Interorganizational Linkages and Service and Personnel Shortages in Rural Nursing Homes

1996 ◽  
Vol 15 (2) ◽  
pp. 172-187 ◽  
Author(s):  
Diane Brannon ◽  
Kathryn Dansky ◽  
Cathy Kassab ◽  
Larry Gamm
2019 ◽  
Vol 40 (4) ◽  
pp. 432-437 ◽  
Author(s):  
Darren K. Pasay ◽  
Micheal S. Guirguis ◽  
Rhonda C. Shkrobot ◽  
Jeremy P. Slobodan ◽  
Adrian S. Wagg ◽  
...  

AbstractObjectives:To measure the impact of an antimicrobial stewardship initiative on the rate of urine culture testing and antimicrobial prescribing for urinary tract infections (UTIs) between control and intervention sites. Secondary objectives included evaluation of potential harms of the intervention and identifying characteristics of the population prescribed antimicrobials for UTI.Design:Cluster randomized controlled trial.Setting:Nursing homes in rural Alberta, Canada.Participants:The study included 42 nursing homes ranging from 8 to 112 beds.Methods/interventions:Intervention sites received on-site staff education, physician academic detailing, and integrated clinical decision-making tools. Control sites provided standard care. Data were collected for 6 months prior to and 12 months after the intervention.Results:Resident age (83.0 vs 83.8 years) and sex distribution (female, 62.5% vs 64.5%) were similar between the groups. Statistically significant decreases in the rate of urine culture testing (−2.1 tests per 1,000 resident days [RD]; 95% confidence interval [CI], −2.5 to −1.7;P< .001) and antimicrobial prescribing for UTIs (−0.7 prescriptions per 1,000 RD; 95% CI, −1.0 to −0.4;P< .001) were observed in the intervention group. There was no difference in hospital admissions (0.00 admissions per 1,000 RD; 95% CI, −0.4 to 0.3;P= .76), and the mortality rate decreased by 0.2 per 1,000 RD in the intervention group (95% CI, −0.5 to −0.1;P= .002). Chart reviews indicated that UTI symptoms were charted in 16% of cases and that urine culture testing occurred in 64.5% of cases.Conclusion:A multimodal antimicrobial stewardship intervention in rural nursing homes significantly decreased the rate of urine culture testing and antimicrobial prescriptions for UTI, with no increase in hospital admissions or mortality.


1998 ◽  
Vol 19 (3) ◽  
pp. 157-159 ◽  
Author(s):  
Joann G. Congdon ◽  
Joan K. Magilvy

2011 ◽  
Vol 12 (3) ◽  
pp. B18-B19
Author(s):  
Chandni Tara Sud ◽  
Chandni Tara Sud ◽  
Jurgis Karuza ◽  
Tobie H. Olsan ◽  
Suzanne M. Gillespie ◽  
...  

2017 ◽  
Vol 24 (6) ◽  
pp. 1170-1183 ◽  
Author(s):  
Jingyu Yu ◽  
Guixia Ma ◽  
Xiaoyan Jiang

Purpose The ageing of rural Chinese populations is challenging health and social policy, driving growth in rural nursing homes. Living environment plays a role in enhancing elderly quality of life (QoL), however, the impact of the built environment and care services are under-studied. The purpose of this paper is to investigate the influence of the built environment and care services on the QoL of elderly people within rural nursing homes in China. Design/methodology/approach A total of 242 residents of nursing home were surveyed, of which 76 percent were male and 24 percent were female. In total, 25.6 percent were aged between 60 and 69, 40.1 percent between 70 and 79, 31 percent between 80 and 89, and 3.3 percent were 90 or above. Quantitative data were analyzed through factor analysis, reliability test and multiple regression modeling. Findings The authors identified six built environment factors (room distance, space, barrier-free design, indoor environment, fire safety, and support facilities) and three services factors (i.e. daily care services, cleaning services, and healthcare services). QoL was measured over four dimensions: QoL, physical health, psychological health, and social relationships. Elderly QoL could be accurately predicted from room distance, space, barrier-free design, indoor environment, daily care services, and cleaning services. Practical implications Interventions in design of the built environment and the provision of care services are proposed, including dimensions of living space, heating, and provisions for qualified care providers. Originality/value This paper provides a clear picture about elderly special requirements on their built environment and healthcare services, helping architects, engineers and facilities managers understand elderly needs and improve built environment during design and operation stages.


2021 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n=31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).


2020 ◽  
Author(s):  
Vivian Isaac ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Edward Strivens ◽  
Jennene Greenhill

Abstract BackgroundThere is limited best- practice evidence to address behavioral and psychiatric symptoms for those with advanced dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.MethodsA quasi-experimental study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with advanced dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focusing on the theory and delivery of the Progressively Lowered Stress Threshold principles and a music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. Triangulation using post- intervention qualitative evaluation from 13 focus group discussion and 38 staff interviews. This study adheres to the CONSORT guidelines.ResultsMean age of residents with advanced dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was comparable reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.ConclusionsThe Harmony in the Bush model is effective in reducing behavioral and psychiatric symptoms in advanced dementia with significant reduction in staff stress levels in nursing homes in rural Australia.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458


2002 ◽  
Vol 32 (3) ◽  
pp. 152-161 ◽  
Author(s):  
Debra G. Morgan ◽  
Karen M. Semchuk ◽  
Norma J. Stewart ◽  
Carl D???Arcy

2015 ◽  
Vol 23 (1) ◽  
pp. 82-95 ◽  
Author(s):  
Elizabeth Andersen ◽  
Farinaz Havaei

Background and Purpose: The Relational Care Scale (RCS) is a Canadian evaluative instrument designed to measure nursing home residents’ perceptions of care aides’ relational abilities. Care aides’ abilities to be reliable and empathetic with nursing home residents are very important determinants of quality of care, but few instruments are designed specifically for residents or focus exclusively on these determinants. Initially developed and tested in metropolitan teaching-affiliated nursing homes in Ontario, we expanded testing by reevaluating the psychometric properties of the RCS in 5 rural nursing homes in British Columbia. Method: There were 62 residents living in 5 rural nursing homes who completed 3 instruments: the RCS under investigation, the Experiences in Close Relationships-Relationship Structures (ECR-RS) questionnaire to test for convergent validity, and the Lubben Social Network Scale-6 (LSNS-6) to test for discriminant validity. Results: The reliability of the RCS was strongly supported (Cronbach’s alpha = .90, item–total correlation > .77). Consistent with previous testing, a unidimensional internal structure was extracted. A moderate to strong correlation between the RCS and the Anxiety and Avoidance subscales of the ECR-RS supported convergent validity of the instrument. Last, partial support was obtained for the discriminant validity of the RCS. Conclusions: The RCS was easy to use for both residents and researchers. Expanded testing demonstrated its recurring reliability and validity.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 869-870
Author(s):  
Sungjae Hong ◽  
Shannon Meija

Abstract The impact of COVID-19 has been greatest in vulnerable US populations. This study examines the cumulative geographical and racial disparities of COVID-19 cases in nursing homes. Analysis of COVID-19 Nursing Home Data from Centers for Medicare & Medicaid Services was limited to weekly reports from the nursing homes that reported the ratio of black residents, from 2020-05-31 to 2021-01-17 (N=268,222 from 8,026 nursing homes). The outcomes were weekly COVID-19 cases and death per 1,000 occupied beds. Nursing homes were categorized by a geographic (rural vs. urban) and racial composition (&gt;50% of residents are black vs. else). Elapsed time and county-level weekly COVID-19 cases and deaths/1,000 people were the key covariates. Multilevel zero-inflated negative binomial regression revealed evidence of cumulative COVID-19 disparity between rural and urban nursing homes. At the earliest time, COVID-19 incidence was lower in rural nursing homes than in urban nursing homes (IRR=0.406 for cases, 0.034 for death). The significant interaction with time implied that, over and above evolving disease prevalence, rural nursing homes became more likely than urban nursing homes to experience COVID-19 over time (IRR=1.057 for cases, 1.193 for death). Nursing homes, with &gt;50% black residents, were more likely to experience COVID-19 than their counterparts at the earliest time (IRR=1.339 for cases, 5.630 for death), but independent of local disease prevalence, this disparity decreased over time (IRR=0.973 for cases, 0.972 for death). Our findings suggest that racial and geographic factors contribute to the cumulation of disadvantage during the COVID-19 crisis at the second half of 2020.


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