scholarly journals Rebalance Without the Balance: A Research Note on the Availability of Community-Based Services in Areas Where Nursing Homes Have Closed

2015 ◽  
Vol 39 (5) ◽  
pp. 597-611 ◽  
Author(s):  
Denise A. Tyler ◽  
Mary L. Fennell
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Rural Areas ◽  
Local Level ◽  
Population Characteristics ◽  
Local Market ◽  
Clear Understanding ◽  
Community Based ◽  
Multinomial Logistic Model ◽  
Community Based Services

Policies to “rebalance” funding away from nursing homes and toward home and community-based services (HCBS) have encouraged national trends of nursing home closure and an expansion of the HCBS industry. These changes are unfolding without a clear understanding of what services are available at the local level. The purpose of this study was: (1) to describe the current distribution of community-based services (CBS) in areas where nursing homes have closed and (2) to examine differences in availability of CBS using local market and population characteristics as regressors in a multinomial logistic model. We collected data on and geocoded CBS facilities and then used ArcGIS to define a 5-mile radius around all nursing homes that closed between 2006 and 2010 and compared these local market areas. In rural areas, availability of CBS does not appear to compensate for nursing home closures. Policies encouraging HCBS may be outpacing availability of CBS, especially in rural areas.

scholarly journals IS BEING HOME GOOD FOR YOUR HEALTH? OUTCOMES OF MEDICAID HOME- AND COMMUNITY-BASED SERVICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S547-S548
Author(s):  
R Tamara Konetzka ◽  
Rebecca J Gorges ◽  
Daniel H Jung ◽  
Prachi H Sanghavi
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Health Outcomes ◽  
Race And Ethnicity ◽  
Nursing Home Care ◽  
Policy Changes ◽  
Community Based ◽  
National Estimates ◽  
Poor Outcomes ◽  
Community Based Services

Abstract Expanding home- and community-based services (HCBS) alternatives to nursing homes has become a priority for many state Medicaid programs. Dramatic policy changes affecting diverse patient and family populations are being made on the basis of surprisingly little evidence about the outcomes of HCBS relative to the alternatives. Our study is designed to address that gap, providing the first national estimates of plausibly causal health outcomes for recipients of Medicaid HCBS relative to nursing home care. We also examine heterogeneity of these effects by several important subgroups. Results indicate that HCBS users have rates of hospitalization similar to their nursing home counterparts, and rates are higher for those with dementia. Furthermore, disparities by race and ethnicity that have been well-documented in nursing homes also appear to extend to the HCBS setting. The costs of potentially poor outcomes need to be part of the policy equation.

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.

scholarly journals Outlining the Prior Infection with SARS-CoV-2 study (PICOV) - preliminary findings on symptoms in nursing home residents and staff.

2021 ◽  
Author(s):  
Maria E. Goossens ◽  
Kristof Y. Neven ◽  
Pieter Pannus ◽  
Cyril Barbezange ◽  
Isabelle Thomas ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Acute Respiratory Infection ◽  
Nursing Home Residents ◽  
Population Characteristics ◽  
Geriatric Population ◽  
Health Concerns ◽  
Staff Members ◽  
Important Health ◽  
Prior Infection

Abstract Background: COVID-19 has presented itself as one of the most important health concerns of 2020. The geriatric population is arguably hit the hardest by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The ”Prior Infection with SARS-COV-2” (PICOV) study investigates both residents and staff members from nursing homes. The primary aim of the study is to compare the time to occurrence of an influenza-like illness (ILI) or acute respiratory infection (ARI) between participants with a confirmed past SARS-CoV-2 infection and those without an infection. This paper details the study design, sampling scheme, biological measurements, and population characteristics at baseline.Methods: In 26 Belgian nursing homes, all eligible residents and staff members with or without a past SARS-CoV-2 infection (ratio 40/60) were invited to participate. Consent was obtained from 1,375 participants and 1,226 completed the baseline questionnaire. Prevalence of symptoms during a prior SARS-CoV-2 infection was compared between residents and staff members with χ2 statistics.Results: Nursing home residents (both with and without a prior SARS-CoV-2 infection) systematically reported fewer symptoms than staff members. Moreover, results from prior nasopharyngeal RT-qPCR and baseline serology show that antibody development after a SARS-CoV-2 infection differs between residents and staff members.Conclusions: We can postulate that disease development and symptoms is different between a geriatric and younger population. Therefore, the occurrence and severity of a future ILI and/or ARI might vary from resident to staff.

scholarly journals The Potential for Ducted Wind Turbines in an Urban Environment

2019 ◽  
Author(s):  
Dhruv Suri
Keyword(s):  
Urban Environment ◽  
Wind Turbines ◽  
Rural Areas ◽  
Energy Production ◽  
Local Level ◽  
Urban Infrastructure ◽  
Community Based ◽  
Present Letter ◽  
Decentralized Energy ◽  
Speed Effect

This article discusses the applicability of Ducted Wind Turbines for decentralized energy generation in an urban environment. Ducted Wind Turbines overcome various constraints posed by urban infrastructure including reduced wind speed, effect of the atmospheric boundary layer as well as lesser space availability. Ducted Wind Turbines present a new way of sourcing energy at a local level, aiding community based models of energy distribution and consumption. The main aim of the present letter is to propose Ducted Wind Turbines as a precursor for energy production in urban, peri-urban as well as rural areas around the world.

scholarly journals Challenges in Current Nursing Home Care in Rural Germany and How They Can Be Reduced by Telehealth - an Exploratory Pre-post Study

2021 ◽  
Author(s):  
Susann May ◽  
Kai Jonas ◽  
Thomas Zahn ◽  
Martin Heinze ◽  
Felix Mühlensiepen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Rural Areas ◽  
Qualitative Content Analysis ◽  
Nursing Home Residents ◽  
Nursing Home Care ◽  
Alternative Form ◽  
Supporting Evidence ◽  
Existing Structures

Abstract BackgroundTelemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. ObjectiveThe goal was to assess the effect of implement medical video consultations into nursing home care addressing the following research questions:- How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? - How can video consultations be used to reduce difficulties arising in everyday care? - How does implementation of video consultations impact day-to-day nursing home care delivery?MethodsTwenty-one guided interviews (pre-implementation n=13; post-implementation n=8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis.ResultsChallenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly.ConclusionsTelehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.

scholarly journals Spreading Telehealth for Older Adults in Rural Areas Through Network of Geriatric Interprofessional Teams

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 796-796
Author(s):  
Steven Barczi ◽  
Megan Gately ◽  
Lauren Welch ◽  
Kathryn Nearing ◽  
Stephen Thielke ◽  
...  
Keyword(s):  
Older Adults ◽  
Rural Areas ◽  
Urban Areas ◽  
Care Needs ◽  
Community Based ◽  
Team Care ◽  
Geriatric Consultation ◽  
Complex Care Needs ◽  
Nursing Professionals ◽  
Community Based Services

Abstract Older adults living in rural areas have limited access to geriatrics interprofessional team care. In the Veteran healthcare system, geriatric teams such as geriatricians, nursing professionals, social workers, pharmacists and psychologists, located in urban areas link up with rural clinics to provide geriatric consultation remotely through clinical video telehealth and other means in the project GRECC Connect. Since its inception in 2014, the service has now grown to 16 geriatric teams offering consultation to over 100 clinic sites serving older rural Veterans. GRECC Connect delivered over 2,000 consultations in 2019, meeting complex care needs by identifying and linking geriatric services and management to patients with geriatric syndromes. The network of established geriatric teams, local champions and a shared Electronic Health Record facilitated the spread, while ongoing effort to build and maintain relationships between consultants and local rural provider teams and other community based services are important for ongoing success.

Location Matters: Disparities in the Likelihood of Receiving Services in Late Life

2020 ◽  
pp. 009141502094820
Author(s):  
Raven H. Weaver ◽  
Karen A. Roberto
Keyword(s):  
Older Adults ◽  
Service Delivery ◽  
Home Care ◽  
Rural Areas ◽  
Late Life ◽  
Community Based ◽  
Fresh Food ◽  
Delivery Strategies ◽  
To Receive ◽  
Community Based Services

Moving beyond typical dichotomous rural–urban categorizations, this study examines older adults’ likelihood of receiving home- and community-based services. Data from 1608 individuals aged 60+ who requested assistance from Area Agencies on Aging in Virginia in 2014–2015 were analyzed; 88% of individuals received at least one service. Receiving services was associated with geographic-based factors. Individuals living in completely rural areas were significantly less likely to receive any service compared to individuals in mostly rural (OR = 2.46, p = .003) and mostly urban (OR = 1.97, p = .024) areas. There were subtle but significant geographic-based differences in the likelihood of receiving specific services including food/meal, fresh food, information and referral, in-home care, utilities support, and transportation. Findings provide nuanced insights about geographic-based disparities in the receipt of services and suggest the need for new and modified service delivery strategies that maximize older adults’ ability to live.

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