scholarly journals Typology of residential long-term care units in Germany: An explorative hierarchical clustering on principal components analysis

2019 ◽  
Author(s):  
Johannes Michael Bergmann ◽  
Armin Michael Ströbel ◽  
Bernhard Holle ◽  
Rebecca Palm
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Long Term Care ◽  
Health Care Research ◽  
Term Care ◽  
Convenience Sample ◽  
Care Research ◽  
Agglomerative Hierarchical Cluster Analysis ◽  
Residential Long Term Care

Abstract Background Organizational health care research focuses on describing structures and processes in organizations and investigating their impact on the quality of health care. In the setting of residential long-term care, this effort includes the examination and description of structural differences among the organizations (e.g., nursing homes). The objective of the analysis is to develop an empirical typology of living units in nursing homes that differ in their structural characteristics. Methods Data from the DemenzMonitor Study were used. The DemenzMonitor is an observational study carried out in a convenience sample of 103 living units in 51 nursing homes spread over 11 German federal states. Characteristics of living units were measured by 19 variables related to staffing, work organization, building characteristics and meal preparation. Multiple correspondence analysis (MCA) and agglomerative hierarchical cluster analysis (AHC) are suitable to create a typology of living units. Both methods are multivariate and explorative. We present a comparison with a previous typology (created by a nonexplorative and nonmultivariate process) of the living units derived from the same data set. Results The MCA revealed differences among the living units, which are defined in particular by the size of the living unit (number of beds), the additional qualifications of the head nurse, the living concept and the presence of additional financing through a separate benefit agreement. Three clusters could be identified; these clusters occur significantly with a certain combination of characteristics. In terms of content, the three clusters can be defined as "house community", "dementia special care units” and "usual care". Conclusion The typology of living units allows to identify more suitable outcomes and to develop more tailor-made interventions. Furthermore, the development of a typology is useful to gain a deeper understanding of the differences in the care structures of residential long-term care organizations. The intended theory development on the subject of different types of living units and the subsequent definition of these units will enable the long-term evaluation of their influence in further health care research.

scholarly journals Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis

2020 ◽  
Author(s):  
Johannes Michael Bergmann ◽  
Armin Michael Ströbel ◽  
Bernhard Holle ◽  
Rebecca Palm
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Long Term Care ◽  
Practical Recommendation ◽  
Term Care ◽  
Data Set ◽  
Convenience Sample ◽  
Agglomerative Hierarchical Cluster Analysis ◽  
Residential Long Term Care

Abstract Background Organizational health care research focuses on describing structures and processes in organizations and investigating their impact on the quality of health care. In the setting of residential long-term care, this effort includes the examination and description of structural differences among the organizations (e.g., nursing homes). The objective of the analysis is to develop an empirical typology of living units in nursing homes that differ in their structural characteristics. Methods Data from the DemenzMonitor Study were used. The DemenzMonitor is an observational study carried out in a convenience sample of 103 living units in 51 nursing homes spread over 11 German federal states. Characteristics of living units were measured by 19 variables related to staffing, work organization, building characteristics and meal preparation. Multiple correspondence analysis (MCA) and agglomerative hierarchical cluster analysis (AHC) are suitable to create a typology of living units. Both methods are multivariate and explorative. We present a comparison with a previous typology (created by a nonexplorative and nonmultivariate process) of the living units derived from the same data set. Results The MCA revealed differences among the living units, which are defined in particular by the size of the living unit (number of beds), the additional qualifications of the head nurse, the living concept and the presence of additional financing through a separate benefit agreement. We identified three types of living units; these clusters occur significantly with a certain combination of characteristics. In terms of content, the three clusters can be defined as: "house community", "dementia special care units” and "usual care". Conclusion A typology is useful to gain a deeper understanding of the differences in the care structures of residential long-term care organizations. In addition, the study provides a practical recommendation on how to apply the results, enabling housing units to be assigned to a certain type. The typology can be used as a reference for definitions.

scholarly journals Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis

2020 ◽  
Author(s):  
Johannes Michael Bergmann ◽  
Armin Michael Ströbel ◽  
Bernhard Holle ◽  
Rebecca Palm
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Long Term Care ◽  
Practical Recommendation ◽  
Term Care ◽  
Data Set ◽  
Convenience Sample ◽  
Agglomerative Hierarchical Cluster Analysis ◽  
Residential Long Term Care

Abstract Background: Organizational health care research focuses on describing structures and processes in organizations and investigating their impact on the quality of health care. In the setting of residential long-term care, this effort includes the examination and description of structural differences among the organizations (e.g., nursing homes). The objective of the analysis is to develop an empirical typology of living units in nursing homes that differ in their structural characteristics. Methods: Data from the DemenzMonitor Study were used. The DemenzMonitor is an observational study carried out in a convenience sample of 103 living units in 51 nursing homes spread over 11 German federal states. Characteristics of living units were measured by 19 variables related to staffing, work organization, building characteristics and meal preparation. Multiple correspondence analysis (MCA) and agglomerative hierarchical cluster analysis (AHC) are suitable to create a typology of living units. Both methods are multivariate and explorative. We present a comparison with a previous typology (created by a nonexplorative and nonmultivariate process) of the living units derived from the same data set.Results: The MCA revealed differences among the living units, which are defined in particular by the size of the living unit (number of beds), the additional qualifications of the head nurse, the living concept and the presence of additional financing through a separate benefit agreement. We identified three types of living units; these clusters occur significantly with a certain combination of characteristics. In terms of content, the three clusters can be defined as: "house community", "dementia special care units” and "usual care". Conclusion: A typology is useful to gain a deeper understanding of the differences in the care structures of residential long-term care organizations. In addition, the study provides a practical recommendation on how to apply the results, enabling housing units to be assigned to a certain type. The typology can be used as a reference for definitions.

scholarly journals Comparing residential long-term care regulations between nursing homes and assisted living facilities

2020 ◽  
Vol 68 (1) ◽  
pp. 114-122 ◽  
Author(s):  
Alison M. Trinkoff ◽  
Jung Min Yoon ◽  
Carla L. Storr ◽  
Nancy B. Lerner ◽  
Bo Kyum Yang ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Assisted Living ◽  
Long Term Care ◽  
Assisted Living Facilities ◽  
Term Care ◽  
Residential Long Term Care

scholarly journals Planning for the Future

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Mitch Levine
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Health Care Providers ◽  
Long Term Care ◽  
Care Providers ◽  
Advanced Dementia ◽  
Term Care ◽  
Advanced Directive ◽  
Advanced Directives

In this issue of CJGIM Quinn et al discuss the merits of physicians taking the time to focus on the overall goals of care in patients with advanced dementia who present for the treatment of an acute problem. Rather than immediately managing the presenting new illness they suggest that the clinical management plan be put into the context of what are the specific overarching goals and expectations of the individual patient with an advanced dementia. The problem of course is that unless it is clearly spelled out in advance, it is a challenge to know what these consist of for a patient who is in an advanced state of cognitive decline. In this situation health care providers frequently have to rely on the patient’s family for some direction, but the latter are not always fully informed. In Ontario, a document issued by the Ontario Ministry of Health and Long-Term Care called a “Do Not Resuscitate Confirmation Form” gives clear direction regarding the use of CPR.1 When completed for an individual in a long-term care facility, this information provides excellent guidance for first responders and health care providers regarding resuscitation. But these forms do not discuss the various degrees of medical care that can be provided beyond cardio-pulmonary resuscitation. Interventions such as IV fluids, antibiotics and feeding options, still need to be addressed. These are treatments that patients may or may not want. Clearly what is needed is a more comprehensive document that is widely proffered by provincial ministries of health, to be completed or updated annually by the patients in long-term care institutions (or by their power of attorneys).When a patient deteriorates in a long-term care institution the nursing staff often feel uncomfortable making pivotal decisions and as a result patients are inevitably transferred to acute care facilities for assessment and possible treatment. But if the patients are accompanied by a clear and standardized detailed advanced directive this will assist the physicians to do what Quinn et al are suggesting in their article. As such, it should be apparent that the completion of an advanced directive is the vital step to ensuring that patient care is reflective of what patients want. Yet advance directives do not accompany all patient transfers from nursing homes to hospital emergency rooms despite that it is now more than one and a half decades since a clinical trial showed the benefits of employing advanced directives in nursing homes.2 Perhaps what is needed is for the completion of a detailed advanced directive to become a designated Quality Indicator (QI) in the long-term care setting. In a health care environment that is linking budgets to QIs, nothing catches a health care administrator’s attention faster than a QI with implications. The universal completion of a detailed health care advanced directive would provide sufficient guidance for all physicians treating patients with advanced dementia who they are meeting for the first time. As a consequence, making clinical decisions that reflect the patient’s values will become the standard of care.

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 Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 704-704
Author(s):  
Yuchi Young ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Systems ◽  
Long Term Care ◽  
The United States ◽  
World Population ◽  
Term Care ◽  
The Usa ◽  
Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

scholarly journals Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 48
Author(s):  
Roger E. Thomas
Keyword(s):  
Nursing Homes ◽  
Infection Control ◽  
Strong Evidence ◽  
Disease Transmission ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities ◽  
Meta Analyses ◽  
Tract Infections

The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents’ own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.

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