scholarly journals Visitation Access to U.S. Nursing Homes: An Analysis of Facility Locations, Ratings, and Disparities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 114-114
Author(s):  
Mary Helander
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Population Data ◽  
Well Being ◽  
Care Quality ◽  
Term Care ◽  
Facility Locations ◽  
Research Findings ◽  
Regular Family

Abstract Research findings suggest that family visits to nursing home residents are important for countering depression, increasing residents’ well-being and quality of life (Miller, 2019; Durkin et al., 2014), maintaining physical function (Shankar et al., 2017), and improving general health (Parmenter et al., 2012). Presence by family can directly impact a resident’s care quality, since family members may take a role in monitoring their older relative’s status (Miller, 2019). Unfortunately, regular family visits to nursing homes may be difficult, or impossible, due to challenges that include distance, travel time, lack of transportation, and cost (Fields et al., 2019) (Miller, 2019). These same challenges may translate to socio-economic barriers for families, eliminating long-term-care as an option for older relatives (Ferraro et al., 2017), (Angel and Berlinger, 2018). This paper considers the issue of nursing home visitation access and examines related disparities through spatial and demographic analysis of 15,000+ US facilities monitored by the Centers for Medicare the Medicaid Services. Mathematical models are used to analyze facility and population data, using access measures adapted from the geography discipline (Lou and Wang, 2003; Paez et al., 2019). Analysis explores whether higher rated nursing homes are more likely to be closer to affluent populations, and whether socioeconomic status is a significant factor in overall access. Analysis reveals patterns of access disparity with respect to nursing home ratings and geographies. For example, proximity to higher rated facilities increases monotonically with median household income. Specific policy recommendations are discussed.

scholarly journals A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Cordes ◽  
Laura L. Bischoff ◽  
Daniel Schoene ◽  
Nadja Schott ◽  
Claudia Voelcker-Rehage ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Physical Functioning ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Well Being ◽  
Term Care

Abstract Background Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life. Methods A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45–60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents’ capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only). Discussion This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents. Trial registration The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

scholarly journals Person-Centred Care Transformation in a Nursing Home for Residents with Dementia

2021 ◽  
pp. 1-9
Author(s):  
Peiyan Ho ◽  
Rachel Chin Yee Cheong ◽  
Siew Pei Ong ◽  
Carol Fusek ◽  
Shiou Liang Wee ◽  
...  
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Quality Care ◽  
Well Being ◽  
Care Quality ◽  
Care Recipient ◽  
Staff Retention ◽  
Term Care

<b><i>Background:</i></b> Conventional nursing homes in Singapore adopt an institutional and medical model of care with a focus on safety and risk management. As such, less regard is placed on upholding the dignity and autonomy of the resident, which compromises quality of care and the well-being of the resident. Today, person-centred care (PCC) has become synonymous with high-quality care that sustains the well-being and personhood of the care recipient. <b><i>Objectives:</i></b> To describe the model of PCC adopted by a nursing home, Apex Harmony Lodge (AHL), with a logic model and evaluate outcomes on residents’ well-being, care quality, and staff attrition by comparing pre-PCC initiation (2015) to post-implementation (2016). <b><i>Methods:</i></b> Male residents in a 30-bed assisted living facility for persons with dementia in AHL were assessed using Dementia Care Mapping. Residents’ well-being and staff attrition were measured before and after PCC implementation. <b><i>Results:</i></b> There were statistically significant improvements in resident well-being (Δ = 0.44, <i>p</i> = 0.029), Positive Engagement Potential (Δ = 0.17, <i>p</i> = 0.002), and Occupational Diversity (Δ = 0.12, <i>p</i> = 0.014) in 2016. Withdrawal and Passive Engagement in the residents were reduced significantly as were Care Detractors. There was also a 55% reduction in staff attrition rates post-PCC. <b><i>Conclusions:</i></b> Post-PCC implementation, the outcomes indicate a superior quality of care, enhanced resident well-being, and better staff retention. The AHL PCC model could serve as a roadmap for other nursing homes aspiring to raise the quality of care and influence long-term care standards and regulations for policy makers and legislators.

scholarly journals Nursing home care quality: a cluster analysis

2017 ◽  
Vol 30 (1) ◽  
pp. 25-36 ◽  
Author(s):  
Vigdis Abrahamsen Grøndahl ◽  
Liv Berit Fagerli
Keyword(s):  
Cluster Analysis ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Well Being ◽  
Care Quality ◽  
Nursing Home Care ◽  
Healthcare Personnel ◽  
Content Type ◽  
Quality Perceptions

Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients’ perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents (n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ2 tests and one-way between-groups ANOVA were performed to characterise the clusters (p<0.05). Findings Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents’ care quality perceptions.

Geriatric Health Experts Validate Oral Neglect Timelines for the Institutionalized Elderly

2019 ◽  
Vol 39 (11) ◽  
pp. 1250-1257
Author(s):  
Sharon M. Casey ◽  
Ralph V. Katz ◽  
Shulamite Huang ◽  
Barbara J. Smith
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Standard Of Care ◽  
Delphi Survey ◽  
Oral Disease ◽  
Oral Diseases ◽  
Term Care ◽  
Institutionalized Elderly

The purpose of this follow-up Delphi survey was to have an expert panel of 31 academic geriatric physicians, geriatric nurses, and medical directors of nursing homes evaluate the original timeline set to avoid oral neglect of nursing home residents. The Oral Neglect in Institutionalized Elderly (ONiIE) timelines defined oral neglect as having occurred when >7 days for acute oral diseases/conditions or >34 days for chronic oral disease/conditions had passed between initial diagnosis and offering access to dental care to the long-term care (LTC) nursing home resident. The results of this follow-up Delphi survey validated those originally defined ONiIE timelines as 90% of this panel agreed with the original timelines. This ONiIE definition adds a broad-based validation for the ONiIE timelines for setting an oral health standard of care for institutionalized elderly residents of nursing homes and should now be used to protect the vulnerable elderly residing in LTC nursing homes.

scholarly journals Impact of morbidity on care need increase and mortality in nursing homes: a retrospective longitudinal study using administrative claims data

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Katrin C. Reber ◽  
Ivonne Lindlbauer ◽  
Claudia Schulz ◽  
Kilian Rapp ◽  
Hans-Helmut König
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Claims Data ◽  
Nursing Home Residents ◽  
Medical Conditions ◽  
Term Care ◽  
Care Level ◽  
Level Change ◽  
Risk Of Mortality

Abstract Background A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality. Methods In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality. Results The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2. Conclusion This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).

scholarly journals A Visual Analysis on How the Physical Environment Conditions Relatives’ Involvement in Nursing Homes

SAGE Open ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. 215824401774039
Author(s):  
Jessica Holmgren
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Physical Environment ◽  
Visual Analysis ◽  
Nursing Home Residents ◽  
Well Being ◽  
Care Environment ◽  
Cultural Symbols ◽  
Information Displays ◽  
Physical Care

This study seeks to describe how the composition of the physical care environment conditions relatives’ involvement in nursing home institutions. It is well known that the physical care environment in institutions has a significant impact on the well-being of residents and the work satisfaction of nursing staff. Less explored is how physical care environmental factors are related to the involvement of relatives in nursing homes. A visual analysis of 52 photographs from three nursing homes in Sweden shows how the physical environment acts to condition the involvement of relatives through the use of design, information displays, and cultural symbols. Although various aspects of the physical environment promoted participation of relatives, that engagement was based on certain limited concepts of involvement. This suggests that other conceptual frameworks of involvement in nursing homes are possible, and that these might encourage other aspects of involvement from the relatives of nursing home residents.

scholarly journals Care Deficiencies and Super-Organization of American Nursing Homes in Hospital Referral Region

2021 ◽  
Vol 8 ◽  
Author(s):  
Tyler Pittman
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Ownership ◽  
Open Data ◽  
Nursing Home Residents ◽  
The United States ◽  
Care Quality ◽  
Hospital Referral Region ◽  
Hospital Referral ◽  
Open Datasets

Super-organization has been associated with worse care quality in nursing homes. Previous research on the chain ownership of American nursing homes excluded government facilities in public-private partnerships, and focused on corporate entities. This longitudinal study proposes a novel method of demarcating the latent ownership networks of for-profit, government and non-profit nursing homes in the United States through use of open data and social network analysis. Facility characteristics and care quality measures were analyzed from an ecological cohort of 9,001 American nursing homes that had a registered organization for owner, and were reimbursed through Medicare or Medicaid. Information was obtained from the Nursing Home Compare open datasets at five semi-annual processing dates from March 2016 to March 2018. Ownership networks of American nursing homes were constructed using the exact legal name of registered organizations. As hospital discharge is a routine admission source of nursing home residents, hospital referral region was actualized to demarcate focal area. Utilizing Bayesian hierarchical models, the association between nursing home super-organization in hospital referral region (inferred by degree-based centrality and Herfindahl-Hirschman Index) to scope of cited care deficiencies (denoted by Total Weighted Health Survey Score) was explored. The percentage of nursing homes having super-organization increased from 56.8 to 56.9% over the 2-year period. During this interval, the mean size of nursing home ownership group in hospital referral region increased from 3.11 to 3.23 facilities. Overall, super-organization in hospital referral region was not associated with care deficiencies in American nursing homes. However, being part of an ownership group with more facilities was beneficial for care quality among nursing homes with super-organization.

Tuberculosis in Long-Term Care Facilities

1990 ◽  
Vol 11 (1) ◽  
pp. 42-46 ◽  
Author(s):  
David W. Bentley
Keyword(s):  
United States ◽  
Nursing Home ◽  
Nursing Homes ◽  
Age Groups ◽  
Nursing Home Residents ◽  
The United States ◽  
High Risk Group ◽  
Elderly Persons ◽  
Tuberculosis Case ◽  
Term Care

Persons age 65 and over constitute the largest reservoir of Mycobacterium tuberculosis infection in the United States today. During 1987, 6,150 tuberculosis cases were reported among this high-risk group. These cases represent 27% of the total US tuberculosis morbidity, although this age group constitutes only 12% of the US population. Tuberculosis case rates in the United States are higher among the elderly (20.6 per 100,000) than among all other age groups (average 9.3 per 100,000).More Americans live in nursing homes than in any other type of residential institution; on any given day approximately 5% of all elderly persons are living in a nursing home. Elderly nursing home residents are at greater risk for tuberculosis than elderly persons living in the community. In a Centers for Disease Control (CDC)-sponsored survey of 15,379 routinely-reported tuberculosis cases from 29 states, 8% of the 4,919 cases that occurred among elderly persons occurred among residents of nursing homes. The incidence of tuberculosis among nursing home residents was 39.2 per 100,000 person years, whereas the incidence of tuberculosis among elderly persons living in the community was 21.5 per 100,000. The observed rate of tuberculosis among nursing home employees was three times the rate expected in employed adults of similar age, race and sex (CDC, unpublished data).

scholarly journals Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025614 ◽  
Author(s):  
Jonas Czwikla ◽  
Maike Schulz ◽  
Franziska Heinze ◽  
Thomas Kalwitzki ◽  
Daniel Gand ◽  
...  
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Medical Care ◽  
Delphi Study ◽  
Nursing Home Residents ◽  
Community Dwelling ◽  
Mixed Methods Study ◽  
Care Needs ◽  
Term Care

IntroductionNursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate.Methods and analysisFirst, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes.Ethics and disseminationThis study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.Trial registration numberDRKS00012383.

They Know Me Here: Patients' Perspectives on Their Nursing Home Experiences

2016 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruth Tappen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Patient Experience ◽  
Nursing Home Residents ◽  
Patient Experiences ◽  
Background Information ◽  
Term Care ◽  
Hospital Stays ◽  
Preferences For Care

Perspectives from patients who reside in nursing homes can inform administrators and providers about the patient experience in long-term care. In a study of preferences for care in the nursing home or hospital should an acute change in condition occur, nursing home residents offered spontaneous descriptions of their experiences in the nursing home and during their prior hospital stays. This article offers background information about nursing home reform and standards, and contemporary reports on the patient experience in nursing homes. Methods, results, and discussion of the study findings will inform readers specifically about the analysis of the narrative data as it relates to the patient experience. Positive and negative aspects of nursing home patient experiences are discussed and compared to hospital patient experiences. Both settings were both praised and strongly criticized. Many concerns identified as patients discussed their experiences can be remedied by the owners and administrators of these facilities.

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