Recruiting Resident Participants from Nursing Homes During the COVID Pandemic: Challenges and Solutions

Abstract Recruiting nursing home residents as participants in research is challenging. In early 2021, Covid-19 cases rose rapidly in nursing homes, prompting the rapid deployment of infectious disease protocols and ultimately, facility lockdowns to control the spread of the virus. By September, 2020, many research projects were delayed or cancelled, and future research was jeopardized. During this period, as well as prior to and after the administration of the COVID vaccine, we enrolled residents in a complex protocol involving administration of two Shingles vaccines (0- and 90 days) and three separate blood samples. Here, we present the strategies we used to recruit 216 residents, from 23 homes, over a 9-month period. We faced many challenges. Our research staff faced weekly COVID-19 antigen tests prior to entering the facility, adhering to strict protocols on travel, as well as packaging of materials that entered and left the facility. N95 masks and face shields further made it difficult to communicate with residents. For homes, COVID protocols required residents to be transported to specified areas to meet with research staff. Daily monitoring of COVID and Shingrix vaccine symptoms became part of daily care. To minimize resident harm and interruption of workflow in nursing homes, we utilized principles of stakeholder engagement, healthcare leadership, infectious disease/immunology, and staff (research and nursing homes) empowerment. In the face of crisis, like the COVID-19 pandemic, we have gained the trust and commitment of these facilities; thus, establishing a sustainable partnership that is prepared for what comes next.

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Does using the interRAI Palliative Care instrument reduce the needs and symptoms of nursing home residents receiving palliative care?

Palliative & Supportive Care ◽

10.1017/s1478951517000153 ◽

2017 ◽

Vol 16 (1) ◽

pp. 32-40 ◽

Cited By ~ 3

Author(s):

Kirsten Hermans ◽

Johanna De Almeida Mello ◽

Nele Spruytte ◽

Joachim Cohen ◽

Chantal Van Audenhove ◽

...

Keyword(s):

Palliative Care ◽

Nursing Homes ◽

Prior Experience ◽

Nursing Home Residents ◽

Assessment Instrument ◽

Future Research ◽

Term Care ◽

Quasi Experimental ◽

One Year

ABSTRACTObjective:This study aimed to evaluate whether using the interRAI Palliative Care instrument (the interRAI PC) in nursing homes is associated with reduced needs and symptoms in residents nearing the end of their lives.Method:A quasi-experimental pretest–posttest study using the Palliative care Outcome Scale (POS) was conducted to compare the needs and symptoms of residents nearing the end of their lives in the control and intervention nursing homes. Care professionals at the intervention nursing homes filled out the interRAI PC over the course of a year for all residents aged 65 years and older who were nearing the end of their lives. This intervention was not implemented in the control nursing homes.Results:At baseline, POS scores in the intervention nursing homes were lower (more favorable) than in the control nursing homes on the items “pain”, “other symptoms”, “family anxiety”, and the total POS score. Posttest POS scores for “wasted time” were higher (less favorable) than pretest scores in the intervention nursing homes. In the intervention nursing homes where care professionals did not have prior experience with the interRAI Long-Term Care Facilities (LTCF) assessment instrument (n = 8/15), total POS scores were lower (more favorable) at posttest.Significance of results:One year after introducing the interRAI PC, no reduction in residents' needs and symptoms were detected in the intervention nursing homes. However, reductions in needs and symptoms were found in the subgroup of intervention nursing homes without prior experience with the interRAI LTCF instrument. This may suggest that the use of an interRAI instrument other than the interRAI PC specifically can improve care. Future research should aim at replicating this research with a long-term design in order to evaluate the effect of integrating the use of the interRAI PC in the day-to-day practices at nursing homes.

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Sounds in nursing homes and their effect on health in dementia: a systematic review

International Psychogeriatrics ◽

10.1017/s1041610220000952 ◽

2020 ◽

pp. 1-18

Author(s):

Sarah I. M. Janus ◽

Janouk Kosters ◽

Kirsten A. van den Bosch ◽

Tjeerd C. Andringa ◽

Sytse U. Zuidema ◽

...

Keyword(s):

Systematic Review ◽

Nursing Homes ◽

Cognitive Abilities ◽

Nursing Home Residents ◽

Sound Intensity ◽

Future Research ◽

Negative Effects ◽

Sound Sources ◽

Cross Sectional ◽

Nighttime Sleep

ABSTRACT Objectives: Nursing home residents with dementia are sensitive to detrimental auditory environments. This paper presents the first literature review of empirical research investigating (1) the (perceived) intensity and sources of sounds in nursing homes, and (2) the influence of sounds on health of residents with dementia and staff. Design: A systematic review was conducted in PubMed, Web of Science and Scopus. Study quality was assessed with the Mixed Methods Appraisal Tool. We used a narrative approach to present the results. Results: We included 35 studies. Nine studies investigated sound intensity and reported high noise intensity with an average of 55–68 dB(A) (during daytime). In four studies about sound sources, human voices and electronic devices were the most dominant sources. Five cross-sectional studies focused on music interventions and reported positives effects on agitated behaviors. Four randomized controlled trials tested noise reduction as part of an intervention. In two studies, high-intensity sounds were associated with decreased nighttime sleep and increased agitation. The third study found an association between music and less agitation compared to other stimuli. The fourth study did not find an effect of noise on agitation. Two studies reported that a noisy environment had negative effects on staff. Conclusions: The need for appropriate auditory environments that are responsive to residents’ cognitive abilities and functioning is not yet recognized widely. Future research needs to place greater emphasis on intervention-based and longitudinal study design.

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Facility Characteristics and Quality Deficiencies of Florida Nursing Homes With COVID-19 Cases and Deaths

Innovation in Aging ◽

10.1093/geroni/igaa057.3461 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 945-945

Author(s):

Xiaochuan Wang ◽

Courtney Wilson

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Infection Control ◽

Nursing Home Residents ◽

The United States ◽

Future Research ◽

Staffing Level ◽

Policy And Practice ◽

Staff Shortage ◽

Facility Size

Abstract The Coronavirus disease 2019 (COVID-19) has been disproportionately affecting nursing homes throughout the United States, resulting elevated risk for COVID-19 morbidity and mortality to nursing home residents. Given the high percentage of aging population, large number of nursing homes, and staggering surge of COVID-19 cases in Florida, it’s critical to understand factors that may affect Florida nursing homes’ vulnerability to the COVID-19 pandemic. Using Nursing Home COVID-19 Dataset as of July 26, 2020 obtained through Centers for Medicare and Medicaid Services (CMS), and Provider Info Dataset and Health Deficiencies Dataset available through CMS Nursing Home Compare data, we constructed a database of Florida nursing facilities with confirmed COVID-19 cases and deaths, with corresponding facility characteristics and quality deficiencies. We examined the facility characteristics (e.g. facility size, ownership state, chain affiliation, staffing level) and quality deficiencies (e.g. infection control deficiencies) of Florida nursing homes with and without publicly reported COVID-19 cases and deaths. Results indicated that, as of July 26, 2020, 73.3% and 40.8% of Florida nursing homes had resident COVID-19 cases and death, respectively (N=701). Findings also suggested that Florida nursing homes of large facility size, chain affiliated, and for profit, were significantly more likely to have documented resident COVID-19 cases (p<.05). Larger facility size (120 beds or more), staff shortage, and having prior infection control deficiency citation, were significantly related to the odds of having resident COVID-19 deaths (p<.05). Policy and practice implications and future research directions will be addressed to better protect the at-risk nursing home residents.

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FACILITY AND RESIDENT LEVEL DIFFERENCES: ANTIBIOTIC USE IN NURSING HOMES FOR RESIDENTS WITH ADVANCE DEMENTIA

Innovation in Aging ◽

10.1093/geroni/igz038.3233 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S883-S883

Author(s):

Meghan Hendricksen ◽

Daniel Habtemariam ◽

Susan Mitchell

Keyword(s):

Infectious Disease ◽

Nursing Home ◽

Nursing Homes ◽

Nurse Practitioners ◽

Nursing Home Residents ◽

Antibiotic Use ◽

Resistant Bacteria ◽

Antimicrobial Use ◽

Full Time ◽

Advanced Dementia

Abstract Previous studies have shown that there is a high frequency of antibiotic use in NH for advance dementia patients. However, research has shown limited clinical benefit from antimicrobial use for this population, and antimicrobial exposure increases colonization with drug-resistant bacteria in nursing homes. The aim of this study was to identify NH and resident level characteristics associated with antibiotic use for patients with advance dementia. Using data from an ongoing cluster RCT in 28 Boston NHs; Trial to Reduce Antimicrobial use in Nursing home residents with Alzheimer’s disease and other Dementias (TRAIN-AD), testing a program intervention to improve management of infections in advanced dementia. These data are taken from baseline measurements 2 months prior to intervention, and individual nursing home residents with advance dementia are units of analysis (n = 425). We ran multivariable logistic regression model with antibiotic use as the outcome, adjusting for clustering at NH level, with NH (#beds, profit status, staffing, #cognitively impaired, etc.) and individual patient characteristics (age, gender, race, etc.) as independent variables. Analyses found residents were more likely to receive antibiotics if they resided in nursing homes that employed less intense infectious disease practices prior to baseline (AOR = 2.34; 95% CI 1.08, 5.05), and full-time nurse practitioners or physician assistants (AOR= 3.68; 95%CI 1.49, 9.04). Female patients also had higher odds of receiving antibiotics (AOR=2.16; 95%CI1.10, 4.67). These findings provide potential insight into the importance of education regarding stringent infectious disease practices for practitioners, particularly for patients with advanced dementia.

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LESSONS LEARNED FROM NURSING HOME CIVIL MONETARY PENALTY PROJECTS

Innovation in Aging ◽

10.1093/geroni/igz038.2832 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S770-S770

Author(s):

Diana L Sturdevant ◽

Kathleen C Buckwalter

Keyword(s):

Nursing Home ◽

Quality Of Care ◽

Nursing Homes ◽

Nursing Home Residents ◽

Lessons Learned ◽

Federal State ◽

Future Research ◽

Term Care ◽

Home Setting

Abstract Nursing homes must comply with numerous federal/state regulations to receive Medicare and Medicaid funding. Failure to comply with these regulations can result in deficiency citations, and depending on the severity of the deficiency, a resulting Civil Monetary Penalty (CMP). Through the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty Reinvestment Program, CMP funds are reinvested to support activities that benefit nursing home residents and that protect or improve their quality of life or quality of care. This symposium presents some of the unique challenges, successes, failures, and surprise findings from CMP-funded nursing home quality improvement projects in two, predominantly rural Midwestern states: Oklahoma and Kansas. Dr. Williams presents findings of a pilot-study testing an adaptation of a successful family caregiver telehealth support intervention in the nursing home setting and implications for future research. Dr. Sturdevant shares successes, challenges, and unanticipated results from the “It’s Not OK to Fall” project, a comprehensive, 3 year fall prevention project implemented in Oklahoma nursing homes. Lastly, Ms. Round’s paper describes the implementation and findings of a Long-term Care Leadership Academy aimed at improving leadership and team building skills of three levels of nursing home staff, including Administrators/Directors’ of Nursing, RN/LPN charge nurses and certified nursing assistants. Discussant, Dr. Kathleen Buckwalter Ph.D., FAAN, RN, will discuss how principles of nursing home culture change provides a common framework for these projects and conclude by offering suggestions on how promotion of these principles might improve the quality of care provided by nursing homes.

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The Psychological Consequences of the COVID-19 on Residents and Staff in Nursing Homes

Work Aging and Retirement ◽

10.1093/workar/waaa021 ◽

2020 ◽

Vol 6 (4) ◽

pp. 254-259

Author(s):

Shenjiang Mo ◽

Junqi Shi

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Older People ◽

Nursing Home Residents ◽

Future Research ◽

Psychological Consequences ◽

Ethical Challenges ◽

Role Conflicts ◽

External Stakeholders

Abstract In this commentary, we overview the existing research on psychological consequences caused by COVID-19 for both residents and staff in the nursing homes. We identify loneliness and emotional anxiety as main psychological consequences for nursing home residents, whereas uncertainty, hopelessness, work overload, and role conflicts are the most salient psychological challenges for the staff in the nursing homes during the pandemic. We then summarize the existing strategies and interventions responsive to the above challenges. We suggest that this overview may help nursing home managers understand what are the key psychological challenges and how to deal with them during a crisis period. Finally, we also encourage future research to pay more attention to exploring interventions specifically designed for vulnerable older people, understanding the role of the nursing home leader team in managing emotional and ethical challenges in organizations, and developing community-wide collaboration with multiple external stakeholders.

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Family Advocacy for Residents in Nursing Homes During the COVID-19 Pandemic

Innovation in Aging ◽

10.1093/geroni/igab046.2928 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 801-801

Author(s):

Cristina de Rosa ◽

Yanjun Zhou ◽

Amy Lyons ◽

Yu-Ping Chang

Keyword(s):

Nursing Homes ◽

Communicable Disease ◽

Quality Care ◽

Family Members ◽

Nursing Home Residents ◽

Future Research ◽

Missed Opportunities ◽

Individual Interviews ◽

Psychosocial Wellbeing ◽

Family Advocacy

Abstract To protect one of the most vulnerable populations from COVID-19, nursing homes enacted and enforced visiting restrictions and other measures to limit the spread of this communicable disease. Family members, many of whom are former caregivers, were suddenly cut off from nursing home residents, and struggled to maintain connection with their loved ones residing in nursing homes. The purpose of this study was to describe the experiences of family members of residents in nursing homes in advocating for residents and themselves during a time of uncertainty and many challenges. This study used a qualitative descriptive approach to conduct individual interviews. Ten family members of residents of two nursing homes in a Northeastern state were interviewed by phone or videoconference using a semi-structured guide. Interviews were transcribed verbatim and analyzed using Braun and Clarke’s Reflexive Thematic Analysis. Family members expressed concerns for the lockdown’s impact on residents’ psychosocial wellbeing in addition to the potential physical dangers of COVID-19. They explored creative means of meeting needs for information and interaction, but often felt that these efforts fell short of replicating the connectedness of in-person visits. Family members identified multiple missed opportunities for involvement in care, and voiced willingness to comply with infection prevention guidelines, such as maintaining distance, to be present with residents. Our findings indicate that family members advocated for residents’ interests to ensure quality care. Future research and policy should consider family members as a potential resource for providing care and companionship during times of crisis.

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The effect of the implementation of a good medical practice booklet on nursing home residents’ drug prescriptions: a difference-in-differences analysis based on data from electronic pill dispensers (Preprint)

10.2196/preprints.13507 ◽

2019 ◽

Author(s):

Stéphane Sanchez ◽

Cécile Payet ◽

Marie Herr ◽

Anne Dazinieras ◽

Caroline Blochet ◽

...

Keyword(s):

Nursing Homes ◽

Medical Practice ◽

Intervention Group ◽

Medication Use ◽

Nursing Home Residents ◽

Control Group ◽

Multilevel Regression ◽

Difference In Differences ◽

Good Medical Practice ◽

The Impact

BACKGROUND The elderly are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. OBJECTIVE We aimed to evaluate the impact of the implementation of a good medical practice booklet on polypharmacy in nursing homes. METHODS We identified nursing homes belonging to a geriatric care provider that had launched a policy of proper medication use using a good medical practice booklet delivered to prescribers and pharmacists. Data were derived from electronic pill dispensers. The effect of the intervention on polypharmacy was assessed with multilevel regression models, with a control group to account for natural trends over time. The main outcomes were the average daily number of times when medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (-0.05 and -0.06). The good medical practice booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P=.45). CONCLUSIONS Although the good medical practice booklet itself did not seem effective in decreasing medication use, our data show the effectiveness of a higher-level policy to decrease polypharmacy.

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