A Comparison of Home Care Clients and Nursing Home Residents: Can Community Based Care Keep the Elderly and Disabled at Home?

Abstract The Veterans Health Administration’s (VHA’s) Medical Foster Home (MFH) program was developed as a community-based alternative to institutional care. This study compares the clinical and functional characteristics of Veterans in the VHA MFH program to residents in nursing homes to understand whether MFHs substitute for nursing home care or serve a population with different care needs. All data were derived from Minimum Data Set (MDS) 3.0 assessments. Nurses collected MDS assessments from Veterans (n=92) in 4 MFHs between April 2014-December 2015. Data for nursing home residents were from a national nursing home dataset of residents with an annual MDS assessment in 2014 (n=818,287). We found that MFH Veterans were more likely to be male, have higher functional status, and perform more activities of daily living (ADLs) independently relative to nursing home residents (p<0.01 for all comparisons). Yet, a similar proportion of MFH Veterans and nursing home residents required total assistance in 9 of the 11 measured ADLs. Cognitive impairment, neurological comorbidity, and psychiatric comorbidity were similar in both cohorts; however, MFH Veterans were more likely to have traumatic brain injury (p<0.01), higher Patient Health Questionnaire (PHQ)-9 depression scores (p=0.04) and less likely to have anxiety (p=0.05). Our results suggest there are two distinct MFH populations, one with lower-care needs and another with Veterans completely dependent in performing ADLs. Given these findings, MFHs may be an ideal setting for both low-care nursing home residents with less functional impairment as well as residents with higher care needs who desire community-based long-term care.

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Quality of Life Among Nursing Home Residents Compared With the Elderly at Home

Shiraz E-Medical Journal ◽

10.17795/semj22718 ◽

2014 ◽

Vol 15 (4) ◽

Cited By ~ 6

Author(s):

Hamid Reza Hedayati ◽

Negin Hadi ◽

Ladan Mostafavi ◽

Armin Akbarzadeh ◽

Ali Montazeri

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Nursing Home Residents ◽

The Elderly ◽

At Home

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Benzodiazepine-Induced and Anticholinergic-Induced Delirium in the Elderly

International Psychogeriatrics ◽

10.1017/s1041610291000832 ◽

1991 ◽

Vol 3 (2) ◽

pp. 397-408 ◽

Cited By ~ 56

Author(s):

Larry E. Tune ◽

Fred W. Bylsma

Keyword(s):

Nursing Home ◽

Cognitive Impairments ◽

Anticholinergic Drug ◽

Nursing Home Residents ◽

The Elderly ◽

Quantitative Eeg ◽

Extensive Literature ◽

Drug Levels ◽

Patient Morbidity ◽

Increasing Risk

Encompassing the range from subtle cognitive impairments to frank delirium, toxicity due to benzodiazepines and to anticholinergic-containing compounds is reviewed. For benzodiazepines, an extensive literature suggests that they impair immediate and delayed memory, psychomotor performance, and subjective complaints of station. This, in several studies, results in increased patient morbidity (e.g., increasing risk of hip fractures). Anticholinergic compounds are widely utilized in managing elderly patients, particularly nursing home residents. Toxicity from anticholinergic compounds, detected by anticholinergic drug levels, is significantly correlated with the presence and severity of delirium in a number of settings including postoperative patients and elderly nursing home residents. Possible means of identifying the syndrome by prediction of dose and type of medication, as well as by quantitative EEG, are reviewed.

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The Role of Nursing Homes Architectural Design in Mitigating the Risk of COVID-19 Pandemics: The Case of Slovenia

Athens Journal of Architecture ◽

10.30958/aja.8-1-3 ◽

2022 ◽

Vol 8 (1) ◽

pp. 51-66

Author(s):

Vesna Žegarac Leskovar ◽

Vanja Skalicky Klemenčič

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Older People ◽

Architectural Design ◽

Nursing Home Residents ◽

The Elderly ◽

Evaluation Tool ◽

Negative Effect ◽

Disproportionate Number ◽

Role Of Nursing

Currently, many older people live in institutions for various social and health reasons. In Slovenia, this proportion is almost 5% of the population aged 65 and over. In the COVID-19 pandemic, the elderly proved to be the most vulnerable social group, as they are exposed to a number of comorbidities that increase the risk of mortality. At that time, nursing homes represented one of the most critical types of housing, as seen from a disproportionate number of infections and deaths among nursing home residents worldwide, including Slovenia. During the emergency, a number of safety protocols had to be followed to prevent the spread of infection. Unfortunately, it turned out that while the safety measures protected the nursing home residents, they also had a negative effect on their mental health, mainly due to isolation and social distancing. It follows that especially in times of epidemics of infectious respiratory diseases, the quality of life in nursing homes requires special attention. In this context, it is also necessary to consider whether and how an appropriate architectural design can help mitigating the spread of infections, while at the same time enable older people to live in dignity and with a minimum of social exclusion. To this end, the present study examined 97 nursing homes in Slovenia, analysing the number of infections in nursing homes and their correlation with the degree of infection in the corresponding region in Slovenia. Additionally, 2 nursing homes were studied in more detail with the use of newly developed “Safe and Connected” evaluation tool, analysing the architectural features of each building. The advantages identified so far include living in smaller units, single rooms with balconies, the possibility of using green open spaces and the use of an adequate ventilation. Conclusions of this study are useful for further consideration of design of new nursing homes and the refurbishment of existing ones.

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Annabel O. Pelham and William F. Clark (eds), Managing Home Care for the Elderly: Lessons From Community-Based Agencies, Springer Publishing Company Inc., New York, 1985, 196 pp., $20.95, ISBN 0 8261 4700 3.

Ageing and Society ◽

10.1017/s0144686x00012915 ◽

1987 ◽

Vol 7 (3) ◽

pp. 374-376

Author(s):

Ian Sinclair

Keyword(s):

New York ◽

Home Care ◽

The Elderly ◽

Publishing Company ◽

Community Based ◽

Care For The Elderly

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At-home care : interactions between nurses and the elderly/family

Acta Paulista de Enfermagem ◽

10.1590/s0103-21002012000800012 ◽

2012 ◽

Vol 25 (spe1) ◽

pp. 74-80

Author(s):

Esperança Alves Gago ◽

Manuel José Lopes

Keyword(s):

Home Care ◽

Nursing Practice ◽

The Elderly ◽

Diagnostic Assessment ◽

Care Process ◽

Structured Interviews ◽

The Family ◽

Home Context ◽

The Relationship ◽

At Home

OBJECTIVE: To understand the interaction process between the elderly and the family and the nurses during home care. METHODS: Grounded theory qualitative study in a community where 40% of the population is aged 65 or above. The collection of data was made via the non-participating observation of nursing practice during 41 home visits and semi-structured interviews to nurses, the elderly and the family. RESULTS: the following categories emerged - structural organization of at-home care, diagnostic assessment in context and therapeutic intervention in context. CONCLUSION: the central category was "Building the relationship in an at-home context", due to the fact that the relationship between the nurse, the elderly and the family is central across the entire care process. The relation is, simultaneously, the context for all the care and a therapeutic instrument.

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Functional Assessment of Elderly Clients of a Rural Community-Based Long-Term Care Program: A 10-Year Cohort Study

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980800001768 ◽

2002 ◽

Vol 21 (3) ◽

pp. 455-463 ◽

Cited By ~ 4

Author(s):

Frank J. Elgar ◽

Graham Worrall ◽

John C. Knight

Keyword(s):

Home Care ◽

Long Term Care ◽

Care Program ◽

The Elderly ◽

Home Care Services ◽

Community Based ◽

Term Care ◽

Risk Of Death ◽

Affective Functioning

ABSTRACTAs the demand for home care services increases, health care agencies should be able to predict the intake capacity of community-based long-term care (CBLTC) programs. Two hundred and thirty-seven clients entering a CBLTC program were assessed for activities of daily living (ADL) and cognitive and affective functioning and were then followed to monitor attrition and reasons why clients left the program. Compromised ADL functioning at baseline increased likelihood of death and institutionalization by 2 per cent each year. Over a 10-year period, reduced cognitive functioning at baseline increased the risk of death by 9 per cent and decreased the likelihood of leaving the program due to improvement by 18 per cent. Reduced affective functioning at baseline increased the risk of institutionalization during the course of the study by 3 per cent. Routine functional assessments with the elderly may help in the management of similar home care programs.

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