The Impact of Changes in Direct Care Staffing Policies and Outcomes for Assisted Living Residents With Dementia

Abstract We identified a cohort of 410,413 Medicare beneficiaries residing in 10,623 large (25+bed) assisted living (AL) communities between 2007 and 2017. We conducted linear probability models with a difference-in-difference framework to examine the association between hospitalization and changes in regulations pertaining to staff training (model 1) and staffing levels (model 2), adjusting for time trends, resident characteristics, and state-license fixed effects. During this 11-year period, six states changed their staff training requirements and two states introduced/increased direct care staffing levels. A change in regulations related to staffing levels was associated with a reduction in the probability of hospitalization during the month of -0.0056 percentage points (95%CI=-0.008,-0.003). A change in regulations related to staff training was associated with a reduction in the probability of hospitalization during the month of -0.0035 percentage points (95%CI=-0.006,-0.002). The policy effects represent clinically important differences of approximately 21% in the mean monthly hospitalization rate. Part of a symposium sponsored by Assisted Living Interest Group.

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From Micro to Macro: Exploring Preference-Based Person Centered Care from Multiple Perspectives

Innovation in Aging ◽

10.1093/geroni/igaa057.3062 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 836-836

Author(s):

Katherine Abbott ◽

Kristine Williams

Keyword(s):

Nursing Home ◽

Assisted Living ◽

Fixed Effects ◽

Nursing Home Residents ◽

Direct Care ◽

Multiple Perspectives ◽

Person Centered Care ◽

Fixed Effects Panel Regression ◽

Centered Care ◽

The Impact

Abstract Advancing our knowledge related to honoring nursing home resident preferences is a cornerstone of person-centered care (PCC). While there are multiple approaches to providing PCC, we focus on resident preferences as assessed via the Preferences for Everyday Living Inventory (PELI). The PELI is an evidenced-based, validated instrument that can be used to enhance the delivery of PCC. In this symposium, we explore the perspectives of a variety of stakeholders including nursing home residents, staff, and the impact of preference-based care on provider level regulatory outcomes. First, we present a comparative study of preference importance among n=317 African America and White nursing home residents that found more similarities than differences between the two groups. Second, a content analysis of the responses from n=196 interviews with nursing home residents details the barriers and facilitators connected to their levels of satisfaction with their preferences being fulfilled. Third, perspectives from n=27 direct care workers explore the concept of pervasive risk avoidance to the delivery of PCC. Fourth, systems-level practices, such as shift assignments and provider schedules are identified as barriers to successfully fulfilling resident preferences from the perspectives of n=19 staff within assisted living. Our final presentation utilizes a fixed-effects panel regression analysis with n=551 Ohio nursing home providers to explore the impact of PELI use on regulatory outcomes such as substantiated complaints and deficiency scores reported in the CMS Nursing Home Compare data. Discussant Dr. Kristi Williams will integrate findings, highlighting implications for policy, practice, and future directions. Research in Quality of Care Interest Group Sponsored Symposium.

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TWELVE YEARS OF CHANGES IN STATES’ ASSISTED LIVING REQUIREMENTS FOR DEMENTIA-SPECIFIC STAFF TRAINING

Innovation in Aging ◽

10.1093/geroni/igz038.2006 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S545-S545

Author(s):

Paula Carder ◽

Lindsey Smith ◽

Seamus Taylor ◽

Brian Kaskie ◽

Kali S Thomas

Keyword(s):

Assisted Living ◽

Staff Training ◽

Direct Care ◽

Care Staff ◽

Direct Care Staff ◽

Specific Training ◽

Training Requirements ◽

Admission Screening ◽

State Variation ◽

Discharge Criteria

Abstract We describe two categories of dementia-specific AL requirements: staff training and admission/discharge criteria. We reviewed current requirements for all states and the District of Columbia, and amendments made over 12 years. Current and historic regulations were collected and analyzed using policy surveillance and qualitative coding. Twenty-three states currently require dementia-specific training, and 22 require continuing education. Nearly all states (49) require administrators to complete dementia-specific training. Of these, 13 states specified 7 to 120 hours of dementia care training. Some states added pre-admission screening for cognitive impairment; a few require a dementia diagnosis for admission. We describe state variation longitudinally in direct care staff training requirements, including: number of training hours, training content, and use of examinations or other tests of knowledge, skills and abilities. In addition, we categorize changes in admission/discharge criteria over time, including the use of medical versus behavioral health symptoms.

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Delivering Person-Centered Care During a Pandemic: Stakeholder Perspectives

Innovation in Aging ◽

10.1093/geroni/igab046.1037 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 269-270

Author(s):

Katherine Abbott ◽

Kirsten Corazzini

Keyword(s):

Family Involvement ◽

Health Care Providers ◽

Assisted Living ◽

Direct Care ◽

Care Providers ◽

Improvement Project ◽

Stakeholder Perspectives ◽

Person Centered Care ◽

Centered Care ◽

The Impact

Abstract Person-centered care (PCC) is an approach to care that both nursing homes (NH) and assisted living (AL) communities strive to provide. PCC is a philosophy that recognizes knowing the person and honoring individual preferences. However, when COVID-19 emerged, the NH and AL environments were ground zero for infection spread and disproportionate numbers of deaths among residents. As a result, many practices changed dramatically in efforts to reduce the transmission of COVID-19 in these communities. The purpose of this symposium is to discuss several projects that can speak to the impact of the pandemic on stakeholder efforts to provide PCC. First, Dr. Roberts presents feedback from residents and family members on the challenges COVID-19 created for family involvement in care conferences. In the second study, Dr. Behrens examines focus group data from direct-care nurses on their perceptions of delivering PCC related to risk of harm to staff and residents. The third study presents the voices of activities professionals who were implementing a PCC quality improvement project to communicate resident preferences, which illustrates both the importance of PCC during the pandemic, but also the challenges implementing during the pandemic. Fourth, the Kansas PEAK 2.0 program used provider feedback to direct and inform program responses through components such as consistent staffing. Finally, Dr. Zimmerman presents qualitative data from over 100 AL administrators, medical, and mental health care providers on their experiences pivoting during COVID-19. Our discussant will explore the implications of these studies in terms of the future of PCC in residential settings.

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Hidden Casualties: The Links between Armed Conflict and Intimate Partner Violence in Colombia

Politics & Gender ◽

10.1017/s1743923x2100043x ◽

2021 ◽

pp. 1-33

Author(s):

Signe Svallfors

Keyword(s):

Intimate Partner Violence ◽

Partner Violence ◽

Armed Conflict ◽

Fixed Effects ◽

Intimate Partner ◽

Probability Models ◽

Women’S Experiences ◽

Women's Experiences ◽

Nationally Representative ◽

Linear Probability

Abstract The Colombian peace process was internationally celebrated for its unprecedented focus on women's experiences of war, but the everyday violence women that may face in their homes was not acknowledged. This article explores the links between exposure to local armed conflict violence and individual women's experiences of intimate partner violence. I combine pooled nationally representative data on individual women's experiences of intimate partner violence with information about the intensity of conflict during 2004–16. Results of fixed-effects linear probability models show that conflict was generally linked to a slightly elevated risk of women experiencing emotional, physical, and sexual violence perpetrated by their partner. Among women who had experienced intimate partner violence, conflict was related to an increased probability of being partnered at interview, which could reflect women staying in abusive relationships because conflict normalizes violence or increases women's reluctance to leave those relationships.

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Impact of Free Trade Agreement Use on Import Prices

The World Bank Economic Review ◽

10.1093/wber/lhx026 ◽

2018 ◽

Vol 33 (3) ◽

pp. 643-660

Author(s):

Kazunobu Hayakawa ◽

Nuttawut Laksanapanyakul ◽

Hiroshi Mukunoki ◽

Shujiro Urata

Keyword(s):

Free Trade ◽

Fixed Effects ◽

Free Trade Agreement ◽

Trade Agreement ◽

Firm Characteristics ◽

Most Favored Nation ◽

Rules Of Origin ◽

Import Prices ◽

Percentage Points ◽

The Impact

Abstract We examine the impact of free trade agreement (FTA) use on import prices. For this analysis, we employ establishment-level import data with information on tariff schemes, that is, the FTA and most-favored-nation schemes used for importing. Unlike previous studies, we estimate the effects of FTA use on prices by controlling for differences in importing-firm characteristics. There are three main findings. First, the effect of FTA use is overestimated when not controlling for importing firm-related fixed effects. Second, on average, firms’ FTA use reduces tariffs by 12 percentage points and raises import prices by 3.6–6.7 percent. Third, in general, we do not find a price rise resulting from the costs of complying with rules of origin.

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Barriers to using clinical decision support in ambulatory care: Do clinics in health systems fare better?

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocab064 ◽

2021 ◽

Author(s):

Yunfeng Shi ◽

Alejandro Amill-Rosario ◽

Robert S Rudin ◽

Shira H Fischer ◽

Paul Shekelle ◽

...

Keyword(s):

Decision Support ◽

Ambulatory Care ◽

Health Systems ◽

Clinical Decision Support ◽

Clinical Decision ◽

User Acceptance ◽

Probability Models ◽

Percentage Points ◽

Rural Clinics ◽

Linear Probability

Abstract Objective We quantify the use of clinical decision support (CDS) and the specific barriers reported by ambulatory clinics and examine whether CDS utilization and barriers differed based on clinics’ affiliation with health systems, providing a benchmark for future empirical research and policies related to this topic. Materials and Methods Despite much discussion at the theoretic level, the existing literature provides little empirical understanding of barriers to using CDS in ambulatory care. We analyze data from 821 clinics in 117 medical groups, based on in Minnesota Community Measurement’s annual Health Information Technology Survey (2014-2016). We examine clinics’ use of 7 CDS tools, along with 7 barriers in 3 areas (resource, user acceptance, and technology). Employing linear probability models, we examine factors associated with CDS barriers. Results Clinics in health systems used more CDS tools than did clinics not in systems (24 percentage points higher in automated reminders), but they also reported more barriers related to resources and user acceptance (26 percentage points higher in barriers to implementation and 33 points higher in disruptive alarms). Barriers related to workflow redesign increased in clinics affiliated with health systems (33 points higher). Rural clinics were more likely to report barriers to training. Conclusions CDS barriers related to resources and user acceptance remained substantial. Health systems, while being effective in promoting CDS tools, may need to provide further assistance to their affiliated ambulatory clinics to overcome barriers, especially the requirement to redesign workflow. Rural clinics may need more resources for training.

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Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis

Public Health Nutrition ◽

10.1017/s1368980014000238 ◽

2014 ◽

Vol 18 (2) ◽

pp. 189-197 ◽

Cited By ~ 29

Author(s):

Summer Sherburne Hawkins ◽

Ariel Dora Stern ◽

Christopher F Baum ◽

Matthew W Gillman

Keyword(s):

Higher Education ◽

Breast Feeding ◽

Fixed Effects ◽

Maternal Education ◽

Baby Friendly Hospital Initiative ◽

Feeding Rates ◽

Exclusive Breast Feeding ◽

Percentage Points ◽

Lower Education ◽

The Impact

AbstractObjectiveTo evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education.DesignQuasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for ≥4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups.SettingThirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA.SubjectsMothers (n 11 723) who gave birth in BFHI hospitals and mothers (n 13 604) from nineteen matched non-BFHI facilities.ResultsAlthough we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0·024; 95 % CI −0·00, 0·51), breast-feeding initiation increased by 3·8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0·05), but not among mothers with higher education (adjusted coefficient = 0·002; 95 % CI −0·04, 0·05). BFHI accreditation also increased exclusive breast-feeding for ≥4 weeks by 4·5 percentage points (P = 0·02) among mothers with lower education who delivered in BFHI facilities.ConclusionsBy increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding.

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Links Between Chronic Illness and Late-Life Cognition: Evidence From Four Latin American Countries

Journal of Aging and Health ◽

10.1177/0898264316674557 ◽

2016 ◽

Vol 30 (2) ◽

pp. 262-304 ◽

Cited By ~ 1

Author(s):

Mariana P. Socal ◽

Antonio J. Trujillo

Keyword(s):

Cognitive Decline ◽

Latin American ◽

Chronic Conditions ◽

Survey Methods ◽

Well Being ◽

Ordinary Least Squares ◽

Community Dwelling ◽

Probability Models ◽

Linear Probability ◽

The Impact

Objectives: We explored the links between chronic diseases and cognitive ability using datasets of community-dwelling older adults from Brazil, Chile, Mexico, and Uruguay from the SABE (Health, Well-Being, and Aging) survey. Methods: Ordinary least squares (OLS), Tobit and linear probability models, adjusting for extensive health and socio-demographic factors, were implemented separately for men and women and complemented by a series of robustness checks. Results: We find a negative association between the number of chronic conditions and cognitive decline that has the following characteristics: (a) differs across gender, (b) increases with the number of chronic conditions, (c) is larger among those individuals in the bottom of the cognitive distribution, (d) and is different across types of chronic conditions. Discussion: These results suggest that returns from preventive policies to reduce cognitive decline would increase if they were targeted to seniors with chronic conditions and implemented before the impact from multiple comorbidities makes the cognitive decline too steep to be reversed.

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Empirical Analyses of Associations between State Political Attitudes and Gains in Health Insurance Coverage after the Affordable Care Act (ACA)

10.1101/605022 ◽

2019 ◽

Author(s):

Bisakha Sen ◽

Reena Joseph

Keyword(s):

Young Adults ◽

Affordable Care Act ◽

Insurance Coverage ◽

Baseline Period ◽

Behavioral Risk ◽

Surveillance Systems ◽

Medicaid Expansion ◽

Probability Models ◽

Percentage Points ◽

Linear Probability

AbstractObjectivesTo explore whether state-level political-sentiment is associated with gains in insurance post Affordable Care Act (ACA). This is especially relevant given the lawsuit brought by several Republican-leaning states against the ACA, and the ruling of one Texas federal judge that the ACA is unconstitutional, which potentially jeopardizes ACA’s future.MethodsMultivariate linear-probability models are estimated using data from the Behavioral Risk Factor Surveillance Systems for 2011-2017. The outcome is self-reported insurance status. States are placed in quartiles based on votes for President Obama in 2008 and 2012 elections. Starting 2014, ACA health exchanges became active and several states expanded Medicaid, so 2014 onwards is considered as the ‘post-ACA’ period. Models are estimated for all adults under 65-years and for young adults under 35-years. All models control extensively for respondent socio-economic-demographic characteristics and state characteristics.ResultsIn the pre-ACA baseline period, respondents in states with higher Anti-Obama-voting (AOV) were less likely to have insurance. For example, residents in highest AOV-quartile states were 8.0-percentage-points less likely (p<0.001) to have insurance than those in the lowest AOV-quartile states. Post-ACA, fewer high AOV-quartile states expanded Medicaid, and overall insurance gains inclusive of Medicaid-expansion are similar across states. However, net of Medicaid-expansion, residents in higher AOV states saw higher insurance gains. For example, all adults had 2.8-percentage points higher likelihood (p<0.01) and young adults had 4.9-percentage point higher likelihood (p<0.01) of getting insurance in the highest AOV-quartile states compared to the lowest AOV quartile states. Minorities and those with chronic-conditions had larger insurance gains across the country post-ACA, but the extent of these gains did not differ by state AOV levels.ConclusionsState AOV and insurance gains from ACA appear to be incongruent. Policymakers and stakeholders should be aware that non-Medicaid residents of higher-AOV states might potentially lose the most if ACA is revoked.

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Challenges Faced by Nursing Home Direct Care Workers During the COVID-19 Pandemic: A Comparison Across Care Settings

Innovation in Aging ◽

10.1093/geroni/igab046.955 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 248-248

Author(s):

Verena Cimarolli ◽

Robyn Stone ◽

Natasha Bryant

Keyword(s):

Nursing Home ◽

Assisted Living ◽

Direct Care ◽

Direct Care Workers ◽

Health Crisis ◽

Work Related ◽

Care Workers ◽

Direct Care Workforce ◽

The Impact

Abstract The COVID-19 pandemic has generated awareness of the value of the direct care workforce to provide care in settings serving those most at risk from the disease. However, few studies have gauged the impact of COVID-19 on this workforce and their pandemic-related challenges. The purpose of this study was to examine the challenges and stress experienced by direct care workers (N=1,414) and their perceptions of preparation and quality of employer communication during this health crisis. Nursing home (NH) workers reported separation from family members and understaffing as the top external and work-related challenges. They felt adequately prepared and gave their employers high marks for communicating with them during the pandemic. NH direct care workers were more likely to report increased workload and understaffing as a challenge compared to workers in home and community-based settings. They also experienced a significantly higher number of work-related challenges compared to workers in assisted living.

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