scholarly journals Providing Nursing Home Care in an Era of Increasing Scarcity: The Case of Pennsylvania

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 504-504
Author(s):  
Edward Miller ◽  
Molly Wylie ◽  
Elizabeth Simpson ◽  
Marc Cohen
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Low Income ◽  
Quality Care ◽  
State Level ◽  
Safety Net ◽  
Nursing Home Care ◽  
Population Projections ◽  
Term Care ◽  
Over Time

Abstract Medicaid financing of nursing home (NH) care provides the strongest safety net for low income older adults, persons who have high-intensity long-term care (LTC) needs, and consumers with exorbitant LTC costs. Yet, NHs currently face serious threats to their financial viability, particularly in the context of the COVID-19 pandemic, where the costs of caring for residents in a safe way have increased significantly, even as the ability to recoup these costs from the Medicaid program has been constrained. The purpose of this study is to assess key demand and supply factors affecting the performance of the NH industry in Pennsylvania over time. It draws from several large, national data sources, including NH Compare, LTCFocus.org, the U.S. Bureaus of the Census and Labor Statistics, and Certification and Survey Provider Enhanced Reports, as well as state-level population projections and Departments of Health and Human Services data. An aggregate database was constructed with historical data points at the facility, regional, and state level. Annual total and regional trends were examined from 2010 to 2020. Findings suggest a growing gap between what NHs require to meet the needs of residents and the level of reimbursement paid by the largest funder: Medicaid. Considering demographic trends, this gap will only grow over time in the absence of policy change. The pandemic has further highlighted the existing challenges resulting from an underfunded service infrastructure and the need for additional investment if NHs are to provide high quality care to a growing cohort of older adults requiring support.

scholarly journals (UN)EQUAL BURDEN OF CARE: STAFF PERSPECTIVES ON NURSING HOME CARE AND QUALITY OF LIFE FOR RESIDENTS OF COLOR

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S780-S781
Author(s):  
Odichinma C Akosionu ◽  
Tetyana P Shippee ◽  
Heather Davila ◽  
Mai See Thao ◽  
Moses Waiswa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Quality Care ◽  
Nursing Home Care ◽  
Care Staff ◽  
Burden Of Care ◽  
Structured Interviews ◽  
Term Care ◽  
Color Experience

Abstract Racial disparities in quality of care (QoC) and quality of life (QoL) for nursing home (NH) residents persist even as the proportion of minorities is significantly increasing. Staff of color are a growing part of the long-term care workforce and staffing is a key component for delivering quality care. This study looks at staff (n=60) perspectives on resident QOL through semi-structured interviews, using thematic analysis in six Minnesota high proportion minority NHs. Key findings show that staff of color are concerned about the QoC and QoL residents of color experience, and take extra steps to provide care that goes beyond addressing their clinical needs. This agency of providing extra care is a factor in burnout among staff of color. More research on how this unequal burden of care impacts QoC/QoL is important to address the disproportionate role that staff of color play in reducing disparities in resident QoC and QoL.

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.

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.

A Model of Risk Reduction for Older Adults Vulnerable to Nursing Home Placement

2014 ◽  
Vol 28 (2) ◽  
pp. 162-192 ◽  
Author(s):  
Janice L. Palmer ◽  
Joanne C. Langan ◽  
Jean Krampe ◽  
Mary Krieger ◽  
Rebecca A. Lorenz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Nursing Home ◽  
Health Care Providers ◽  
Functional Disability ◽  
Nursing Home Placement ◽  
Nursing Home Care ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
Home Placement

Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.

The vulnerability of nursing home residents to the Covid-19 pandemic

2020 ◽  
Vol 23 (2-3) ◽  
pp. 57-60 ◽  
Author(s):  
Edward H Wagner
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Nursing Assistants ◽  
Nursing Home Care ◽  
Term Care ◽  
Staff Members ◽  
Care Facilities

Residents in nursing homes and other long-term care facilities comprise a large percentage of the deaths from Covid 19. Is this inevitable or are there problems with NHs and their care that increase the susceptibility of their residents. The first U.S. cluster of cases involved the residents, staff, and visitors of a Seattle-area nursing home. Study of this cluster suggested that infected staff members were transmitting the disease to residents. The quality of nursing home care has long been a concern and attributed to chronic underfunding and resulting understaffing. Most NH care is delivered by minimally trained nursing assistants whose low pay and limited benefits compel them to work in multiple long-term care settings, increasing their risk of infection, and work while ill. More comparative studies of highly infected long-term care facilities with those organizations that were able to better protect their residents are urgently needed. Early evidence suggests that understaffing of registered nurses may increase the risk of larger outbreaks.

scholarly journals Municipalities’ Decision to Care: At Home or in a Nursing Home

2020 ◽  
Vol 26 (4) ◽  
pp. 327-342
Author(s):  
Theis Theisen
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Long Term Care ◽  
Nursing Home Care ◽  
Empirical Literature ◽  
Term Care ◽  
Scant Attention ◽  
Insurance Mechanism ◽  
Using Data

AbstractAn almost ideal demand system for long-term care is estimated using data from Norway, where the split of long-term care between home care and care in nursing homes is determined by municipalities. Previous literature has barely addressed what determines municipalities’ or other organizations’ allocations of resources to the sub-sectors of long-term care. The results show that home care is a luxury, while nursing home care is a necessity with respect to total expenditures on long-term care. Municipalities respond to high unit costs for home care by reducing that type of care. Municipalities are highly responsive to variations in the need for the two types of care and seem to provide a well-functioning insurance mechanism for long-term care. In the previous empirical literature, municipalities’ role as providers of insurance against the consequences of disabilities and frailty has received scant attention.

scholarly journals 2400 How have characteristics of end-of-life family caregiving changed from 1999 to 2015? Preliminary results from two waves of nationally representative data

2018 ◽  
Vol 2 (S1) ◽  
pp. 82-82
Author(s):  
Judith Vick ◽  
Jennifer Wolff
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Family Caregivers ◽  
Family Caregiving ◽  
Physical Strain ◽  
Term Care ◽  
Care Survey ◽  
Nationally Representative ◽  
Over Time

OBJECTIVES/SPECIFIC AIMS: Family members are often critical in the delivery of hands-on care and decisions about care for persons approaching end-of-life (EOL). Prompted by concerns about the poor quality and high costs of care at the EOL, recent delivery reform efforts—such as the growth of hospice and palliative care—have been directed at improving EOL care for both patients and family. Trends of the characteristics of EOL family caregivers and care recipients over time have not been well described. The goal of this study is to evaluate changes in EOL family caregiving from 1999 to 2015. METHODS/STUDY POPULATION: This study uses reconciled data from two nationally representative surveys and their linked caregiver surveys: the 1999 wave of the National Long-Term Care Survey (NLTCS) and the Informal Care Survey (ICS), and the 2015 wave of the National Health and Aging Trends Study (NHATS) and the National Survey of Caregiving (NSOC). RESULTS/ANTICIPATED RESULTS: Crude analysis shows that older adults living in the community and receiving help from family caregivers in the last year of life were significantly better educated (72% with greater than 12 years of education vs. 46%), and more diverse (78% White vs. 89%) in 2015 compared with 1999. Family caregivers in the last year of life were less likely to be female in 2015 compared with 1999 (74% vs. 68%, NS) and significantly less likely to be spouses (45% vs. 38%) in 2015. In 2015, a significantly greater proportion of older adults received help with five or more activities of daily living (47% vs. 34%), but family caregivers reported significantly lower levels of caregiving-associated distress: financial strain (80% reporting none in 2015 vs. 53%), emotional (51% vs. 39%), and physical strain (70% vs. 45%). In addition, a significantly greater proportion of EOL family caregivers used respite care in 2015 compared to 1999 (15% vs. 4%). DISCUSSION/SIGNIFICANCE OF IMPACT: Changes in the experience of EOL family caregiving may be impossible to capture in studies of single interventions, but tracking nationally representative trends can be used as an indicator of broader changes that take place cumulatively over time. Although studies of this nature cannot identify causal mechanisms of change, they are important to monitor long-term impact of program implementation and to guide future research, policy, and resource allocation.

The High Price of Obesity in Nursing Homes

2015 ◽  
Vol 16 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Cindy L. Marihart ◽  
Ardith R. Brunt ◽  
Angela A. Geraci
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
The United States ◽  
Nursing Home Care ◽  
Health Concern ◽  
High Price ◽  
Obese Adults ◽  
Obese People

This article provides a commentary on the costs of obese nursing home patients. We conducted a comprehensive literature search, which found 46 relevant articles on obesity in older adults and effects on nursing home facilities. This review indicated obesity is increasing globally for all age groups and older adults are facing increased challenges with chronic diseases associated with obesity more than ever before. With medical advances comes greater life expectancy, but obese adults often experience more disabilities, which require nursing home care. In the United States, the prevalence of obesity in adults aged 60 years and older increased from 9.9 million (23.6%) to 22.2 million (37.0%) in 2010. Obese older adults are twice as likely to be admitted to a nursing home. Many obese adults have comorbidities such as Type 2 diabetes; patients with diabetes incurred 1 in every 4 nursing home days. Besides the costs of early entrance into nursing facilities, caring for obese residents is different than caring for nonobese residents. Obese residents have more care needs for additional equipment, supplies, and staff costs. Unlike emergency rooms and hospitals, nursing homes do not have federal requirements that require them to serve all patients. Currently, some nursing homes are not prepared to deal with very obese patients. This is a public health concern because there are more obese people than ever in history before and the future appears to have even a heavier generation moving forward. Policymakers need to become aware of this serious gap in nursing home care.

scholarly journals Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study (Preprint)

2020 ◽  
Author(s):  
Guillaume Sacco ◽  
Sébastien Lléonart ◽  
Romain Simon ◽  
Frédéric Noublanche ◽  
Cédric Annweiler ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Older People ◽  
Acute Care ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Term Care ◽  
Telephone Calls ◽  
Acute Care Unit

BACKGROUND Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. OBJECTIVE Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. METHODS The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. RESULTS A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (<i>P</i>=.03) and were more satisfied with their communication experiences (<i>P</i>=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (<i>P</i>=.1), with no effect of age (<i>P</i>=.97) or gender (<i>P</i>=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (<i>P</i>=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; <i>P</i>=.02). CONCLUSIONS Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. CLINICALTRIAL ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849.

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