scholarly journals Barriers to a Timely Discharge From Short-Term Care in VA Community Living Centers

2019 ◽  
Vol 32 (2) ◽  
pp. 141-156
Author(s):  
Denise A. Tyler ◽  
Renée R. Shield ◽  
Jill Harrison ◽  
Whitney L. Mills ◽  
Kristen E. Morgan ◽  
...  
Keyword(s):  
Community Living ◽  
Short Term ◽  
Term Care ◽  
Community Living Centers

scholarly journals Distress Behavior Conversations: Supporting Whole Person Whole Team Responses in VA Community Living Centers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 854-854
Author(s):  
Julia Loup ◽  
Kate Smith ◽  
Susan Wehry ◽  
Sharon Sloup ◽  
Jennie Keleher ◽  
...  
Keyword(s):  
Personal Information ◽  
Unmet Need ◽  
Medical Model ◽  
Action Planning ◽  
Collaborative Problem Solving ◽  
Community Living ◽  
Team Approach ◽  
Term Care ◽  
Whole Person ◽  
Community Living Centers

Abstract Resident distress behavior, a prevalent challenge in long-term care, contributes to resident morbidity, staff burden, and turnover. We describe an education model developed in the Veterans Administration (VA) Community Living Centers (CLC) through a CONCERT (VA CLCs’ Ongoing Center for Enhancing Resources & Training) quality improvement series. The Distress Behavior Conversation (DBC) uses a team meeting structure and process. Informed by unmet need and relational coordination theories, it guides the whole team, inclusive of interdisciplinary team members and front-line staff with resident contact, through a collaborative problem-solving action-planning discussion. DBC uses facilitated round-robins to identify potential resident behavior causes and individualized solutions. DBC supports the team in maintaining whole person and whole team mindsets, thus challenging the narrower medical model of discipline-specific clinical mindsets and staff level hierarchies. Over two years we have co-created and refined DBC through trainings and team debriefings with over 80 CLCs. Care teams reported “aha” moments during DBCs their thinking shifted (“we are now looking at the REAL why”; “we went from asking, how did he fall? to, why did he fall?; “tended to try to treat falls in a standardized way, [but] when you focus on a specific person you get to focus on HIS needs”; “personal information about the Veteran is the 5th vital sign!”). Teams additionally reported reduced strain and improved collaborative thinking (“I feel better about what I’m doing...more motivated to keep going!; “Now I see it is a team approach – don’t have to do it by myself.”).

scholarly journals 2012. Trends in Microbiological Culture Collection Across Veterans Affairs Medical Centers and Community Living Centers, 2010 to 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S675-S675
Author(s):  
Haley Appaneal ◽  
Aisling Caffrey ◽  
Stephanie Hughes ◽  
Vrishali Lopes ◽  
Robin L Jump ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Culture Collection ◽  
Veterans Affairs ◽  
Community Living ◽  
Term Care ◽  
Medical Centers ◽  
Community Living Centers ◽  
Veterans Affairs Medical Centers ◽  
Tract Infections ◽  
Over Time

Abstract Background Microbiological cultures are critical in the diagnosis of infection, identification of pathogenic organisms, and tailoring antibiotic use. However, unnecessary collection of cultures, particularly from the urine, may lead to overuse of antibiotics. There have been no national studies to evaluate trends in the collection of cultures in acute and long-term care settings. Here we describe changes in the collection of cultures nationally across Veterans Affairs medical centers (VAMCs) and Community Living Centers (CLCs). Methods All positive and negative cultures collected from 2010 to 2017 among Veterans admitted to VAMCs or CLCs were included. Cultures were categorized by specimen source (urine, blood, skin and soft tissue, or lung). Joinpoint software was used for regression analyses of trends over time and to estimate annual average percent changes with 95% confidence intervals (CI). Results A total of 5,089,640 cultures from 158 VAMCS and 342,850 cultures from 146 CLCs were identified. The number of cultures collected for all culture types in VAMCs and CLCs decreased significantly. The number of cultures collected per admission decreased significantly by 5.5% annually among VAMCs (95% CI −7.0 to −4.0%) and by 8.4% annually among CLCs (95% CI −10.1 to −6.6%). The proportion of positive cultures decreased 1.6% annually among VAMCs (95% CI −2.3 to −0.9%) and remained stable among CLCs (-0.4% annually, 95% CI, −1.1 to 0.4%). The most common culture source among VAMCs was blood (36.2%), followed by urine (31.8%), and among CLCs was urine (56.9%), followed by blood (16.0%). Urine cultures decreased by 4.5% annually among VAMCs (95% CI −5.4 to −3.6%) and 7.0% annually among CLCs (95% CI −7.6 to −6.4%). Conclusion Our study demonstrates a significant reduction in the number of cultures collected over time. Positive cultures decreased significantly in VAMCs, possibly indicating fewer culture-positive infections.In both VAMCs and CLCs, decreases in cultures taken may represent an important reduction in the collection of unnecessary cultures nationally driven by increased awareness about over-testing and over-treatment of presumed infection, particularly urinary tract infections. Disclosures All authors: No reported disclosures.

scholarly journals Change in VA Community Living Centers 2004–2011: Shifting Long-Term Care to the Community

2018 ◽  
Vol 30 (2) ◽  
pp. 93-108 ◽  
Author(s):  
Kali S. Thomas ◽  
Danielle Cote ◽  
Rajesh Makineni ◽  
Orna Intrator ◽  
Bruce Kinosian ◽  
...  
Keyword(s):  
Long Term Care ◽  
Community Living ◽  
Term Care ◽  
Community Living Centers

Implementing a cornerstone of culture change: Consistent staff assignment in VHA community living centers.

2017 ◽  
Vol 14 (3) ◽  
pp. 327-336 ◽  
Author(s):  
Sonne Lemke ◽  
Penny L. Brennan ◽  
Sonya SooHoo ◽  
Kathleen K. Schutte
Keyword(s):  
Culture Change ◽  
Community Living ◽  
Staff Assignment ◽  
Community Living Centers

Community Care in Camberwell

1984 ◽  
Vol 145 (2) ◽  
pp. 178-186 ◽  
Author(s):  
Elizabeth Sturt
Keyword(s):  
Patient Care ◽  
Residential Care ◽  
Day Care ◽  
Community Care ◽  
Important Determinant ◽  
First Year ◽  
Short Term ◽  
Term Care ◽  
Residential Services ◽  
History Of

SummaryA census was taken of all patients in psychiatric hostels and homes, psychiatric day care, and short-term in-patient care who also had at least one year's history of contact with services. During the following two years, 61% of the patients stayed continuously in day or residential care, while 17% were discharged from care within the first year and made no further use of day or residential services. Two main patterns of contact were evident–repeated short-term in-patient care or longer-term care in services outside hospital. Their most important determinant was whether a viable marriage still existed for the patient.

scholarly journals Predicting Incidence of Long-term Care Insurance Certification in Japan with the Kihon Checklist for Frailty Screening Tool: Analysis of Local Government Survey Data

2020 ◽  
Author(s):  
Kumiko Ito ◽  
Hisashi Kawai ◽  
Harukazu Tsuruta ◽  
Shuichi Obuchi
Keyword(s):  
Logistic Regression ◽  
Local Government ◽  
Long Term Care ◽  
Multiple Logistic Regression ◽  
Short Term ◽  
Term Care ◽  
Specificity And Sensitivity ◽  
Long Term Care Insurance ◽  
Level 1

Abstract Background: Predicting incidence of long-term care insurance (LTCI) certification in the short term is of increasing importance in Japan. The present study examined whether the Kihon Checklist (KCL) can be used to predict incidence of LTCI certification (care level 1 or higher) in the short term among older Japanese persons.Methods: In 2015, the local government in Tokyo, Japan, distributed the KCL to all individuals older than 65 years who had not been certified as having a disability or who had already been certified as requiring support level 1–2 according to LTCI system. We also collected LTCI certification data within the 3 months after collecting the KCL data. The data of 17785 respondents were analyzed. First, we selected KCL items strongly associated with incidence of LTCI certification, using stepwise forward-selection multiple logistic regression. Second, we conducted receiver operating characteristic (ROC) analyses for three conditions (1: Selected KCL items, 2: The main 20 KCL items (nos. 1–20), 3: All 25 KCL items). Third, we estimated specificity and sensitivity for each condition.Results: During a 3-month follow-up, 81 (0.5%) individuals required new LTCI certification. Eight KCL items were selected by multiple logistic regression as predictive of certification. The area under the ROC curve in the three conditions was 0.92–0.93, and specificity and sensitivity for all conditions were greater than 80%.Conclusions: Three KCL conditions predicted short-term incidence of LTCI certification. This suggests that KCL items may be used to screen for the risk of incident LTCI certification.

scholarly journals Psychiatric intensive care and low secure units: where are we now?

2008 ◽  
Vol 32 (12) ◽  
pp. 441-443 ◽  
Author(s):  
M. Dominic Beer
Keyword(s):  
Mental Health ◽  
Intensive Care ◽  
Health Services ◽  
Intensive Care Units ◽  
Short Term ◽  
Term Care ◽  
Policy Makers ◽  
General Mental Health ◽  
Department Of Health ◽  
Patient Groups

SummaryThe last decade has seen clinicians and policy makers develop psychiatric intensive care units and low secure units from the so-called ‘special care wards’ of the 1980s and 1990s. Psychiatric intensive care units are for short-term care, while low secure units are for care for up to about 2 years. Department of Health standards have been set for these units. A national survey has shown that there are two main patient groups in the low secure units: patients on forensic sections coming down from medium secure units and those on civil sections who are transferred from general psychiatric facilities. Recent clinical opinion has emphasised the important role both psychiatric intensive care units and low secure units play in providing a bridge between forensic and general mental health services.

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