scholarly journals Risk of Death Scale: A Death Prediction Model Based on US Nursing Home Admissions in 2011 and 2012

2019 ◽  
Author(s):  
John N Morris ◽  
Elizabeth Howard ◽  
Sabrina Egge ◽  
Erez Schachter ◽  
Fredrik Sjostrand
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Nursing Homes ◽  
Clinical Status ◽  
Cognitive Status ◽  
Term Care ◽  
Death Rates ◽  
Risk Of Death ◽  
National Cohort ◽  
One Year

Abstract Background : Care planning has become more complex as nursing homes now are serving an ever more complex patient population. The primary purpose of this project is to identify, among persons admitted to and remaining up to 12 months, in a long-term care setting, those at more imminent risk of death, revealing the relevant risk factors and summarizing these factors within a Risk of Death Scale. Design : Longitudinal analysis of a national cohort of nursing home admissions from all United States facilities during years 2011 and 2012. Setting and Participants : Cohort included 1,536,842 admissions (764,002 for 2011, 772,840 for 2012). Repeated assessments are required every 90 days, with an additional assessment at discharge. Follow-up data over three years were examined. Methods : The Risk of Death Scale is based on two sub-scales. One included five very high risk of death measures. The second was composed of an additional eighteen risk factors. The dependent variable against which these models were developed was death by 365 days. Death rates are described from one-month post-admission to three years post-admission. Results : The Risk of Death Scale has twelve graded levels. The lowest four categories of the scale (0-3) represent approximately half the cohort and have one-year death rates that range from 3% to 15.5%, whereas the mean of the whole cohort is 24.2% at one year. The top four categories represent about 7% of the cohort and have one-year death rates ranging from 55.8% to 90.5%. The death rates increased steadily across the scale scores, a pattern that held through the three-year post admission period. Conclusions/Implications : The Risk of Death Scale for new admissions to nursing homes rests on a broad spectrum of 23 independent variables – including measures of prognosis, treatments, diagnoses, clinical status, function, cognitive status, and age. Almost 10% of the sample (n=149,073) had a risk score of 7 or greater and the average one-year mortality for this group was 68.6% (range of 47.5-90.5%).

scholarly journals Risk of Death: The Death Experience of Persons Admitted to US Nursing Homes

2021 ◽  
Author(s):  
John N Morris ◽  
Elizabeth P Howard ◽  
Sabrina Egge ◽  
Erez Schachter ◽  
Fredrick Sjostrand
Keyword(s):  
Nursing Home ◽  
Clinical Status ◽  
Nursing Home Residents ◽  
Personal Characteristics ◽  
Cognitive Status ◽  
Term Care ◽  
Death Rates ◽  
Entire Cohort ◽  
Risk Of Death ◽  
One Year

Abstract Background: An increase in both the complexity of nursing home case-mix and corresponding challenges faced by staff in planning for the care of these individuals are notable outcomes from the growth in residential and service alternatives. The purpose of this project was to identify, among long-term care nursing home residents, those personal characteristics that indicate one’s risk of dying and then summarize these items in a Risk of Death Scale. In addition, an assessment of how possible confounding facility-level characteristics might impact on the risk of death model was completed. Methods: The design of the study was a longitudinal analysis of a national cohort of US nursing home admissions from 2011 to 2012, followed over 2 years and a validation study using 2013 data The 2011-2012 sample included 1,536,842 nursing home admissions and the 2013 validation sample consisted of 769,148 admissions We based the Risk of Death Scale on resident characteristics. While it is based on death status at 12 months, we describe death rates under the model from one-month post-admission to two years post-admission. Results: The Risk of Death Scale has seventeen graded levels. The lowest four scale categories (0-3) represent half the cohort with one-year death rates from 2% to 13.8%, whereas the mean of the entire cohort is 24.1% at one year. The top nine categories represent approximately 9% and have one-year death rates ranging from 51.7% to 95.7%. Conclusions/Implications: The Risk of Death Scale includes a broad spectrum of 30 independent variables, including measures of prognosis, treatments, diagnoses, clinical status, function, cognitive status, and age.

Discharge Outcomes in Seniors Hospitalized for More than 30 Days

2005 ◽  
Vol 24 (S1) ◽  
pp. 107-119 ◽  
Author(s):  
Anita L. Kozyrskyj ◽  
Charlyn Black ◽  
Dan Chateau ◽  
Carmen Steinbach
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Support Services ◽  
Term Care ◽  
Home Discharge ◽  
Discharge Outcomes ◽  
Acute Hospitals ◽  
Sentinel Event ◽  
One Year

ABSTRACTHospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using Manitoba's health care databases, the likelihood of death in hospital, discharge to a nursing home, and transfer to another hospital was determined for a set of risk factors in seniors with long-stay hospitalizations in Winnipeg's acute hospitals. Of the 17,984 long-stay hospitalizations during 1993–2000, 45 per cent were discharged home, 20 per cent died, and 30 per cent were discharged to a nursing home or another hospital. Seniors who received home care prior to hospitalization were more likely to be discharged to a nursing home or die in hospital than to go home. Stroke and cognitive impairment increased the likelihood of discharge to a nursing home. Seniors with neoplasms, multiple co-morbidities, and length-of-stay more than 120 days were more likely to die in hospital. Long-stay patients with risk factors who did go home had few co-morbidities. Within one year of home discharge, 20 per cent of seniors died, 5–15 per cent were admitted to a nursing home or long-term care institution, and 26–35 per cent of persons were re-hospitalized from home. A full 37 per cent experienced none of these outcomes. Our findings point to opportunities to improve discharge outcomes and plan support services for seniors.

scholarly journals Culture Change and Quality Star Ratings in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 679-679
Author(s):  
Latarsha Chisholm ◽  
Akbar Ghiasi ◽  
Justin Lord ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Culture Change ◽  
Ethnic Disparities ◽  
Change Initiatives ◽  
Term Care ◽  
Star Rating ◽  
Nursing Home Quality ◽  
Literature Culture ◽  
One Year

Abstract Racial/ethnic disparities have been well documented in long-term care literature. Culture change is a movement to transition nursing homes to more home-like environments to improve the quality of care for all residents. 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 facilities. The final model consisted of an ordinal logistic regression. 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.

scholarly journals Risk factors for mortality of residents in nursing homes with Covid-19: a retrospective cohort study

2020 ◽  
Author(s):  
Clara Suñer ◽  
Dan Ouchi ◽  
Miquel Àngel Mas ◽  
Rosa Lopez Alarcon ◽  
Mireia Massot Mesquida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities ◽  
Pandemic Response ◽  
Facility Level ◽  
Preventative Interventions

AbstractBackgroundNursing homes have shown remarkably high Covid-19 incidence and mortality. We aimed to explore the contribution of structural factors of nursing home facilities and the surrounding district to all-cause and Covid-19-related deaths during a SARS-CoV-2 outbreak.MethodsIn this retrospective cohort study, we investigated the risk factors of Covid-19 mortality at the facility level in nursing homes in Catalonia (North-East Spain). The investigated factors included characteristics of the residents (age, gender, comorbidities, and complexity and/or advanced disease), structural features of the nursing home (total number of residents, residents who return home during the pandemic, and capacity for pandemic response, based on an ad hoc score of availability of twelve essential items for implementing preventive measures), and sociodemographic profile of the catchment district (household income, population density, and population incidence of Covid-19). Study endpoints included all-cause death and Covid-19-related death (either PCR-confirmed or clinical suspicion).FindingsThe analysis included 167 nursing homes that provide long-term care to 8,716 residents. Between March 1 and June 1, 2020, 1,629 deaths were reported in these nursing homes; 1,089 (66□9%) of them were Covid-19-confirmed. The multivariable regression showed a higher risk of death associated with a higher percentage of complex patients (HR 1□09; 95%CI 1□05-1□12 per 10% increase) or those with advanced diseases (1□13; 1□07-1□19), lower capacity for implementing preventive measures (1□08; 1□05-1□10 per 1-point increase), and districts with a higher incidence of Covid-19 (2□98; 2□53-3□50 per 1000 cases/100,000 population increase). A higher population density of the catchment area was a protective factor (0□60; 0□50-0□72 per log10 people/Km2 increase).InterpretationPresence of residents with complex/advance disease, low capacity for pandemic response and location in areas with high incidence of Covid-19 are risk factors for Covid-19 mortality in nursing homes and may help policymakers to prioritize preventative interventions for pandemic containment.FundingCrowdfunding campaign YoMeCorono (https://www.yomecorono.com/), and Generalitat de Catalunya.Research in contextEvidence before this studyWe searched PubMed for studies exploring the management of Covid-19 in long-term care settings. The search was performed on May 1, 2020, and included the keywords “Covid-19”, “nursing home”, “long term care”, and “skilled nursing facility” with no language restriction. In addition to descriptive reports of Covid-19 mortality in the long-term care setting, we found studies providing evidence on the influence of age and comorbidities to mortality at the individual level. Some authors reported comparisons in the incidence and mortality of Covid-19 between facilities and country areas, and suggested the characteristics of each area/facility that may explain differences in mortality. However, we found no published works specifically investigating the contribution of structural features of the facility and sociodemographic characteristics of the area to explaining differences in Covid-19 mortality among long-term care facilities.Added value of this studyThis is the first analysis of risk of mortality at a facility level of residents with Covid-19 in nursing homes. We enrolled up to 167 nursing homes providing long-term care to 8,716 residents and we actively identified risk factors for Covid-19 mortality at the facility level. We found that nursing homes with lower capacity for pandemic response, and located in districts with a higher incidence of Covid-19 had significantly higher risks of Covid-19 mortality. The percentage of complex and/or advanced disease patients was also a risk factor.Implications of all the available evidenceOur findings provide policymakers with critical information to prioritize long-term care facilities at higher risk when deploying preventative interventions to minimize mortality in this setting. The association between mortality within the nursing home and Covid-19 incidence in the catchment area reinforces the importance of preventing the entry of SARS-CoV-2 into facilities. Nursing homes with limited capacity to implement containment measures should be prioritized when deploying preventative interventions for minimizing Covid-19 mortality in long-term care facilities.

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 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.

Geriatric Health Experts Validate Oral Neglect Timelines for the Institutionalized Elderly

2019 ◽  
Vol 39 (11) ◽  
pp. 1250-1257
Author(s):  
Sharon M. Casey ◽  
Ralph V. Katz ◽  
Shulamite Huang ◽  
Barbara J. Smith
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Standard Of Care ◽  
Delphi Survey ◽  
Oral Disease ◽  
Oral Diseases ◽  
Term Care ◽  
Institutionalized Elderly

The purpose of this follow-up Delphi survey was to have an expert panel of 31 academic geriatric physicians, geriatric nurses, and medical directors of nursing homes evaluate the original timeline set to avoid oral neglect of nursing home residents. The Oral Neglect in Institutionalized Elderly (ONiIE) timelines defined oral neglect as having occurred when >7 days for acute oral diseases/conditions or >34 days for chronic oral disease/conditions had passed between initial diagnosis and offering access to dental care to the long-term care (LTC) nursing home resident. The results of this follow-up Delphi survey validated those originally defined ONiIE timelines as 90% of this panel agreed with the original timelines. This ONiIE definition adds a broad-based validation for the ONiIE timelines for setting an oral health standard of care for institutionalized elderly residents of nursing homes and should now be used to protect the vulnerable elderly residing in LTC nursing homes.

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