No Other Safe Care Option: Nursing Home Admission as a Last Resort Strategy

Abstract Background and Objectives Nursing homes are intended for older adults with the highest care needs. However, approximately 12% of all nursing home residents have similar care needs as older adults who live in the community and the reasons they are admitted to nursing homes is largely unstudied. The purpose of this study was to explore the reasons why lower-care nursing home residents are living in nursing homes. Research Design and Methods A qualitative interpretive description methodology was used to gather and analyze data describing lower-care nursing home resident and family member perspectives regarding factors influencing nursing home admission, including the facilitators and barriers to living in a community setting. Data were collected via semistructured interviews and field notes. Data were coded and sorted, and patterns were identified. This resulted in themes describing this experience. Results The main problem experienced by lower-care residents was living alone in the community. Residents and family members used many strategies to avoid safety crises in the community but experienced multiple care breakdowns in both community and health care settings. Nursing home admission was a strategy used to avoid a crisis when residents did not receive the needed support to remain in the community. Discussion and Implications To successfully remain in the community, older adults require specialized supports targeting mental health and substance use needs, as well as enhanced hospital discharge plans and improved information about community-based care options. Implications involve reforming policies and practices in both hospital and community-based care settings.

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Impact of Roommates on MDRO Spread in Nursing Homes

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.553 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s66-s67

Author(s):

Gabrielle M. Gussin ◽

Ken Kleinman ◽

Raveena D. Singh ◽

Raheeb Saavedra ◽

Lauren Heim ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Secondary Analysis ◽

Nursing Home Residents ◽

Multidrug Resistant ◽

Healthcare Intervention ◽

Odds Ratios ◽

Care Needs ◽

Environmental Cleaning ◽

The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

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ISSUES IN HOME CARE AND CAREGIVING ARE MEDICAL FOSTER HOMES SERVING VETERANS WHO HAVE SIMILAR FUNCTIONAL IMPAIRMENT AS TYPICAL NURSING HOME RESIDENTS?

Innovation in Aging ◽

10.1093/geroni/igz038.3032 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S822-S823

Author(s):

Cari Levy ◽

Kate Magid ◽

Chelsea Manheim ◽

Kali S Thomas ◽

Leah M Haverhals ◽

...

Keyword(s):

Nursing Home ◽

Home Care ◽

Functional Impairment ◽

Nursing Home Residents ◽

Similar Proportion ◽

Care Needs ◽

Community Based ◽

Foster Home ◽

Term Care ◽

Data Set

Abstract The Veterans Health Administration’s (VHA’s) Medical Foster Home (MFH) program was developed as a community-based alternative to institutional care. This study compares the clinical and functional characteristics of Veterans in the VHA MFH program to residents in nursing homes to understand whether MFHs substitute for nursing home care or serve a population with different care needs. All data were derived from Minimum Data Set (MDS) 3.0 assessments. Nurses collected MDS assessments from Veterans (n=92) in 4 MFHs between April 2014-December 2015. Data for nursing home residents were from a national nursing home dataset of residents with an annual MDS assessment in 2014 (n=818,287). We found that MFH Veterans were more likely to be male, have higher functional status, and perform more activities of daily living (ADLs) independently relative to nursing home residents (p<0.01 for all comparisons). Yet, a similar proportion of MFH Veterans and nursing home residents required total assistance in 9 of the 11 measured ADLs. Cognitive impairment, neurological comorbidity, and psychiatric comorbidity were similar in both cohorts; however, MFH Veterans were more likely to have traumatic brain injury (p<0.01), higher Patient Health Questionnaire (PHQ)-9 depression scores (p=0.04) and less likely to have anxiety (p=0.05). Our results suggest there are two distinct MFH populations, one with lower-care needs and another with Veterans completely dependent in performing ADLs. Given these findings, MFHs may be an ideal setting for both low-care nursing home residents with less functional impairment as well as residents with higher care needs who desire community-based long-term care.

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Alzheimer's Disease and Other Dementia in Nursing Homes: Levels of Management and Cost

International Psychogeriatrics ◽

10.1017/s1041610201007736 ◽

2001 ◽

Vol 13 (3) ◽

pp. 347-358 ◽

Cited By ~ 24

Author(s):

Judith A. O'Brien ◽

J. Jaime Caro

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Nursing Home ◽

Nursing Homes ◽

Nursing Home Resident ◽

Annual Cost ◽

Nursing Home Residents ◽

Care Needs ◽

Diagnosis Of Dementia ◽

Care Costs

Objective: To estimate comparative mangement levels and the annual cost of caring for a nursing home resident with and without dementia. Method: Data from the 1995 Massachusetts Medicaid nursing home database were used to examine residents with Alzheimer's disease, other types of dementia, and no dementia to determine care and dependency levels. Massachusetts Medicaid 1997 per-diem rates for each of 10 designated management levels were applied accordingly to residents in each level to estimate annual care costs. Costs from this analysis are reported in 1997 U.S. dollars. Results: Of the 49,724 nursing home residents identified, 26.4% had a documented diagnosis of dementia. On average, a resident with dementia requires 229 more hours of care annually than one without dementia, resulting in a mean additional cost of $3,865 per patient with dementia per year. Conclusions: Dementia increases the care needs and cost of caring for a nursing home resident.

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Comparison of the Microbiota of Older Adults Living in Nursing Homes and the Community

mSphere ◽

10.1128/msphere.00210-17 ◽

2017 ◽

Vol 2 (5) ◽

Cited By ~ 12

Author(s):

Mary-Claire Roghmann ◽

Alison D. Lydecker ◽

Lauren Hittle ◽

Robert T. DeBoy ◽

Rebecca G. Nowak ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Nursing Home ◽

Nursing Homes ◽

Relative Abundance ◽

Bacterial Communities ◽

Nursing Home Residents ◽

The Body ◽

Health Care Environment ◽

The Past

ABSTRACT The nose, throat, and skin over the subclavian and femoral veins are the body sites which harbor the bacteria which most commonly cause health care-associated infection. We assessed the effect of nursing home residence on the microbiota of these body sites in older adults. We found that the microbiota composition of the different body sites was similar between nursing home and community participants, but we identified differences in relative abundance levels. We found remarkable similarities in the bacterial communities of different body sites in older adults who lived in nursing homes compared to those in the community among people who had not been on antibiotics for the past 3 months. We also found that the femoral skin microbiota had evidence of stool contamination in the nursing home residents, providing a rationale for improved skin hygiene. Taken together, it appears that the health care environment does not alter the microbiota to the extent that antibiotics do. Our objective for this study was to characterize the microbial communities of the anterior nares (nose), posterior pharynx (throat), and skin of the femoral and subclavian areas in older adults from nursing homes and the community. Older adults (≥65 years) without antibiotic use for the past 3 months were recruited from nursing homes (NH; n = 16) and from the community (CB; n = 51). Specimens were taken from nose, throat, and skin sites for culture and bacterial profiling using 16S rRNA gene sequencing. We found that pathogenic Gram-negative rod (GNR) colonization on the femoral skin was higher in NH participants than CB participants; otherwise, there were no differences in GNR colonization at other body sites or in Staphylococcus aureus colonization at any body site. Bacterial community profiling demonstrated that the operational taxonomic unit compositions of the different body sites were similar between NH and CB participants, but the analysis identified differences in relative abundance levels. Streptococcus spp. were more abundant and Prevotella spp. were less abundant in the throats of NH participants than in throats of CB participants. Proteus, Escherichia coli, and Enterococcus were more abundant in NH participants on the femoral skin. We found a pattern of decreased abundance of specific Proteobacteria in NH participants at the anterior nares and at both skin sites. We concluded that bacterial communities were largely similar in diversity and composition within body sites between older adults without recent antibiotic use from NH compared to those from the community. Our findings support the rationale for improved hygiene in NH residents to reduce the transmission risk of antibiotic-resistant bacteria, such as Enterococcus spp. or Enterobacteriaceae. IMPORTANCE The nose, throat, and skin over the subclavian and femoral veins are the body sites which harbor the bacteria which most commonly cause health care-associated infection. We assessed the effect of nursing home residence on the microbiota of these body sites in older adults. We found that the microbiota composition of the different body sites was similar between nursing home and community participants, but we identified differences in relative abundance levels. We found remarkable similarities in the bacterial communities of different body sites in older adults who lived in nursing homes compared to those in the community among people who had not been on antibiotics for the past 3 months. We also found that the femoral skin microbiota had evidence of stool contamination in the nursing home residents, providing a rationale for improved skin hygiene. Taken together, it appears that the health care environment does not alter the microbiota to the extent that antibiotics do.

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Nurse-Patient Interaction: A Vital Salutogenic Resource in Nursing Home Care

Health Promotion in Health Care – Vital Theories and Research ◽

10.1007/978-3-030-63135-2_10 ◽

2021 ◽

pp. 117-136

Author(s):

Gørill Haugan

Keyword(s):

Older Adults ◽

Health Promotion ◽

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Patient Interaction ◽

Health Promoting ◽

To Come

AbstractWe are now witnessing a major change in the world’s population. Many people globally grow very old: 80, 90, and 100 years. Increased age is followed by an increased incidence of functional and chronic comorbidities and diverse disabilities, which for many leads to the need for long-term care in a nursing home. Quality of life and health promotive initiatives for older persons living in nursing homes will become ever more important in the years to come. Therefore, this chapter focuses on health promotion among older adults living in nursing homes. First, this chapter clarifies the concepts of health, salutogenesis, and pathogenesis, followed by knowledge about health promotion. Then insight and knowledge about the nursing home population is provided; what promotes health and well-being in nursing home residents?Health promotion in the health services should be based on integrated knowledge of salutogenesis and pathogenesis. The salutogenic understanding of health is holistic and considers man as a wholeness including physical, mental, social, and spiritual/existential dimensions. Research indicates that various health-promoting interventions, specifically the nurse–patient interaction, influence on older adults in nursing homes as a wholeness of body–soul–spirit, affecting the whole being. Hence, dimensions such as pain, fatigue, dyspnea, nausea, loneliness, anxiety, and depressive symptoms will be influenced through health-promoting approaches. Therefore, two separate studies on the health-promoting influences of nurse–patient interaction in nursing home residents were conducted. In total, nine hypotheses of directional influence of the nurse–patient interaction were tested, all of which finding support.Along with competence in pain and symptom management, health-promoting nurse–patient interaction based on awareness and attentional skills is essential in nursing home care. Thus, health care workers should be given the opportunity to further develop their knowledge and relational skills, in order to “refine” their way of being present together with residents in nursing homes. Health professionals’ competence involves the “being in the doing”; that is, both the doing and the way of being are essential in health and nursing care.

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Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2018-025614 ◽

2019 ◽

Vol 9 (8) ◽

pp. e025614 ◽

Cited By ~ 3

Author(s):

Jonas Czwikla ◽

Maike Schulz ◽

Franziska Heinze ◽

Thomas Kalwitzki ◽

Daniel Gand ◽

...

Keyword(s):

Nursing Home ◽

Mixed Methods ◽

Nursing Homes ◽

Medical Care ◽

Delphi Study ◽

Nursing Home Residents ◽

Community Dwelling ◽

Mixed Methods Study ◽

Care Needs ◽

Term Care

IntroductionNursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate.Methods and analysisFirst, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes.Ethics and disseminationThis study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.Trial registration numberDRKS00012383.

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Association of body composition with functional capacity and cognitive function in older adults living in nursing homes

Current Aging Science ◽

10.2174/1874609814666210831155002 ◽

2021 ◽

Vol 14 ◽

Author(s):

Pinelopi Stavrinou ◽

George Aphamis ◽

Eleni Andreou ◽

Marios Pantzaris ◽

Christoforos Giannaki

Keyword(s):

Older Adults ◽

Body Composition ◽

Nursing Home ◽

Cognitive Function ◽

Nursing Homes ◽

Body Fat ◽

Functional Capacity ◽

Handgrip Strength ◽

Nursing Home Residents ◽

Sit To Stand

Objective: Older adults living in nursing homes have an increased risk of adverse outcomes. However, the role of body composition in vital health and quality of life parameters such as functional capacity and cognitive function is less studied in this group of older adults compared to community-dwelling counterparts. Objective: The aim of the present study was to examine the association of body composition with functional capacity and cognitive function in nursing home residents. Methods: Fifty-three older adults (82.8±7.3 years) were enrolled in this study and they underwent body composition evaluation, functional capacity and cognitive function measurements. Results: The results showed a high prevalence of obesity accompanied by functional capacity limitations and cognitive impairment in older adults living in nursing homes. Partial correlations, controlling for age, showed that body fat percentage was positively correlated with sit-to-stand-5 (r=0.310, p=0.025) and timed-up-and-go (r=0.331, p=0.017), and negatively correlated with handgrip strength test results (r=-0.431, p<0.001), whereas greater lean body mass was associated with better sit-to-stand-5 (r=-0.410, p=0.003), handgrip strength (r=0.624, p<0.001) and cognitive function performance (r=0.302, p=0.037). Conclusions: These important associations reinforce the need to develop effective healthy lifestyle interventions targeting both lean mass and body fat to combat functional and cognitive decline in nursing home residents.

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THE SUPPORT OF AUTONOMY FOR NURSING HOME RESIDENTS WITH DEMENTIA: OBSERVATION OF MORNING CARE

Innovation in Aging ◽

10.1093/geroni/igz038.285 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S73-S73

Author(s):

Linda J Hoek ◽

Hilde Verbeek ◽

Erica De Vries ◽

Jolanda C Van Haastregt ◽

Ramona Backhaus ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Relational Autonomy ◽

Staff Members ◽

People With Dementia ◽

Centered Care ◽

Field Notes ◽

Almost All ◽

Physical Care

Abstract People with dementia in nursing homes need their social environment in supporting their autonomy. This study explored how this relational autonomy is supported by staff for residents with dementia during morning care in nursing homes. Structured observations (n=1815) were carried out to assess how resident choice is supported within staff-resident interaction. Observation of morning care consisted of four main categories: ‘getting up’, ‘physical care’, ‘physical appearance’ and ‘breakfast’. In addition, qualitative field notes were taken to support observations. In total, 55 residents with dementia were included from eight nursing home wards in The Netherlands. Results indicated that resident autonomy during morning care was only limitedly supported. Individual staff members took over tasks, regardless of resident’s individual capabilities to make a choice. Staff controlled resident’s choice for almost all observed categories. The findings of this study implicate that person-centered care during morning routine can be improved by addressing individual needs

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How Do German General Practitioners Assess Medical Specialist Care Needs of Nursing Home Residents? Results of a Postal Survey in North-Western Germany

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197126 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7126

Author(s):

Ove Spreckelsen ◽

Guido Schmiemann ◽

Alexander Maximilian Fassmer ◽

Bettina Engel ◽

Falk Hoffmann ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Medical Care ◽

General Practitioners ◽

Nursing Home Residents ◽

Specialist Care ◽

Care Needs ◽

Cross Sectional ◽

Western Germany ◽

North Western

The frequency of contacts of nursing home residents with medical specialists is lower compared to the general population of the same age group in Germany. The aim of this study was to assess general practitioners’ (GPs) views on specialist care needs of nursing home residents, on questions of qualification and care coordination. A cross-sectional study was conducted with a postal questionnaire among a representative sample of 1121 GPs in north-western Germany in 2018. The perceptions of GPs about the relative importance of the type of specialist care that is required in nursing homes was assessed on a five-point Likert scale (0 = very low to 4 = very high). A total of 375 GPs (response 33.5%; mean age 54.4 years; 57.6% male) participated in the survey. GPs assessed care needs as highest for neurologists and psychiatrists (68.7%) and lowest for gynecologists (6.5%). Almost all respondents (96.2%) strongly agreed that medical care for nursing home residents should be coordinated by GPs and that GPs should initiate the referral for further specialist care when required (87.5%). A minority (25.7%) agreed that quality of medical care would improve when care for a nursing home was provided by only one GP practice. GPs perceive the needs of nursing home residents for specialist care as high only in relation to care by neurologists and psychiatrists. GPs consider their own coordination function for medical care in nursing homes as very important.

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Qualitative Study of the Implementation and Potential of a Social Intervention at Nursing Homes in Denmark

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041808 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1808

Author(s):

Anne Sophie Mikkelsen ◽

Maria Kristiansen

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Qualitative Study ◽

Social Relations ◽

Nursing Home Residents ◽

Social Intervention ◽

Social Interventions ◽

Health And Wellbeing ◽

Educational Backgrounds ◽

Field Notes

(1) Background: The effect of social relations on health and wellbeing is well documented. However, knowledge about social interventions specifically in nursing homes and their potential for health and wellbeing is inadequate. In this qualitative study, we explore the implementation of a social intervention entitled Tell Stories for Life implemented in Danish nursing homes. (2) Methods: Through a qualitative multi-perspective longitudinal approach, nursing home residents and employees were interviewed from May–December 2016 (N = 14). The authors made participatory observations and took field notes. (3) Results: The intervention did not appear to establish or strengthen social relations between nursing home residents. However, nursing home residents enjoyed participating, narrating and having someone listen to their stories. The identity of nursing home residents and their relationships to nursing home employees facilitating the intervention appeared to be strengthened. Barriers were related to lack of support from management, nursing home employees’ educational backgrounds and experiences, and nursing home residents’ cognitive ability. (4) Conclusions: This study found that the Tell Stories for Life intervention did not appear to strengthen and establish social relations among nursing home residents. However, we found that there might be potential for strengthening residents’ sense of identity and the relation between residents and nursing home employees.

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