scholarly journals CAPABLE Transitions: A Home Health Agency-Based Intervention to Optimize the SNF-to-Home Transition

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 872-873
Author(s):  
Rachel Missell ◽  
Sarah Szanton ◽  
Thomas Caprio ◽  
Kobi Nathan ◽  
Adam Simning
Keyword(s):  
Older Adults ◽  
Feasibility Study ◽  
Skilled Nursing Facility ◽  
Aging In Place ◽  
Health Agency ◽  
Home Health ◽  
Medical Services ◽  
Care Transition ◽  
Skilled Nursing ◽  
Home Health Agency

Abstract Community Aging in Place-Advancing Better Living for Elders (CAPABLE) consists of an interprofessional team of a registered nurse (RN), occupational therapist (OT), and handyworker that delivers an in-home client-specific package of interventions to optimize function. CAPABLE aims to reduce functional impairment, home hazards, and acute medical services use and is being widely disseminated. To expand CAPABLE to older adults transitioning from the skilled nursing facility (SNF) to home, we developed CAPABLE Transitions, which makes several important modifications to CAPABLE. First, CAPABLE Transitions will be implemented within a Medicare-certified home health agency (CHHA) and delivered to CHHA clients. Second, it will be delivered to CHHA clients with and without dementia. Adding urgency to CAPABLE Transitions’ development, including persons with dementia has the potential to decrease high utilization of services and meet care transition needs. Third, it includes an initial RN care transition visit. Fourth, its services are more intensely delivered at the beginning of the intervention, shortly after SNF discharge. Beginning in the fall of 2020, CAPABLE Transitions will be tested in a feasibility study of 60 older adults discharged from post-acute SNF care to CHHA services in Rochester, NY. We have designed this 3-year feasibility study to consist of yearly recruitment waves that will enable us to iteratively assess and refine the intervention. Following this study, we hope to test CAPABLE Transitions’ effect on improving home time, quality of life, and the use of acute medical services in order to assist older adults in aging in place.

scholarly journals Skilled Nursing Facility Patients Discharged to Home Health Agency Services Spend More Days at Home

2020 ◽  
Vol 68 (7) ◽  
pp. 1573-1578 ◽  
Author(s):  
Adam Simning ◽  
Jessica Orth ◽  
Jinjiao Wang ◽  
Thomas V. Caprio ◽  
Yue Li ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Health Agency ◽  
Home Health ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Home Health Agency ◽  
At Home

scholarly journals 1206. Association of Aging, Frailty and Place of Residence with Skin, Oral and Gut Microbiome Characteristics and Pathogenicity Reservoirs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S625-S625
Author(s):  
Peter J Larson ◽  
Julia Oh ◽  
Julie Robison ◽  
James Grady ◽  
George Kuchel
Keyword(s):  
Older Adults ◽  
Gut Microbiome ◽  
Skilled Nursing Facility ◽  
Antibiotic Resistance Genes ◽  
Community Dwelling ◽  
Colonization Resistance ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Cutibacterium Acnes ◽  
Control And Prevention

Abstract Background Despite their elevated risk for morbidity and mortality from infections, the microbiota of older adults remain understudied. While colonization resistance from resident microflora is a promising means to prevent infections, little is known about pathogenicity reservoirs and colonization resistance in this vulnerable population. Here we study the skin, oral, and gut microbiome dynamics of older adults in both community and Skilled Nursing Facility (SNF) settings, investigating relationships between age, frailty, environment, microbiota, and pathogenicity reservoirs. Methods We conducted a longitudinal metagenome survey of 47 adults age 65+ years of age; 22 residents of 3 different SNFs and 25 community dwelling individuals. We performed metagenomic whole genome shotgun sequencing on stool, oral, and skin samples from 8 sites, 1421 total. To correlate clinical and behavioral variables, we measured frailty, collected medical records, and interviewed participants on diet and lifestyle. We also draw comparisons with previous younger cohorts. Results • Compared to younger adults, the skin microbiota of older adults was characterized by ◦ High heterogeneity ◦ Decreased stability over time, suggesting increased susceptibility to colonization and pathogenicity ◦ Compositional differences including significantly lower levels of Cutibacterium acnes, with reciprocal increases in Staphylococci, Corynebacteria, and Malassezia • In older adults, Frailty (Rockwood) was found to have linear correlation with relative abundance of species relevant to infection risk including acnes, staphylococci, streptococci, E. coli, Akkermansia mucinophila, and Enterococcus faecalis. • The skin, oral, and gut microbiota of SNF residents had substantially elevated virulence factor and antibiotic resistance genes. Conclusion To the best of our knowledge, this is largest report to date of the skin metagenome in older adults. We demonstrate distinct and significant differences between cohorts with clinically relevant implications. We believe these results may inform infection control and prevention by increasing our understanding of colonization resistance and pathogenicity reservoirs, as well as advance our knowledge of the relationship between aging, the microbiome, and infections. Disclosures All Authors: No reported disclosures

Robotic-assisted total hip arthroplasty: an economic analysis

2021 ◽  
Author(s):  
James Pierce ◽  
Keith Needham ◽  
Chris Adams ◽  
Andrea Coppolecchia ◽  
Carlos Lavernia
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Skilled Nursing Facility ◽  
Health Agency ◽  
Inpatient Rehabilitation ◽  
Cost Index ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Robotic Assisted ◽  
Total Hip

Aim: To evaluate 90-day episode-of-care (EOC) resource consumption in robotic-assisted total hip arthroplasty (RATHA) versus manual total hip arthroplasty (mTHA). Methods: THA procedures were identified in Medicare 100% data. After propensity score matching 1:5, 938 RATHA and 4,670 mTHA cases were included. 90-day EOC cost, index costs, length of stay and post-index rehabilitation utilization were assessed. Results: RATHA patients were significantly less likely to have post-index inpatient rehabilitation or skilled nursing facility admissions and used fewer home health agency visits, compared with mTHA patients. Total 90-day EOC costs for RATHA patients were found to be US$785 less than those of mTHA patients (p = 0.0095). Conclusion: RATHA was associated with an overall lower 90-day EOC cost when compared with mTHA. The savings associated with RATHA were driven by reduced utilization and cost of post-index rehabilitation services.

scholarly journals Clinical Courses and Characteristics of Residents During a SARS-CoV-2 Outbreak at a Central Indiana Skilled Nursing Facility

2020 ◽  
Vol 3 ◽  
Author(s):  
Lauren Albert ◽  
Kristi Lieb ◽  
Laramie Mack ◽  
Kathleen Unroe
Keyword(s):  
Older Adults ◽  
Case Reports ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Retrospective Case ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Increased Risk ◽  
Symptom Load ◽  
Retrospective Case Study

Background/Objective: Older adults such as skilled nursing facility residents have increased risk of serious SARS-CoV-2 infection and comprise a large proportion of the COVID-19 pandemic’s deceased—the US Centers for Medicare & Medicaid Services report 232,831 cases and 38,518 resident deaths to date. Recent case reports reveal, as in other diseases, older adults may experience atypical symptomology, complicating identification of ill residents and efforts to slow transmission. While a few facility outbreaks have been characterized epidemiologically, little research exists regarding clinical timelines and trajectories which residents experience during COVID-19 illness.   Methods: From May 9, 2020-June 1, 2020, daily notes on each COVID-19 positive resident’s status (n = 69) were taken by the medical director of a central Indiana nursing facility. Combined with a retrospective resident chart review of this same period, these notes were examined for COVID-19 infection symptoms and illness timelines to descriptively categorize a number of common illness trajectories and symptoms seen in residents with SARS-CoV-2 infection.  Results: Residents fit four descriptive clinical timelines: concurrent symptom load with quick death (Avg 5.6 days) (n = 5), accumulating symptom load with gradual decline (Avg. 13.9 days) (n = 9), prolonged active symptom load with periods of stabilization and symptom reoccurrence (n = 42), and asymptomatic or atypical symptom load (n = 12). Most common symptoms were fever, hypoxia, anorexia, and fatigue/malaise. Of the 14 residents who died (20.3% of infected), 8 died in the facility and 6 died in the hospital.  Conclusion and Implications: This retrospective case study adds to literature describing the presentation and symptomology of SARS-CoV-2 infection in residents of skilled nursing facilities and aids efforts to evaluate resident presentation, prognosis, and disease course. Robust descriptions of expected clinical courses may support realistic expectations of disease progression for residents and their family members experiencing future outbreaks.

Rosehedge: A home health agency and adult family home

1998 ◽  
Vol 9 (4) ◽  
pp. 56-57
Author(s):  
Sean Oslin ◽  
Connie Heavey ◽  
Priscilla Horner
Keyword(s):  
Health Agency ◽  
Home Health ◽  
Home Health Agency ◽  
Family Home
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