scholarly journals The Impact of State Dementia Training Requirements for Nursing Homes on Resident Outcomes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 550-550
Author(s):  
Yuna Bae-Shaaw ◽  
Cara Lekovitch ◽  
Felicia Chew ◽  
Natalie Leland ◽  
Neeraj Sood ◽  
...  
Keyword(s):  
Nursing Home ◽  
State Level ◽  
Physical Restraints ◽  
Specific Knowledge ◽  
Difference In Differences ◽  
Training Requirements ◽  
Restraint Use ◽  
The Impact ◽  
The Relationship ◽  
Level Training

Abstract Stakeholders, including policymakers, have prioritized the need to educate nursing home (NH) staff about Alzheimer’s disease and dementia. Despite this prioritization and the relationship between staff training and outcomes, dementia-specific knowledge is variable. This study examined state-level training policies between 2011-2016. During this time 12 states (regulators and payers) implemented NH dementia training requirements, creating an opportunity for a natural experiment between states with and without new requirements. We estimated difference-in-differences models to determine the effect of state requirements on outcomes. Data from Nursing Home Compare and LTCFocus.org were linked to data on state policies. Training requirements were associated with 0.39 and 0.17 percentage point reductions in antipsychotics use and restraint use, respectively, and no impact on falls or need for help with daily activities. State requirements for dementia training in NHs are associated with a small, but significant reduction in the use of antipsychotic medication and physical restraints.

scholarly journals Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

2018 ◽  
Vol 55 ◽  
pp. 004695801878799
Author(s):  
R. Tamara Konetzka ◽  
Hari Sharma ◽  
Jeongyoung Park
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Fixed Effects ◽  
Online Survey ◽  
Market Competition ◽  
Consumer Welfare ◽  
Data Sets ◽  
For Profit ◽  
The Impact ◽  
The Relationship

An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw’s Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.

Sodium menu labelling: priorities for research and policy

2020 ◽  
pp. 1-10
Author(s):  
Eleanore Alexander ◽  
Lainie Rutkow ◽  
Kimberly A Gudzune ◽  
Joanna E Cohen ◽  
Emma E McGinty
Keyword(s):  
Local Level ◽  
State Level ◽  
The State ◽  
Rigorous Research ◽  
The Usa ◽  
Legal Databases ◽  
State And Local ◽  
The Impact ◽  
The Relationship ◽  
Research And Policy

Abstract Objective: To understand the different Na menu labelling approaches that have been considered by state and local policymakers in the USA and to summarise the evidence on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers. Design: Proposed and enacted Na menu labelling laws at the state and local levels were reviewed using legal databases and an online search, and a narrative review of peer-reviewed literature was conducted on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers. Setting: Local and state jurisdictions in the USA Participants: Not applicable. Results: Between 2000 and 2020, thirty-eight laws – eleven at the local level and twenty-seven at the state level – were proposed to require Na labelling of restaurant menu items. By 2020, eight laws were enacted requiring chain restaurants to label the Na content of menu items. Five studies were identified that evaluated the impact of Na menu labelling on Na content of menu items offered by restaurants or purchased by consumers in the USA. The studies had mixed results: two studies showed a statistically significant association between Na menu labelling and reduced Na content of menu items; three showed no effects. Conclusion: Data suggest that Na menu labelling may reduce Na in restaurant menu items, but further rigorous research evaluating Na menu labelling effects on Na content of menu items, as well as on the Na content in menu items purchased by consumers, is needed.

The Impact of Tax and Expenditure Limitations on Municipal Revenue Volatility

2018 ◽  
Vol 50 (2) ◽  
pp. 71-84 ◽  
Author(s):  
Tucker C. Staley
Keyword(s):  
Local Level ◽  
State Level ◽  
Policy Makers ◽  
Tax And Expenditure Limitations ◽  
Goods And Services ◽  
Expenditure Limitations ◽  
Revenue Volatility ◽  
Stringency Level ◽  
The Impact ◽  
The Relationship

Stable revenue flows are paramount for policy makers at all levels of government in order to effectively and efficiently provide goods and services to constituents. This work examines the relationship between tax and expenditure limitations (TELs) and municipal revenue volatility. The current literature suggests that more stringently binding TELs at the state level are associated with greater levels of revenue volatility. This work tests whether this finding extends to the local level of government as well. Examining ninety-nine municipalities over eight years (2004–2011), this work provides evidence that the stringency level of TELs is associated with reduced fluctuations in municipal revenue streams.

scholarly journals The Impact of Ride-Hailing Services on Private Car Use in Urban Areas: An Examination in Chinese Cities

2020 ◽  
Vol 2020 ◽  
pp. 1-15
Author(s):  
Jun Zhong ◽  
Yan Lin ◽  
Siqi Yang
Keyword(s):  
Urban Areas ◽  
Negative Impact ◽  
Rapid Development ◽  
Utilization Rate ◽  
Difference In Differences ◽  
Car Use ◽  
Significant Negative Impact ◽  
Private Car ◽  
The Impact ◽  
The Relationship

The rapid development of internet-based ride-hailing services has contributed to transportation in cities and, at the same time, has significantly impacted existing travel modes in cities. A question has emerged as to whether and to what extent ride-hailing services replace private car use. Although the private car is convenient, comfortable, and flexible, it has low utilization rate and high maintenance and parking costs. Better understanding of the relationship between ride-hailing services and the use of private cars has been brought to the forefront for auto dealers and urban transportation policymakers. However, controversies remain regarding how ride-hailing services will impact the use of private cars in cities. Given this setting, our study applied a difference-in-differences method to analyze the impact of ride-hailing services on the use of private cars with balanced panel data from 109 prefecture-level cities in China from 2010 to 2016. Moreover, we employed some methods to verify the robustness of the preliminary results. The empirical results show that ride-hailing services had a negative impact on the use of private cars in urban areas. Over time, the negative impact initially strengthened and then weakened. Further studies showed that ride-hailing services had a more significant negative impact on private car use in eastern cities than in western cities. The results showed that the influence of ride-hailing services on private car use in urban areas is heterogeneous across time and cities.

scholarly journals THE IMPACT OF CULTURE CHANGE ON FINANCIAL PERFORMANCE OF HIGH MEDICAID NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S156-S156
Author(s):  
Justin C Lord ◽  
Ganisher K Davlyatov ◽  
Akbar Ghiasi ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Culture Change ◽  
Market Competition ◽  
Profit Margin ◽  
Organizational Level ◽  
Poverty Level ◽  
The Impact ◽  
The Relationship

Abstract This study examines the association between culture change artifacts and financial performance among under-resourced nursing homes (70% or higher Medicaid census). Culture change represents a transformational process to become person-centered, through staff and resident empowerment. Cultural artifacts represent the physical evidences that culture change is occurring. In this study, we focus on the workplace (nurse staffing consistent assignments) and leadership (residents engagement) artifacts to assess the relationship between culture change practices and performance. Survey data came from 387 nursing home directors from 2016- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the total profit margin (%), while the independent variables comprised composite scores for leadership (0-25) and workplace artifacts (0-15). Control variables included organizational-level (ownership, chain affiliation, size, occupancy rate, and Medicare and Medicaid payer mix), and county-level factors (Medicare Advantage penetration, per capita income, educational level, unemployment rate, poverty level and competition). Multivariate regression was used to model the relationship between cultural change artifacts and financial performance. Workplace artifacts in nursing homes were found to be associated with significantly higher profit margin (β = 0.30, p < 0.05), while leadership artifacts were not. Culture change practices aimed at improving nursing staff consistent assignments are associated with better financial performance. Given increasing nursing home market competition and declining resources for high Medicaid nursing homes, facilities with a greater emphasis on workplace culture may be able to perform better financially among these under-resourced facilities.

scholarly journals Impact of Internet Use on Mental Health among Elderly Individuals: A Difference-in-Differences Study Based on 2016–2018 CFPS Data

2021 ◽  
Vol 19 (1) ◽  
pp. 101
Author(s):  
Huan Zhang ◽  
Hongyang Wang ◽  
Huiyu Yan ◽  
Xiaoyu Wang
Keyword(s):  
Mental Health ◽  
Life Satisfaction ◽  
Internet Use ◽  
Difference In Differences ◽  
Elderly Individuals ◽  
The Past ◽  
Internet Users ◽  
Using Data ◽  
The Impact ◽  
The Relationship

The number of elderly Internet users has increased significantly in the past few years. However, the impact of Internet use on mental health remains unclear. In this study, we performed a difference-in-differences analysis using data from the 2016 and 2018 waves of the China Family Panel Studies (CFPS) to evaluate the impact of Internet usage on mental health among elderly individuals. A total of 5031 validated respondents were included to explore the relationship between Internet use and reduced levels of depression as well as improved life satisfaction among elderly individuals. The results showed that Internet use significantly reduced depression levels. Unexpectedly, Internet use was not found to improve life satisfaction. Moreover, discontinuing Internet use was not significantly associated with improvements in depression or life satisfaction. More research is needed to fully elucidate the relationship between Internet use and depression levels, as well as life satisfaction among elderly individuals.

scholarly journals Physical restraint of dementia patients in acute care hospitals during the COVID-19 pandemic: A cohort analysis in Japan

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260446
Author(s):  
Takuya Okuno ◽  
Hisashi Itoshima ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Acute Care ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Physical Restraint ◽  
Acute Care Hospitals ◽  
Physical Restraints ◽  
Restraint Use ◽  
Dementia Patients ◽  
Number Of Patients ◽  
The Impact

Introduction The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals. Methods In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint. Results In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic. Conclusion Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.

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