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

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025614 ◽  
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.

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

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.

scholarly journals THE USE OF SPECIALIST HEALTH CARE IN NURSING HOMES AS AN INDICATOR FOR QUALITY OF CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S73-S74
Author(s):  
Karin Wolf-Ostermann ◽  
Karin Wolf-Ostermann ◽  
Annika Schmidt ◽  
Daniel Gand ◽  
Ansgar Gerhardus ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Medical Care ◽  
Secondary Data ◽  
Community Dwelling ◽  
Care Needs ◽  
Term Care ◽  
Related Data ◽  
Medical Needs ◽  
Specialist Health Care

Abstract Needs-based medical care is essential for maintaining and promoting health and quality of life in long-term care. But still knowledge of medical needs and of needs-based medical care of nursing home (NH) residents is limited. However, individual studies, primarily based on secondary data, show that NH residents have significantly less contact with specialists than community-dwelling elderly. The aim of the study is therefore to gain knowledge about medical needs of NH residents as well as about the use of (specialist) medical care especially with respect to vision, hearing and oral health. Besides sociodemographic and care-related data we evaluated health status and utilization of medical care by means of standardized assessments for n=500 NH-residents. Results show that there are inequalities in (specialist) medical care: More experienced knowledge about unmet medical care needs will be used to generate ideas on how to improve the provision of medical care in nursing homes.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

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.

scholarly journals 0721 Daytime Sleepiness and Napping in Nursing-Home Eligible Community Dwelling Older Adults: A Mixed Methods Study

SLEEP ◽  
2018 ◽  
Vol 41 (suppl_1) ◽  
pp. A268-A268
Author(s):  
M V McPhillips ◽  
J Li ◽  
P Z Cacchione ◽  
V V Dickson ◽  
N S Gooneratne ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Mixed Methods ◽  
Daytime Sleepiness ◽  
Community Dwelling ◽  
Mixed Methods Study ◽  
Community Dwelling Older Adults

Geriatric Health Experts Validate Oral Neglect Timelines for the Institutionalized Elderly

2019 ◽  
Vol 39 (11) ◽  
pp. 1250-1257
Author(s):  
Sharon M. Casey ◽  
Ralph V. Katz ◽  
Shulamite Huang ◽  
Barbara J. Smith
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Standard Of Care ◽  
Delphi Survey ◽  
Oral Disease ◽  
Oral Diseases ◽  
Term Care ◽  
Institutionalized Elderly

The purpose of this follow-up Delphi survey was to have an expert panel of 31 academic geriatric physicians, geriatric nurses, and medical directors of nursing homes evaluate the original timeline set to avoid oral neglect of nursing home residents. The Oral Neglect in Institutionalized Elderly (ONiIE) timelines defined oral neglect as having occurred when >7 days for acute oral diseases/conditions or >34 days for chronic oral disease/conditions had passed between initial diagnosis and offering access to dental care to the long-term care (LTC) nursing home resident. The results of this follow-up Delphi survey validated those originally defined ONiIE timelines as 90% of this panel agreed with the original timelines. This ONiIE definition adds a broad-based validation for the ONiIE timelines for setting an oral health standard of care for institutionalized elderly residents of nursing homes and should now be used to protect the vulnerable elderly residing in LTC nursing homes.

scholarly journals Impact of morbidity on care need increase and mortality in nursing homes: a retrospective longitudinal study using administrative claims data

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Katrin C. Reber ◽  
Ivonne Lindlbauer ◽  
Claudia Schulz ◽  
Kilian Rapp ◽  
Hans-Helmut König
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Claims Data ◽  
Nursing Home Residents ◽  
Medical Conditions ◽  
Term Care ◽  
Care Level ◽  
Level Change ◽  
Risk Of Mortality

Abstract Background A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality. Methods In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality. Results The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2. Conclusion This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).

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

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.

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

2020 ◽  
Vol 60 (8) ◽  
pp. 1504-1514
Author(s):  
Heather J Campbell-Enns ◽  
Megan Campbell ◽  
Kendra L Rieger ◽  
Genevieve N Thompson ◽  
Malcolm B Doupe
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Community Setting ◽  
Nursing Home Admission ◽  
Care Needs ◽  
Community Based ◽  
Field Notes ◽  
Care Nursing

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.

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

2001 ◽  
Vol 13 (3) ◽  
pp. 347-358 ◽  
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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