The Physical and Social Environments of Small Rural Nursing Homes: Assessing Supportiveness for Residents with Dementia

2003 ◽  
Vol 22 (3) ◽  
pp. 283-296 ◽  
Author(s):  
Debra G. Morgan ◽  
Karen M. Semchuk ◽  
Norma J. Stewart ◽  
Carl D'Arcy
Keyword(s):  
Nursing Homes ◽  
Institutional Care ◽  
Nursing Home Residents ◽  
Dementia Care ◽  
Physical Factors ◽  
Social Environments ◽  
Assessment Protocol ◽  
Rural Nursing ◽  
Key Dimensions ◽  
Therapeutic Tools

ABSTRACTThe physical and social environments are recognized as important therapeutic tools in the care of nursing home residents with dementia, yet little is known about the environments of rural nursing homes. This study was conducted in one rural health authority (16,000 km 2) in the province of Saskatchewan. Long-term institutional care was provided in seven small (15 to 35 beds), publicly funded nursing homes, none of which had separate dementia special care units (SCUs). The Physical Environmental Assessment Protocol (PEAP) was used to evaluate the facilities on nine key dimensions of dementia care environments. Facilities were most supportive in provision of privacy and least supportive on maximizing awareness and orientation. Focus groups were conducted with registered nurses, nursing aides, and activity workers. Staff caregivers identified six special needs of residents with dementia that were difficult to meet in the nursing homes, two of which were related to the physical environment (safety and a calm, quiet environment) and four of which were related to the social environment (meaningful activity and one-to-one contact, opportunity to use remaining abilities, flexible policy, and knowledgeable caregivers who enjoy working with persons with dementia). Staff suggested separate dementia SCUs as one approach to managing dementia care but also identified challenges in creating dementia units in small rural facilities. Results provide support for conceptual models of dementia care settings that emphasize the interaction of organizational, social, and physical factors.

“Medication Is Just One Piece of the Whole Puzzle”: How Nursing Homes Change Their Use of Antipsychotic Medications

2020 ◽  
pp. 073346482095891
Author(s):  
Marsha Rosenthal ◽  
Jessica Poling ◽  
Aleksandra Wec ◽  
Elizabeth Connolly ◽  
Beth Angell ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Research Policy ◽  
Nursing Home Residents ◽  
Dementia Care ◽  
Policy And Practice ◽  
Antipsychotic Medications ◽  
Positive Attitudes ◽  
National Partnership ◽  
Person Centered Approach

Antipsychotic medication use for nursing home residents with dementia poses major patient safety challenges. This article investigates health professionals’ experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes (National Partnership) and its companion state coalitions. These programs were introduced in 2012 to encourage reductions in antipsychotic use and increased use of nonpharmacological treatments for dementia. Interviews with 40 nursing home physicians and staff in seven states found that reducing antipsychotics is more time and resource-intensive than relying on medication, because it requires a person-centered approach. However, respondents supported reductions in antipsychotic use, and indicated that with sufficient staffing, effective communications, and training, they could create or implement individualized treatments. Their positive attitudes suggest that the National Partnership has been a catalyst in reducing antipsychotic medications, and their perspectives can inform further research, policy and practice in nursing homes toward achieving quality dementia care.

Measuring Relational Care in Nursing Homes: Psychometric Evaluation of the Relational Care Scale

2015 ◽  
Vol 23 (1) ◽  
pp. 82-95 ◽  
Author(s):  
Elizabeth Andersen ◽  
Farinaz Havaei
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Convergent Validity ◽  
Discriminant Validity ◽  
Nursing Home Residents ◽  
Reliability And Validity ◽  
Psychometric Evaluation ◽  
Rural Nursing ◽  
Care Aides ◽  
Relational Care

Background and Purpose: The Relational Care Scale (RCS) is a Canadian evaluative instrument designed to measure nursing home residents’ perceptions of care aides’ relational abilities. Care aides’ abilities to be reliable and empathetic with nursing home residents are very important determinants of quality of care, but few instruments are designed specifically for residents or focus exclusively on these determinants. Initially developed and tested in metropolitan teaching-affiliated nursing homes in Ontario, we expanded testing by reevaluating the psychometric properties of the RCS in 5 rural nursing homes in British Columbia. Method: There were 62 residents living in 5 rural nursing homes who completed 3 instruments: the RCS under investigation, the Experiences in Close Relationships-Relationship Structures (ECR-RS) questionnaire to test for convergent validity, and the Lubben Social Network Scale-6 (LSNS-6) to test for discriminant validity. Results: The reliability of the RCS was strongly supported (Cronbach’s alpha = .90, item–total correlation > .77). Consistent with previous testing, a unidimensional internal structure was extracted. A moderate to strong correlation between the RCS and the Anxiety and Avoidance subscales of the ECR-RS supported convergent validity of the instrument. Last, partial support was obtained for the discriminant validity of the RCS. Conclusions: The RCS was easy to use for both residents and researchers. Expanded testing demonstrated its recurring reliability and validity.

scholarly journals ‘All We Have to Decide Is What to Do with the Time That Is Given to Us’ A Photovoice Study on Physical Activity in Nursing Homes

2021 ◽  
Vol 18 (10) ◽  
pp. 5481
Author(s):  
Dorothée Altmeier ◽  
Ansgar Thiel ◽  
Annika Frahsa
Keyword(s):  
Physical Activity ◽  
Nursing Homes ◽  
Thematic Analysis ◽  
Physical Inactivity ◽  
Nursing Home Residents ◽  
Social Environments ◽  
Daily Work ◽  
Stakeholder Groups ◽  
Social Incentives ◽  
High Prevalence

(1) Background: Despite high prevalence of physical inactivity and sedentariness among nursing home residents, research on the influence of environments on this topic remains scarce. This Photovoice study explores how structural and social environments relate to residents’ everyday physical activity (PA). (2) Methods: 27 residents, staff, and significant others conducted Photovoice in eight nursing homes in Germany to document factors facilitating or hindering PA. Photographs were discussed with the participants in eight focus groups and analysed using thematic analysis. (3) Results: 169 photographs (between 8 and 42per home) were categorized into three thematic groups: (1) ‘architectural challenges for PA promotion in nursing homes’; (2) ‘opportunities and limitations of using daily work equipment for PA promotion’; (3) ‘social incentives for PA promotion’. Photographs’ foci in the homes differed considerably between participant groups. Staff primarily chose environmental constructions and aids that they perceived to enable residents’ PA. Residents were more likely to express affections and emotions that would encourage them to be active. (4) Conclusions: PA promotion research in this setting should be sensitive to diverse perceptions of different stakeholder groups and existing power imbalances. Interventions are needed that integrate residents’ needs and train staff on how to consider residents’ perspectives.

scholarly journals Pneumonia in Indiana nursing homes: a retrospective case series

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Andrew Shearn ◽  
Kathleen Unroe, MD, MHA ◽  
Jennifer Carnahan, MD, MPH, MA
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Institutional Care ◽  
Case Series ◽  
Nursing Home Residents ◽  
The Elderly ◽  
Nursing Facilities ◽  
Retrospective Case ◽  
Avoidable Hospitalizations ◽  
Medical Quality

Background  The Optimizing Patient Transfers, Impacting Medical Quality, & Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project is a Centers for Medicare and Medicaid (CMS) demonstration project, tasked with reducing potentially avoidable hospitalizations of nursing home residents. OPTIMISTIC-enrolled nursing homes are reimbursed by CMS for treating residents with pneumonia in place. The purpose of this study is to examine the diagnosis, treatment, and outcomes of episodes of pneumonia in OPTIMISTIC nursing homes.  Project Methods  This case series uses data from nursing home medical records of the seven facilities with the highest pneumonia caseload identified from the OPTIMISTIC database. Cases are from billing episodes spanning November 2017 through April 2018. Within each facility, cases of pneumonia were randomly selected for inclusion. Data were entered into an extraction tool designed by the study team.  Results  Data were extracted from 41 records of unique patients. Despite CMS reimbursing for a maximum of 7 days for treatment of pneumonia, 78.0% of patients were monitored beyond that time and with greater attention than usual care. Of all 41 patients treated with antibiotics, 53.7% were given a fluoroquinolone and 24.4% were given amoxicillin/clavulanate.  CURB-65 scores showed 58.3% scored in a range recommending hospitalization. Most patients (87.8%) were stabilized in the nursing home; three (7.3%) were hospitalized, one (2.4%) transferred to hospice, and one (2.4%) died.  Conclusion and Potential Impact  OPTIMISTIC-affiliated nursing facilities successfully provide enhanced care for most patients diagnosed with pneumonia in the facilities. Given the high incidence of fluoroquinolone use, one area for improvement is reduction of this medication contraindicated in the elderly.

Examining the Effectiveness of Traditional Audiological Assessments for Nursing Home Residents with Dementia-Related Behaviors

2009 ◽  
Vol 20 (09) ◽  
pp. 529-538 ◽  
Author(s):  
Carmen L. Burkhalter ◽  
Rebecca S. Allen ◽  
Denell C. Skaar ◽  
Jessica Crittenden ◽  
Louis D. Burgio
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Demographic Data ◽  
Descriptive Analysis ◽  
Nursing Home Residents ◽  
Testing Procedures ◽  
Assessment Protocol ◽  
Hearing Assessment ◽  
Assessment Procedures

Background: It is currently estimated that the resident population of individuals over the age of 65 living in nursing homes will double by 2020. Nearly one-third of all nursing home residents have difficulty seeing or hearing, 46% have some form of dementia, and 30–84% of those with dementia in nursing homes show some form of agitation. Nursing home residents who do not receive appropriate audiological services may experience social isolation, cognitive decline and decreased mobility. Purpose: To examine the effectiveness of standard audiological testing procedures for nursing home residents and to discuss the purpose of adapting assessment procedures that can lead to more effective audiological assessments for this population. Research Design: A retrospective chart analyses. A 33-item coding form was used to complete descriptive analysis of original audiological data and demographic data for 307 nursing home residents for a study to examine the effects of auditory stimulation on dementia-related behavior problems exhibited by nursing home residents through audiotape exposure to environmental sounds or soothing voice. Results: Although 77% (n = 235) of the 307 residents were considered compliant for the testing process and 74% (n = 288) tolerated putting on headphones, audiological assessment using air conduction testing could be completed in both ears on 32% (n = 100) of the residents. In fact, only 5% (n = 16) of the 307 residents were able to complete a full traditional audiometric assessment protocol. Conclusions: Proper identification of hearing impairment through effective and appropriate audiological assessment is crucial for preserving and enhancing quality-of-life in nursing home residents. This study served as an introduction to the problem of using traditional behavioral testing for hearing assessment of nursing home residents. Much work needs to be done to establish best practices for audiometric assessment in this population.

The effect of the implementation of a good medical practice booklet on nursing home residents’ drug prescriptions: a difference-in-differences analysis based on data from electronic pill dispensers (Preprint)

2019 ◽  
Author(s):  
Stéphane Sanchez ◽  
Cécile Payet ◽  
Marie Herr ◽  
Anne Dazinieras ◽  
Caroline Blochet ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Medical Practice ◽  
Intervention Group ◽  
Medication Use ◽  
Nursing Home Residents ◽  
Control Group ◽  
Multilevel Regression ◽  
Difference In Differences ◽  
Good Medical Practice ◽  
The Impact

BACKGROUND The elderly are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. OBJECTIVE We aimed to evaluate the impact of the implementation of a good medical practice booklet on polypharmacy in nursing homes. METHODS We identified nursing homes belonging to a geriatric care provider that had launched a policy of proper medication use using a good medical practice booklet delivered to prescribers and pharmacists. Data were derived from electronic pill dispensers. The effect of the intervention on polypharmacy was assessed with multilevel regression models, with a control group to account for natural trends over time. The main outcomes were the average daily number of times when medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (-0.05 and -0.06). The good medical practice booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P=.45). CONCLUSIONS Although the good medical practice booklet itself did not seem effective in decreasing medication use, our data show the effectiveness of a higher-level policy to decrease polypharmacy.

scholarly journals Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092879
Author(s):  
Katarina Fehir Šola ◽  
Iva Mucalo ◽  
Andrea Brajković ◽  
Ivona Jukić ◽  
Donatella Verbanac ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Therapy ◽  
Medication Management ◽  
Institutional Care ◽  
Nursing Home Residents ◽  
Median Number ◽  
Cross Sectional ◽  
High Prevalence ◽  
Care Facilities ◽  
Drug Therapy Problems

Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.

scholarly journals A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

2021 ◽  
pp. 1-13
Author(s):  
Julie L. O’Sullivan ◽  
Sonia Lech ◽  
Paul Gellert ◽  
Ulrike Grittner ◽  
Jan-Niklas Voigt-Antons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Psychotropic Medication ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Design: Cluster-randomized controlled trial. Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI −3.54, 2.33 for TBI and .36 points, 95% CI −3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

scholarly journals Reducing Loneliness in Stationary Geriatric Care with Robots and Virtual Encounters—A Contribution to the COVID-19 Pandemic

2021 ◽  
Vol 18 (9) ◽  
pp. 4846
Author(s):  
Andreas Follmann ◽  
Franziska Schollemann ◽  
Andrea Arnolds ◽  
Pauline Weismann ◽  
Thea Laurentius ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Social Isolation ◽  
Nursing Home Residents ◽  
Phone Call ◽  
Observational Trial ◽  
General Acceptance ◽  
Frequency Of Use ◽  
Geriatric Hospital ◽  
Hospital Patients ◽  
The Subject

The bans on visiting nursing homes during the COVID-19 pandemic, while intended to protect residents, also have the risk of increasing the loneliness and social isolation that already existed among the older generations before the pandemic. To combat loneliness and social isolation in nursing homes, this trial presents a study during which social networks of nursing home residents and elderly hospital patients were maintained through virtual encounters and robots, respectively. The observational trial included volunteers who were either residents of nursing homes or patients in a geriatric hospital. Each volunteer was asked to fill in a questionnaire containing three questions to measure loneliness. The questionnaire also documented whether video telephony via the robot, an alternative contact option (for example, a phone call), or no contact with relatives had taken place. The aim was to work out the general acceptance and the benefits of virtual encounters using robots for different roles (users, relatives, nursing staff, facilities). Seventy volunteers with three possible interventions (non-contact, virtual encounters by means of a robot, and any other contact) took part in this trial. The frequency of use of the robot increased steadily over the course of the study, and it was regularly used in all facilities during the weeks of visitor bans (n = 134 times). In the hospital, loneliness decreased significantly among patients for whom the robot was used to provide contact (F(1,25) = 7.783, p = 0.01). In the nursing homes, no demonstrable effect could be achieved in this way, although the subject feedback from the users was consistently positive.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

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