scholarly journals Predictors of Nursing Home Covid-19 Cases: a Community Vulnerability Approach

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1023-1023
Author(s):  
Matthew Peterson ◽  
Larry Lawhorne
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Large Scale ◽  
Vulnerability Index ◽  
Study Data ◽  
Urban Setting ◽  
Social Vulnerability Index ◽  
Community Factors ◽  
For Profit ◽  
Urban Rural

Abstract It is well known that the Covid-19 pandemic has placed considerable burden on nursing homes, including from resident, facility, and community perspectives, among others. This study examined facility and community factors that were related to incident Covid-19 cases in nursing home facilities. N=12,473 US nursing homes were included in this study. Data from June 2020 - January 2021 from several publicly available sources were combined to create a dataset that included facility name, size, ownership, mortality rate, Covid case rate, personal protective equipment (PPE) and staff shortages, % white residents, and % Medicaid residents. Community factors included core-based statistical area (CBSA) Covid case rates, urban/rural, CBSA death rates, and the CDC’s Social Vulnerability Index (SVI). Zero-inflated Poisson regression models were used to determine predictors of 8-month Covid case counts, normalized by facility size. Results indicated that higher staff shortages, poorer facility rating, for-profit ownership, proportionally more Medicaid and non-white residents were all significantly associated with higher Covid case rates over 8 months (all P < 0.0001). Significant community level predictors of higher cases included urban setting and higher SVI. PPE shortages was not associated with higher case counts. Of all the factors included, SVI was the strongest predictor of Covid case counts. This large US study assists in determining critical facility and community factors that predict increasing Covid burden in nursing homes. Particularly, SVI is an important factor in determining facility and public health policy, and targeting resources in large scale health crises such as the Covid-19 pandemic.

scholarly journals Social Vulnerability across the Great Lakes Basin: A County-Level Comparative and Spatial Analysis

2021 ◽  
Vol 13 (13) ◽  
pp. 7274
Author(s):  
Joshua T. Fergen ◽  
Ryan D. Bergstrom
Keyword(s):  
Great Lakes ◽  
Spatial Patterns ◽  
Social Vulnerability ◽  
Vulnerability Index ◽  
Social Vulnerability Index ◽  
Great Lakes Basin ◽  
Empirical Examination ◽  
Regional Patterns ◽  
Urban Rural ◽  
Social Vulnerabilities

Social vulnerability refers to how social positions affect the ability to access resources during a disaster or disturbance, but there is limited empirical examination of its spatial patterns in the Great Lakes Basin (GLB) region of North America. In this study, we map four themes of social vulnerability for the GLB by using the Center for Disease Control’s Social Vulnerability Index (CDC SVI) for every county in the basin and compare mean scores for each sub-basin to assess inter-basin differences. Additionally, we map LISA results to identify clusters of high and low social vulnerability along with the outliers across the region. Results show the spatial patterns depend on the social vulnerability theme selected, with some overlapping clusters of high vulnerability existing in Northern and Central Michigan, and clusters of low vulnerability in Eastern Wisconsin along with outliers across the basins. Differences in these patterns also indicate the existence of an urban–rural dimension to the variance in social vulnerabilities measured in this study. Understanding regional patterns of social vulnerability help identify the most vulnerable people, and this paper presents a framework for policymakers and researchers to address the unique social vulnerabilities across heterogeneous regions.

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.

Illusions of Affection: Bureaucratic Ritualization's Relation to Emotional Abuse and Neglect in Nursing Homes

2009 ◽  
Vol 33 (3) ◽  
pp. 238-257 ◽  
Author(s):  
Jason S. Ulsperger ◽  
J. David Knottnerus
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Emotional Abuse ◽  
Nursing Home Residents ◽  
For Profit ◽  
The Poor ◽  
Structural Ritualization Theory ◽  
Abuse And Neglect ◽  
Poor Treatment ◽  
Everyday Interaction

This research uses 40 ethnographies, biographies, and autobiographies to explore various symbolic themes expressed through everyday interaction in nursing homes. The themes involve bureaucratic concepts such as staff separation, rules, documentation, and efficiency. They also involve ideas of emotional abuse and neglect, like objectification, compassion transgressions, and spiritual negligence. Relying on structural ritualization theory, we argue ritualized symbolic practices of bureaucracy unintentionally facilitate attitudes and acts of emotional neglect in both for-profit and nonprofit nursing homes. This assists in the development of rituals facilitating the poor treatment of residents. Overall, we propose that if society is going to have humane care for nursing home residents, it must first understand the ritual dynamics that lead to employees viewing and treating those they care for with a lack of dignity.

scholarly journals Nursing Home Factors and Their Impact on COVID-19 Cases: A Study of Wisconsin State

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 884-884
Author(s):  
Mohammed Abahussain ◽  
Priya Nambisan ◽  
Colleen Galambos ◽  
Bo Zhang ◽  
Elizabeth Bukowy
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Missing Values ◽  
Organizational Factors ◽  
Data Sets ◽  
Occupancy Rate ◽  
Free Standing ◽  
Staff Shortage ◽  
For Profit ◽  
Nurse Aides

Abstract COVID-19 has been devastating for Nursing Homes (NHs). The concentration of older adults with underlying chronic conditions inevitably made the setting highly vulnerable leading to high rates of mortality for residents. However, some nursing homes fared better than others. This study examines several quality measures and organizational factors to understand whether these factors are associated with COVID-19 cases in Wisconsin. We combined three datasets from Centers for Medicare & Medicaid Services (CMS) – the Star Rating dataset, Provider Information dataset and COVID-19 Nursing Home dataset. Data used is from the period of Jan 1 – Oct 25, 2020 for the state of Wisconsin. The analysis includes 331 free-standing NHs with no missing values from the data sets. The variables used were self-reported information on nursing home ratings, staff shortage, staff reported hours, occupancy rate, number of beds and ownership. Of the 331 NHs examined, shortages were reported of 25.4%, 31.1%, 3.2% and 15.6% of licensed nurse staff (25.4%), nurse aides (31.1%), clinical staff, (3.2%) and other staff (15.6%) Additionally, there was a significant (p<.05) positive correlation between number of beds and COVID-19 cases, and there was no statistically significant association between occupancy rate and COVID-19 cases. NHs with better star ratings were also found to have less COVID-19 cases. Interestingly, private NHs had significantly higher COVID-19 cases than for-profit and government owned NHs, a finding that is congruent with other studies in this area. Recommendations for practice will be discussed.

scholarly journals For-Profit Nursing Homes in the Netherlands: What Factors Explain Their Rise?

2020 ◽  
Vol 50 (4) ◽  
pp. 431-443 ◽  
Author(s):  
Aline Bos ◽  
Florien Margareth Kruse ◽  
Patrick Paulus Theodoor Jeurissen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
The Netherlands ◽  
Nonprofit Organizations ◽  
Private Equity ◽  
Nonprofit Sector ◽  
Nursing Home Care ◽  
Specialist Care ◽  
Labor Costs ◽  
For Profit

This exploratory, mixed-methods study analyzes characteristics of the emerging for-profit nursing home industry in the Netherlands and identifies the interrelated set of factors (context, trends, and sector conditions) that contribute to its growth. Until recently, the Dutch nursing home sector relied almost exclusively on nonprofit providers. Even though profit distribution in nursing home care is still banned, the for-profit nursing home sector is expanding. The study uses economic theory on nonprofit organizations and mixed-form markets to understand this expansion. We find that changes in the regulatory framework have unlocked the potential of the for-profit nursing home sector, enabling for-profit nursing homes to circumvent the for-profit ban. The expansion of the for-profit sector was mainly driven by the low responsiveness of the nonprofit sector to increased and changed demands. For-profit providers took advantage of this void. Moreover, they exploited “cream-skimming” potential in the market and used the wider care system to reduce their labor costs by relying on external specialist care. Another main driver was the access to financial capital from private investors (e.g., private equity firms).

scholarly journals Social Vulnerability Assessment for Flood Risk Analysis

Water ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 558 ◽  
Author(s):  
Laura Tascón-González ◽  
Montserrat Ferrer-Julià ◽  
Maurici Ruiz ◽  
Eduardo García-Meléndez
Keyword(s):  
Vulnerability Assessment ◽  
Flood Risk ◽  
Social Vulnerability ◽  
Large Scale ◽  
Vulnerability Index ◽  
Social Vulnerability Index ◽  
Coping Capacity ◽  
High Exposure ◽  
Public Data ◽  
Social Vulnerability Assessment

This paper proposes a methodology for the analysis of social vulnerability to floods based on the integration and weighting of a range of exposure and resistance (coping capacity) indicators. It focuses on the selection and characteristics of each proposed indicator and the integration procedure based on the analytic hierarchy process (AHP) on a large scale. The majority of data used for the calculation of the indicators comes from open public data sources, which allows the replicability of the method in any area where the same data are available. To demonstrate the feasibility of the method, a study case is presented. The flood social vulnerability assessment focuses on the municipality of Ponferrada (Spain), a medium-sized town that has high exposure to floods due to potential breakage of the dam located upstream. A detailed mapping of the social vulnerability index is generated at the urban parcel scale, which shows an affected population of 34,941 inhabitants. The capability of working with such detailed units of analysis for an entire medium-sized town provides a valuable tool to support flood risk planning and management.

Ownership and Quality in Markets with Asymmetric Information: Evidence from Nursing Homes

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Avner Ben-Ner ◽  
Pinar Karaca-Mandic ◽  
Ting Ren
Keyword(s):  
Nursing Home ◽  
Local Government ◽  
Asymmetric Information ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Quality Attributes ◽  
For Profit ◽  
Different Types

Abstract The ownership and governance of for-profit (FP), nonprofit (NP), and local government (LG) organizations are different. Therefore, the objectives of these different types of organizations and their performance may differ. We conjecture that in markets where there is substantial asymmetric information between providers and customers, FP firms, LG organizations and NP organizations provide similar levels of quality attributes that are observable to their customers and are well understood by them. However, FP firms are likely to provide lower levels of less-well observed and less-well understood desirable but costly quality attributes than their NP and LG counterparts. Using a rich dataset, we study the quality of outcomes for Minnesota nursing homes, which do not compete on prices. We find support for our theoretical conjectures: FP homes provide lower quality on a number of dimensions, especially those that are less observable by nursing home residents and their families.

Nursing home performance in resident care in the United States: is it only a matter of for-profit versus not-for-profit?

2008 ◽  
Vol 3 (2) ◽  
pp. 115-140 ◽  
Author(s):  
FREDERIC H. DECKER
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Resource Dependence ◽  
Physical Restraint ◽  
Resource Dependence Theory ◽  
The United States ◽  
For Profit ◽  
Not For Profit ◽  
Resident Care ◽  
Restraint Use

Abstract:Poorer resident care in US for-profit relative to not-for-profit nursing homes is usually blamed on the profit motive. But US nursing home performance may relate to Medicaid public financing in a manner qualifying the relationship between ownership and quality. We investigated effects of Medicaid resident census, Medicaid payment, and occupancy on performance. Resource dependence theory implies these predictors may affect discretion in resources invested in resident care across for-profit and not-for-profit facilities. Models on physical restraint use and registered nurse (RN) staffing were studied using generalized estimating equations with panel data derived from certification inspections of nursing homes. Restraint use increased and RN staffing levels decreased among for-profit and not-for-profit facilities when the Medicaid census increased and Medicaid payment decreased. Interaction effects supported a theory that performance relates to available discretion in resource allocation. Effects of occupancy appear contingent on the dependence on Medicaid. Poorer performance among US for-profit nursing homes may relate to for-profit homes having lower occupancy, higher Medicaid census, and operating in US states with lower Medicaid payments compared to not-for-profit homes. Understanding the complexity of factors affecting resources expended on resident care may further our understanding of the production of quality in nursing homes, whether in the US or elsewhere.

scholarly journals Large-scale silane bead-based SARS-CoV-2 testing of a nursing home in Spain identifies a viral reservoir during lockdown period

2021 ◽  
Author(s):  
Nicholas D. Weber ◽  
Ainhoa Goñi-Salaverri ◽  
Jose A. Rodríguez ◽  
Juan Pablo Unfried ◽  
Daniel Alameda ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Large Scale ◽  
Magnetic Beads ◽  
Rna Extraction ◽  
Academic Research ◽  
High Sensitivity ◽  
Viral Reservoir ◽  
Clinical Samples ◽  
Clinical Surveillance

AbstractBackgroundSpain is one of the countries most heavily affected by the COVID-19 pandemic. As in other countries such as UK and USA, nursing homes have been an important human reservoir for the virus and the population with the highest mortality worldwide. The presence of asymptomatic carriers within nursing homes is one of the factors that could provoke new outbreaks during the relaxing of lockdown measures.MethodsWe developed a high-throughput protocol for RNA extraction of patient samples based on silane magnetic beads in multi-well plates. The sensitivity, specificity and reproducibility rates were assessed using positive and negative clinical samples from the Clinica Universidad de Navarra, Spain. We utilized the protocol to test a pilot cohort of 138 residents and 87 staff from a nursing home in Northern Navarre, Spain.FindingsOur protocol showed high sensitivity (100%), specificity (96·0%) and linear correlation with PCR cycle threshold values obtained with a standard testing kit (R2 = 0·807, p=3E-05). Testing of 225 individuals from the nursing home revealed 63 residents (46%) and 14 staff (16%) positive for SARS-CoV-2. Only 18 of the positive residents (28·6%) were symptomatic at time of testing. During follow-up, 6 PCR-negative symptomatic residents were retested and resulted positive. One-month mortality among positive residents was higher than in negative residents (15·9% vs 1·3%), regardless of age or comorbidities.InterpretationRapid silane bead-based RNA extraction expanded the testing capabilities and COVID-19 patients were promptly identified. Personal and public health measures were enacted to avoid spreading and tighten clinical surveillance. The ability to easily adapt the technical capabilities of academic research centers to large-scale testing for SARS-CoV-2 could provide an invaluable tool for ensuring a safe lifting of lockdown in countries with high numbers of cases.FundingEuropean Molecular Biology Organization and Genomics Unit, Cima Universidad de Navarra.

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