Barriers to Nursing Home Care for Nonelderly Rural Residents

2017 ◽  
Vol 38 (12) ◽  
pp. 1708-1727
Author(s):  
Carrie Henning-Smith ◽  
Katy Kozhimannil ◽  
Shailendra Prasad

Rural residents experience higher disability, mortality, and poverty rates than their urban counterparts; they also have more barriers to accessing care, including nursing home care. Meanwhile, the proportion of nonelderly adult nursing home residents (<65 years old) is growing, yet little is known about this population and barriers they face trying to access care, especially in rural areas. This qualitative study uses data from 23 semistructured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We grouped those barriers into three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes—and discuss each in the article, along with potential policy and programmatic interventions to improve access to nursing home care for nonelderly rural residents.

2021 ◽  
Author(s):  
Susann May ◽  
Kai Jonas ◽  
Thomas Zahn ◽  
Martin Heinze ◽  
Felix Mühlensiepen

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.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Susann May ◽  
Kai Jonas ◽  
Georgia V. Fehler ◽  
Thomas Zahn ◽  
Martin Heinze ◽  
...  

Abstract Background Telemedical 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. The goal was to assess the effect of implementing 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? Methods Twenty-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. Results Challenges 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. Conclusions Telehealth 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.


Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 672
Author(s):  
Gerd Ahlström ◽  
Nina Stååhl Markeling ◽  
Ulrika Liljenberg ◽  
Helena Rosén

In aging societies worldwide, spouses take on great responsibility for care when their partner continues to live at home. Nursing home placement occurs when the partner becomes too frail due to multimorbidity, and this will cause a change in the spouse’s life. This study aimed to explore the spouse’s experience of their partner’s move to a nursing home. Two interviews were conducted at 9-month intervals within the project entitled “Implementation of Knowledge-Based Palliative Care in Nursing Homes”. Thirteen spouses from both urban and rural areas were included, with an age-range of 60–86 years (median 72). Qualitative content analysis was performed. The main findings were captured in two themes: Breaking up of close coexistence and Towards a new form of daily life. The first encompassed processing loneliness, separation and grief, exhaustion, increased burden, and a sense of guilt. The second encompassed a sense of freedom, relief, acceptance, support and comfort. Professionals in both home care and nursing home care need to develop and provide a support programme conveying knowledge of the transition process to prevent poor quality of life and depression among the spouses. Such a programme should be adaptable to individual needs and should ideally be drawn up in consultation with both partners.


Author(s):  
Gørill Haugan

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.


2020 ◽  
pp. 073346482094692
Author(s):  
Debra Parker Oliver ◽  
Abigail J. Rolbiecki ◽  
Karla Washington ◽  
Robin L. Kruse ◽  
Lori Popejoy ◽  
...  

Background and Objectives: Many family members struggle to negotiate their aging relative’s care with nursing home staff, potentially leading to depression and other negative outcomes for residents’ families. This pilot study tested an intervention designed to empower residents’ family members to attend and participate in nursing home care plan meetings. Research Design and Methods: We conducted a small, randomized, controlled trial of the Families Involved in Nursing home Decision-making (FIND) intervention, which used web conferencing to facilitate family participation in care plan meetings. Results: Overall, FIND was feasible and acceptable. Family members who received the FIND intervention were more likely to experience decreased depressive symptoms than those who did not. Discussion and Implications: FIND is a promising approach to reduce depression among family members of nursing home residents. Findings support the need for a follow-up clinical trial.


1995 ◽  
Vol 77 (3_suppl) ◽  
pp. 1169-1170 ◽  
Author(s):  
Frances C. Lawrence ◽  
E. Barry Moser ◽  
Aimee D. Prawitz ◽  
Michael W. Collier

Gender was associated with one type of fund used for financing nursing home care, assistance from children. Female nursing home residents were more likely to receive assistance from adult children than were male residents.


2018 ◽  
Vol 30 (2) ◽  
pp. 109-126
Author(s):  
Carrie Henning-Smith ◽  
Katy B. Kozhimannil ◽  
Michelle M. Casey ◽  
Shailendra Prasad

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