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 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 Evidence for Publicly Reported Quality Indicators in Residential Long-Term Care: A Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 181-181
Author(s):  
Franziska Zúñiga ◽  
Magdalena Osinska ◽  
Franziska Zuniga
Keyword(s):  
New Zealand ◽  
Quality Indicators ◽  
Long Term Care ◽  
Grey Literature ◽  
Public Reporting ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Residential Long Term Care

Abstract Quality indicators (QIs) are used internationally to measure, compare and improve quality in residential long-term care. Public reporting of such indicators allows transparency and motivates local quality improvement initiatives. However, little is known about the quality of QIs. In a systematic literature review, we assessed which countries publicly report health-related QIs, whether stakeholders were involved in their development and the evidence concerning their validity and reliability. Most information was found in grey literature, with nine countries (USA, Canada, Australia, New Zealand and five countries in Europe) publicly reporting a total of 66 QIs in areas like mobility, falls, pressure ulcers, continence, pain, weight loss, and physical restraint. While USA, Canada and New Zealand work with QIs from the Resident Assessment Instrument – Minimal Data Set (RAI-MDS), the other countries developed their own QIs. All countries involved stakeholders in some phase of the QI development. However, we only found reports from Canada and Australia on both, the criteria judged (e.g. relevance, influenceability), and the results of structured stakeholder surveys. Interrater reliability was measured for some RAI QIs and for those used in Germany, showing overall good Kappa values (>0.6) except for QIs concerning mobility, falls and urinary tract infection. Validity measures were only found for RAI QIs and were mostly moderate. Although a number of QIs are publicly reported and used for comparison and policy decisions, available evidence is still limited. We need broader and accessible evidence for a responsible use of QIs in public reporting.

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 1240. Antibiotic Prescribing in US Nursing Homes Using National Pharmacy Transaction Data

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S377-S377
Author(s):  
Danielle Palms ◽  
Sarah Kabbani ◽  
Monina Bartoces ◽  
David Y Hyun ◽  
James Baggs ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
The South ◽  
Provider Type ◽  
Term Care ◽  
Data Set

Abstract Background Antibiotics are frequently prescribed inappropriately in nursing homes (NHs); however, national estimates of NH antibiotic use are limited. We aimed to describe antibiotic prescribing in US NHs to identify potential targets for antibiotic stewardship. Methods A descriptive analysis was conducted using the 2014 proprietary IQVIA long-term care (LTC) Xponent database, which captures oral and intravenous antibiotic prescription transactions from sampled LTC pharmacies representing 70–85% of the LTC market. The data are projected to 100% of the US LTC market. Denominators for rate calculations were captured from the 2014 Minimum Data Set as the number of residents with at least one resident day in an NH in 2014. Antibiotic transaction counts and rates were calculated by resident gender, age, US census region, route of administration, antibiotic class and agent, and total transaction counts were summarized by provider type. Prescribing patterns for antibiotic classes and agents stratified by resident age were also calculated. Results In 2014, there were over 14 million antibiotic transactions in LTC pharmacies, for a rate of 3,302 per 1,000 residents. Female residents accounted for 62% of antibiotic transactions at a rate of 3,305 transactions per 1,000 residents compared with 3,240 per 1,000 male residents. Antibiotic prescribing was highest in the South at 3,752 transactions per 1,000 residents (vs. 2,601 per 1,000 residents in the West). Oral antibiotics accounted for 85% of transactions. Fluoroquinolones were the most frequently prescribed antibiotic class (22%; 723 transactions per 1,000 residents) and the most common agents were levofloxacin, ciprofloxacin, and sulfamethoxazole–trimethoprim. Stratified by age, the percent change in prescribing rates among residents aged <85 to residents aged ≥85 was largest for fluoroquinolones (645 vs. 883) and urinary anti-infectives (210 vs. 319). Internal medicine and family practice providers accounted for 37% and 32% of all antibiotic transactions, respectively. Conclusion A potential antibiotic stewardship target in NHs is fluoroquinolone prescribing. Targeting states in the South for interventions may have the largest impact. Figure. Antibiotic prescribing rates in long-term care by U.S. census regions Disclosures All authors: No reported disclosures.

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.

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