A Preliminary Evaluation of the Paid Feeding Assistant Regulation: Impact on Feeding Assistance Care Process Quality in Nursing Homes

Abstract Background and Objectives To examine whether nursing homes (NHs) provide better quality when unemployment rates rise (countercyclical) and explore mechanisms contributing to the relationship between quality and unemployment rates. Research Design and Methods The study uses the data on privately owned, freestanding NHs in the continental United States that span a period from 2001 through 2015. The empirical analysis relies on panel fixed-effect regressions with the key independent variable being the county-level unemployment rate. NH quality is measured using deficiencies, outcomes, and care process measures. We also examine nursing staff levels, as well as employee turnover and retention. Results NHs have better quality when unemployment rates increase. Higher unemployment rates are associated with fewer deficiencies and lower deficiency scores. This countercyclical relationship is also found among other quality measures. In terms of mechanisms, we find higher nursing staff levels, lower employee turnover, and better workforce retention when unemployment rates rise. Improvement in staffing is likely contributing to better quality during recessions. Interestingly, these effects predominately occur in for-profit NHs for deficiencies and staffing levels. Discussions and Implications NH quality is countercyclical. With near record-low unemployment rates in 2018, regulatory agencies should pay close attention to NH quality when and where the local economy registers strong growth. On the other hand, the finding of the unemployment rate–staffing/turnover relationship also suggests that policies increasing staffing and reducing employee turnover may not only improve NH quality but also have the potential to smooth quality fluctuations between business cycles.

Download Full-text

Advancing the Big Five of user-oriented care and accounting for its variations

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-03-2015-0040 ◽

2016 ◽

Vol 29 (2) ◽

pp. 162-176 ◽

Cited By ~ 10

Author(s):

Petri Kajonius ◽

Ali Kazemi

Keyword(s):

Big Five ◽

Elderly Care ◽

Process Quality ◽

Care Process ◽

Content Type ◽

Care Services ◽

Care Workers ◽

Wide Range ◽

Care Worker ◽

Quality Variation

Purpose – Care process quality (i.e. how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The purpose of this paper is to describe the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care. Design/methodology/approach – Two municipalities were selected for in-depth field studies. First, in each municipality, the authors interviewed and observed care workers’ interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, the authors conducted interviews with care workers and care unit managers (Study 2). Findings – A new taxonomy for categorizing process quality variation, the Big Five of user-oriented care (task-focus, person-focus, affect, cooperation, and time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality level). Originality/value – The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

Download Full-text

Do Volunteers Make a Difference on Nursing Home Quality Measures?

Innovation in Aging ◽

10.1093/geroni/igaa057.1229 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 382-382

Author(s):

Paul Falkowski ◽

Christopher Kelly ◽

Nancy Kelley

Keyword(s):

Nursing Home ◽

Urinary Tract ◽

Nursing Homes ◽

Urinary Tract Infections ◽

Quality Measures ◽

Bivariate Analysis ◽

Volunteer Program ◽

Hypnotic Drugs ◽

Feeding Assistance ◽

Tract Infections

Abstract The purpose of this study was to explore the relationship between nursing home volunteer programming and quality measures and increase the knowledge base of nursing home volunteer programming in various settings. Fifty-two nursing homes were surveyed using electronic surveys and personal interviews. Questions focused on the organization of the nursing home, characteristics of the volunteer program and volunteer activities. Of the 52 facilities surveyed, 19 were not part of a chain, 37 were in urban settings, and 24 were for-profit entities. Volunteers were used in 46 nursing homes with a mean number of volunteers of 51.7 onsite an average of 4.9 days per week. Bivariate analysis revealed statistically significant correlations (p<.05) between organizational and volunteer programming characteristics and six quality measures (pressure sores, urinary tract infections, depression, use of restraints, falls, use of antipsychotic and hypnotic drugs). Statistically significant (p<.05) inverse relationships were found between volunteers providing individualized activities (e.g., feeding assistance, combing hair, doing nails, and letter writing) and the incidence of urinary tract infections and the use of psychotropic drugs. Multiple regression analysis revealed a statistically significant (p<.05) inverse relationship between personal volunteer services such as combing hair and doing nails and the use of hypnotic drugs and antipsychotic drugs. This study indicates a significant correlation between volunteer programming and quality measure scores. A larger study of these relationships is indicated.

Download Full-text

Impacts of a care process model and inpatient electrophysiology service on cardiovascular implantable electronic device infections: a preliminary evaluation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-017-0282-2 ◽

2017 ◽

Vol 50 (1) ◽

pp. 117-124 ◽

Cited By ~ 1

Author(s):

Eugene M. Tan ◽

Avish Nagpal ◽

Daniel C. DeSimone ◽

Brenda Anderson ◽

Jane Linderbaum ◽

...

Keyword(s):

Process Model ◽

Electronic Device ◽

Care Process ◽

Preliminary Evaluation ◽

Cardiovascular Implantable Electronic Device

Download Full-text

Use of Notification and Communication Technology (Call Light Systems) in Nursing Homes: Observational Study

Journal of Medical Internet Research ◽

10.2196/16252 ◽

2020 ◽

Vol 22 (3) ◽

pp. e16252

Author(s):

Haneen Ali ◽

Huiyang Li

Keyword(s):

Health Care ◽

Nursing Home ◽

Nursing Homes ◽

Task Analysis ◽

Standard Procedure ◽

Care Process ◽

Nursing Home Staff ◽

Light System ◽

Before And After

Background The call light system is one of the major communication technologies that link nursing home staff to the needs of residents. By providing residents the ability to request assistance, the system becomes an indispensable resource for patient-focused health care. However, little is known about how call light systems are being used in nursing homes and how the system contributes to safety and quality of care for seniors. Objective This study aimed to understand the experiences of nursing home staff who use call light systems and to uncover usability issues and challenges associated with the implemented systems. Methods A mix of 150 hours of hypothetico-deductive (unstructured) task analysis and 90 hours of standard procedure (structured) task analysis was conducted in 4 different nursing homes. The data collected included insights into the nursing home’s work system and the process of locating and responding to call lights. Results The data showed that the highest alarm rate is before and after mealtimes. The staff exceeded the administration’s expectations of time to respond 50% of the time. In addition, the staff canceled 10.0% (20/201) of call lights and did not immediately assist residents because of high workload. Furthermore, the staff forgot to come back to assist residents over 3% of the time. Usability issues such as broken parts, lack of feedback, lack of prioritization, and low or no discriminability also contributed to the long response time. More than 8% of the time, residents notified the staff about call lights after they waited for a long time, and eventually, these residents were left unattended. Conclusions Nursing homes that are still using old call light systems risk the continuation of usability issues that can affect the performance of the staff and contribute to declining staff and resident outcomes. By incorporating feedback from nurses, nursing home management will better understand the influence that the perceptions and usability of technology have on the quality of health care for their residents. In this study, it has been observed that the call light system is perceived to be an important factor affecting the outcomes of the care process and satisfaction of both residents and staff as well as the staff’s performance. It is important to recognize that communication and notification technology contributes to the challenges the staff faced during their work, making their working conditions more difficult and challenging.

Download Full-text

Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives

BMC Health Services Research ◽

10.1186/s12913-021-07001-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Liza Behrens ◽

Marie Boltz ◽

Kiernan Riley ◽

Karen Eshraghi ◽

Barbara Resnick ◽

...

Keyword(s):

Nursing Homes ◽

Process Evaluation ◽

Implementation Strategy ◽

Well Being ◽

Cost Of Care ◽

Barriers And Facilitators ◽

Direct Care ◽

Care Process ◽

Implementation Success ◽

Stakeholder Groups

Abstract Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders’ perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. Methods EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. Conclusion Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. Trial Registration The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov (NCT03014570) January 9, 2017.

Download Full-text