scholarly journals Hospital Admissions From Care Homes in England During the COVID-19 Pandemic: A Retrospective, Cross-Sectional Analysis Using Linked Administrative Data

2021 ◽  
Author(s):  
Fiona Grimm ◽  
Karen Hodgson ◽  
Richard Brine ◽  
Sarah R Deeny
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Hospital Admissions ◽  
Care Home ◽  
Nursing Home Residents ◽  
Care Homes ◽  
Hospital Treatment ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Healthcare Needs

Background: Care home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. Objective: To examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak. Methods: Retrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England (257,843 residents, 45% in nursing homes) between 20 January 2020 and 28 June 2020, compared to admissions during the corresponding period in 2019 (252,432 residents, 45% in nursing homes). Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May and primary admissions reasons for this period were compared across years. Results: Hospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents (13,191 fewer admissions in total). Emergency admissions for acute coronary syndromes fell by 43% and 29% (105 fewer admission) and emergency admissions for stroke fell by 17% and 25% (128 fewer admissions) for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents (3,762 fewer admissions). Conclusions: This is the first study showing that care home residents’ hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.

scholarly journals Hospital admissions from care homes in England during the COVID-19 pandemic: a retrospective, cross-sectional analysis using linked administrative data

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Fiona Grimm ◽  
Karen Hodgson ◽  
Richard Brine ◽  
Sarah R Deeny
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Hospital Admissions ◽  
Care Home ◽  
Nursing Home Residents ◽  
Care Homes ◽  
Hospital Treatment ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Healthcare Needs

BackgroundCare home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. ObjectivesTo examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak. MethodsRetrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England (257,843 residents, 45% in nursing homes) between 20 January 2020 and 28 June 2020, compared to admissions during the corresponding period in 2019 (252,432 residents, 45% in nursing homes). Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May 2020 and primary admission reasons for this period were compared across years. ResultsHospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents (13,191 fewer admissions in total). Emergency admissions for acute coronary syndromes fell by 43% and 29% (105 fewer admission) and emergency admissions for stroke fell by 17% and 25% (128 fewer admissions) for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents (3,762 fewer admissions). ConclusionsThis is the first study showing that care home residents' hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.

scholarly journals Hospital Admissions From Care Homes in England During the COVID-19 Pandemic: A Retrospective, Cross-Sectional Analysis Using Linked Administrative Data

2021 ◽  
Author(s):  
Fiona Grimm ◽  
Karen Hodgson ◽  
Richard Brine ◽  
Sarah R Deeny
Keyword(s):  
Nursing Home ◽  
Hospital Admissions ◽  
Care Home ◽  
Nursing Home Residents ◽  
Care Homes ◽  
Hospital Treatment ◽  
Cross Sectional ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Healthcare Needs

Background: Care home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. Objective: To examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak. Methods: Retrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England between 20 January 2020 and 28 June 2020, compared to the corresponding period in 2019. Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May and primary admissions reasons for this period were compared across years. Results: Hospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents. Emergency admissions for acute coronary syndromes fell by 42% and 28% and emergency admissions for stroke fell by 16% and 24% for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents. Conclusions: This is the first study showing that care home residents’ hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.

scholarly journals Effect on secondary care of providing enhanced support to residential and nursing home residents: a subgroup analysis of a retrospective matched cohort study

2019 ◽  
Vol 28 (7) ◽  
pp. 534-546 ◽  
Author(s):  
Therese Lloyd ◽  
Stefano Conti ◽  
Filipe Santos ◽  
Adam Steventon
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Older People ◽  
Residential Care ◽  
Rate Ratio ◽  
Care Home ◽  
Nursing Home Residents ◽  
Care Homes ◽  
Emergency Admissions ◽  
Hospital Use

BackgroundThirteen residential care homes and 10 nursing homes specialising in older people in Rushcliffe, England, participated in an improvement programme. The enhanced support provided included regular visits from named general practitioners and additional training for care home staff. We assessed and compared the effect on hospital use for residents in residential and nursing homes, respectively.MethodsUsing linked care home and administrative hospital data, we examined people aged 65 years or over who moved to a participating care home between 2014 and 2016 (n=568). We selected matched control residents who had similar characteristics to the residents receiving enhanced support and moved to similar care homes not participating in the enhanced support (n=568). Differences in hospital use were assessed for residents of each type of care home using multivariable regression.ResultsResidents of participating residential care homes showed lower rates of potentially avoidable emergency admissions (rate ratio 0.50, 95% CI 0.30 to 0.82), emergency admissions (rate ratio 0.60, 95% CI 0.42 to 0.86) and Accident & Emergency attendances (0.57, 95% CI 0.40 to 0.81) than matched controls. Hospital bed days, outpatient attendances and the proportion of deaths that occurred out of hospital were not statistically different. For nursing home residents, there were no significant differences for any outcome.ConclusionsThe enhanced support was associated with lower emergency hospital use for older people living in residential care homes but not for people living in nursing homes. This might be because there was more potential to reduce emergency care for people in residential care homes. In nursing homes, improvement programmes may need to be more tailored to residents’ needs or the context of providing care in that setting.

scholarly journals Complementary therapy for advanced dementia palliation in nursing homes

2020 ◽  
Vol 28 (4) ◽  
pp. 419-432
Author(s):  
Bryan Mitchell ◽  
Graham A. Jackson ◽  
Barbara Sharp ◽  
Debbie Tolson
Keyword(s):  
Nursing Home ◽  
Action Research ◽  
Nursing Homes ◽  
Care Home ◽  
Nursing Home Residents ◽  
Objective Measure ◽  
Complementary Therapy ◽  
Advanced Dementia ◽  
Content Type ◽  
Care Home Staff

PurposeThis paper reports on an action research study that aimed to collaboratively develop a complementary therapy care intervention to augment palliative care choices available to nursing home residents with advanced dementia.Design/methodology/approachAn action research design was adopted that consisted of a series of action cycles involving collaborative exploration, problem-solving planning, development and evidence gathering. A combination of mixed methods was used when gaining data at the different stages, including face to face delivered questionnaires, observational notes, focus groups, and the objective measure of the Neuropsychiatric Inventory adapted for Nursing Homes (NPI-NH).FindingsCare home staff and relatives considered the use of Complementary Therapy to be a helpful intervention promoting that it can reduce a sense of loneliness and provide companionship for residents experiencing distress. Analysis of NPI-NH scores showed a reduction in presenting neuropsychiatric behaviours associated with stress and distress.Research limitations/implicationsDiffering levels of participant group engagement may affect this study’s findings as it was noted that care home staff provided a fuller contribution to the project in comparison to relatives.Practical implicationsImplementation guidance is needed when implementing complementary therapy within the nursing home practice to promote consistency and successful integration of an intervention that is not provided as routine care.Originality/valueThe findings of this study are encouraging and demonstrate the acceptability of complementary therapies to residents with advanced dementia, where positive impacts on otherwise difficult to address dementia symptoms related to stress and distress are highlighted.

scholarly journals Implementation of a strategy involving a multidisciplinary mobile unit team to prevent hospital admission in nursing home residents: protocol of a quasi-experimental study (MMU-1 study)

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e034742 ◽  
Author(s):  
Antonio Nouvenne ◽  
Caterina Caminiti ◽  
Francesca Diodati ◽  
Elisa Iezzi ◽  
Beatrice Prati ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
University Hospital ◽  
Urgent Care ◽  
Mobile Unit ◽  
Italian Law ◽  
Unplanned Hospital Admissions

IntroductionNursing home residents represent a particularly vulnerable population experiencing high risk of unplanned hospital admissions, but few interventions have proved effective in reducing this risk. The aim of this research will be to verify the effects of a hospital-based multidisciplinary mobile unit (MMU) team intervention delivering urgent care to nursing home residents directly at their bedside.Methods and analysisFour nursing homes based in the Parma province, in Northern Italy, will be involved in this prospective, pragmatic, multicentre, 18-month quasiexperimental study (sequential design with two cohorts). The residents of two nursing homes will receive the MMU team care intervention. In case of urgent care needs, the nursing home physician will contact the hospital physician responsible for the MMU team by phone. The case will be triaged as (a) manageable by phone advice, (b) requiring urgent assessment by the MMU team or (c) requiring immediate emergency department (ED) referral. MMU team is composed of one senior physician and one emergency-medicine resident chosen within the staff of Internal Medicine and Critical Subacute Care Unit of Parma University-Hospital, usually with different specialty background, and equipped with portable ultrasound, set of drugs and devices useful in urgency. The MMU visits patients in nursing homes, with the mission to stabilise clinical conditions and avoid hospital admission. Residents of the other two nursing homes will receive usual care, that is, ED referral in every case of urgency. Study endpoints include unplanned hospital admissions (primary), crude all-cause mortality, hospital mortality, length of stay and healthcare-related costs (secondary).Ethics and disseminationThe study protocol was approved by the Ethics Committee of Area Vasta Emilia Nord (Emilia-Romagna region). Informed consent will be collected from patients or legal representatives. The results will be actively disseminated through peer-reviewed journals and conference presentations, in compliance with the Italian law.Trial registration numberClinicalTrials.gov Registry (NCT 04085679); Pre-results.

scholarly journals Exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and manager’s in nursing homes in England and Sweden: a survey protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038390
Author(s):  
N Carey ◽  
Nouf Alkhamees ◽  
Anna Cox ◽  
Marta Sund-Levander ◽  
Pia Tingström ◽  
...  
Keyword(s):  
Nursing Home ◽  
Decision Support ◽  
Nursing Homes ◽  
Early Detection ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
User Engagement ◽  
Cross Sectional ◽  
Support Tool ◽  
Care Workers

IntroductionIn order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic.We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden.Methods and analysisAn international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents.Ethics and disseminationThis study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information.This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost–benefit analyses as the work progresses.

scholarly journals INTEREST GROUP SESSION—SYSTEMS RESEARCH IN LONG TERM CARE: DEVELOPING AN EVIDENCE BASE FOR NURSING HOME STAFFING IN EUROPE AND BEYOND: MANY PATHS TO ONE GOAL?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S380-S381
Author(s):  
Jan Hamers ◽  
Ramona Backhaus ◽  
Kirsten Corazzini
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Care Home ◽  
Nursing Home Residents ◽  
Evidence Base ◽  
Research Literature ◽  
Term Care ◽  
Complex Needs ◽  
Systems Research ◽  
New Instrument

Abstract Despite heterogeneity across countries, nursing homes worldwide have to ensure the delivery of high quality care. At the same time, adequately staffing the homes remains a major concern in most countries. It is a significant challenge to determine the numbers and type of staff as well as staff’s competencies that are necessary to meet the complex needs of nursing home residents. While, especially in the US, research on the relationship between staffing and quality in nursing homes has received considerable attention, the research literature is contradictory. Evidence shows that employing more staff or more registered nurses instead of nurse assistants will not automatically lead to better nursing home quality. This inconsistency of evidence might be explained by a myriad of methodological and theoretical challenges. This symposium aims to provide an international perspective on how researchers from different European countries contribute to the development of an evidence base for nursing home staffing. The first presenter will draw on findings from a realist review conducted in the UK, focusing on the mechanisms (how, why and in what circumstances) under which staff influence care home quality. The second presenter will offer insights into a Swiss study, taking a broader perspective on measuring staffing and quality in nursing homes. The third presenter will present a new instrument to identify staffing ratios in German nursing homes and provide insight into its development process. The fourth presenter will discuss the results of a critical review on the evidence base of a Dutch nursing home staffing guideline.

164 Standardised Anticipatory Care Planning in Care Homes Reduces Unscheduled Hospital Admissions

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
L A Munang ◽  
J H W Rimer ◽  
K Ralston ◽  
L Kirby ◽  
K Robertson ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Hospital Admissions ◽  
Care Home ◽  
Education Programme ◽  
Care Homes ◽  
Care Planning ◽  
Staff Nurse ◽  
Continuous Education ◽  
Admission Rates ◽  
Health And Social Care

Abstract Background Anticipatory care planning (ACP) is a proactive person-centred approach for “thinking ahead”, exploring and recording a person’s goals and preferred actions when their health deteriorates. As a key part of Comprehensive Geriatric Assessment of frail patients, care home (CH) residents would benefit from ACP. Introduction West Lothian has 16 care homes with 853 residents. Between Oct—Dec 2017, 5.21% of CH residents were admitted to hospital each month. Some of these admissions could have been avoided had there been robust ACP in place. Methods In 2017 West Lothian Health and Social Care Partnership appointed a GP lead for Care Homes. Through standardising ACP for CH residents, the goal was to improve the pathway for managing medical emergencies and reduce unnecessary unscheduled care calls and admissions. In 2019 this role was taken over by a team of 2WTE Advanced Nurse Practitioners and 1WTE Staff Nurse. Outcome measures include hospital admission rates, number of ACPs in place and uptake of ACP training amongst CH staff. Interventions In collaboration with the Medicine of the Elderly Department at St John’s Hospital, a standardised ACP Summary document was developed for use in all CHs. A medical advice and emergency flowchart was created to reduce unnecessary hospital admissions. An continuous education programme was delivered across all CH staff to facilitate and implement this. Results Medical admission rates from CHs have decreased by 60% from 6 to 2.2 admissions per week. The largest reduction is in CHs with full ACP use. Conclusions Standardised ACP significantly reduces the number of medical admissions. Continuous education and training is crucial in maintaining its implementation, and ensuring its routine use throughout CHs in West Lothian.

scholarly journals A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

2021 ◽  
pp. 1-13
Author(s):  
Julie L. O’Sullivan ◽  
Sonia Lech ◽  
Paul Gellert ◽  
Ulrike Grittner ◽  
Jan-Niklas Voigt-Antons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Psychotropic Medication ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Design: Cluster-randomized controlled trial. Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI −3.54, 2.33 for TBI and .36 points, 95% CI −3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

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