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).

scholarly journals A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Cordes ◽  
Laura L. Bischoff ◽  
Daniel Schoene ◽  
Nadja Schott ◽  
Claudia Voelcker-Rehage ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Physical Functioning ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Well Being ◽  
Term Care

Abstract Background Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life. Methods A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45–60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents’ capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only). Discussion This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents. Trial registration The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

They Know Me Here: Patients' Perspectives on Their Nursing Home Experiences

2016 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruth Tappen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Patient Experience ◽  
Nursing Home Residents ◽  
Patient Experiences ◽  
Background Information ◽  
Term Care ◽  
Hospital Stays ◽  
Preferences For Care

Perspectives from patients who reside in nursing homes can inform administrators and providers about the patient experience in long-term care. In a study of preferences for care in the nursing home or hospital should an acute change in condition occur, nursing home residents offered spontaneous descriptions of their experiences in the nursing home and during their prior hospital stays. This article offers background information about nursing home reform and standards, and contemporary reports on the patient experience in nursing homes. Methods, results, and discussion of the study findings will inform readers specifically about the analysis of the narrative data as it relates to the patient experience. Positive and negative aspects of nursing home patient experiences are discussed and compared to hospital patient experiences. Both settings were both praised and strongly criticized. Many concerns identified as patients discussed their experiences can be remedied by the owners and administrators of these facilities.

Accuracy of influenza vaccination rate estimates in United States nursing home residents

2014 ◽  
Vol 143 (12) ◽  
pp. 2588-2595 ◽  
Author(s):  
J. M. GROSHOLZ ◽  
S. BLAKE ◽  
J. D. DAUGHERTY ◽  
E. AYERS ◽  
S. B. OMER ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Influenza Vaccination ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Term Care ◽  
Vaccination Rates ◽  
Vaccination Recommendations ◽  
The Impact

SUMMARYThe US Center for Medicare and Medicaid Services (CMS) requires nursing homes and long-term-care facilities to document residents' vaccination status on the Resident Assessment Instrument (RAI). Vaccinating residents can prevent costly hospital admissions and deaths. CMS and public health officials use RAI data to measure vaccination rates in long-term-care residents and assess the quality of care in nursing homes. We assessed the accuracy of RAI data against medical records in 39 nursing homes in Florida, Georgia, and Wisconsin. We randomly sampled residents in each home during the 2010–2011 and 2011–2012 influenza seasons. We collected data on receipt of influenza vaccination from charts and RAI data. Our final sample included 840 medical charts with matched RAI records. The agreement rate was 0·86. Using the chart as a gold standard, the sensitivity of the RAI with respect to influenza vaccination was 85% and the specificity was 77%. Agreement rates varied within facilities from 55% to 100%. Monitoring vaccination rates in the population is important for gauging the impact of programmes and policies to promote adherence to vaccination recommendations. Use of data from RAIs is a reasonable approach for gauging influenza vaccination rates in nursing-home residents.

A comparison of cognitive functioning in long-term care and short-stay nursing home residents

2015 ◽  
Vol 37 (1) ◽  
pp. 1-13 ◽  
Author(s):  
WILLIAM E. MANSBACH ◽  
RYAN A. MACE ◽  
KRISTEN M. CLARK ◽  
ISABELLA M. FIRTH
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Nursing Homes ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Short Stay ◽  
Severe Dementia ◽  
Term Care ◽  
Cognitive Levels

ABSTRACTIt can be challenging to provide person-centred care for individuals with cognitive impairment if they are unable to communicate their needs to facility providers clearly. The high base rates of dementia and mild cognitive impairment (MCI) in US nursing homes is well documented; however, our understanding of the unique prevalence of cognitive levels in long-term care and short-stay residents is limited. Our aim is to determine whether there are significant differences in specific cognitive levels between these two groups. Long-term care and short-stay residents (N = 579) were randomly selected from 18 Maryland, US skilled nursing facilities; 345 met inclusion criteria for participation (mean age 79.41) and completed a cognitive test (Brief Cognitive Assessment Tool (BCAT)). Based on BCAT scores, 78.9 per cent of the long-term care residents had dementia compared to 61.4 per cent for short-stay residents. The proportions of MCI, mild, and moderate to severe dementia were significantly different between the two groups (p = 0.00). The odds of residents having moderate to severe dementia were 2.76 times greater for long-term care compared to short-stay residents. BCAT total and factor scores were significantly different between long-term care and short-stay nursing home residents (p < 0.001). We discuss the implications of these empirical findings in terms of facilitating person-centred care in nursing homes.

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 The Interplay Between Infection Risk Factors of SARS-CoV-2 and Prognosis: A Cross-Sectional Study from a Cohort of Long-Term Care Nursing Home Residents

2021 ◽  
Author(s):  
Laura Soldevila ◽  
Núria Prat ◽  
Miquel À. Mas ◽  
Mireia Massot ◽  
Ramon Miralles ◽  
...  
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Risk Of Infection ◽  
Cross Sectional ◽  
Term Care ◽  
Facility Size ◽  
Care Nursing ◽  
Pcr Test

Abstract Background: Covid-19 pandemic has particularly affected older people living in Long-term Care settings. Methods: We carried out a cross-sectional analysis of a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at last one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered.Results: A total of 8021 participants were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = 0.03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < .001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). Conclusions: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

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