scholarly journals Culture Change and Quality Star Ratings in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 679-679
Author(s):  
Latarsha Chisholm ◽  
Akbar Ghiasi ◽  
Justin Lord ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Culture Change ◽  
Ethnic Disparities ◽  
Change Initiatives ◽  
Term Care ◽  
Star Rating ◽  
Nursing Home Quality ◽  
Literature Culture ◽  
One Year

Abstract Racial/ethnic disparities have been well documented in long-term care literature. Culture change is a movement to transition nursing homes to more home-like environments to improve the quality of care for all residents. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid facilities. The final model consisted of an ordinal logistic regression. High-Medicaid nursing homes with six or more years in culture change initiatives had higher odds of having a higher star rating, while facilities with one year or less had significantly lower odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

scholarly journals Culture Change Initiatives in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Latarsha Chisholm ◽  
Akbar Ghiasi ◽  
Justin Lord ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Culture Change ◽  
Fixed Effects ◽  
Ethnic Disparities ◽  
State Level ◽  
Change Initiatives ◽  
Term Care ◽  
Star Rating ◽  
Racial Ethnic

Abstract Racial/ethnic disparities have been well documented in long-term care literature. As the population ages and becomes more diverse over time, it is essential to identify mechanisms that may eliminate or mitigate racial/ethnic disparities. Culture change is a movement to transition nursing homes to more home-like environments. The literature on culture change initiatives and quality has been mixed, with little to no literature on the use of culture change initiatives in high Medicaid nursing homes and quality. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid (85% or higher) nursing homes. The outcome of interest was the overall nursing home star rating obtained from the Nursing Home Compare Five-Star Quality Rating System. The primary independent variable of interest was the years of involvement in culture change initiatives among nursing homes, which was obtained from the nursing home administrator survey. The final model consisted of an ordinal logistic regression with state-level fixed effects. High-Medicaid nursing homes with six or more years in culture change initiatives had higher odds of having a higher star rating, while facilities with one year or less had significantly lower odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

scholarly journals High-Minority Nursing Homes Disproportionately Affected by COVID-19 Deaths

2021 ◽  
Vol 9 ◽  
Author(s):  
Robert Weech-Maldonado ◽  
Justin Lord ◽  
Ganisher Davlyatov ◽  
Akbar Ghiasi ◽  
Gregory Orewa
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Ethnic Disparities ◽  
Nursing Facilities ◽  
Term Care ◽  
The Face ◽  
Facility Level ◽  
The Relationship ◽  
Racial Ethnic

Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Using the Centers for Medicare and Medicaid Services' Nursing Home COVID-19 Public File, this study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths [Incidence Rate Ratio (IRR) = 1.61; p < 0.001] as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.

scholarly journals When Is a Nursing Home Complaint Really a Complaint? Making Sense Out of Increased Complaints in U.S. Nursing Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 852-853
Author(s):  
Xiao Qiu ◽  
Jane Straker ◽  
Katherine Abbott
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Urban Areas ◽  
Family Satisfaction ◽  
Term Care ◽  
Making Sense ◽  
Nurse Aide ◽  
Nursing Home Quality ◽  
Director Of Nursing ◽  
Occupancy Rates

Abstract Official complaints are one tool for addressing nursing home quality concerns in a timely manner. Similar to trends nationwide, the Ohio Department of Health (ODH) has noticed a trend in increasing nursing home complaints and has partnered with the Scripps Gerontology Center to learn more about facilities that receive complaints. Greater understanding may lead to proactive approaches to addressing and preventing issues. This study relies on two years of statewide Ohio nursing home complaint data. Between 2018 and 2019, the average complaint rate per 100 residents went from 6.59 to 7.06, with more than 70% of complaints unsubstantiated. Complaint information from 629 Ohio nursing homes in 2018 was linked with Centers for Medicare and Medicaid Services Nursing Home Compare data, the Ohio Biennial Survey of Long-Term Care Facilities, and Ohio Nursing Home Resident and Family Satisfaction Surveys. Using ordered logistic regression analyses, we investigated nursing home providers' characteristics using different levels of complaints and substantiated complaints. Findings suggest that providers with higher complaint rates are located in urban areas, had administrator and/or director of nursing (DON) turnover in the previous 3 years, experienced decreased occupancy rates, had reduced nurse aide retention, and received lower family satisfaction scores. Additionally, providers with administrator and/or DON turnover, and low family satisfaction scores are more likely to have substantiated complaints. Because increasing numbers of complaints are accompanied by relatively low substantiation rates, policy interventions targeted to specific types of providers may improve the cost-effectiveness of complaint resolution, as well as the quality of care.

scholarly journals Risk of Death Scale: A Death Prediction Model Based on US Nursing Home Admissions in 2011 and 2012

2019 ◽  
Author(s):  
John N Morris ◽  
Elizabeth Howard ◽  
Sabrina Egge ◽  
Erez Schachter ◽  
Fredrik Sjostrand
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Nursing Homes ◽  
Clinical Status ◽  
Cognitive Status ◽  
Term Care ◽  
Death Rates ◽  
Risk Of Death ◽  
National Cohort ◽  
One Year

Abstract Background : Care planning has become more complex as nursing homes now are serving an ever more complex patient population. The primary purpose of this project is to identify, among persons admitted to and remaining up to 12 months, in a long-term care setting, those at more imminent risk of death, revealing the relevant risk factors and summarizing these factors within a Risk of Death Scale. Design : Longitudinal analysis of a national cohort of nursing home admissions from all United States facilities during years 2011 and 2012. Setting and Participants : Cohort included 1,536,842 admissions (764,002 for 2011, 772,840 for 2012). Repeated assessments are required every 90 days, with an additional assessment at discharge. Follow-up data over three years were examined. Methods : The Risk of Death Scale is based on two sub-scales. One included five very high risk of death measures. The second was composed of an additional eighteen risk factors. The dependent variable against which these models were developed was death by 365 days. Death rates are described from one-month post-admission to three years post-admission. Results : The Risk of Death Scale has twelve graded levels. The lowest four categories of the scale (0-3) represent approximately half the cohort and have one-year death rates that range from 3% to 15.5%, whereas the mean of the whole cohort is 24.2% at one year. The top four categories represent about 7% of the cohort and have one-year death rates ranging from 55.8% to 90.5%. The death rates increased steadily across the scale scores, a pattern that held through the three-year post admission period. Conclusions/Implications : The Risk of Death Scale for new admissions to nursing homes rests on a broad spectrum of 23 independent variables – including measures of prognosis, treatments, diagnoses, clinical status, function, cognitive status, and age. Almost 10% of the sample (n=149,073) had a risk score of 7 or greater and the average one-year mortality for this group was 68.6% (range of 47.5-90.5%).

Quality in Nursing Homes

2019 ◽  
Author(s):  
Matteo Lippi Bruni ◽  
Irene Mammi ◽  
Rossella Verzulli
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Developed Countries ◽  
Poor Quality ◽  
Nursing Home Care ◽  
Future Research ◽  
Term Care ◽  
Nursing Home Quality ◽  
Wide Range ◽  
The Impact

In developed countries, the role of public authorities as financing bodies and regulators of the long-term care sector is pervasive and calls for well-planned and informed policy actions. Poor quality in nursing homes has been a recurrent concern at least since the 1980s and has triggered a heated policy and scholarly debate. The economic literature on nursing home quality has thoroughly investigated the impact of regulatory interventions and of market characteristics on an array of input-, process-, and outcome-based quality measures. Most existing studies refer to the U.S. context, even though important insights can be drawn also from the smaller set of works that covers European countries. The major contribution of health economics to the empirical analysis of the nursing home industry is represented by the introduction of important methodological advances applying rigorous policy evaluation techniques with the purpose of properly identifying the causal effects of interest. In addition, the increased availability of rich datasets covering either process or outcome measures has allowed to investigate changes in nursing home quality properly accounting for its multidimensional features. The use of up-to-date econometric methods that, in most cases, exploit policy shocks and longitudinal data has given researchers the possibility to achieve a causal identification and an accurate quantification of the impact of a wide range of policy initiatives, including the introduction of nurse staffing thresholds, price regulation, and public reporting of quality indicators. This has helped to counteract part of the contradictory evidence highlighted by the strand of works based on more descriptive evidence. Possible lines for future research can be identified in further exploration of the consequences of policy interventions in terms of equity and accessibility to nursing home care.

scholarly journals An Ecological Analysis of Quality Ratings and Inspections Associated with COVID-19 Outbreaks in Skilled Nursing Homes

2021 ◽  
pp. 1-6
Author(s):  
M.D. Simon ◽  
S.D. Meshkat ◽  
N. Raja
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Demographic Data ◽  
The United States ◽  
Term Care ◽  
Skilled Nursing ◽  
Health Inspection ◽  
Quality Ratings ◽  
Nursing Home Quality ◽  
Skilled Nursing Homes

Objectives: As COVID-19 spread across the United States, and most rapidly in skilled nursing homes, public health departments developed policies to mitigate the spread. Concerns grew over whether this spread linked to nursing home quality. Design: We collected data on nursing home quality, staffing, and COVID-19 cases from the Centers of Medicare and Medicaid Services. Demographic data was sourced from Long Term Care Focus. Settings and Participants: The analysis used cross-sectional data from 1,025 California skilled nursing homes including quality ratings and confirmed COVID-19 cases between May 17, 2020 and August 23, 2020. Methods: The dependent variable was confirmed COVID-19 cases among residents. The primary independent variables were Overall Rating and Health Inspection Rating, while also including nursing home beds, patient race composition, ownership and geographic classification. Results: 5-Star Overall Rating, 5-Star Health Inspection Rating, and a lower count of health inspection deficiencies each predicted a lower likelihood of having a confirmed COVID resident case (p<.05). Conclusions and Implications: Skilled nursing homes with higher quality ratings and fewer health inspection deficiencies were less likely to have a confirmed case of COVID-19 among residents.

scholarly journals Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations

2018 ◽  
Vol 55 ◽  
pp. 004695801878732 ◽  
Author(s):  
Kira L. Ryskina ◽  
R. Tamara Konetzka ◽  
Rachel M. Werner
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Acute Care ◽  
Rating System ◽  
Preventable Hospitalizations ◽  
Star Rating ◽  
Hospitalization Rates ◽  
Nursing Home Quality ◽  
Potentially Preventable Hospitalizations ◽  
Post Acute Care

Nursing homes’ publicly reported star ratings increased substantially since Centers for Medicare & Medicaid Services’s Nursing Home Compare adopted a 5-star rating system. Our objective was to test whether the improvements in nursing home 5-star ratings were correlated with reductions in rates of hospitalization. We hypothesized that increased attention to 5-star star ratings motivated nursing homes to make changes that improved their star ratings but did not affect their hospitalization rate, resulting in a weakened association between ratings and hospitalizations. We used 2007-2010 Medicare hospital claims and nursing home clinical assessment data to compare the correlation between nursing home 5-star ratings and hospitalization rates before versus after 5-star ratings were publicly released. The correlation between the rate of hospitalization and a nursing home’s 5-star rating weakened slightly after the ratings became publicly available. This decrease in correlation was concentrated among patients receiving post-acute care, who experienced relatively more hospitalizations from best-rated nursing homes. The improvements in nursing home star ratings after the release of Medicare’s 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients. Although this dissociation may be due to better matching of sicker patients to higher-quality nursing homes or superficial improvements by nursing homes to increase their ratings without substantial investments in quality improvement, the 5-star ratings nonetheless became less meaningful as an indicator of nursing home quality for post-acute care patients.

scholarly journals Disparities in COVID-19 Mortality in High-Minority Nursing Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 523-524
Author(s):  
Robert Weech-Maldonado ◽  
Justin Lord ◽  
Ganisher Davlyatov ◽  
Akbar Ghiasi ◽  
Gregory Orewa
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Resource Availability ◽  
Negative Binomial ◽  
Ethnic Disparities ◽  
Organizational Characteristics ◽  
Term Care ◽  
Facility Level ◽  
The Relationship ◽  
Racial Ethnic

Abstract Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Minorities continue to utilize nursing home services at a higher rate than White residents, contributing to existing health inequity concerns. This study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality using the CMS Nursing Home COVID-19 Public File. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. Four nested sequential negative binomial regressions were used to model the relationship between racial/ethnic disparities in COVID-19 deaths and the separate contributions of facility-level resident characteristics (percent of females, percent of residents 65 years and older, percent of residents with congestive heart failure, hypertension, and obesity, and the average level of residents’ acuity), resource availability (nursing homes’ payer-mix, occupancy rate, county-level Social Deprivation Index, and nursing home location), and other organizational characteristics (nursing home for-profit status, chain affiliation, and self-reported nursing, clinical, aides, and other staff shortages). After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths (Incidence Rate Ratio [IRR] = 1.61; p &lt; 0.001) as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the long-term care.

Uitbraak COVID-19 in de verpleeghuiszorg

2020 ◽  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Informal Caregivers ◽  
Rapid Review ◽  
Daily Routine ◽  
Term Care ◽  
Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

Predictors of Mortality in Board and Care Homes

1997 ◽  
Vol 36 (1) ◽  
pp. 77-87 ◽  
Author(s):  
Nicholas G. Castle
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Social Services ◽  
Long Term Care ◽  
Significant Proportion ◽  
The Elderly ◽  
Term Care ◽  
Care Facilities ◽  
Board And Care

Long-term care institutions have emerged as dominant sites of death for the elderly. However, studies of this trend have primarily examined nursing homes. The purpose of this research is to determine demographic, functional, disease, and facility predictors and/or correlates of death for the elderly residing in board and care facilities. Twelve factors are found to be significant: proportion of residents older than sixty-five years of age, proportion of residents who are chair- or bed-fast, proportion of residents with HIV, bed size, ownership, chain membership, affiliation with a nursing home, number of health services provided other than by the facility, the number of social services provided other than by the facility, the number of social services provided by the facility, and visits by Ombudsmen. These are discussed and comparisons with similar studies in nursing homes are made.

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