scholarly journals Evidence for Publicly Reported Quality Indicators in Residential Long-Term Care: A Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 181-181
Author(s):  
Franziska Zúñiga ◽  
Magdalena Osinska ◽  
Franziska Zuniga
Keyword(s):  
New Zealand ◽  
Quality Indicators ◽  
Long Term Care ◽  
Grey Literature ◽  
Public Reporting ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Residential Long Term Care

Abstract Quality indicators (QIs) are used internationally to measure, compare and improve quality in residential long-term care. Public reporting of such indicators allows transparency and motivates local quality improvement initiatives. However, little is known about the quality of QIs. In a systematic literature review, we assessed which countries publicly report health-related QIs, whether stakeholders were involved in their development and the evidence concerning their validity and reliability. Most information was found in grey literature, with nine countries (USA, Canada, Australia, New Zealand and five countries in Europe) publicly reporting a total of 66 QIs in areas like mobility, falls, pressure ulcers, continence, pain, weight loss, and physical restraint. While USA, Canada and New Zealand work with QIs from the Resident Assessment Instrument – Minimal Data Set (RAI-MDS), the other countries developed their own QIs. All countries involved stakeholders in some phase of the QI development. However, we only found reports from Canada and Australia on both, the criteria judged (e.g. relevance, influenceability), and the results of structured stakeholder surveys. Interrater reliability was measured for some RAI QIs and for those used in Germany, showing overall good Kappa values (>0.6) except for QIs concerning mobility, falls and urinary tract infection. Validity measures were only found for RAI QIs and were mostly moderate. Although a number of QIs are publicly reported and used for comparison and policy decisions, available evidence is still limited. We need broader and accessible evidence for a responsible use of QIs in public reporting.

scholarly journals Depressive symptoms in long term care facilities in Western Canada: a cross sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Matthias Hoben ◽  
Abigail Heninger ◽  
Jayna Holroyd-Leduc ◽  
Jennifer Knopp-Sihota ◽  
Carole Estabrooks ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Western Canada ◽  
Cross Sectional ◽  
Term Care ◽  
Data Set ◽  
For Profit

Abstract Background The main objective is to better understand the prevalence of depressive symptoms, in long-term care (LTC) residents with or without cognitive impairment across Western Canada. Secondary objectives are to examine comorbidities and other factors associated with of depressive symptoms, and treatments used in LTC. Methods 11,445 residents across a random sample of 91 LTC facilities, from 09/2014 to 05/2015, were stratified by owner-operator model (private for-profit, public or voluntary not-for-profit), size (small: < 80 beds, medium: 80–120 beds, large > 120 beds), location (Calgary and Edmonton Health Zones, Alberta; Fraser and Interior Health Regions, British Columbia; Winnipeg Health Region, Manitoba). Random intercept generalized linear mixed models with depressive symptoms as the dependent variable, cognitive impairment as primary independent variable, and resident, care unit and facility characteristics as covariates were used. Resident variables came from the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 records (the RAI-MDS version routinely collected in Western Canadian LTC). Care unit and facility variables came from surveys completed with care unit or facility managers. Results Depressive symptoms affects 27.1% of all LTC residents and 23.3% of LTC resident have both, depressive symptoms and cognitive impairment. Hypertension, urinary and fecal incontinence were the most common comorbidities. Cognitive impairment increases the risk for depressive symptoms (adjusted odds ratio 1.65 [95% confidence interval 1.43; 1.90]). Pain, anxiety and pulmonary disorders were also significantly associated with depressive symptoms. Pharmacologic therapies were commonly used in those with depressive symptoms, however there was minimal use of non-pharmacologic management. Conclusions Depressive symptoms are common in LTC residents –particularly in those with cognitive impairment. Depressive symptoms are an important target for clinical intervention and further research to reduce the burden of these illnesses.

Hearing Loss and Cognitive-Communication Test Performance of Long-Term Care Residents With Dementia: Effects of Amplification

2016 ◽  
Vol 59 (6) ◽  
pp. 1533-1542 ◽  
Author(s):  
Tammy Hopper ◽  
Susan E. Slaughter ◽  
Bill Hodgetts ◽  
Amberley Ostevik ◽  
Carla Ickert
Keyword(s):  
Hearing Loss ◽  
Test Performance ◽  
Speech Intelligibility ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Hearing Ability ◽  
The Relationship

Purpose The study aims were (a) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and (b) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were (a) What is the effect of amplification on cognitive-communication test performance of LTC residents with early- to middle-stage dementia and mild-to-moderate hearing loss? and (b) What is the relationship between measured hearing ability and hearing ability recorded by staff using the Resident Assessment Instrument–Minimum Data Set 2.0 (RAI-MDS; Hirdes et al., 1999)? Method Thirty-one residents from 5 long-term care facilities participated in this quasiexperimental crossover study. Residents participated in cognitive-communication testing with and without amplification. RAI-MDS ratings of participants' hearing were compared to audiological assessment results. Results Participants' speech intelligibility index scores significantly improved with amplification; however, participants did not demonstrate significant improvement in cognitive-communication test scores with amplification. A significant correlation was found between participants' average pure-tone thresholds and RAI-MDS ratings of hearing, yet misclassification of hearing loss occurred for 44% of participants. Conclusions Measuring short-term improvement of performance-based cognitive communication may not be the most effective means of assessing amplification for individuals with dementia. Hearing screenings and staff education remain necessary to promote hearing health for LTC residents.

Registered Nurses’ experiences with, and feelings and attitudes towards, the International Resident Assessment Instrument for Long-Term Care Facilities in New Zealand in 2017

2019 ◽  
Vol 25 (2) ◽  
pp. 141-155
Author(s):  
Minna Vuorinen
Keyword(s):  
New Zealand ◽  
Long Term Care ◽  
Assessment Tool ◽  
Assessment Instrument ◽  
Term Care ◽  
Care Facilities ◽  
Resident Assessment ◽  
Negative Feelings ◽  
Resident Assessment Instrument

Background The International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF) is a Web-based assessment tool designed to comprehensively assess older adults (≥65 years) living in aged residential care. In 2015 New Zealand was the first country where it was made mandatory nationwide. Aims The purpose of this study was to explore Registered Nurses’ (RNs’) experiences, feelings and attitudes towards interRAI-LTCF. Methods Twelve interviews were conducted 18 months after interRAI-LTCF became mandatory. The interview questions were based on a United Theory of Acceptance and Use of Technology model. Findings were analysed thematically. Results The findings reveal that RNs of all ages embrace technology, and have mostly positive attitudes towards interRAI-LTCF. Limited value, however, is seen in dementia and end-of-life care. RNs reported good experiences with trainers and venues, but inconsistency between training courses. Negative feelings towards interRAI-LTCF were caused by insufficient time to complete assessments. RNs also feel apprehensive about the Assessment & Intelligence Systems, Inc. competency tests. Conclusions Overall RNs supported the use of interRAI-LTCF as a comprehensive assessment tool. Duplication in data entry, insufficient training, and the annual tests caused most stress and negative feelings. Recommendations were made to rectify issues.

scholarly journals Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis

2020 ◽  
Author(s):  
Johannes Michael Bergmann ◽  
Armin Michael Ströbel ◽  
Bernhard Holle ◽  
Rebecca Palm
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Long Term Care ◽  
Practical Recommendation ◽  
Term Care ◽  
Data Set ◽  
Convenience Sample ◽  
Agglomerative Hierarchical Cluster Analysis ◽  
Residential Long Term Care

Abstract Background Organizational health care research focuses on describing structures and processes in organizations and investigating their impact on the quality of health care. In the setting of residential long-term care, this effort includes the examination and description of structural differences among the organizations (e.g., nursing homes). The objective of the analysis is to develop an empirical typology of living units in nursing homes that differ in their structural characteristics. Methods Data from the DemenzMonitor Study were used. The DemenzMonitor is an observational study carried out in a convenience sample of 103 living units in 51 nursing homes spread over 11 German federal states. Characteristics of living units were measured by 19 variables related to staffing, work organization, building characteristics and meal preparation. Multiple correspondence analysis (MCA) and agglomerative hierarchical cluster analysis (AHC) are suitable to create a typology of living units. Both methods are multivariate and explorative. We present a comparison with a previous typology (created by a nonexplorative and nonmultivariate process) of the living units derived from the same data set. Results The MCA revealed differences among the living units, which are defined in particular by the size of the living unit (number of beds), the additional qualifications of the head nurse, the living concept and the presence of additional financing through a separate benefit agreement. We identified three types of living units; these clusters occur significantly with a certain combination of characteristics. In terms of content, the three clusters can be defined as: "house community", "dementia special care units” and "usual care". Conclusion A typology is useful to gain a deeper understanding of the differences in the care structures of residential long-term care organizations. In addition, the study provides a practical recommendation on how to apply the results, enabling housing units to be assigned to a certain type. The typology can be used as a reference for definitions.

scholarly journals Characteristics of Socially Isolated Residents in Long-Term Care: A Retrospective Cohort Study

2020 ◽  
Vol 6 ◽  
pp. 233372142097532
Author(s):  
Stephanie A. Chamberlain ◽  
Wendy Duggleby ◽  
Pamela B. Teaster ◽  
Carole A. Estabrooks
Keyword(s):  
Cohort Study ◽  
Functional Status ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Socially Isolated

Objectives: To identify socially isolated long-term care residents and to compare their demographic characteristics, functional status, and health conditions to residents who are not isolated. Methods: We conducted a retrospective cohort study using the Resident Assessment Instrument, Minimum Data Set, 2.0 (RAI-MDS) data, from residents in 34 long-term care homes in Alberta, Canada (2008–2018). Using logistic regression, we compared the characteristics, conditions, and functional status of residents who were socially isolated (no contact with family/friends) and non-socially isolated residents. Results: Socially isolated residents were male, younger, and had a longer length of stay in the home, than non-socially isolated residents. Socially isolated residents lacked social engagement and exhibited signs of depression. Discussion: Socially isolated residents had unique care concerns, including psychiatric disorders, and co-morbid conditions. Our approach, using a single item in an existing data source, has the potential to assist clinicians in screening for socially isolated long-term care residents.

scholarly journals Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Nicole Williams ◽  
Natalie A Phillips ◽  
Walter Wittich ◽  
Jennifer L Campos ◽  
Paul Mick ◽  
...  
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Individual Level ◽  
The Individual

Abstract Background and Objectives The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions. Research Design and Methods This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants’ most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan–Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC. Results In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer’s dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11). Discussion and Implications Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.

scholarly journals DEVELOPING A RAI-MDS 2.0 BEHAVIOR-BASED PAIN ASSESSMENT SCALE FOR LONG-TERM CARE RESIDENTS WITH ADVANCED DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S622-S623
Author(s):  
Jennifer A Knopp-Sihota
Keyword(s):  
Pain Assessment ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Assessment Scale ◽  
Self Report ◽  
Factor Analyses ◽  
Factor Solution ◽  
Term Care ◽  
Data Set

Abstract In Canadian and many international long-term care (LTC) facilities, pain assessment frequently relies on data from the Resident Assessment Instrument – Minimum Data Set 2.0 (RAI-MDS). The RAI-MDS produces a two-item scale, measuring both pain frequency and pain intensity. This scale correlates well with self-reported pain in cognitively intact LTC residents, but despite repeated testing, is less valid for use in residents with more advanced cognitive impairment who are unable to self-report their pain. In this study we aimed to develop and validate a behaviour-based pain assessment scale for long-term care residents using data available in the RAI-MDS. To construct our initial scale, we reviewed the literature and compiled a list of observable indicators of pain (e.g., grimacing) and linked these with 28 similar items available in the RAI-MDS. Using Delphi techniques, we further refined this to 20 items. We then evaluated the psychometric properties of our scale using two independent, representative samples, of urban LTC residents in Western Canada. Exploratory factor analyses were conducted in sample one (n=16,282) and confirmatory factor analyses (CFA) were then conducted in sample two (n=15,785) in order to test, and confirm, our model. A two-factor solution was identified grouping RAI-MDS items into subscales 1) change in status (e.g., new onset restlessness) and 2) behaviours (e.g., crying). Commonly recognized model fit indices were acceptable suggesting the adequacy of the two-factor solution. Results provide preliminary support for the use of behavioural-based pain assessment scale using RAI-MDS data. Further evaluation and validation of our scale is warranted.

scholarly journals Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis

2020 ◽  
Author(s):  
Johannes Michael Bergmann ◽  
Armin Michael Ströbel ◽  
Bernhard Holle ◽  
Rebecca Palm
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Long Term Care ◽  
Practical Recommendation ◽  
Term Care ◽  
Data Set ◽  
Convenience Sample ◽  
Agglomerative Hierarchical Cluster Analysis ◽  
Residential Long Term Care

Abstract Background: Organizational health care research focuses on describing structures and processes in organizations and investigating their impact on the quality of health care. In the setting of residential long-term care, this effort includes the examination and description of structural differences among the organizations (e.g., nursing homes). The objective of the analysis is to develop an empirical typology of living units in nursing homes that differ in their structural characteristics. Methods: Data from the DemenzMonitor Study were used. The DemenzMonitor is an observational study carried out in a convenience sample of 103 living units in 51 nursing homes spread over 11 German federal states. Characteristics of living units were measured by 19 variables related to staffing, work organization, building characteristics and meal preparation. Multiple correspondence analysis (MCA) and agglomerative hierarchical cluster analysis (AHC) are suitable to create a typology of living units. Both methods are multivariate and explorative. We present a comparison with a previous typology (created by a nonexplorative and nonmultivariate process) of the living units derived from the same data set.Results: The MCA revealed differences among the living units, which are defined in particular by the size of the living unit (number of beds), the additional qualifications of the head nurse, the living concept and the presence of additional financing through a separate benefit agreement. We identified three types of living units; these clusters occur significantly with a certain combination of characteristics. In terms of content, the three clusters can be defined as: "house community", "dementia special care units” and "usual care". Conclusion: A typology is useful to gain a deeper understanding of the differences in the care structures of residential long-term care organizations. In addition, the study provides a practical recommendation on how to apply the results, enabling housing units to be assigned to a certain type. The typology can be used as a reference for definitions.

scholarly journals Developing an RAI-MDS Behavior-Based Pain Scale for Long-Term Care Residents With Advanced Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 203-204
Author(s):  
Jennifer Knopp-Sihota ◽  
Matthias Hoben ◽  
Jeff Poss ◽  
Carole Estabrooks
Keyword(s):  
Pain Assessment ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Assessment Scale ◽  
Self Report ◽  
Factor Analyses ◽  
Factor Solution ◽  
Term Care ◽  
Data Set

Abstract In Canadian and many international long-term care (LTC) facilities, pain assessment frequently relies on data from the Resident Assessment Instrument – Minimum Data Set 2.0 (RAI-MDS). The RAI-MDS produces a two-item scale, measuring both pain frequency and pain intensity. This scale correlates well with self-reported pain in cognitively intact LTC residents, but despite repeated testing, is less valid for use in residents with more advanced cognitive impairment who are unable to self-report their pain. In this study we aimed to develop and validate a behaviour-based pain assessment scale for long-term care residents using data available in the RAI-MDS. To construct our initial scale, we reviewed the literature and compiled a list of observable indicators of pain (e.g., grimacing) and linked these with 28 similar items available in the RAI-MDS. Using Delphi techniques, we further refined this to 20 items. We then evaluated the psychometric properties of our scale using two independent, representative samples, of urban LTC residents in Western Canada. Exploratory factor analyses were conducted in sample one (n=16,282) and confirmatory factor analyses (CFA) were then conducted in sample two (n=15,785) in order to test, and confirm, our model. A two-factor solution was identified grouping RAI-MDS items into subscales 1) change in status (e.g., new onset restlessness) and 2) behaviours (e.g., crying). Commonly recognized model fit indices were acceptable suggesting the adequacy of the two-factor solution. Results provide preliminary support for the use of behavioural-based pain assessment scale using RAI-MDS data. Further evaluation and validation of our scale is warranted.

scholarly journals Relationship between environmental factors and responsive behaviours in long-term care homes: a secondary data analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047364
Author(s):  
Kelsey Holt ◽  
Matthias Hoben ◽  
Lori Weeks ◽  
Carole Estabrooks
Keyword(s):  
Environmental Quality ◽  
Long Term Care ◽  
Care Delivery ◽  
Research Programme ◽  
Assessment Instrument ◽  
Cross Sectional ◽  
Term Care ◽  
Data Set

ObjectiveResponsive behaviours (eg, wandering, resisting care and verbal abuse) are a continuing issue for staff and individuals living in long-term care (LTC) homes. The LTC environment can influence responsive behaviours and is a factor in determining the quality of life for those living there. The ways in which the quality of the environment might influence responsive behaviours has not been investigated yet. We hypothesised that better quality environments would be associated with reduced rates of responsive behaviours. We used a tool that simultaneously encompasses human and structural elements of the environment, a novel approach in this field of research.DesignCross-sectional study, using data collected from September 2014 to May 2015 as part of the Translating Research in Elder Care research programme.SettingA representative, stratified (size, owner-operator model and health region) random sample of 76 LTC homes in British Columbia, Alberta, Manitoba.Participants13 224 individuals (67.3% females) living in participating LTC homes.Outcome measuresQuality of care unit work environment was assessed using the observable indicators of quality (OIQ) tool. Responsive behaviours were assessed using routinely collected Resident Assessment Instrument-Minimum Data Set V.2.0 data.ResultsAdjusted regression coefficients of overall Aggressive Behaviour Scale score and interpersonal communication were 0.02 (95% CI −0.011 to 0.045), grooming 0.06 (95% CI −0.032 to 0.157), environment-basics 0.067 (95% CI 0.024 to 0.110), odour −0.066 (95% CI −0.137 to −0.004), care delivery −0.007 (95% CI −0.033 to 0.019), environment-access −0.027 (95% CI −0.062 to 0.007), environment-homelike −0.034 (95% CI −0.065 to −0.002) and total OIQ score 0.003 (95% CI −0.004 to 0.010).ConclusionsWe found small associations between the environmental quality and responsive behaviours in Western Canadian LTC homes. Higher scores on homelikeness were associated with decreased responsive behaviours. Higher scores on basic environmental quality were associated with increased responsive behaviours.

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