scholarly journals County-Level Social Determinants of Health and COVID-19 in Nursing Homes, United States, June 1, 2020–January 31, 2021

2021 ◽  
pp. 003335492110536
Author(s):  
Adam Hege ◽  
Sandi Lane ◽  
Trent Spaulding ◽  
Margaret Sugg ◽  
Lakshmi S. Iyer
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Ethnic Minority ◽  
Census Data ◽  
Determinants Of Health ◽  
Future Research ◽  
County Level ◽  
Infection Rates ◽  
Structural Determinants ◽  
Racial And Ethnic Minority

Objectives Nursing homes are a primary setting of COVID-19 transmission and death, but research has primarily focused only on factors within nursing homes. We investigated the relationship between US nursing home–associated COVID-19 infection rates and county-level and nursing home attributes. Methods We constructed panel data from the Centers for Medicare & Medicaid Services (CMS) minimum dataset, CMS nursing home data, 2010 US Census data, 5-year (2012-2016) American Community Survey estimates, and county COVID-19 infection rates. We analyzed COVID-19 data from June 1, 2020, through January 31, 2021, during 7 five-week periods. We used a maximum likelihood estimator, including an autoregressive term, to estimate effects and changes over time. We performed 3 model forms (basic, partial, and full) for analysis. Results Nursing homes with nursing (0.005) and staff (0.002) shortages had high COVID-19 infection rates, and locally owned (−0.007) or state-owned (−0.025) and nonprofit (–0.011) agencies had lower COVID-19 infection rates than privately owned agencies. County-level COVID-19 infection rates corresponded with COVID-19 infection rates in nursing homes. Racial and ethnic minority groups had high nursing home–associated COVID-19 infection rates early in the study. High median annual personal income (−0.002) at the county level correlated with lower nursing home–associated COVID-19 infection rates. Conclusions Communities with low rates of nursing home infections had access to more resources (eg, financial resources, staffing) and likely had better mitigation efforts in place earlier in the pandemic than nursing homes that had access to few resources and poor mitigation efforts. Future research should address the social and structural determinants of health that are leaving racial and ethnic minority populations and institutions such as nursing homes vulnerable during times of crises.

scholarly journals Trends in racial and ethnic disparities in coronavirus disease 2019 (COVID-19) outcomes among nursing home residents

2021 ◽  
pp. 1-7
Author(s):  
Yue Li ◽  
Xueya Cai ◽  
Yunjiao Mao ◽  
Zijing Cheng ◽  
Helena Temkin-Greener
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Ethnic Minority ◽  
Negative Binomial ◽  
Nursing Home Residents ◽  
Ethnic Disparities ◽  
Relative Increase ◽  
Racial And Ethnic Disparities ◽  
Rate Ratios ◽  
Racial And Ethnic Minority

Abstract Objectives: To evaluate trends in racial and ethnic disparities in weekly cumulative rates of coronavirus disease 2019 (COVID-19) cases and deaths in Connecticut nursing homes. Design: Longitudinal analysis of nursing-home COVID-19 reports and other databases. Multivariable negative binomial models were used to estimate disparities in COVID-19 incidence and fatality rates across nursing-home groups with varying proportions of racial and ethnic minority residents, defined as low-, medium-, medium-high-, and high-proportion groups. Trends in such disparities were estimated from week 1 (April 13) to week 10 (ending on June 19, 2020). Setting: The study was conducted across 211 nursing homes. Results: The average number of cases ranged from 6.1 cases per facility for the low-proportion group to 11.7 cases per facility for the high-proportion group in week 1, and from 26.7 to 58.5 cases per facility in week 10. Compared to the low-proportion group, the adjusted incidence rate ratios (IRRs) for the high-proportion group were 1.18 (95% confidence interval [CI], 0.77–1.80; P > .10) in week 1 and 1.54 (95% CI, 1.05–2.25; P < .05) in week 10, showing a 30% (95% CI, 5%–62%) relative increase (P < .05). The average weekly number of COVID-19–related deaths ranged from 0 to 0.3 deaths per facility for different groups in week 1, and from 7.6 to 13.3 deaths per facility in week 10. Adjusted disparities in fatalities similarly increased over time. Conclusions: Connecticut nursing homes caring for predominately racial and ethnic minority residents tended to have higher COVID-19 incidence and fatality rates. These across-facility disparities increased during the early periods of the pandemic.

scholarly journals Appropriate leadership in nursing home care: a narrative review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nick Zonneveld ◽  
Carina Pittens ◽  
Mirella Minkman
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Leadership Behaviors ◽  
Narrative Review ◽  
Nursing Home Care ◽  
Added Value ◽  
Future Research ◽  
Content Type ◽  
Definition Of

Purpose The purpose of this paper is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors. Design/methodology/approach A narrative review was performed in three steps: the establishment of scope, systematic search in five databases and assessment and analysis of the literature identified. Findings A total of 44 articles were included in the review. The results of the study imply that a stronger focus on leadership behaviors related to the specific context rather than leadership styles could be of added value in nursing home care. Research limitations/implications Only articles applicable to nursing home care were included. The definition of “nursing home care” may differ between countries. This study only focused on the academic literature. Future research should focus on strategies and methods for the translation of leadership into behavior in practice. Practical implications A broader and more conceptual perspective on leadership in nursing homes – in which leadership is seen as an attribute of all employees and enacted in multiple layers of the organization – could support leadership practice. Originality/value Leadership is considered an important element in the delivery of good quality nursing home care. This study provides insight into leadership behaviors and influencing contextual factors specifically in nursing homes.

scholarly journals Facility Characteristics and Quality Deficiencies of Florida Nursing Homes With COVID-19 Cases and Deaths

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 945-945
Author(s):  
Xiaochuan Wang ◽  
Courtney Wilson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Infection Control ◽  
Nursing Home Residents ◽  
The United States ◽  
Future Research ◽  
Staffing Level ◽  
Policy And Practice ◽  
Staff Shortage ◽  
Facility Size

Abstract The Coronavirus disease 2019 (COVID-19) has been disproportionately affecting nursing homes throughout the United States, resulting elevated risk for COVID-19 morbidity and mortality to nursing home residents. Given the high percentage of aging population, large number of nursing homes, and staggering surge of COVID-19 cases in Florida, it’s critical to understand factors that may affect Florida nursing homes’ vulnerability to the COVID-19 pandemic. Using Nursing Home COVID-19 Dataset as of July 26, 2020 obtained through Centers for Medicare and Medicaid Services (CMS), and Provider Info Dataset and Health Deficiencies Dataset available through CMS Nursing Home Compare data, we constructed a database of Florida nursing facilities with confirmed COVID-19 cases and deaths, with corresponding facility characteristics and quality deficiencies. We examined the facility characteristics (e.g. facility size, ownership state, chain affiliation, staffing level) and quality deficiencies (e.g. infection control deficiencies) of Florida nursing homes with and without publicly reported COVID-19 cases and deaths. Results indicated that, as of July 26, 2020, 73.3% and 40.8% of Florida nursing homes had resident COVID-19 cases and death, respectively (N=701). Findings also suggested that Florida nursing homes of large facility size, chain affiliated, and for profit, were significantly more likely to have documented resident COVID-19 cases (p&lt;.05). Larger facility size (120 beds or more), staff shortage, and having prior infection control deficiency citation, were significantly related to the odds of having resident COVID-19 deaths (p&lt;.05). Policy and practice implications and future research directions will be addressed to better protect the at-risk nursing home residents.

scholarly journals Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative

2017 ◽  
Vol 27 (6) ◽  
pp. 464-473 ◽  
Author(s):  
Shawna N Smith ◽  
M Todd Greene ◽  
Lona Mody ◽  
Jane Banaszak-Holl ◽  
Laura D Petersen ◽  
...  
Keyword(s):  
Patient Safety ◽  
Nursing Home ◽  
Urinary Tract ◽  
Nursing Homes ◽  
Safety Culture ◽  
Negative Binomial ◽  
Patient Safety Culture ◽  
Infection Rates ◽  
Tract Infections ◽  
Over Time

BackgroundRecent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data from a large number of nursing homes.ObjectiveTo examine the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes.MethodsIn this prospective cohort study of nursing homes, facility staff completed the NHSOPS at intervention start and 11 months later. National Healthcare Safety Network-defined CAUTI rates were collected monthly for 1 year. Negative binomial models examined CAUTI rates as a function of both initial and time-varying facility-aggregated NHSOPS components, adjusted for facility characteristics.ResultsStaff from 196 participating nursing homes completed the NHSOPS and reported CAUTI rates monthly. Nursing homes saw a 52% reduction in CAUTI rates over the intervention period. Seven of 13 NHSOPS measures saw improvements, with the largest improvements for ‘Management Support for Resident Safety’ (3.7 percentage point increase in facility-level per cent positive response, on average) and ‘Communication Openness’ (2.5 percentage points). However, these increases were statistically insignificant, and multivariate models did not find significant association between CAUTI rates and initial or over-time NHSOPS domains.ConclusionsThis large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates.

scholarly journals THE RELATIONSHIP BETWEEN ORGANIZATIONAL CULTURE AND FINANCIAL PERFORMANCE AMONG HIGH-MEDICAID NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S698-S698
Author(s):  
Robert Weech-Maldonado ◽  
Akbar Ghiasi ◽  
Ganisher K Davlyatov ◽  
Justin C Lord ◽  
Jane Banaszak-Holl
Keyword(s):  
Organizational Culture ◽  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Working Environment ◽  
Future Research ◽  
Market Culture ◽  
Operating Margin ◽  
Clan Culture ◽  
The Relationship

Abstract This study examines the relationship between organizational culture and financial performance of high Medicaid census (70% or higher) nursing homes (NHs). Based on the Competing Values Framework, there are four types of organizational culture: clan culture (friendly working environment); adhocracy culture (dynamic/creative working environment); market culture (results-based organization); and hierarchy culture (formalized/structured work environment). This study used facility survey data from approximately 324 nursing home administrators (30% response rate) from 2017- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the operating margin, while the independent variable comprised type of organizational culture. Control variables were organizational (ownership, chain affiliation, size, occupancy rate, and payer mix), and county-level factors (Medicare Advantage penetration, income, education, unemployment rate, poverty, and competition). Multivariable regression was used to model the relationship between organizational culture type and financial performance. Regression results show that compared to a market culture, a hierarchy culture was associated with an 11.8 % lower operating margin, a clan culture with a 10.6% lower operating margin, and a non-dominant culture with 11.4% lower operating margin. Organizational culture is associated with financial performance among high Medicaid facilities, with market cultures outperforming other organizational cultures. Given increasing competition in the nursing home market and declining resources for high Medicaid nursing homes, facilities with a more external orientation and focus on results may be able to perform better financially. Future research should examine the effect of organizational culture on quality of care.

scholarly journals LESSONS LEARNED FROM NURSING HOME CIVIL MONETARY PENALTY PROJECTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S770-S770
Author(s):  
Diana L Sturdevant ◽  
Kathleen C Buckwalter
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Lessons Learned ◽  
Federal State ◽  
Future Research ◽  
Term Care ◽  
Home Setting

Abstract Nursing homes must comply with numerous federal/state regulations to receive Medicare and Medicaid funding. Failure to comply with these regulations can result in deficiency citations, and depending on the severity of the deficiency, a resulting Civil Monetary Penalty (CMP). Through the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty Reinvestment Program, CMP funds are reinvested to support activities that benefit nursing home residents and that protect or improve their quality of life or quality of care. This symposium presents some of the unique challenges, successes, failures, and surprise findings from CMP-funded nursing home quality improvement projects in two, predominantly rural Midwestern states: Oklahoma and Kansas. Dr. Williams presents findings of a pilot-study testing an adaptation of a successful family caregiver telehealth support intervention in the nursing home setting and implications for future research. Dr. Sturdevant shares successes, challenges, and unanticipated results from the “It’s Not OK to Fall” project, a comprehensive, 3 year fall prevention project implemented in Oklahoma nursing homes. Lastly, Ms. Round’s paper describes the implementation and findings of a Long-term Care Leadership Academy aimed at improving leadership and team building skills of three levels of nursing home staff, including Administrators/Directors’ of Nursing, RN/LPN charge nurses and certified nursing assistants. Discussant, Dr. Kathleen Buckwalter Ph.D., FAAN, RN, will discuss how principles of nursing home culture change provides a common framework for these projects and conclude by offering suggestions on how promotion of these principles might improve the quality of care provided by nursing homes.

scholarly journals Effects of a staff education programme about person-centred care and promotion of thriving on relatives’ satisfaction with quality of care in nursing homes: a multi-centre, non-equivalent controlled before-after trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Qarin Lood ◽  
Karin Sjögren ◽  
Ådel Bergland ◽  
Marie Lindkvist ◽  
Marit Kirkevold ◽  
...  
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Intervention Group ◽  
Education Programme ◽  
Future Research ◽  
Control Group ◽  
Staff Education ◽  
Study Sites

Abstract Background As part of a nursing home intervention study, the aim of this paper was 1) to evaluate the effects of a staff education programme about person-centred care and promotion of thriving on relatives’ satisfaction with quality of care and their perceptions of the person-centredness of the environment, and 2) to outline factors of importance to explain the variance in relatives’ satisfaction with quality of care. Relatives are often referred to as vital for the operationalisation of person-centredness in nursing homes, representing an important source of information for care planning and quality of care assessments. However, the evidence for effects of person-centredness in nursing homes on relatives’ experiences is sparse and little is known on what could explain their satisfaction with the quality of care. Methods A multi-centre, non-equivalent controlled group before-after design with study sites in Australia, Norway and Sweden. Staff in the intervention group participated in a 14-month education on person-centredness, person-centred care, thriving and caring environment. Staff in the control group received a one-hour lecture before the intervention period. Data were collected at baseline, after the intervention and six months after the end of the intervention, and analysed using descriptive statistics, a generalised linear model and hierarchical multiple regression. Results In general, relatives from both the intervention and control nursing homes were satisfied with the quality of care, and no statistically significant overall between-group-effects of the intervention were revealed on satisfaction with quality of care or perceptions of the person-centredness of environment. A person-centred environment in terms of safety and hospitality were identified as factors of prominent importance for the relatives’ satisfaction with the quality of care. Conclusion The findings of this paper provide a foundation for future research in terms of intervention design in nursing home contexts. Staff availability, approachability, competence and communication with relatives may be important factors to consider to improve quality of care from the perspective of relatives, but more research both with and for relatives to people living in nursing homes is necessary to identify the keys to success. Trial registration ClinicalTrials.gov-NCT02714452. Registered on March 19, 2016.

scholarly journals Exploring the N95 and Surgical Mask Supply in U.S. Nursing Homes During COVID-19

2020 ◽  
pp. 073346482096901
Author(s):  
Yumeng Li ◽  
Fang Fang ◽  
Mengying He
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Health Care Facilities ◽  
Protective Equipment ◽  
County Level ◽  
Multivariate Logistic Regression ◽  
For Profit ◽  
Not For Profit ◽  
Surgical Masks ◽  
Care Facilities

U.S. health care facilities have been encountering a recurrence of medical supply shortage since COVID-19 exploded in March 2020. There is an urgent need for important Personal Protective Equipment (PPE) such as N95 and surgical masks. This project examined the factors that were associated with nursing homes’ N95 and surgical mask supply. We analyzed data from the Nursing Home COVID-19 Public File and conducted a multivariate logistic regression estimating the association between nursing home characteristics and county-level demographic parameters with mask supply. We found that a high number of resident COVID-19 cases contributed to the supply of N95, but not surgical masks, whereas a high number of staff cases did not lead to an adequate supply of either N95 or surgical masks. Compared with not-for-profit (NFP) facilities, for-profit (FP) nursing homes were less likely to get enough masks. A better supply distribution plan is needed to prepare for future possible PPE shortage.

scholarly journals The Psychological Consequences of the COVID-19 on Residents and Staff in Nursing Homes

2020 ◽  
Vol 6 (4) ◽  
pp. 254-259
Author(s):  
Shenjiang Mo ◽  
Junqi Shi
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Older People ◽  
Nursing Home Residents ◽  
Future Research ◽  
Psychological Consequences ◽  
Ethical Challenges ◽  
Role Conflicts ◽  
External Stakeholders

Abstract In this commentary, we overview the existing research on psychological consequences caused by COVID-19 for both residents and staff in the nursing homes. We identify loneliness and emotional anxiety as main psychological consequences for nursing home residents, whereas uncertainty, hopelessness, work overload, and role conflicts are the most salient psychological challenges for the staff in the nursing homes during the pandemic. We then summarize the existing strategies and interventions responsive to the above challenges. We suggest that this overview may help nursing home managers understand what are the key psychological challenges and how to deal with them during a crisis period. Finally, we also encourage future research to pay more attention to exploring interventions specifically designed for vulnerable older people, understanding the role of the nursing home leader team in managing emotional and ethical challenges in organizations, and developing community-wide collaboration with multiple external stakeholders.

Assuring Quality in Nursing Homes: The Black Box of Administrative and Clinical Leadership --a Scoping Review

2020 ◽  
Author(s):  
Elena O Siegel ◽  
Heather M Young
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Scoping Review ◽  
Research Policy ◽  
Quality Care ◽  
Black Box ◽  
Future Research ◽  
Nursing Home Administrators ◽  
Policy Practice ◽  
Role Structure

Abstract Background and Objectives Licensed nursing home administrators (NHA) and directors of nursing (DON) are responsible for nursing home quality and assuring optimal performance and job satisfaction/retention of their nursing home workforce. NHA/DON-focused studies have generated important foundational knowledge over the last three decades; yet, targeted research is needed to understand and apply the complexities of the black box of this top management team. This scoping review identifies, reviews, synthesizes and maps the topical areas of research in NHA/DON positions in US nursing homes. Research Design and Methods We conducted searches of five databases, yielding 3,479 records; screening/review yielded 88 unique records analyzed using Donabedian’s structure-process-outcome model (Donabedian, 2003) as an organizing framework. Results Most papers (n=40) focused on role characteristics, 23 examined approaches to management and leadership, 24 focused on perceptions about the role, and the remaining 12 examined role structure. The role-related themes linked to outcomes (n=42), processes (n=27) and structures (n=30). Discussion and Implications We highlight important gaps for future research and offer a call to action for research, policy, practice, and education collaborations to accelerate the rate of research and translate the findings into best practices for NHA/DON to lead and manage the nursing home workforce and build capacity to ensure person-centered, high quality care. Based on foundational descriptive studies, it is time to use what is known to design and implement interventions that enhance the capacity of NHA/DON to improve the structures, processes and outcomes of nursing homes.

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