It Is Not Your Parents’ Long-Term Services System: Nursing Homes in a Changing World

2018 ◽  
Vol 39 (8) ◽  
pp. 898-901
Author(s):  
Robert Applebaum ◽  
Shahla Mehdizadeh ◽  
Diane Berish
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Length Of Stay ◽  
Older Person ◽  
Home Practice ◽  
Data Set ◽  
Study Results ◽  
Utilization Data ◽  
First Time

The long-term services system has changed substantially since the mid-1970s, when the landmark book Last Home for the Aged argued that the move to the nursing home was the last move an older person would make until death. Using detailed nursing home utilization data from the Minimum Data Set, this study tracks three cohorts of first-time nursing home admissions in Ohio from 1994 through 2014. Each cohort was followed for a 3-year period. Study results report dramatic reductions in nursing home length of stay between the 1994 and 2011 cohorts. Reduction in length of stay has important implications for nursing home practice and quality monitoring. The article argues that administrative and regulatory practices have not kept pace with the dramatic changes in how nursing homes are now being used in the long-term services system.

scholarly journals Trends in antibiotics use among long-term US nursing-home residents

2020 ◽  
pp. 1-7
Author(s):  
Catherine C. Cohen ◽  
Andrew W. Dick ◽  
Mansi Agarwal ◽  
Tadeja Gracner ◽  
Susan Mitchell ◽  
...  
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Cognitive Status ◽  
Cross Sectional ◽  
Data Set

Abstract Objectives: Antibiotics are overly prescribed in nursing homes. Recent antibiotic stewardship efforts attempt to reduce inappropriate use. Our objective was to describe antibiotic use from 2012 to 2016 among nursing-home residents with various health conditions. Design: Retrospective, repeated cross-sectional analysis. Setting and participants: All long-term residents in a random 10% sample of national nursing homes: 2,092,809 assessments from 319,615 nursing-home residents in 1,562 nursing homes. Measurements: We calculated a 1-day antibiotic prevalence using all annual and quarterly clinical assessments in the Minimum Data Set (MDS) from April 2012 through December 2016. We calculated prevalence of antibiotic use overall and within conditions of interest: Alzheimer’s disease and related dementias (ADRD), advanced cognitive impairment (ACI), and infections likely to be treated with antibiotics. We applied logistic regressions with nursing-home cluster, robust standard errors to assess changes in conditions and antibiotic use 2012–2016. Results: Overall, antibiotic use did not change (2012 vs 2016, adjusted odds ratio [AOR], 1.00; 95% CI, 0.97–1.03). Antibiotic use was higher in 2016 versus 2012 among assessments with any infection (AOR, 1.10; 95% CI, 1.04–1.16), urinary tract infection (AOR, 1.18; 95% CI, 1.12–1.25), and no infection (AOR, 1.13; 95% CI, 1.09–1.17). Results were similar by cognitive status. Conclusions: The increased proportion of assessments recording antibiotics but no infection may not be clinically appropriate. Higher antibiotic use among infected residents with advanced cognitive impairment is also concerning. Further efforts to understand mechanisms driving these trends and to promote antibiotic stewardship in nursing homes are warranted.

scholarly journals Transfers among Long-term Nursing Home Residents during the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 733-733
Author(s):  
Ana Montoya ◽  
Chiang-Hua Chang ◽  
Pil Park ◽  
Julie Bynum
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Nursing Homes ◽  
Functional Decline ◽  
Nursing Home Residents ◽  
Data Set ◽  
Transfer Rates ◽  
Logistic Regression Models

Abstract Transferring long-term nursing home residents between facilities can compromise the quality of life and be associated with functional decline, hospitalizations, and even death. This study aimed to examine transfer rates and identify risk factors associated with transfers among long-term nursing home residents before (2018-2019) and during the COVID-19 pandemic (2020). Using the Michigan state Minimum Data Set data 2018-2020, we identified long-term residents as those who stayed in nursing homes for at least 100 days each year (N=39,693, 39,454, and 35,575, respectively). We defined a facility-to-facility transfer as a direct transfer between two nursing homes. We first examined the likelihood of transfer by year using logistic regression models, adjusting for residents’ age, sex, race, and marital status. We then examined two health statuses that could be associated with a transfer: activities of daily living (ADL) and cognitive impairment. Finally, we compared transfers that occurred before COVID-19 (2018-2019) and during COVID-19 (2020), adjusting for residents’ demographic characteristics and health statuses. After adjustment, age was the only factor associated with transfers for all three years (Age>=80: AOR=0.61, 95% CI: 0.54-0.69; AOR=0.63, 95% CI: 0.55-0.72; AOR=0.71, 95% CI: 0.63-0.80, respectively). New risk factors in 2020 were Black race (AOR=1.22, 95% CI: 1.07-1.40) and requiring ADL assistance (AOR=1.24, 95% CI: 1.03-1.49). The COVID-19 period had higher transfer rate (unadjusted rates 2.9%, 2.7%, 3.5%, respectively) with 10% higher odds of transfer compared to before COVID-19 (AOR=1.10, 95% CI: 1.01-1.20). This finding suggests that COVID-19 has an impact on how nursing home transferred their long-term residents.

Uitbraak COVID-19 in de verpleeghuiszorg

2020 ◽  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Informal Caregivers ◽  
Rapid Review ◽  
Daily Routine ◽  
Term Care ◽  
Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

Predictors of Mortality in Board and Care Homes

1997 ◽  
Vol 36 (1) ◽  
pp. 77-87 ◽  
Author(s):  
Nicholas G. Castle
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Social Services ◽  
Long Term Care ◽  
Significant Proportion ◽  
The Elderly ◽  
Term Care ◽  
Care Facilities ◽  
Board And Care

Long-term care institutions have emerged as dominant sites of death for the elderly. However, studies of this trend have primarily examined nursing homes. The purpose of this research is to determine demographic, functional, disease, and facility predictors and/or correlates of death for the elderly residing in board and care facilities. Twelve factors are found to be significant: proportion of residents older than sixty-five years of age, proportion of residents who are chair- or bed-fast, proportion of residents with HIV, bed size, ownership, chain membership, affiliation with a nursing home, number of health services provided other than by the facility, the number of social services provided other than by the facility, the number of social services provided by the facility, and visits by Ombudsmen. These are discussed and comparisons with similar studies in nursing homes are made.

scholarly journals Facilitators and barriers to implement nurse-led interventions in long-term dementia care: a qualitative interview study with Swiss nursing experts and managers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julian Hirt ◽  
Melanie Karrer ◽  
Laura Adlbrecht ◽  
Susi Saxer ◽  
Adelheid Zeller
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Public Perception ◽  
Dementia Care ◽  
Term Care ◽  
Face To Face ◽  
People With Dementia ◽  
Qualitative Interview Study ◽  
Facilitators And Barriers

Abstract Background To support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in long-term dementia care. Methods We conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples’ perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant’s choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants’ perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript. Results Six dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n = 12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in long-term dementia care: «A common attitude and cohesion within the organization», «Commitment on several levels», «A needs-oriented implementation», «The effect and the public perception of the intervention», «A structured and guided implementation process», «Supporting knowledge and competencies», as well as «Resources for implementing the intervention». Conclusions To support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is necessary that the value of the intervention is perceptible.Commitment-building is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents and relatives. Furthermore, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia, thus. Therefore, it is important to support dementia-specific competencies in long-term care. Findings indicate that the barrier is determined by the intervention and its implementation – and not by the behaviour of the person with dementia.

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).

Towards upgraded capability in offshore seismic studies with the new National Australian Pool of Ocean Bottom Seismographs

2013 ◽  
Vol 53 (2) ◽  
pp. 482
Author(s):  
Alexey Goncharov ◽  
Nicholas Rawlinson ◽  
Bruce Goleby
Keyword(s):  
Natural Hazard ◽  
Ocean Bottom ◽  
Data Set ◽  
Multi Scale ◽  
Refraction Seismic ◽  
Short And Long Term ◽  
Ocean Bottom Seismographs ◽  
Obs Data ◽  
First Time

In 2013, Australia, for the first time in its history, will obtain a national pool of ocean-bottom seismographs (OBSs) suitable for multi-scale experiments at sea and for onshore-offshore combined observations. Twenty broadband OBS instruments will be purchased for short- and long-term deployment (up to 12 months) to a maximum depth of 6 km. The instruments will be made available to Australian researchers through ANSIR, with only the costs of mobilisation and deployment to be met. It is anticipated that the OBS facility will greatly enhance the research capabilities of Australian scientists in the area of Earth imaging, offshore exploration, and natural hazard assessment. OBS experiments in Australia have been limited so far, with the only data set collected by Geoscience Australia in 1995–96 on a number of coincident reflection/refraction seismic transects across the northwestern Australian Margin. The main findings from that experiment will be reviewed in the context of recent OBS data processing and acquisition advances. The scope of the experiments with the new national Australian pool of OBSs will be presented, as well as practicalities and logistics of the OBS experiments.

Sleep and agitation in nursing home residents with and without dementia

2015 ◽  
Vol 27 (12) ◽  
pp. 1945-1955 ◽  
Author(s):  
Donnamay T. Brown ◽  
Juanita L. Westbury ◽  
Benjamin Schüz
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Poor Sleep ◽  
Moderation Effect ◽  
Significant Relationships ◽  
Study Results ◽  
Hypnotic Medication ◽  
Benzodiazepine Use ◽  
The Relationship

ABSTRACTBackground:The prevalence of dementia in Australian nursing homes is high. A large proportion of residents express themselves through agitated behaviors, with substantial interpersonal and day-to-day variance. One factor that may increase agitation is poor sleep. The current study aimed to determine if sleep influences symptoms of agitation in nursing home residents, and whether this effect differed by dementia status. As benzodiazepines are used widely as hypnotic medication, their impact was also considered.Methods:Actigraph devices worn on residents’ non-dominant wrists for three days were used to obtain objective measures of sleep. Symptoms of agitation were assessed using staff responses to two standardized questionnaires – the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory – nursing home version (NPI-NH). Presence of dementia and benzodiazepine use were obtained from resident medical charts.Results:Forty-nine residents (mean age: 85.57 years) from four nursing homes in Tasmania were included in the study. Results indicated that residents were in bed for an average of 11.04 h and slept for 10.14 h per day. Significant relationships between sleep and verbal as well as non-aggressive agitation were found. No relationships between sleep and aggressive agitation were detected. A significant moderation effect of dementia was found, in which residents without dementia expressed verbal agitation when obtaining less sleep, but not residents with dementia. Benzodiazepine use did not result in significantly more sleep.Conclusions:These results suggest that sleep could play an important role in explaining agitation, but more research is needed to explore the relationship between sleep and benzodiazepines in nursing home residents.

Ethics of Assisted Autonomy in the Nursing Home: Types of Assisting Among Long-Term Care Nurses

1996 ◽  
Vol 3 (3) ◽  
pp. 224-235 ◽  
Author(s):  
June M. Whitler
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Personal Autonomy ◽  
Self Determination ◽  
Decisional Capacity ◽  
Term Care ◽  
Ethical Implications

Twenty-five long-term care nurses in eight nursing homes in central Kentucky were inter viewed concerning ways in which they might assist elderly residents to preserve and enhance their personal autonomy. Data from the interviews were analysed using grounded theory methodology. Seven specific categories of assisting were discovered and described: personalizing, informing, persuading, shaping instrumental circumstances, considering, mentioning opportunities, and assessing causes of an impaired capacity for decision-making. The ethical implications of these categories of assisting for clinical prac tice are examined. Although nurses recognized the importance of resident autonomy, the majority of them failed consistently to employ the categories of assistance to foster resi dent self-determination and most of them held an inadequate understanding of the con cepts of consent and decisional capacity. To assure confidentiality, pseudonyms are used in the following cases and discussions for all names of nurses, residents and facilities.

scholarly journals High-Minority Nursing Homes Disproportionately Affected by COVID-19 Deaths

2021 ◽  
Vol 9 ◽  
Author(s):  
Robert Weech-Maldonado ◽  
Justin Lord ◽  
Ganisher Davlyatov ◽  
Akbar Ghiasi ◽  
Gregory Orewa
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Ethnic Disparities ◽  
Nursing Facilities ◽  
Term Care ◽  
The Face ◽  
Facility Level ◽  
The Relationship ◽  
Racial Ethnic

Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Using the Centers for Medicare and Medicaid Services' Nursing Home COVID-19 Public File, this study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths [Incidence Rate Ratio (IRR) = 1.61; p < 0.001] as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.

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