present could support RCC.
Venturato et al. (2013), Australia	n/a	Qualitative, hermeneutics and institutional ethnography	To identify and analyze the primary documents utilized for dementia care in a large LTC home	The study revealed inconsistencies and lack of clarity in the philosophy of dementia care, including disconnects in the essential documents used for such care.
Watson (2019), United Kingdom	n = 24 staff interviews	Qualitative, ethnography	To explore the impacts of embodied and interembodied selfhood in care relationships within a dementia care home	Themes affecting the caregiver–resident relationship included physical care, recognizing and nurturing individual identity, and responding to distress signals.
Wills and Day (2008), Ireland	n = 5 residents and 3 family careers	Qualitative, focus groups	To engage residents in co-creating life story books (LSB) and then evaluate these detailed books with residents and their families	The LBS extensively covered participants’ upbringing, detailing their social roles from past work, the impact of religion, the importance of relationships, and their personal identity.
Wilson (2009), United Kingdom	n = 16 residents, 25 staff and 18 families	Qualitative, interviews, participant observation and focus groups	To explore the factors that impact relationship development in care homes and their role in fostering community formation	Critical factors in relationship-building included leadership, staff consistency, personal philosophies of staff, and contributions from residents and families to home life. Effective leadership plays a pivotal role in shaping community within care homes due to its profound impact on care organization.
Wilson and Davies (2009), United Kingdom	n = 16 residents, 25 staff and 18 families	Qualitative, participant observation and interviews	To investigate how relationships affect the experiences of older residents, their families, and caregivers	Findings emphasized that staff in care homes applied personalized approaches focused on tasks, residents, and relationships, influencing the dynamics among staff, residents, and families.
Wilson et al. (2013), United Kingdom	n = 11 staff	Mixed method, pre- and post-intervention design and focus group with staff	To develop, implement, and evaluate a training program aimed at enhancing dementia care quality based on the RCC principles described in the Senses Framework	Staff felt more confident in collecting and applying biographical details following the training workshops. This enabled them to initiate meaningful conversations with dementia patients during daily care, ultimately improving their overall well-being.
Wu et al. (2018), Canada	n = 64 residents, 25 care staff for mealtime scans, and 9 care staff for interviews	Mixed method, mealtime scans and semi-structured interviews	To determine if the CHOICE program can modify physical, social, and RCC practices and to identify necessary program adjustments or additions	Staff perceived the CHOICE program principles as goals for dining and found them resonant. The CHOICE program has the potential to improve dining practices, including physical aspects.
Care relationships and relational care
Andersen and Spiers (2016), United States of America	n = 22 care aides	Qualitative, focused ethnography	To explore elements of caregiving, workplace environment, and characteristics of care aides	Care aides expressed aspirations to build and maintain “ideal” relationships with residents and their families, while also acknowledging the practical challenges of their work.
Banerjee et al. (2015), Canada	n = 141 RNs, 139 LPNs and 415 care workers	Mixed method, focus groups and survey	To explain how a reductionist approach has shaped nursing care organization in ways that do not meet the needs of relational care	Time constraints and paperwork reduced focus on residents as individuals, creating barriers for relational care. Systemic knowledge hierarchies further added to care workers’ distress, exacerbating tensions between relational care needs and organizational demands.
Banerjee et al. (2021), Canada	n = 23 health care assistants, 11 RNs, 6 managers and senior leadership, 6 LPNs, 5 allied health professionals and 1 facilitator	Qualitative, observation and group/individual interviews	To emphasize the outcomes of a successful practice where workers and managers participated in facilitated reflection sessions aimed at identifying and resolving issues	A safe environment allowed workers to communicate openly, feeling valued and respected. The relational approach fostered respect, trust, and collaborative efforts.
Barken and Lowndes (2018), Canada	n = 101 staff, 31 family members, 9 volunteers and 8 residents	Qualitative, rapid ethnography	To identify strategies that facilitate meaningful involvement of family members in care homes	Family members’ meaningful engagement necessitated care practices extending beyond clinical tasks and official guidelines. These practices fostered collaborative, supportive relationships between staff and families from entry to end-of-life stages in the care home.
Chamberlain et al. (2017), Canada	n = 273 family members	Quantitative, surveys	To investigate care models, physical features, and relational aspects associated with enhancing families’ perceptions of homeliness in care homes	The connection between staff and families, interactions among residents, and involving families in decision-making processes enhanced the sense of home for family members in LTC home.
Cranley et al. (2020), Canada	n = 9 residents, families, and staff	Qualitative, individual interviews	To explore how residents, families, and staff collaborate on decision-making and to establish effective mechanisms to promote shared decision-making in care homes	Themes identified pathways of verbal communication to share information, enhancing residents’ decision-making autonomy through relational care, and highlighted challenges in effective communication hindering shared decision-making.
Daly and Szebehely (2012), Canada and Sweden	n = 557 in Canada, 292 in Sweden (care aides and assistant nurses)	Quantitative, survey	To contrast the daily work experiences of caregivers in Canadian and Swedish care homes	Canada favored a task-based work approach, whereas Sweden adopted a relational care model. Canadian care aides faced more challenging and demanding labor conditions than their Swedish counterparts.
Dohmen et al. (2022), Netherlands	n = 424 care staff	Qualitative, narrative approach	To explore the experiences of care home staff by examining their personal stories during the COVID-19 pandemic	Good care by staff relied on a relational-moral approach, which was disrupted by COVID-19 mitigation measures. These measures created internal conflict for staff as they conflicted with their relational-moral caregiving.
Dunn and Moore (2016), United Kingdom	n = 5 care staff	Qualitative, interviews	To investigate care staff’s perspectives on meeting the nutritional needs of residents	Relational care in nursing homes is limited by staff shortages, routine practices, and residents’ resistance, preventing staff from addressing residents’ psychosocial needs during mealtimes.
Goodman et al. (2015), United Kingdom	n = 58 care homeowners/representatives, residents’ representatives, regulator, health and social care staff and residents	Qualitative, semi-structured interviews	To identify the essential components of service delivery models that facilitate the provision of National Health Services (NHS) to care homes	Increased relational collaboration between care home staff and visiting NHS staff enhanced continuity and mutual learning, improving healthcare access for older residents.
Gordon et al. (2018), United Kingdom	n = 181 residents, relatives, care home staff, community nurses, allied health care professionals, and GPs	Qualitative, interviews and focus groups	To understand how healthcare organization affects resource utilization	Including relational aspects in work fostered trust between practitioners, enhancing collaboration between healthcare services and care home staff.
Heggestad et al. (2015), Norway	n = 7 relatives of people with dementia	Qualitative, participant observations and interviews	To examine how the dignity of people with dementia is maintained or compromised in a care home setting	Relatives valued their family members with dementia being seen as relational human beings. However, a task-oriented approach and limited resources hindered residents’ dignity and relational care.
Hradcová (2017), Czech Republic	Care assistants, nurses, social workers, and technical staff	Qualitative, ethnography	To outline the care practices for individuals with dementia in LTC homes	A relational care approach is essential to promote dignity and autonomy for people living with dementia, offering an opportunity for high-quality care.
Marquis et al. (2004), Australia	n = 7 family members of residents	Qualitative, ethnographic interviews	To identify factors that encouraged family involvement in aged care	Building relationships with relatives, assisting them through changes, and forming partnerships for new caring roles (e.g., providing emotional and social support) were found to be important.
McGilton et al. (2003), Canada	n = 50 residents for questionnaires, 40 residents, and 34 nursing staff for observations	Mixed method, questionnaires and observations	To examine the effects of a relationship-enhancing program of care (REPC) on care staff and resident outcomes	The REPC significantly influenced residents’ views on care staff’s relational care, relational behaviors, and continuity of care.
McGilton et al. (2012), Canada	n = 38 residents with dementia and 35 care providers	Quantitative, descriptive repeated measure	To explore how care providers’ relational behaviors vary across different caregiving situations and residents and to examine the connection between these behaviors and residents’ mood and affect	Care providers’ relational behaviors were most observed during interpersonal interactions and least during mealtimes. Residents viewed as most resistive to care exhibited fewer observed relational behaviors. Effective relational behaviors were positively linked to residents’ mood and affect.
Molterer et al. (2020), Germany	Staff, residents, visitors, relatives, nurses, and asylum seekers	Qualitative, ethnographic observations	To explore the meaning of good care in LTC home	Care relationships involve intricate negotiations, with care being delivered through a process of balancing various competing priorities.
Sellevold et al. (2019), Norway	n = 25 ethnic health care workers	Qualitative, participatory action research	To explore the experiences of multi-ethnic healthcare staff concerning their working relationships and their impact on the quality of care for residents with dementia	Good relationships, characterized by understanding each other’s vulnerabilities and learning from mutual experiences, are essential for quality care.
Walsh and Shutes (2013), Ireland and United Kingdom	n = 41 older people and 90 migrant care workers	Mixed method, focus groups, surveys, and interviews	To explore the dynamics between older Irish and British individuals and migrant care workers	Findings showed that relationships between migrant care workers and older people were influenced by individual, structural, and temporal factors.

Collecting, Synthesizing, and Reporting the Results

Inductive content analysis was used to systematically describe and interpret findings. As a research method, content analysis allows for systematic description of phenomena and deeper insights into the data (Elo & Kyngäs, 2008). The process involved (i) open coding (the first author reviewed texts to establish initial headings); (ii) category development (grouping these codes into broader categories); and (iii) abstraction (refining groups into overarching categories). The second author reviewed and adjusted codes, achieving consensus on final categories. NVivo 12 supported the iterative analysis (Zamawe, 2015).

Consulting Stakeholders

To enhance the review’s relevance, we consulted RCC and LTC experts, who reviewed our research question, methods, and preliminary findings via virtual meetings and email. Their insights helped us refine categories, identify key studies, and align our analysis with current LTC needs.

Results

Out of 1211 articles initially identified, 1070 were excluded after removing duplicates and screening titles and abstracts. This left 141 articles for evaluation against inclusion and exclusion criteria. In total, 41 articles were reviewed to explore RCC approaches for older adults in LTC settings (see Figure 1 for the Flow Diagram of Study Identification and Selection). Table 2 provides a summary of selected study characteristics for this scoping review. As shown in Figure 2, 26 studies employed qualitative methods, eight quantitative, and seven mixed methods. The studies were in Canada (13), the United States (3), Europe (21), Australia (3), and one in both Canada and Sweden.

Figure 2.

Identified articles distributed by study methods and location.

Findings

Findings reveal three main categories: (1) Core Practices in RCC: Relationship Building and Reciprocal Exchange, (2) Transformative Impacts of RCC: Strengthened Care and Collaborations, and (3) Pathways and Roadblocks to RCC: Individual and Organizational Factors (see Table 3 for a synthesis of key findings). This scoping review maps a comprehensive understanding of RCC in LTC for older adults, highlighting core practices such as personalized engagement, reciprocal exchange, empathy, and family involvement. Evidence shows that RCC leads to numerous positive outcomes, including enhanced resident well-being, improved family satisfaction, and stronger staff-resident relationships, though there is a lack of discussion on potential adverse outcomes. However, RCC implementation is influenced by supportive factors like teamwork, consistent staffing, and a homelike environment, as well as barriers such as staffing shortages, high turnover, and regulatory challenges.

Table 3.

Synthesis of Key Findings From the Scoping Review.

Category	Key Findings
Core Practices In RCC: Relationship Building and Reciprocal Exchange	⁃ Relationship building and reciprocal exchange are foundational.
	⁃ Emphasis on understanding personal histories, preferences, and preserving dignity.
	⁃ Techniques include life story books, personalized memory boxes, and active listening.
	⁃ Collaboration with families and involvement in care planning enhance trust.
	⁃ Supportive relationships are fostered by treating residents like family, promoting mutual respect.
Transformative Impacts Of RCC: Strengthened Care and Collaborations	⁃ RCC improves resident care, family involvement, leadership, staff development, and workplace dynamics.
	⁃ Workshops and relational care practices increased resident–staff interactions and emotional engagement.
	⁃ Enhanced leadership skills and relational behaviors fostered a supportive, culturally sensitive workplace.
	⁃ Strengthened workplace culture with collaborative feedback and shared decision-making.
Pathways and Roadblocks To RCC: Individual and Organizational Factors	⁃ Compassionate attitudes, teamwork, and cultural sensitivity are essential for RCC.
	⁃ Staff rotation, time constraints, and high workload hinder RCC implementation.
	⁃ Organizational factors like continuity, policies, funding, and the physical environment affect care quality.
	⁃ Emotional labor, communication challenges, and ethical dilemmas impact staff’s ability to provide RCC.

Core Practices in RCC: Relationship Building and Reciprocal Exchange

The foundation of RCC in LTC is built on relationship building and reciprocal exchange. This approach emphasizes understanding residents’ personal histories and preferences, preserving dignity while fostering trust, rapport, and supportive relationships and collaboration.

Understanding Personal Histories and Preferences

Relational care in LTC settings began with a deep understanding of residents’ personal histories and preferences. Staff document residents’ shared life experiences, cultural beliefs, and family bonds in life story books, which provided valuable insights into each resident (Wills & Day, 2008). Similarly, creating personalized memory boxes for residents with dementia, allowed staff to seamlessly integrate meaningful moments from residents’ past into daily routines, thereby strengthening relationships (Compton et al., 2022; Wilson et al., 2013). Such documentation was crucial for fostering personalized and empathetic care, creating an environment where residents felt understood and respected, ultimately enhancing their dignity and emotional well-being.

Preserving Dignity while Building Trust and Rapport

Preserving residents’ dignity while establishing and maintaining trust and rapport was essential for effective relational care. Residents’ relatives emphasized the importance of preserving dignity and autonomy by recognizing residents’ relational humanity and addressing their emotional needs (Heggestad et al., 2015; Marquis et al., 2004). Staff engaged in active listening, maintained curiosity, and involved families in care planning to better understand residents’ preferences and build strong, trust-based relationships (Andersen & Spiers, 2016; Barken & Lowndes, 2018; Dewar & MacBride, 2017; Walsh & Shutes, 2013). Moving beyond standardized care plans, staff needed to use their experiential knowledge and flexible approaches in care delivery, along with providing personalized care that respected residents’ dignity and emotional needs to foster mutual trust and connections (Andersen & Spiers, 2016; Dunn & Moore, 2016; Molterer et al., 2020; Walsh & Shutes, 2013). During the COVID-19 pandemic, customizing activities to align with residents’ identities and fostering one-on-one interactions were particularly important in strengthening connections between residents and staff (Dohmen et al., 2022). In dementia care, empathy and an appreciative approach were particularly crucial, as meeting deeper emotional needs extended beyond merely completing tasks (Watson, 2019).

Fostering Supportive Relationships and Collaboration

Collaborative efforts and reciprocal engagement were vital for effective relational care. Treating residents like family enhanced emotional well-being and fostered supportive relationships among residents, families, and staff (Allison et al., 2019). Many residents perceived staff members as friends, with approximately 70% forming such bonds (Compton et al., 2022). Staff across various roles, including dietary, housekeeping, and administrative, were crucial in initiating and sustaining these supportive relationships (Barken & Lowndes, 2018; Marquis et al., 2004; Wilson & Davies, 2009). Care staff, such as nurse practitioners (NPs), played a crucial role in involving residents and their families in decision-making, fostering a sense of importance for residents and engagement for families (Dewar et al., 2019; Ploeg et al., 2013). Staff also recognized and facilitated relationships between residents and their significant others, promoting well-being, nurturing reciprocal relationships, and fostering a harmonious community within LTC settings (Dohmen et al., 2022).

Care managers and staffs’ ongoing commitment and dedication to their roles, a strong sense of curiosity, openness and respect for colleagues’ diverse cultures, cultural sensitivity in teamwork, and self-reflection further promoted collaboration and relational care in LTC settings (Dewar et al., 2019; Dewar & MacBride, 2017; Sellevold et al., 2020). Active participation from relatives in care activities lead to meaningful contributions, collaboration, and a sense of reciprocity, highlighting the interconnectedness and shared responsibility within the caregiving environment (Aveyard & Davies, 2006; Wilson, 2009). Care relationships in LTC homes were multifaceted, encompassing need-oriented, friendship-like, familial, and reciprocal dynamics (Walsh & Shutes, 2013). Hradcová (2017) and Watson (2019) also emphasized the importance of reciprocal exchanges of emotions and needs in care relationships, particularly for residents with dementia.

Moreover, empathetic approaches fostered communal routines based on individual preferences (e.g., bedtime or bath time), promoting shared understanding among residents, families, and staff (Wilson & Davies, 2009). This shared understanding empowered residents to anticipate each other’s needs, fostering acts of reciprocity and negotiation while enabling families to appreciate staff’s efforts in meeting everyone’s needs (Wilson & Davies, 2009). Therefore, recognizing the roles and contributions of all stakeholders, including staff, residents, and families, was integral to an authentic relational care approach (Wilson & Davies, 2009).

Transformative Impacts of RCC: Strengthened Care and Collaborations

The transformative impacts of RCC are evident in the improved care and enhanced collaborations in LTC settings. RCC significantly enhances resident care, family involvement, leadership and staff development, workplace dynamics, and the delivery of culturally sensitive care.

Impact on Resident Care and Family Involvement

RCC significantly increased interactions and enhanced connections between staff, residents, and relatives. Workshops based on RCC principles led to a significant increase in meaningful resident interactions and participation in leisure activities (Wilson et al., 2013). Caring Conversations heightened staff awareness of effective human interactions and fostered emotional engagement with residents, families, and colleagues (Dewar & MacBride, 2017). Consistent relationships with staff also fostered a sense of security among residents (Watson, 2019).

Meaningful interactions, characterized by positive engagement, empathetic care, and strong rapport, reinforced residents’ sense of individuality (Heggestad et al., 2015) and improved their perceptions of care quality (McGilton et al., 2003). Residents’ positive views of relational care and staff engagement in relational behaviors were further associated with enhanced relationships and meaningful connections (McGilton et al., 2003). Increased relational behaviors among staff correlated with reduced levels of anxiety, fear, and sadness among residents, highlighting a positive impact on residents’ emotional well-being (McGilton et al., 2012).

Family involvement in daily life and decision-making significantly contributed to the social and emotional well-being of residents, especially those with dementia (Allison et al., 2019; Dewar et al., 2019; Marquis et al., 2004; Sellevold et al., 2019). Family participation in decision-making, as well as staff–family and resident–resident relationships, helped foster a homelike atmosphere in LTC settings for residents and families (Chamberlain et al., 2017). Relational care also helped relatives cope with the emotional challenges of placing loved ones in LTC, providing crucial support during end-of-life situations (Aveyard & Davies, 2006).

Leadership and Staff Development

RCC-based interventions have led to substantial improvements in LTC managers’ skills. Managers reported a 20% increase in active listening skills and a 16% increase in management and leadership abilities (Dewar et al., 2019). Additionally, staff empowerment increased from 63% to 96%, and managers’ ability to influence improved from 57% to 91% (Dewar et al., 2019). Managers also developed an enhanced comprehension of care culture (96%) and increased confidence, which led to personal growth and positive transformations in resident care, staff interactions, and residents’ QoL (Dewar et al., 2019). Embracing reflective practices allowed managers to gain self-awareness of their assumptions, facilitating relational leadership (Banerjee et al., 2021; Dewar et al., 2019). Managers began exploring new conversational approaches that promoted inclusive dialogue, collaborative ideas, and shared ownership of initiatives involving residents and relatives (Dewar et al., 2019). In turn, relational leadership empowered others, fostered shared understanding and collaboration, provided a sense of security and belonging, and promoted a culturally sensitive and positive organizational culture (Banerjee et al., 2021; Dewar et al., 2019; Heggestad et al., 2015; Sion et al., 2020; Watson, 2019).

Through self-reflection and group discussions facilitated by the relational care approach, care staff felt empowered to ask questions, express emotions, voice concerns openly, bridge hierarchical divides, and foster mutual understanding (Banerjee et al., 2021; Dewar et al., 2019; Dewar & MacBride, 2017). This empowerment nurtured respect, communication, problem-solving abilities, empathy, and overall professional development (Banerjee et al., 2021; Dewar & MacBride, 2017; Sellevold et al., 2019). Personalized caregiving interactions facilitated by RCC enhanced information continuity and communication among staff, positively influencing their sense of purpose and identity (Goodman et al., 2015; Gordon et al., 2018; Jablonski-Jaudon et al., 2016; Talbot & Brewer, 2016).

Enhanced Workplace Dynamics

Emotional sharing in the workplace improved understanding, communication, and conflict resolution, leading to better collaborative engagement (Dewar et al., 2019; Marquis et al., 2004). Collaborative efforts among staff from various units cultivated teamwork, enhanced communication regarding resident care, and contributed to staff feeling more valued by colleagues and families (Wilson et al., 2013). Collaborative efforts, in turn, enabled detailed and comprehensive feedback, fostering a culture of change and improvement, shared decision-making, and meaningful involvement within and beyond LTC homes (Aveyard & Davies, 2006; Cranley et al., 2020; Dewar et al., 2019). Staff also felt empowered to influence organizational policies and practices, leading to improved care practices and a more supportive and collaborative workplace culture (Banerjee et al., 2021). Staff perceived the development of strong relationships through relational care as one of the most fulfilling aspects of their work (Banerjee et al., 2015). Collaborative efforts, particularly between staff and relatives, fostered mutual respect and appreciation, which were essential prerequisites for building meaningful connections (Barken & Lowndes, 2018).

Culturally Sensitive Care

RCC honored and integrated cultural particularities into caregiving practices. The relational model of care embraced cultural nuances by accommodating cultural practices, providing access to religious support (e.g., rabbinical support), and using native language terms (Allison et al., 2019). Staff used terms of endearment in residents’ native languages, such as Russian words like diragaya and diragoy for “darling” and Yiddish terms like mamale or mamishka for “mother,” to strengthen familial bonds with residents (Allison et al., 2019). Multilingual staff practiced culturally sensitive care by communicating in the residents’ preferred languages (Allison et al., 2019).

Cultural understanding among staff about their diverse backgrounds also enriched teamwork and enhanced care delivery (Sellevold et al., 2019). This culturally sensitive approach ensured that care practices were respectful and inclusive, fostering a supportive environment for both residents and staff (Sellevold et al., 2019).

Pathways and Roadblocks to RCC: Individual and Organizational Factors

Implementing RCC in LTC settings is influenced by individual factors, such as compassion, teamwork, communication, and stress management, and organizational factors like continuity of care, funding, policies, and the physical environment.

Compassionate and Respectful Attitudes

Studies have shown that the attitudes and behaviors of staff significantly impact the quality of relational care provided to residents, particularly those with dementia. Compton et al. (2022), Heggestad et al. (2015), Hradcová (2017), Marquis et al. (2004), and Ploeg et al. (2013) found that respectful and compassionate attitudes, along with staff knowledge and competencies, enhanced the care experience for families and residents. Sellevold et al. (2019) emphasized the importance of respectful communication, including self-awareness, patience, politeness, and sensitivity, in creating a nurturing and secure environment. Additionally, staff’s deep understanding of residents’ health conditions fostered comfort and trust, essential for RCC (Ploeg et al., 2013).

Collaboration and Teamwork

Effective collaboration and teamwork, founded on mutual trust, were essential for promoting relational care. Strong team relationships, family trust, and positive rapport with residents were crucial for shared decision-making and implementing a relational approach (Aveyard & Davies, 2006; Cranley et al., 2020). Goodman et al. (2015) and Sellevold et al. (2019) highlighted the importance of collaborative team efforts. Cultivating mutual respect between families and staff through meaningful interactions and effective feedback improved the care experience for residents and their families, particularly during end-of-life processes (Barken & Lowndes, 2018; Marquis et al., 2004).

Continuity of Care and Staffing Issues

Continuity of healthcare staff and the overall care team significantly facilitated positive relationships, improved coordination, and reduced staff turnover (Gordon et al., 2018; McGilton et al., 2003; Watson, 2019). Conversely, staff rotation policies disrupted relationships and strained interactions with families (Watson, 2019). Leadership played an instrumental role in prioritizing relational care, while a focus on safety protocols and paperwork led to more transactional relationships (Wilson, 2009). The COVID-19 pandemic further challenged the maintenance of relational care due to necessary safety measures, such as physical and social distancing (Dohmen et al., 2022; Rutten et al., 2022). Collaborative efforts between volunteers, such as families, and staff helped mitigate some of these challenges, including residents eating alone at mealtimes (Keller et al., 2021).

Insufficient staffing hindered the implementation of RCC in LTC settings, especially during mealtimes, reducing relational behaviors (Compton et al., 2022; Hradcová, 2017; Marquis et al., 2004; McGilton et al., 2012; Trinca et al., 2021; Wu et al., 2018). Staffing shortages negatively impacted communication and trust between care workers and management, contributing to caregiver fatigue and limiting meaningful interactions with residents (Banerjee et al., 2015; Dunn & Moore, 2016). Frequent staff turnover and low engagement discouraged residents from sharing personal stories and led to low family satisfaction regarding residents’ needs (Compton et al., 2022). Further, staff turnover reduced interactions among residents and family satisfaction, highlighting the importance of dedicated and consistent staff time for effective RCC (Compton et al., 2022; Goodman et al., 2015).

Challenges in Acknowledgement and Communication

When providing relational care, there were ongoing challenges in recognizing residents’ humanity and navigating ethical dilemmas among healthcare providers. McGilton et al. (2012) observed that staff behaviors were more relational with cooperative residents during activities such as morning care and mealtimes. However, residents with dementia who had limited verbal communication often experienced difficulties in being acknowledged as relational human beings (Heggestad et al., 2015; McGilton et al., 2012). This underscored the need for staff to possess strong communications skills, including those related to interactions with residents with dementia, to ensure all residents feel recognized and respected (Heggestad et al., 2015; Hradcová, 2017).

Healthcare providers often felt vulnerable when addressing ethical challenges in dementia care, hesitating to discuss these issues with colleagues due to fears of judgment, which negatively impacted their professional self-esteem (Sellevold et al., 2019). Additionally, providers with minority language backgrounds struggled with communication issues, leading to potential misunderstandings (Sellevold et al., 2019). Cultural differences in perspectives on elderly care also resulted in conflicts and tensions among providers (Sellevold et al., 2019).

Workload and Emotional Strain

Routine- and task-oriented environments, along with time constraints, presented significant obstacles to promoting relational care, often leading to neglected resident needs and dignity (Daly & Szebehely, 2012; Dunn & Moore, 2016; Heggestad et al., 2015; Jones & Moyle, 2016; Talbot & Brewer, 2016). These routine tasks often led to depersonalized care and job dissatisfaction due to their focus on efficiency, whereas an integrated model involving staff in a broad range of activities, including relational and domestic tasks, promoted a more holistic approach to LTC (Banerjee et al., 2015; Daly & Szebehely, 2012; Wilson & Davies, 2009). Additionally, high workloads, excessive paperwork, perceived lack of management support, and hierarchical care structures created power imbalances and tensions among care workers (Andersen & Spiers, 2016; Banerjee et al., 2015, 2021; Heggestad et al., 2015; Hradcová, 2017; Jones & Moyle, 2016; Walsh & Shutes, 2013). Care aides’ dual roles of balancing resident well-being and supporting professionals also contributed to work overload (Andersen & Spiers, 2016).

The emotional labor inherent in caregiving roles highlighted the complexity of balancing emotional demands with physical care needs and professional standards (Andersen & Spiers, 2016; Daly & Szebehely, 2012; Talbot & Brewer, 2016; Watson, 2019). Staff often felt stressed and dissatisfied due to unrealistic family demands (Andersen & Spiers, 2016; Dohmen et al., 2022; Jones & Moyle, 2016). Balancing residents’ preferences with biomedical care standards was a significant challenge (Dewar & MacBride, 2017; Dunn & Moore, 2016) that worsened during COVID-19, as staff enforced isolation measures, further increasing emotional distress (Dohmen et al., 2022).

Organizational and Environmental Challenges

Inadequate funding and policies often hindered the implementation of relational care, creating a challenging work environment and concerns about care quality (Banerjee et al., 2015; Daly & Szebehely, 2012; Marquis et al., 2004). Tensions within organizational documents in LTC settings complicated the implementation of relational care, highlighting conflicts between personalized care ideals and regulatory pressures (Venturato et al., 2013). Banerjee et al. (2015) and Hradcová (2017) underscored discrepancies between documented care practices and the real-life experiences of residents and care workers due to diverse interpretations of care across contexts and relationships.

The physical environment of care facilities significantly influenced relationships among residents, families, and staff. A homelike environment, with private areas for family interactions, fostered strong connections and overall satisfaction (Marquis et al., 2004; Wilson, 2009). In contrast, poor facility layout and a bustling environment disrupted care and hindered the implementation of RCC (Keller et al., 2021; Watson, 2019; Wilson, 2009). Additionally, technology offered opportunities to enhance care practices and improve resident well-being (Eyers et al., 2013).

Discussion

This scoping review examines current knowledge on RCC in LTC for older adults, identifying essential practices such as personalized engagement, empathy, and family involvement. Rooted in Nolan et al.'s (2004, 2006, 2008) Senses Framework and Dewar’s (2011) Caring Conversations framework, RCC emphasizes relational interactions to improve care quality and resident well-being. The Senses Framework’s six principles—Security, Continuity, Belonging, Purpose, Fulfillment, and Significance—underscore the importance of LTC environments that address residents’ physical, emotional, psychological, and social needs. Practices like honoring residents’ histories, building trust, and involving family in care decisions (Barken & Lowndes, 2018; Compton et al., 2022; Wilson et al., 2013) support these principles, especially Continuity, Belonging, and Security.

Our findings show that core RCC practices, such as preserving residents’ dignity and involving family, align with the Senses Framework and reinforce existing PCC research (Opperta et al., 2018; Schenell et al., 2020). The Caring Conversations framework further enhances RCC by fostering empathy, curiosity, and openness, transforming routine interactions into meaningful connections. However, structural issues in LTC—such as high staff turnover, regulatory constraints, and heavy workloads—often hinder the consistent application of these principles. These barriers limit staff engagement in relational practices, reducing RCC’s impact on resident well-being (Banerjee et al., 2021; Compton et al., 2022).

RCC has transformative impacts on resident well-being and family empowerment (Allison et al., 2019; Chamberlain et al., 2017), aligning with the Senses and Caring Conversations frameworks’ focus on inclusive, supportive environments. Research shows that meaningful relationships boost residents’ emotional well-being, improve care quality, and enhance family satisfaction (Hayward et al., 2022; Schenell et al., 2020; Sjögren et al., 2013). However, this review raises concerns about whether LTC environments consistently have the resources to fully support RCC. Family empowerment aligns with Belonging and Collaboration; however, limited resources and rigid protocols often hinder involvement, especially in institutionalized settings (Bhattacharyya et al., 2022; Söderman et al., 2018; Thompson et al., 2021). This highlights the need to assess the feasibility of implementing these frameworks in resource-limited LTC settings and to study potential adverse outcomes. While this review highlights RCC’s benefits, gaps remain in addressing potential adverse outcomes in LTC, warranting further study.

The pathways and roadblocks to implementing RCC underscore both its potential and the complexity of establishing meaningful relational care in LTC settings. The Senses Framework and the Caring Conversations framework highlight the importance of supportive leadership, continuity, empathy, and collaboration as foundational to RCC. However, our findings reveal a tension between these relational ideals and the practical challenges of LTC environments. While relational skills and compassionate attitudes are vital, without targeted organizational changes to support manageable workloads and sustainable practices, the transformative potential of RCC may remain aspirational (Compton et al., 2022).

The COVID-19 pandemic highlighted challenges in RCC as infection control measures often conflicted with the Senses of Belonging and Continuity, disrupting routines and restricting family visits, which weakened residents’ sense of security and connection (Iyamu et al., 2023). The LTC sector must balance infection control with RCC’s holistic principles to support resident well-being and relational care. This review, alongside prior research (Backman et al., 2021; du Toit et al., 2020; Rutten et al., 2021), underscores the importance of supportive leadership and stakeholder engagement in strengthening RCC, fostering resilience, and realizing the Senses and Caring Conversations ideals.

Grounding these findings in the Senses Framework and Caring Conversations illuminates both the promise and limitations of RCC in LTC. While these frameworks present a compelling vision for relationship-centered environments, they also highlight the need for practical policy and structural changes to make relational ideals achievable and sustainable within LTC settings.

Implications for Policy and Practice

The scoping review suggests key policy and practice implications based on broad findings. Comprehensive staff training can foster compassion, effective communication, and understanding of residents’ histories, enhancing reciprocal relationships (Compton et al., 2022; Heggestad et al., 2015). Policies promoting teamwork and family involvement may improve shared decision-making and create a homelike environment (Allison et al., 2019; Dewar et al., 2019). Lessons from COVID-19 can inform RCC improvements, such as technology use, refined staff rotation, and infection control (Eyers et al., 2013; Iyamu et al., 2023). Addressing systemic barriers in LTC can further enhance care outcomes and foster a collaborative environment for residents, families, and staff.

Limitations

The inclusion criteria focused on studies from Australia, Europe, New Zealand, and North America to enable a targeted analysis of regions with similar LTC systems (European Observatory on Health Systems and Policies, 2021; OECD, 2021). However, due to each country’s unique approach, findings should be interpreted cautiously. While including other regions would increase diversity, this review was limited to Western contexts, as addressing healthcare system heterogeneity was beyond its scope. Additionally, the absence of reported disadvantages of RCC in current literature limits a comprehensive assessment of its impact, highlighting a need for further research on potential drawbacks. Quality assessment was not conducted in line with the scoping review’s purpose to broadly map existing literature (Joanna Briggs Institute, 2020), a limitation that calls for cautious interpretation of policy and practice recommendations.

Future Research

Future research needs to engage diverse participants—residents, families, and healthcare providers—using varied methods to fully capture RCC practices and impacts (Compton et al., 2022; Cranley et al., 2020). Including diverse ethnic groups is essential for culturally sensitive and equitable RCC, as examining RCC across cultural contexts can reveal its adaptability, benefits, and challenges (Sellevold et al., 2019). Further research on potential adverse outcomes is also needed to understand RCC’s full impact across settings beyond LTC, such as ALFs and community-dwelling environments.

Conclusion

This scoping review examined RCC in LTC settings for older adults, highlighting core practices, transformative impacts, and implementation challenges. It reveals a growing body of evidence on RCC’s positive outcomes, alongside significant gaps regarding potential adverse effects and persistent barriers to implementation. Overall, this review offers a comprehensive foundation on RCC’s key elements, benefits, and challenges, providing valuable insights for future research and practice to improve care experiences.

ORCID iD

Shreemouna Gurung https://orcid.org/0000-0002-5121-993X