scholarly journals State Adoption of Nursing Home Immunity From Legal Liability During the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 159-159
Author(s):  
Pamela Nadash ◽  
Edward Miller ◽  
Elizabeth Simpson ◽  
Michael Gusmano ◽  
Lisa Beauregard
Keyword(s):  
Quality Care ◽  
State Level ◽  
Legal Liability ◽  
Poor Quality ◽  
Fiscal Health ◽  
Cross Sectional ◽  
For Profit ◽  
Complex Process ◽  
State Adoption ◽  
High Death

Abstract Twenty-eight states have provided nursing homes (NHs) with immunity from legal liability related to COVID-19. This study places these provisions in the context of prior actions protecting NHs from legal action and explores factors influencing the adoption of such immunity provisions across states. It uses cross-sectional data to examine patterns of policy adoption and to assess states’ likelihood of adopting immunity provisions using multivariate methods. Variables of interest include information on state political, socioeconomic, programmatic, and COVID-19-related characteristics as well as data on campaign contributions and lobbying activity at the state level. Factors significantly related to NH immunity provision adoption included measures of state fiscal health (unemployment), ideology (percent legislators Democrat), governing capacity (unified government), and NH characteristics (percent not-for-profit, hospital-based, and chain). Population density and Medicaid as a percentage of state general fund expenditures proved significant as well. Against these complex influences, organizations lobbying on behalf of NH residents and their families have found themselves ineffectual in creating avenues for accountability. Results indicate that enforcing accountability for NH deaths during the COVID-19 pandemic is a complex process, constrained by available policy tools and made more complicated by factors external to the NH environment that contributed to high death rates. Historically, the NH industry has been successful in avoiding consequences for poor quality care, a pattern that has persisted in that NHs have generally been successful in avoiding liability for negligence during the COVID-19 pandemic.

Civil Money Penalty Enforcement Actions for Quality Deficiencies in Nursing Homes

2019 ◽  
Vol 60 (5) ◽  
pp. 868-877
Author(s):  
Xiaochuan Wang ◽  
Denise Gammonley ◽  
Felicia Bender
Keyword(s):  
Quality Of Life ◽  
Nursing Homes ◽  
Fixed Effects ◽  
State Level ◽  
Regulatory Oversight ◽  
Cross Sectional ◽  
For Profit ◽  
Profit Status ◽  
Fixed Effects Regression

Abstract Background and Objectives Civil money penalties (CMP) are fines collected by CMS. A portion of these CMPs are redistributed to states for purposes including improving resident care and quality of life through reinvestment in quality improvement projects. This study examined state variation in civil money penalty enforcement actions for quality of life (QOL) and quality of care (QOC) deficiencies in nursing homes. Research Design and Methods 2015–2016 cross-sectional CASPER nursing home survey data obtained from the CMS QCOR database were used to explore the pattern of enforcement actions for QOL and QOC deficiencies across states. Fixed effects regression models examined relationships between state-level characteristics, quality deficiencies, and enforcement actions imposed by states. Results State enforcement actions resulting in a CMP were more likely for QOC deficiencies (M = 0.143, SD = 0.097) than for QOL deficiencies (M = 0.070, SD = 0.056) and states exhibited variability in imposing enforcement actions. The presence of severe QOC deficiencies resulting in actual resident harm contributed to CMP enforcement actions for both QOL and QOC deficiencies. States with primarily for-profit status providers had more enforcement actions. Discussion and Implications The variability noted in state enforcement for quality deficiencies actions parallels inconsistencies in state regulatory oversight of nursing homes.

scholarly journals CULTURAL COMPETENCE TRAINING FOR HOSPICE STAFF: FINDINGS FROM A NATIONAL HOSPICE SURVEY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S6-S6
Author(s):  
Nathan Boucher ◽  
Kimberly S Johnson
Keyword(s):  
Cultural Competence ◽  
Minority Groups ◽  
Quality Care ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Future Research ◽  
Cross Cultural Communication ◽  
For Profit ◽  
Competence Training ◽  
Diverse Groups

Abstract Compared to whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce these disparities. We conducted a national survey of hospices’ practices to promote CC. A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census over 100 (53%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 54% held it annually. Most trainings were one hour (60%); content was delivered via web (58%) and/or lecture (57%). While over 90% of staff (i.e., nurses, social workers, and chaplains) completed CCT, a smaller proportion of medical directors (63%), senior leaders (70%) and board members (23%) did so. Most common (>70%) topics were: cross-cultural communication, death and illness beliefs, and spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (61%)—the most common U.S. minority groups. Almost 30% reported no assessment of effectiveness of CCT while 45% reported a quiz at the end. In this study, most hospices offered some CCT. CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.

Resilience Education for Health-Care Professionals

2020 ◽  
Vol 26 (4) ◽  
pp. 225-231
Author(s):  
Sarah R. Martin ◽  
Elizabeth A. Fiske ◽  
Susan Hayes Lane
Keyword(s):  
Health Care ◽  
Education Program ◽  
Health Care Professionals ◽  
Quality Care ◽  
Well Being ◽  
Cross Sectional ◽  
For Profit ◽  
Not For Profit ◽  
Resilience Scale ◽  
Safety And Health

BackgroundBurnout among health-care professionals is a growing problem having a sizeable impact on patient safety and health care as a whole. High levels of resilience in health-care professionals have been associated with safer care environments, improved health outcomes, higher quality care, and improved caregiver well-being and mental health. Resilience education can improve personal and professional resilience.ObjectiveThe goal of this project was to evaluate a resilience education program to improve measures of burnout and resilience in health-care professionals.DesignA quantitative cross-sectional pretest/posttest design was used.SettingThe resilience education program was implemented in a large, not-for-profit health-care system in the southeastern United States.MethodsParticipants completed the Copenhagen Burnout Inventory (CBI) and The Connor-Davidson Resilience Scale-25 (CD-RISC-25) immediately before the workshop and 2 weeks afterward. Participants also completed an evaluation survey one day after the education.ResultsScores on the CD-RISC-25 showed statistically significant increases in resilience qualities after the education. Although not statistically significant, burnout as measure by CBI scores decreased following the workshop.ConclusionA relatively short educational program can positively impact resilience and burnout levels in health-care professionals. Positive outcomes included successful learning outcomes and increased resilience qualities.

scholarly journals Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?

2020 ◽  
Vol 38 (2) ◽  
pp. 169-174
Author(s):  
Nathan A. Boucher ◽  
Kimberly S. Johnson
Keyword(s):  
Cultural Competence ◽  
Minority Groups ◽  
Quality Care ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Future Research ◽  
Cross Cultural Communication ◽  
For Profit ◽  
Competence Training ◽  
Diverse Groups

Background: Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities. Objective: To describe the state of CC training across hospices. Design: National survey of hospices’ practices to promote CC. Results: A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census less than 100 (47%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 61% held it annually. Most trainings were 1 hour (60%); content was delivered via web (58%) and/or lecture (58%). While over 90% of staff (i.e., nurses, social workers, chaplains) completed CCT, a smaller proportion of medical directors (64%), senior leaders (71%) and board members (26%) did so. Most common topics were: cross-cultural communication, death/illness beliefs, spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (62%)—the most common U.S. minority groups. Almost 30% reported no effectiveness assessment of CCT, while 51% reported a quiz at the end of training. Most hospices offered some CCT. Conclusions: CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.

Twitter Usage Using Common Reference to Tinnitus

2020 ◽  
Vol 29 (2) ◽  
pp. 206-217
Author(s):  
Jianyuan Ni ◽  
Monica L. Bellon-Harn ◽  
Jiang Zhang ◽  
Yueqing Li ◽  
Vinaya Manchaiah
Keyword(s):  
Nonprofit Organizations ◽  
Temporal Trends ◽  
Temporal Analysis ◽  
Cross Sectional ◽  
For Profit ◽  
Common Reference ◽  
Personal Experiences ◽  
Twitter Users ◽  
Sectional Analysis ◽  
Share Information

Objective The objective of the study was to examine specific patterns of Twitter usage using common reference to tinnitus. Method The study used cross-sectional analysis of data generated from Twitter data. Twitter content, language, reach, users, accounts, temporal trends, and social networks were examined. Results Around 70,000 tweets were identified and analyzed from May to October 2018. Of the 100 most active Twitter accounts, organizations owned 52%, individuals owned 44%, and 4% of the accounts were unknown. Commercial/for-profit and nonprofit organizations were the most common organization account owners (i.e., 26% and 16%, respectively). Seven unique tweets were identified with a reach of over 400 Twitter users. The greatest reach exceeded 2,000 users. Temporal analysis identified retweet outliers (> 200 retweets per hour) that corresponded to a widely publicized event involving the response of a Twitter user to another user's joke. Content analysis indicated that Twitter is a platform that primarily functions to advocate, share personal experiences, or share information about management of tinnitus rather than to provide social support and build relationships. Conclusions Twitter accounts owned by organizations outnumbered individual accounts, and commercial/for-profit user accounts were the most frequently active organization account type. Analyses of social media use can be helpful in discovering issues of interest to the tinnitus community as well as determining which users and organizations are dominating social network conversations.

Applicability of management guidelines for surfing resources in California

Shore & Beach ◽  
2020 ◽  
pp. 53-64
Author(s):  
Edward Atkin ◽  
Dan Reineman ◽  
Jesse Reiblich ◽  
David Revell
Keyword(s):  
New Zealand ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Management Guidelines ◽  
For Profit ◽  
Aotearoa New Zealand ◽  
Coastal Marine ◽  
Management Measures ◽  
Legal Frameworks

Surf breaks are finite, valuable, and vulnerable natural resources, that not only influence community and cultural identities, but are a source of revenue and provide a range of health benefits. Despite these values, surf breaks largely lack recognition as coastal resources and therefore the associated management measures required to maintain them. Some countries, especially those endowed with high-quality surf breaks and where the sport of surfing is accepted as mainstream, have recognized the value of surfing resources and have specific policies for their conservation. In Aotearoa New Zealand surf breaks are included within national environmental policy. Aotearoa New Zealand has recently produced Management Guidelines for Surfing Resources (MGSR), which were developed in conjunction with universities, regional authorities, not-for-profit entities, and government agencies. The MGSR provide recommendations for both consenting authorities and those wishing to undertake activities in the coastal marine area, as well as tools and techniques to aid in the management of surfing resources. While the MGSR are firmly aligned with Aotearoa New Zealand’s cultural and legal frameworks, much of their content is applicable to surf breaks worldwide. In the United States, there are several national-level and state-level statutes that are generally relevant to various aspects of surfing resources, but there is no law or policy that directly addresses them. This paper describes the MGSR, considers California’s existing governance frameworks, and examines the potential benefits of adapting and expanding the MGSR in this state.

scholarly journals Pregnant Women Living with Obesity: A Cross-Sectional Observational Study of Dietary Quality and Pregnancy Outcomes

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1652
Author(s):  
Margaret Charnley ◽  
Lisa Newson ◽  
Andrew Weeks ◽  
Julie Abayomi
Keyword(s):  
Pregnant Women ◽  
Maternal Obesity ◽  
Maternal Nutrition ◽  
Saturated Fatty Acids ◽  
Poor Quality ◽  
Dietary Quality ◽  
Obstetric Outcomes ◽  
Dietary Intakes ◽  
Singleton Pregnancy ◽  
Cross Sectional

Good maternal nutrition is key to optimal maternal and foetal health. A poor-quality diet is often associated with obesity, and the prevalence and severity of maternal obesity has increased significantly in recent years. This study observed dietary intakes in pregnant women living with obesity and assessed the quality of their diet. In total, 140 women with a singleton pregnancy, aged > 18 years and BMI ≥ 35 kg/m2, were recruited from antenatal clinics, weighed and completed food diaries at 16-, 28- and 36-weeks’ gestation. Clinical data were recorded directly from the women’s medical records. Nutrient intake was determined using ‘MicrodietTM’, then compared to Dietary Reference Values (DRVs). Energy intakes were comparable with DRVs, but intakes of sugar and saturated fatty acids were significantly higher. Intake of fibre and several key micronutrients (Iron, Iodine, Folate and Vitamin D) were significantly low. Several adverse obstetric outcomes were higher than the general obstetric population. Women with obesity, often considered ‘over nourished’, may have diets deficient in essential micronutrients, often associated with poor obstetric outcomes. To address the intergenerational transmission of poor health via poor diets warrants a multi-disciplinary approach focusing away from ‘dieting’ onto positive messages, emphasising key nutrients required for good maternal and foetal health.

The Conversion Conundrum: The State and Federal Response to Hospitals’ Changes in Charitable Status

1997 ◽  
Vol 23 (2-3) ◽  
pp. 221-250
Author(s):  
Lawrence E. Singer
Keyword(s):  
Joint Venture ◽  
Low Cost ◽  
State Level ◽  
The State ◽  
Nonprofit Hospitals ◽  
For Profit ◽  
Tax Exempt ◽  
Federal Response ◽  
Profit Status ◽  
Hospital Conversions

The pressures encountered by hospitals in the current era of reimbursement declines and stiffened competition are well known. As the “ultimate” payors—primarily employers and government—aggressively continue to seek low cost care, the response of the hospital industry has been to move toward consolidation and efficiency-enhancing mechanisms.Increasingly, nonprofit, tax-exempt hospitals have come to believe that they are at a significant disadvantage vis-á-vis their for-profit brethren in their ability to attract the capital needed to compete in the market. A growing trend among nonprofit hospitals, therefore, is to sell to or enter into a joint venture with a proprietary organization, or alternatively to convert to for-profit status. In 1995, fifty-eight nonprofit hospitals became for-profit; hospital conversions to for-profit status in 1996 are projected to outstrip the pace established the prior year.The conversion trend has not gone unnoticed at the state level. Recently, several states have proposed or enacted laws regulating sales and conversions of nonprofit hospitals, and many more states are contemplating such legislation.

scholarly journals Correlates of Skilled Nursing Facility (SNF) Performance in the SNF Value-Based Purchasing Program

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 83-83
Author(s):  
Dan Andersen ◽  
Sherly Binu ◽  
Mike Sacca
Keyword(s):  
Quality Care ◽  
Skilled Nursing Facility ◽  
Prospective Payment System ◽  
Fiscal Year ◽  
Value Based Purchasing ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Actual Performance ◽  
For Profit ◽  
Matched Data

Abstract We examined the results of the 2020 skilled nursing facility (SNF) value-based purchasing (SNF VBP) program to identify correlates and potential drivers of SNF performance in this program. The SNF VBP program provides incentive payments to SNFs based on their performance on a risk-adjusted hospital readmission measure (i.e., the rate at which SNF residents are admitted back to the hospital within 30-days of being admitted to the SNF). SNFs are assessed on this measure for both improvement compared to their historical baseline and overall achievement compared to their peers. All SNFs that are covered under Medicare’s prospective payment system are included in the SNF VBP program. We performed analyses to assess the correlation between individual SNFs’ performance in the 2020 SNF VBP (n=15,201), which is based on actual performance in fiscal year 2018, with contemporaneous matched data related to SNF health inspection results, staffing, and performance on quality measures (these data form the basis of the five-star quality rating system on the Nursing Home Compare website). We also examined longitudinal trends in these non-SNF VBP program variables and their association with changes in SNF performance in the SNF VBP program. We controlled for important SNF-specific factors (e.g., for-profit status, connected to a hospital). We found strong contemporaneous and longitudinal associations between SNF VBP program performance and some, but not all, of these factors. Our findings are supported by decades of empirical research in SNF quality and highlight potential policy alternatives that could further incentivize high quality care in SNFs.

Usability of India’s government statistics1

2020 ◽  
pp. 1-17
Author(s):  
Vikas Kumar
Keyword(s):  
National Sample ◽  
Poor Quality ◽  
Sample Surveys ◽  
Sources Of Information ◽  
Cross Sectional ◽  
Jammu And Kashmir ◽  
The Poor ◽  
Government Statistics

The quality of metadata is a crucial determinant of usability/interpretability of data. This paper draws attention to the poor quality of India’s government statistics and the paucity of metadata necessary to understand the problems. The paper suggests that there has been a decline in India both in terms of the availability and quality of metadata for key government sources of information including maps, decennial population censuses and National Sample Surveys amidst growing sophistication in the understanding of metadata. The poor quality of metadata impairs cross-sectional as well as inter-temporal comparisons and policymaking apart from concealing biases and lapses of government statisticians. The paper draws on the experience of three states – erstwhile Jammu and Kashmir, Manipur and Nagaland – where government statistics have been affected by serious errors that are not well-understood due to the lack of adequate metadata.

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