scholarly journals Nursing Home Culture Change Practices and Survey Deficiencies: A National Longitudinal Panel Study

2020 ◽  
Vol 60 (8) ◽  
pp. 1411-1423
Author(s):  
Michael J Lepore ◽  
Julie C Lima ◽  
Susan C Miller
Keyword(s):  
Nursing Home ◽  
Physical Environment ◽  
Culture Change ◽  
Multinomial Logistic Regression ◽  
Panel Study ◽  
Care Staff ◽  
Logistic Regression Models ◽  
Practice Adoption ◽  
Centered Care ◽  
The Impact

Abstract Background and Objectives Nursing home (NH) adoption of culture change practices has substantially increased in recent decades. We examined how increasing adoption of culture change practices affected the prevalence of health, severe health, and quality of life (QoL) deficiencies. Research Design and Methods Novel data on culture change practice adoption from a nationally representative NH panel (N = 1,585) surveyed in 2009/2010 and 2016/2017 were used to calculate change in practice adoption scores in 3 culture change domains (resident-centered care, staff empowerment, physical environment). These data were linked to data on health, severe health, and QoL deficiencies and facility-level covariates. Multinomial logistic regression models, with survey weights and inverse probability of treatment weighting, examined how increased culture change practice adoption related to change in deficiencies. Results We generally observed less increase in deficiencies when culture change practices increased. However, after weighting and controlling for baseline deficiencies and culture change scores, we found few statistically significant effects. Still, results show increased physical environment practices resulted in a higher likelihood of decreases or no change (vs increases) in QoL deficiencies; increased resident-centered care practices resulted in decreases or no change (vs increases) in health deficiencies; and increased staff empowerment practices resulted in a higher likelihood of no change (vs increases) in severe health deficiencies. Discussion and Implications This study provides some evidence that culture change practices can help reduce the risk of increasing some types of deficiencies, but the impact of increases in each culture change domain related differently to different types of deficiencies.

scholarly journals NURSING HOME CULTURE CHANGE AND QUALITY OF LIFE AND HEALTH DEFICIENCIES: NATIONWIDE PANEL STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S62-S62
Author(s):  
Michael J Lepore ◽  
Julie C Lima ◽  
Melissa A Clark ◽  
Pedro L Gozalo ◽  
Susan C Miller
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Physical Environment ◽  
Culture Change ◽  
Statistical Significance ◽  
Panel Study ◽  
Care Staff ◽  
Centered Care ◽  
Nationally Representative

Abstract Transforming nursing home (NH) cultures—from impersonal institutions to enriching communities where residents and employees thrive—requires multifaceted change. NHs deploy an array of culture change (CC) practices, in three core domains: resident-centered care, staff empowerment, and physical environment. This study uses novel data on CC practice from a nationally representative panel of NHs (N=1,585) surveyed in 2009/2010 and 2016/2017. To understand how changes in practice adoption may relate to quality changes we linked longitudinal data on the CC practice domain scores for resident-centered care, staff empowerment, and physical environment and on NH deficiencies relating to health and quality of life (QoL) and combined these with Certification and Survey Provider Enhanced Reporting baseline data. Multinomial logistic regressions incorporating survey weights and inverse probability of weight (to address CC selection) estimated the relative risk ratios (RRR) of increased CC practice corresponding with NHs having fewer or no change in deficiencies, versus increased deficiencies. NHs with much increase in staff empowerment scores had a higher likelihood of no change (compared to an increase) in health deficiencies (RRR 2.0; 95% CI 1.15, 3.61) and severe health deficiencies (RRR 2.03; 95% CI 1.05, 3.93). With a RRR of 1.63, NHs with any improvement in resident-centered care scores appeared to have a higher likelihood of no change (compared to an increase) in QoL deficiencies but statistical significance was not reached (p=0.11). This study provides some support for the benefits of CC practices, and in particular, supports the importance of staff empowerment practices in NHs.

scholarly journals The Changing Adoption of Culture Change Practices in U.S. Nursing Homes

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Julie C Lima ◽  
Margot L Schwartz ◽  
Melissa A Clark ◽  
Susan C Miller
Keyword(s):  
Nursing Homes ◽  
Physical Environment ◽  
Culture Change ◽  
Panel Study ◽  
Factors Associated ◽  
Centered Care ◽  
Nationally Representative ◽  
Practice Implementation ◽  
Over Time ◽  
Domain Scores

Abstract Background and Objectives The study aimed to: (i) describe whether culture change (CC) practice implementation related to physical environment, resident-centered care, and staff empowerment increased within the same nursing homes (NHs) over time; and (ii) identify factors associated with observed increases. Research Design and Methods This was a nationally representative panel study of 1,584 U.S. NHs surveyed in 2009/2010 and 2016/2017. Survey data were merged with administrative, NH, and market-level data. Physical environment, staff empowerment, and resident-centered care domain scores were calculated at both time points. Multivariate logistic regression models examined factors associated with domain score increases. Results Overall, 22% of NHs increased their physical environment scores over time, 32% their staff empowerment scores, and 44% their resident-centered care scores. However, 32%–68% of NHs with below median baseline scores improved their domain scores over time compared with only 11%–21% of NHs with baseline scores at or above the median. Overall, NHs in states with Medicaid pay-for-performance (with CC components), in community care retirement communities, with special care units and higher occupancy had significantly higher odds of increases in physical environment scores. Only baseline domain scores were associated with increases in staff empowerment and resident-centered care scores. Discussion and Implications This is the first nationally representative panel study to assess NH CC adoption. Many NHs increased their CC practices, though numerous others did not. While financial incentives and indicators of financial resources were associated with increase in physical environment scores, factors associated with staff empowerment and resident-centered care improvements remain unclear. Studies are needed to assess whether the observed increases in CC adoption are associated with greater quality of life and care gains for residents and whether there is a threshold effect beyond which the efficacy of additional practice implementation may be less impactful.

scholarly journals From Micro to Macro: Exploring Preference-Based Person Centered Care from Multiple Perspectives

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 836-836
Author(s):  
Katherine Abbott ◽  
Kristine Williams
Keyword(s):  
Nursing Home ◽  
Assisted Living ◽  
Fixed Effects ◽  
Nursing Home Residents ◽  
Direct Care ◽  
Multiple Perspectives ◽  
Person Centered Care ◽  
Fixed Effects Panel Regression ◽  
Centered Care ◽  
The Impact

Abstract Advancing our knowledge related to honoring nursing home resident preferences is a cornerstone of person-centered care (PCC). While there are multiple approaches to providing PCC, we focus on resident preferences as assessed via the Preferences for Everyday Living Inventory (PELI). The PELI is an evidenced-based, validated instrument that can be used to enhance the delivery of PCC. In this symposium, we explore the perspectives of a variety of stakeholders including nursing home residents, staff, and the impact of preference-based care on provider level regulatory outcomes. First, we present a comparative study of preference importance among n=317 African America and White nursing home residents that found more similarities than differences between the two groups. Second, a content analysis of the responses from n=196 interviews with nursing home residents details the barriers and facilitators connected to their levels of satisfaction with their preferences being fulfilled. Third, perspectives from n=27 direct care workers explore the concept of pervasive risk avoidance to the delivery of PCC. Fourth, systems-level practices, such as shift assignments and provider schedules are identified as barriers to successfully fulfilling resident preferences from the perspectives of n=19 staff within assisted living. Our final presentation utilizes a fixed-effects panel regression analysis with n=551 Ohio nursing home providers to explore the impact of PELI use on regulatory outcomes such as substantiated complaints and deficiency scores reported in the CMS Nursing Home Compare data. Discussant Dr. Kristi Williams will integrate findings, highlighting implications for policy, practice, and future directions. Research in Quality of Care Interest Group Sponsored Symposium.

scholarly journals The Physical Environment of Nursing Homes for People with Dementia: Traditional Nursing Homes, Small-Scale Living Facilities, and Green Care Farms

Healthcare ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 137 ◽  
Author(s):  
Bram de Boer ◽  
Hanneke Beerens ◽  
Melanie Katterbach ◽  
Martina Viduka ◽  
Bernadette Willemse ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Physical Environment ◽  
Well Being ◽  
Nursing Home Care ◽  
Small Scale ◽  
People With Dementia ◽  
Different Types ◽  
Centered Care ◽  
Green Care Farms

It is well recognized that the physical environment is important for the well-being of people with dementia. This influences developments within the nursing home care sector where there is an increasing interest in supporting person-centered care by using the physical environment. Innovations in nursing home design often focus on small-scale and homelike care environments. This study investigated: (1) the physical environment of different types of nursing homes, comparing traditional nursing homes with small-scale living facilities and green care farms; and (2) how the physical environment was being used in practice in terms of the location, engagement and social interaction of residents. Two observational studies were carried out. Results indicate that the physical environment of small-scale living facilities for people with dementia has the potential to be beneficial for resident’s daily life. However, having a potentially beneficial physical environment did not automatically lead to an optimal use of this environment, as some areas of a nursing home (e.g., outdoor areas) were not utilized. This study emphasizes the importance of nursing staff that provides residents with meaningful activities and stimulates residents to be active and use the physical environment to its full extent.

The impact of person-centered care on residents' perceptions of care quality in nursing homes: an intervention study

2018 ◽  
Vol 7 (2) ◽  
pp. 118-124
Author(s):  
Vigdis Abrahamsen Grøndahl ◽  
Liv Berit Fagerli ◽  
Heidi Karlsen ◽  
Ellen Rosseland Hansen ◽  
Helena Johansson ◽  
...  
Keyword(s):  
Nursing Home ◽  
Intervention Study ◽  
Care Quality ◽  
Legal Rights ◽  
Nursing Home Administrators ◽  
Person Centered Care ◽  
Before And After ◽  
Centered Care ◽  
The Impact ◽  
Perceptions Of Care

Background: The quality of care offered to older people is still poor. Nursing home administrators often claim that they provide person-centered care, but research indicates that institutional goals take precedence. Aim: The aim was to explore the impact of person-centered care on residents’ perceptions of care quality.  Methods: An intervention study was conducted in one nursing home (41 residents). Person-centered care was operationalized into the interventions: greeting the resident on each shift, one-to-one contact (resident – carer) for 30 minutes twice a week, informing the residents continuously about changes in medication, and informing the residents about their legal rights at admission and three months after admission. The interventions were systematically conducted for 12 months. Face-to-face interviews using the Quality from Patient’s Perspective (QPP) questionnaire were conducted both prior to interventions and immediately after the 12-month period. Descriptive and comparative statistics were used to test for differences between care quality perceptions before and after intervention (p ≤ .05). Results: The residents rated all four quality dimensions (caregivers’ medical-technical competence and identity-oriented approach, care organization’s socio-cultural atmosphere, and physical-technical conditions) more highly after the 12-month period, and the socio-cultural atmosphere was rated significantly more highly. At item level, 44 items received higher scores, and, among them, significantly higher scores were given to 6 items. One item received a significantly lower score. Conclusions: Residents’ perceptions of care quality increase when person-centered care is operationalized and takes precedence over the ward’s routines or is part of the ward’s routines. The results indicate that it is possible to design a care system where the residents are at the centre of the health care offered.

scholarly journals A NATIONAL ASSESSMENT OF THE RELATIONSHIP BETWEEN NURSING HOME CULTURE CHANGE AND RESIDENT OUTCOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S61-S61
Author(s):  
Margot L Schwartz ◽  
Julie C Lima ◽  
Pedro L Gozalo ◽  
Melissa A Clark ◽  
Susan C Miller
Keyword(s):  
Nursing Home ◽  
Culture Change ◽  
Leadership Practices ◽  
Statistical Significance ◽  
Physical Restraint ◽  
Care Staff ◽  
Small Samples ◽  
Lower Odds ◽  
Tract Infections ◽  
The Relationship

Abstract Literature is mixed regarding the relationship between Nursing Home (NH) culture change and resident outcomes, and the majority of studies are limited to small samples. We evaluated this relationship separately for five unique domains of NH culture change (physical environment, resident care, staff empowerment, leadership, and family and community involvement practices) using a 2016/2017 survey administered to a stratified-random national sample of NHs; 74% of NH administrators responded (n=1,583). We assessed the relationship between each culture change domain and 8 outcomes (calculated with MDS 3.0 and Medicare claims data) using resident-level multivariable logistic regression models, that accounted for resident and NH characteristics, and were weighted by facility-level inverse probability weights (to address NH Selection). We found the relationship between NH culture change and resident outcomes varied by culture change domain. High scores on leadership practices (i.e., two-way communication, staff involvement, education/training, respect for workers, and coaching) were most strongly associated with outcomes. Compared to the lowest quartile, performance in the highest quartile (most implementation of practices) on the leadership domain was associated with 13% lower odds (OR: 0.87, 95%CI: 0.78, 0.96) of urinary tract infections, 15% lower odds (OR: 0.85, 95%CI: 0.80, 0.91) of worsened locomotion, and 41% lower odds (OR: 0.59, 95%CI: 0.42, 0.83) of physical restraint use. For the other domains the estimates (and statistical significance) of the relationship with outcomes varied more than observed for leadership. Our findings emphasize the importance of high-quality NH leadership. Investments in improved leadership practices may result in higher-quality resident outcomes.

scholarly journals Perspectives of Healthcare Professionals on Meaningful Activities for Persons with Dementia in Transition from Home to a Nursing Home: An Explorative Study

Healthcare ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 98 ◽  
Author(s):  
Mari Groenendaal ◽  
Anne Loor ◽  
Manja Trouw ◽  
Wilco P. Achterberg ◽  
Monique A.A. Caljouw
Keyword(s):  
Nursing Home ◽  
Focus Groups ◽  
Healthcare Professionals ◽  
Interdisciplinary Collaboration ◽  
Specific Information ◽  
Organization Of Care ◽  
The Social ◽  
Centered Care ◽  
Social And Physical Environment ◽  
The Impact

Meaningful activities can enhance quality of life, a sense of connectedness, and personhood for persons with dementia. Healthcare professionals play an important role in maintaining meaningful activities, but little is currently known about the impact of the transition from home to nursing home on these activities. This study explored the experiences of professionals in four Dutch nursing homes, identifying facilitators and barriers to the maintenance of meaningful activities during the transition. A qualitative explorative design was used. Data were collected using focus groups and analyzed using thematic analysis. Twenty-two professionals participated in four focus groups, and three themes were identified: (1) a lack of awareness and attention for meaningful activities; (2) activities should be personalized and factors such as person characteristics, interests, the social and physical environment, and specific information such as roles, routines, activities, and personal issues play an important role in maintaining activities; (3) in the organization of care, a person-centered care vision, attitudes of professionals and interdisciplinary collaboration facilitate maintenance of meaningful activities. Healthcare professionals felt that meaningful activities are difficult to maintain and that improvements are needed. Our study provides suggestions on how to maintain meaningful activities for persons with dementia prior, during and after the transition.

scholarly journals To Move Home or Move On? Investigating the Impact of Recovery Aid on Migration Status as a Potential Tool for Disaster Risk Reduction in the Aftermath of Volcanic Eruptions in Merapi, Indonesia

2019 ◽  
Author(s):  
Jonathan A. Muir ◽  
Michael R. Cope ◽  
Jorden E. Jackson ◽  
Leslie R. Angeningsih
Keyword(s):  
Risk Reduction ◽  
Regression Models ◽  
Multinomial Logistic Regression ◽  
Forced Migration ◽  
Volcanic Eruptions ◽  
Migration Status ◽  
Logistic Regression Models ◽  
The Impact ◽  
Financial Recovery ◽  
Potential Tool

Disasters are associated strongly with forced migration. Indeed, migration is a standard survival strategy for those facing disruptions of this kind. Such is the case with Mt. Merapi, Indonesia, where a series of eruptions occurred in 2010. Mechanisms related to forced migration in such scenarios are fairly well understood, yet it remains less clear what factors may influence return migration. Given local interest in facilitating resettlement out of hazardous areas as a means of risk reduction, we seek to better understand the extent to which recovery aid may create incentives for households to move on rather than move home. We draw upon data collected from a pilot study in the aftermath of the 2010 eruptions and use multinomial logistic regression models to explore the influence of various forms of aid on migration status. Of the various forms of aid considered, financial recovery aid provided to households was consistently associated with moving on. The combination of financial recovery aid with remittances resulted in an association with having moved on that was even stronger than just receiving financial recovery aid. Ultimately, analyses of "aid packages'" suggest that a combination of most, if not all, of the aid was relatively more effective in fostering resettlement, suggesting that while food and health recovery aid as well as remittances may not have been sufficient in and of themselves to increase resettlement, they may enhance the effect of financial recovery aid.

scholarly journals INTEREST GROUP SESSION—RESEARCH IN QUALITY OF CARE: LIVING IN AND LEAVING NURSING HOMES: THE FACTORS THAT CONTRIBUTE TO QUALITY OF LIFE, HEALTH, AND SAFETY OUTCOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S359-S359
Author(s):  
Nancy Kusmaul ◽  
Mercedes Bern-Klug
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Community Dwelling ◽  
Care Staff ◽  
Term Care ◽  
The Impact

Abstract Nursing homes house some of the most vulnerable older adults. They often have complex medical conditions and/or cognitive impairments that put them at risk for negative outcomes and poor quality of life. These outcomes can be altered through incorporating evidence-based practices aimed to improve care and residents’ life experiences. In this symposium we will explore factors that are shown to influence outcomes and quality of life for people that live in and are discharged from, long term care settings. Amy Roberts and colleagues will explore the influences of nursing home social service staff qualifications on residents’ discharge outcomes. Colleen Galambos and colleagues will present findings on advance directives and their impact on reducing potentially avoidable hospitalizations. Kelsey Simons and colleagues will discuss the potential for unmet needs for mental health services as part of nursing home care transitions, and will discuss a model of quality improvement that addresses this gap in care. Vivian Miller will present findings on the impact transportation access has on the ability of community-dwelling family members to visit and provide social support to their family member residents in long-term care. Finally, Nancy Kusmaul and Gretchen Tucker report the findings of their study comparing perceptions of nursing home residents, direct care staff, management, and families on the care practices that influence resident health and quality of life while they live in a long term care setting.

scholarly journals Association of care workers’ job satisfaction and global happiness with change of functional performance of severely disabled elderly residents in nursing homes: a cohort and questionnaire study in Japan

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e033937
Author(s):  
Shino Ikeda-Sonoda ◽  
Nao Ichihara ◽  
Jiro Okochi ◽  
Arata Takahashi ◽  
Hiroaki Miyata
Keyword(s):  
Job Satisfaction ◽  
Nursing Home ◽  
Nursing Homes ◽  
Functional Performance ◽  
Nursing Home Residents ◽  
Care Staff ◽  
Lower Probability ◽  
Disabled Elderly ◽  
The Impact

ObjectivesThere is growing concern regarding quality of work life (QWL) among care staff in nursing homes. However, little is known about the impact of QWL on nursing home residents’ functional performance. Recent literature suggests that job satisfaction and happiness of healthcare workers reflect their perceived QWL and impact the quality of their care. This study examined the association between job satisfaction and global happiness with change in functional performance of severely disabled elderly residents in nursing homes.DesignA retrospective cohort study of nursing home residents combined with a questionnaire survey of their care staff.SettingEighteen nursing homes in Japan.ParticipantsData were collected from 1000 residents with a required care level of 3–5 and from 412 care staff in nursing homes between October 2017 and March 2018.Outcomes and explanatory variablesFunctional performance was structurally assessed with ICF (International Classification of Functioning, Disability and Health) staging, composed of 52 items concerning activities of daily life, cognitive function and social participation, at baseline and 6 months later. Deterioration and improvement of functional performance were dichotomously defined as such change in any of the items. QWL of care staff was evaluated with a questionnaire including questions about job satisfaction and global happiness.ResultsFunctional performance deteriorated and improved in 23.0% and 12.7% of residents, respectively. Global happiness of care staff was associated with lower probability of residents’ deterioration (adjusted OR, 0.61; CI 0.44 to 0.84). There was no significant correlation between job satisfaction or happiness of care staff and improvement of residents’ functional performance.ConclusionThese results suggest that QWL of care staff is associated with changes in functional performance of elderly people with severe disabilities in nursing homes.

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