scholarly journals Does rehabilitation setting influence risk of institutionalization? A register-based study of hip fracture patients in Oslo, Norway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rina Moe Fosse ◽  
Eliva Atieno Ambugo ◽  
Tron Anders Moger ◽  
Terje P. Hagen ◽  
Trond Tjerbo
Keyword(s):  
Primary Care ◽  
Nursing Home ◽  
Fixed Effects ◽  
Healthcare Services ◽  
Index Admission ◽  
Short Term ◽  
Post Discharge ◽  
Term Care ◽  
Unobserved Effects ◽  
At Home

Abstract Background Reducing the economic impact of hip fractures (HF) is a global issue. Some efforts aimed at curtailing costs associated with HF include rehabilitating patients within primary care. Little, however, is known about how different rehabilitation settings within primary care influence patients’ subsequent risk of institutionalization for long-term care (LTC). This study examines the association between rehabilitation setting (outside an institution versus short-term rehabilitation stay in an institution, both during 30 days post-discharge for HF) and risk of institutionalization in a nursing home (at 6–12 months from the index admission). Methods Data were for 612 HF incidents across 611 patients aged 50 years and older, who were hospitalized between 2008 and 2013 in Oslo, Norway, and who lived at home prior to the incidence. We used logistic regression to examine the effect of rehabilitation setting on risk of institutionalization, and adjusted for patients’ age, gender, health characteristics, functional level, use of healthcare services, and socioeconomic characteristics. The models also included fixed-effects for Oslo’s boroughs to control for supply-side and unobserved effects. Results The sample of HF patients had a mean age of 82.4 years, and 78.9 % were women. Within 30 days after hospital discharge, 49.0 % of patients received rehabilitation outside an institution, while the remaining 51.0 % received a short-term rehabilitation stay in an institution. Receiving rehabilitation outside an institution was associated with a 58 % lower odds (OR = 0.42, 95 % CI = 0.23–0.76) of living in a nursing home at 6–12 months after the index admission. The patients who were admitted to a nursing home for LTC were older, more dependent on help with their memory, and had a substantially greater increase in the use of municipal healthcare services after the HF. Conclusions The setting in which HF patients receive rehabilitation is associated with their likelihood of institutionalization. In the current study, patients who received rehabilitation outside of an institution were less likely to be admitted to a nursing home for LTC, compared to those who received a short-term rehabilitation stay in an institution. These results suggest that providing rehabilitation at home may be favorable in terms of reducing risk of institutionalization for HF patients.

scholarly journals Culture Change Initiatives in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Latarsha Chisholm ◽  
Akbar Ghiasi ◽  
Justin Lord ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Culture Change ◽  
Fixed Effects ◽  
Ethnic Disparities ◽  
State Level ◽  
Change Initiatives ◽  
Term Care ◽  
Star Rating ◽  
Racial Ethnic

Abstract Racial/ethnic disparities have been well documented in long-term care literature. As the population ages and becomes more diverse over time, it is essential to identify mechanisms that may eliminate or mitigate racial/ethnic disparities. Culture change is a movement to transition nursing homes to more home-like environments. The literature on culture change initiatives and quality has been mixed, with little to no literature on the use of culture change initiatives in high Medicaid nursing homes and quality. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid (85% or higher) nursing homes. The outcome of interest was the overall nursing home star rating obtained from the Nursing Home Compare Five-Star Quality Rating System. The primary independent variable of interest was the years of involvement in culture change initiatives among nursing homes, which was obtained from the nursing home administrator survey. The final model consisted of an ordinal logistic regression with state-level fixed effects. High-Medicaid nursing homes with six or more years in culture change initiatives had higher odds of having a higher star rating, while facilities with one year or less had significantly lower odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

The Netherlands—zorg in de gemeenschap

2019 ◽  
pp. 61-66
Author(s):  
Mark Britnell
Keyword(s):  
Primary Care ◽  
Older People ◽  
Healthcare System ◽  
Long Term Care ◽  
Term Care ◽  
The World ◽  
Care At Home ◽  
General Care ◽  
At Home

The Dutch healthcare system is considered by many to be one of the finest in the world because of its pioneering provision and decent level of funding. ‘Zorg in de gemeenschap’ or ‘care in the community’ is a both a distinguishing and defining feature of the Dutch cure and care system. The Dutch spend around 3.7% of their GDP on long-term care, the highest in the OECD, and offer many examples of innovation in caring for older people in the community and at home. Nearly 13% of the population aged over 65 receive care at home, compared with just 4.9% across the OECD. In this chapter, Mark Britnell looks at the Dutch healthcare system; its structure, funding, future, and much else. He points out that a strength of the Dutch healthcare system is the emphasis placed on well-resourced primary care, and looks at how it affects general care.

The Overseas Service Veteran At Home Pilot: How Choice of Care May Affect Use of Nursing Home Beds and Waiting Lists

2004 ◽  
Vol 23 (4) ◽  
pp. 367-369 ◽  
Author(s):  
David Pedlar ◽  
John Walker
Keyword(s):  
Nursing Home ◽  
Military Service ◽  
Long Term Care ◽  
Waiting Times ◽  
Pilot Project ◽  
Waiting Lists ◽  
Term Care ◽  
Treatment Services ◽  
At Home

ABSTRACTIn 1999 Veterans Affairs Canada (VAC) implemented the Overseas Service Veterans (OSV) At Home Pilot Project in response to the problem that a growing number of clients were on waiting lists for beds in long-term care facilities. The At Home pilot offered certain clients on waiting lists, who met nursing-level care and military-service requirements, access to home care and treatment services for which they had previously been ineligible. A review of the pilot showed that a large majority of clients preferred to remain at home, with support, rather than accept a long-term care placement, even when a bed became available. The pilot has helped reduce waiting times for nursing home beds and may have important implications for reducing costs and the demand for long-term care beds.

scholarly journals In-hospital dementia-related deaths following implementation of the national dementia plan: observational study of national death certificates from 1996 to 2016

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e023172 ◽  
Author(s):  
Miharu Nakanishi ◽  
Syudo Yamasaki ◽  
Atsushi Nishida
Keyword(s):  
Nursing Home ◽  
Observational Study ◽  
Social Care ◽  
Care Facility ◽  
Geriatric Care ◽  
Individual Characteristics ◽  
Term Care ◽  
Health And Social Care ◽  
Care Systems ◽  
At Home

ObjectiveTo examine changes in places of dementia-related death following implementation of the national dementia plan and other policy initiatives.DesignObservational study.SettingJapan between October 1996 and September 2016. Four major changes in health and social care systems were identified: (1) the public long-term care insurance programme (April 2000); (2) community centres as a first access point for older residents (April 2006); (3) medical care system for older people (April 2008) and (4) the national dementia plan (April 2013).Participants9 60 423 decedents aged 65 years or older whose primary cause of death was Alzheimer’s disease, vascular or other types of dementia or senility.Main outcome measuresPlace of death which was classified into ‘hospital’, ‘intermediate geriatric care facility’ (rehabilitation facility aimed at home discharge), ‘nursing home’ or ‘own home’.ResultsThe annual number of deaths at hospital was consistently increased over time from 1996 to 2016 (age-adjusted OR: 6.01; 95% CI 5.81 to 6.21 versus home deaths). Controlling for individual characteristics, regional supply of hospital and nursing home beds and other changes in health and social care systems, death from dementia following the national dementia plan was likely to occur in hospital (adjusted OR: 1.21; 95% CI 1.18 to 1.24), intermediate geriatric care facility (adjusted OR: 1.53; 95% CI 1.48 to 1.58) or nursing home (adjusted OR: 1.64; 95% CI 1.60 to 1.69) rather than at home.ConclusionsAs the number of deaths from dementia increased over the decades, in-hospital deaths increased regardless of the national dementia plan. Further strategies should be explored to improve the availability of palliative and end-of-life care at patients’ places of residence.

Older couples and long-term care: the financial implications of one spouse entering private or voluntary residential or nursing home care

1999 ◽  
Vol 19 (2) ◽  
pp. 209-237 ◽  
Author(s):  
RUTH HANCOCK ◽  
FAY WRIGHT
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Residential Care ◽  
Married Couples ◽  
Nursing Home Care ◽  
Local Authorities ◽  
Term Care ◽  
Care Costs ◽  
At Home

A minority of older people who move into long-term institutional care are married and have spouses who continue living in the community. The financial complexities and consequences for a couple in this situation deserve to be more widely recognised. Data from the Family Expenditure Survey on the incomes of older married couples are used to examine the financial implications for couples of one spouse entering residential or nursing home care, taking into account local authority procedures for assessing residents' contributions to charges and Income Support rules as they apply to both spouses. We look in particular at the consequences of alternative ways couples might share their incomes, and alternative treatments of such sharing by local authorities and the Department of Social Security. We demonstrate that wives remaining at home are more likely to have low incomes and have recourse to means-tested state benefits if their husbands enter residential care than husbands who remain at home when their wives enter care. Local authorities are likely to be able to require larger contributions to their care costs from husbands than wives. On average, wives whose husbands enter residential care are best off financially when their combined income and savings are shared equally, but this leaves husbands with the least money to contribute to their care costs. If it is the wife who enters care the situation is reversed.

scholarly journals Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain

2017 ◽  
Vol 67 (662) ◽  
pp. e614-e622 ◽  
Author(s):  
Ignacio Aznar-Lou ◽  
Ana Fernández ◽  
Montserrat Gil-Girbau ◽  
Ramón Sabés-Figuera ◽  
Marta Fajó-Pascual ◽  
...  
Keyword(s):  
Primary Care ◽  
Sick Leave ◽  
Healthcare Services ◽  
Economic Consequences ◽  
Short Term ◽  
Productivity Losses ◽  
Lower Productivity ◽  
Clinical Consequences ◽  
The Impact ◽  
Initial Medication

BackgroundInitial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave.AimTo estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups.Design and settingA 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012.MethodThirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre.ResultsInitially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term.ConclusionInitial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.

scholarly journals Local Nursing Home Prescribing Patterns and Psychoactive Prescribing in Assisted Living

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 707-707
Author(s):  
Kali Thomas ◽  
Christopher Wretman ◽  
Philip Sloane ◽  
Anna Beeber ◽  
Paula Carder ◽  
...  
Keyword(s):  
Nursing Home ◽  
Assisted Living ◽  
Fixed Effects ◽  
Linear Models ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Term Care ◽  
Separate Model ◽  
Medication Prescribing

Abstract Because prescribing practices in long-term care settings may reflect regional influences, we examined how potentially inappropriate antipsychotic and antianxiety medication prescribing in assisted living (AL) compared to prescribing in nursing homes (NHs) based on their proximity, using generalized linear models adjusting for facility characteristics and state fixed effects. Data were derived from a seven state sample of AL communities and data for the same seven states drawn from publicly available data reported on the Nursing Home Compare website. In adjusted analyses, AL rates of antipsychotic use were not associated with the rates in the nearest or farthest NHs. However, AL communities that were affiliated with a NH had lower rates of potentially inappropriate antipsychotic use (b=−0.27[95%CI=−0.50,−0.04]). In a separate model, antianxiety medication prescribing rates in AL were significantly associated with neighboring NHs’ rates of prescribing (b=2.65[95%CI=1.00,4.29]). Findings suggest efforts to change prescribing in NHs may influence prescribing in AL.

scholarly journals Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

2019 ◽  
Vol 16 (14) ◽  
pp. 2457 ◽  
Author(s):  
Coffey ◽  
Leahy-Warren ◽  
Savage ◽  
Hegarty ◽  
Cornally ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Discharge Planning ◽  
Acute Care Hospital ◽  
Early Discharge ◽  
Community Services ◽  
Care Hospital ◽  
Post Discharge ◽  
Term Care ◽  
At Home

Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

Characteristics and health conditions of a group of nursing home patients with mental–physical multimorbidity – the MAPPING study

2017 ◽  
Vol 29 (6) ◽  
pp. 1037-1047 ◽  
Author(s):  
Anne M.A. van den Brink ◽  
Debby L. Gerritsen ◽  
Miranda M.H. de Valk ◽  
Richard C. Oude Voshaar ◽  
Raymond T.C.M. Koopmans
Keyword(s):  
Nursing Home ◽  
Neuropsychiatric Symptoms ◽  
Psychiatric Hospitals ◽  
Healthcare Services ◽  
Self Report ◽  
Care Needs ◽  
Term Care ◽  
Knowledge And Skills ◽  
Care Dependency ◽  
Number Of Patients

ABSTRACTBackground:Long-term care facilities have partly taken over the traditional asylum function of psychiatric hospitals and house an increasing group of patients with mental–physical multimorbidity (MPM). Little is known about the characteristics, behavior, and care dependency of these patients. This paper aims to describe these aspects.Methods:Explorative, descriptive study among patients with MPM without dementia (n = 142), living in 17 geronto-psychiatric nursing home (NH) units across the Netherlands, stratified by those referred from mental healthcare services (MHS) and other healthcare services (OHS). Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. Patients referred from MHS (n = 58) and from OHS (n = 84) were compared by descriptive statistics.Results:Despite exclusion of patients with dementia, the majority of participants had cognitive impairment. Prevalence and severity of frontal impairment were high, as well as the number of patients with clinically relevant neuropsychiatric symptoms. MHS patients were younger, had more chronic psychiatric disorders, and more often used antipsychotics. Neuropsychiatric symptoms, domains of care dependency, physical conditions and concomitant medication use differed not significantly between the subgroups.Conclusions:Both groups of patients with MPM showed heterogeneity in various aspects but differed not significantly regarding the consequences of their multimorbidity. In a variety of characteristics, this group seems to be different from other NH patient groups, which requires extra knowledge and skills of the staff. To uncover which knowledge and skills are necessary, the next step should be to investigate the specific care needs of NH patients with MPM without dementia.

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