Our Projects

TREC Measurement System TREC Measurement System

TMS is TREC’s major platform project and research technology. It looks at influences on quality of resident care and life, using data from residents and all levels of staff. Participating nursing homes play a key role in building this first longitudinal database of its kind in Canada or elsewhere.


In the INFORM trial the team is evaluating approaches to accelerating the use of TREC research findings to influence an organization’s context (work environment) by feeding results back to nursing home managers —and finding the most efficient way to feed these and other findings back to managers.

trec-research-scope.png SCOPE

SCOPE is improving safety and quality of care for nursing home residents by developing and supporting care aides as leaders of unit-based quality improvement initiatives and their senior leaders to support such efforts.

Advice Seeking Networks in Long Term Care Advice Seeking Networks

The Advice Seeking Networks in Long Term Care project identifies informal opinion leaders and nursing homes who are key to successful spread of operational initiatives, innovation and the implementation of health new knowledge.

trec-research-salty-stream-1.png SALTY Stream 1

SALTY Stream 1 aims to develop an approach that enables researchers, policy makers and care facilities to validly and reliably measure quality of end of life care in nursing homes on an ongoing basis.

trec-research-system-projects.png Symptom Burden

This project aims to describe trajectories of burdensome symptoms in nursing home residents in the last year of life, and examine links between symptom burden and modifiable features of work environments.


What we Study

Burnout among care aides

We examine predictors of burnout in care aides. Does staff burnout influence resident outcomes?

Health of healthcare aides

We examine the physical and mental health of care aides. Does the workplace influence health? Are these health measures linked to modifiable resident outcomes, such as pain, behavioural problems, depression or use of physical restraints?

Resident Length of Stay

We examine how long residents live in nursing homes. Has this changed over time? How does it vary between different health regions? This project is also an opportunity to explore the effects of policies that aim to keep older adults living in the community longer.


We determine pain trajectories of residents six months before death. Understanding the extent of pain as residents near end-of-life is the first step toward solving it. Next steps are focusing on best practices in managing pain once it is identified.

Responsive Behaviours of Persons or Residents with Dementia

We examining aspects of nursing home work environments that contribute to aggressive behaviours among residents.

Varying Clinical Profiles of Residents by Region

We investigate effects of different numbers of nursing home beds per capita in each province. Are differences associated with clinical complexity of newly admitted residents and consequences of varying admission practices?

Regulated Staff

Analyzing demographic characteristics and health and work-related outcomes for regulated staff (nurses, occupational therapists, physiotherapists, etc.) in Western Canadian nursing homes.

Assessing Work Environment (Context)

Using our Alberta Context Tool allows us to assess nursing home work environment at the unit and facility level. How does context relate to quality of resident care and quality of work life for staff?

Research Approach

TREC approaches improving the lives of nursing home residents from multiple directions:

  • strategies to improve quality of care and quality of end of life care
  • strategies to enrich the daily lives of residents
  • strategies to improve quality of work life for staff
  • strategies to assist managers, administrators, owners and policy makers with evidence-informed decision-making

Many TREC research studies identify specific targets that could yield significant improvements from relatively small changes at ground zero—directly for residents and the staff who care for them. Other studies target strategies to spread innovative and effective practices throughout the nursing home sector.



Platform Technology

The platform for all TREC’s work is the longitudinal TREC Measurement System (TMS). The TMS has matured into a research technology that has been collecting resident, staff, care unit and facility data for 10 years now. It contains standardized observations on resident clinical and functional outcomes. In addition, it includes data on factors that influence their quality of care and quality of life and end of life. The TMS also captures data on characteristics of the front line workforce including indicators of health, and quality of work life for staff, gathered regularly through surveys and interviews. TMS data are from residents and all levels of staff in nearly 100 participating nursing homes in British Columbia, Alberta and Manitoba (and previously Saskatchewan).

From this TMS platform, TREC researchers develop and carry out smaller, short-term projects to create change on many fronts.

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