scholarly journals Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident’s Place of Death

2019 ◽  
Author(s):  
Aluem Tark ◽  
Mansi Agarwal ◽  
Andrew Dick ◽  
Jiyoun Song ◽  
Patricia Stone
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Treatment Program ◽  
Nursing Home Residents ◽  
Vital Statistics ◽  
Short Stay ◽  
Data Set ◽  
Significant Difference ◽  
Life Sustaining Treatment ◽  
The Impact

Abstract Background: The Physician Orders for Life-Sustaining Treatment program was developed to enhance quality of care delivered at end-of-life. Although positive impacts of the Physician Orders for Life-Sustaining Treatment Program use have been identified, the association between a state’s program maturity status and nursing home resident’s likelihood of dying in their current care settings, nursing homes, remain unanswered. Objective: Examine the impact of the Physician Orders for Life-Sustaining Program maturity status on nursing home residents’ odds of dying in nursing homes.Methods: Program maturity status data were linked with multiple datasets: Minimum Data Set, Vital Statistics Data, Master Beneficiary Summary File, Certification and Survey Provider Enhanced Reports, and Area Health Resource File. Stratifying residents on long-stay and short-stay, we used descriptive statistics and multivariable logistic regression models for total 595,152 individuals.Results: Controlling for individual and contextual variables, long-stay nursing home residents living in states where the program was mature status had 20% increased odds of dying in nursing homes (OR: 1.20; CI 1.02-1.43) compared to those who resided in states with non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes (OR: 1.12; CI 1.02-1.24) compared to non-conforming status. No significant difference was noted for short-stay nursing home residents.Conclusion: Mature and developing maturity status were associated with greater likelihood of dying in nursing homes among long-stay residents. Our findings inform that a well-structured advance care planning program such as Physician Orders for Life-Sustaining Program enhances care outcomes among older adults living in nursing homes.

scholarly journals Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident’s Place of Death

2020 ◽  
pp. 104990912095665
Author(s):  
Aluem Tark ◽  
Mansi Agarwal ◽  
Andrew W. Dick ◽  
Jiyoun Song ◽  
Patricia W. Stone
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
National Level ◽  
Nursing Home Residents ◽  
Place Of Death ◽  
Positive Health ◽  
Life Sustaining Treatment ◽  
High Standards ◽  
Positive Health Outcomes ◽  
The Impact

The Physician Orders for Life-Sustaining Treatment (POLST) program was developed to enhance quality of care delivered at End-of-Life (EoL). Although positive impacts of the POLST program have been identified, the association between a program maturity status and nursing home resident’s likelihood of dying in their current care settings remain unanswered. This study aims to evaluate the impact of the POLST program maturity status on nursing home residents’ place of death. Using multiple national-level datasets, we examined total 595,152 residents and their place of death. The result showed that the long-stay residents living in states where the program was mature status had 12% increased odds of dying in nursing homes compared that of non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes. The findings demonstrate that a well-structured and well-disseminated POLST program, combined with a continued effort to meet high standards of quality EoL care, can bring out positive health outcomes for elderly patients residing in care settings.

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.

scholarly journals Association of care workers’ job satisfaction and global happiness with change of functional performance of severely disabled elderly residents in nursing homes: a cohort and questionnaire study in Japan

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e033937
Author(s):  
Shino Ikeda-Sonoda ◽  
Nao Ichihara ◽  
Jiro Okochi ◽  
Arata Takahashi ◽  
Hiroaki Miyata
Keyword(s):  
Job Satisfaction ◽  
Nursing Home ◽  
Nursing Homes ◽  
Functional Performance ◽  
Nursing Home Residents ◽  
Care Staff ◽  
Lower Probability ◽  
Disabled Elderly ◽  
The Impact

ObjectivesThere is growing concern regarding quality of work life (QWL) among care staff in nursing homes. However, little is known about the impact of QWL on nursing home residents’ functional performance. Recent literature suggests that job satisfaction and happiness of healthcare workers reflect their perceived QWL and impact the quality of their care. This study examined the association between job satisfaction and global happiness with change in functional performance of severely disabled elderly residents in nursing homes.DesignA retrospective cohort study of nursing home residents combined with a questionnaire survey of their care staff.SettingEighteen nursing homes in Japan.ParticipantsData were collected from 1000 residents with a required care level of 3–5 and from 412 care staff in nursing homes between October 2017 and March 2018.Outcomes and explanatory variablesFunctional performance was structurally assessed with ICF (International Classification of Functioning, Disability and Health) staging, composed of 52 items concerning activities of daily life, cognitive function and social participation, at baseline and 6 months later. Deterioration and improvement of functional performance were dichotomously defined as such change in any of the items. QWL of care staff was evaluated with a questionnaire including questions about job satisfaction and global happiness.ResultsFunctional performance deteriorated and improved in 23.0% and 12.7% of residents, respectively. Global happiness of care staff was associated with lower probability of residents’ deterioration (adjusted OR, 0.61; CI 0.44 to 0.84). There was no significant correlation between job satisfaction or happiness of care staff and improvement of residents’ functional performance.ConclusionThese results suggest that QWL of care staff is associated with changes in functional performance of elderly people with severe disabilities in nursing homes.

scholarly journals Public reporting of antipsychotic prescribing in nursing homes: population-based interrupted time series analyses

2018 ◽  
Vol 28 (2) ◽  
pp. 121-131 ◽  
Author(s):  
Noah M Ivers ◽  
Monica Taljaard ◽  
Vasily Giannakeas ◽  
Catherine Reis ◽  
Evelyn Williams ◽  
...  
Keyword(s):  
Time Series ◽  
Nursing Home ◽  
Nursing Homes ◽  
Mass Media ◽  
Nursing Home Residents ◽  
Public Reporting ◽  
Increased Risk ◽  
Antipsychotic Prescribing ◽  
The Impact ◽  
Newspaper Articles

BackgroundAlthough sometimes appropriate, antipsychotic medications are associated with increased risk of significant adverse events. In 2014, a series of newspaper articles describing high prescribing rates in nursing homes in Ontario, Canada, garnered substantial interest. Subsequently, an online public reporting initiative with home-level data was launched. We examined the impact of these public reporting interventions on antipsychotic prescribing in nursing homes.MethodsTime series analysis of all nursing home residents in Ontario, Canada, between 1 October 2013 and 31 March 2016. The primary outcome was the proportion of residents prescribed antipsychotics each month. Balance measures were prescriptions for common alternative sedating agents (benzodiazepines and/or trazodone). We used segmented regression to assess the effects on prescription trends of the newspaper articles and the online home-level public reporting initiative.ResultsWe included 120 009 nursing home resident admissions across 636 nursing homes. Following the newspaper articles, the proportion of residents prescribed an antipsychotic decreased by 1.28% (95% CI 1.08% to 1.48%) and continued to decrease at a rate of 0.2% per month (95% CI 0.16% to 0.24%). The online public reporting initiative did not alter this trend. Over 3 years, there was a net absolute reduction in antipsychotic prescribing of 6.0% (95% CI 5.1% to 6.9%). Trends for benzodiazepine prescribing did not change as substantially during the period of observation. Trazodone use has been gradually increasing, but its use did not change abruptly at the time of the mass media report or the public reporting initiative.InterpretationThe rapid impact of mass media on prescribing suggests both an opportunity to use this approach to invoke change and a warning to ensure that such reporting occurs responsibly.

Race, Education, and the Treatment of Depression in Nursing Homes

2012 ◽  
Vol 24 (5) ◽  
pp. 752-778 ◽  
Author(s):  
Michele J. Siegel ◽  
Judith A. Lucas ◽  
Ayse Akincigil ◽  
Dorothy Gaboda ◽  
Donald R. Hoover ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Online Survey ◽  
High School Graduates ◽  
Nursing Home Residents ◽  
Depression Treatment ◽  
Data Set ◽  
Treatment Of Depression ◽  
Logistic Regressions ◽  
Facility Level

Objectives: We investigate, among older adult nursing home residents diagnosed with depression, whether depression treatment differs by race and schooling, and whether differences by schooling differ by race. We examine whether Blacks and less educated residents are placed in facilities providing less treatment, and whether differences reflect disparities in care. Method: Data from the 2006 Nursing Home Minimum Data Set for 8 states ( n = 124,431), are merged with facility information from the Online Survey Certification and Reporting system. Logistic regressions examine whether resident and/or facility characteristics explain treatment differences; treatment includes antidepressants and/or psychotherapy. Results: Blacks receive less treatment (adj. OR = .79); differences by education are small. Facilities with more Medicaid enrollees, fewer high school graduates, or more Blacks provide less treatment. Discussion: We found disparities at the resident and facility level. Facilities serving a low-SES (socioeconomic status), minority clientele tend to provide less depression care, but Blacks also receive less depression treatment than Whites within nursing homes (NHs).

Accuracy of influenza vaccination rate estimates in United States nursing home residents

2014 ◽  
Vol 143 (12) ◽  
pp. 2588-2595 ◽  
Author(s):  
J. M. GROSHOLZ ◽  
S. BLAKE ◽  
J. D. DAUGHERTY ◽  
E. AYERS ◽  
S. B. OMER ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Influenza Vaccination ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Term Care ◽  
Vaccination Rates ◽  
Vaccination Recommendations ◽  
The Impact

SUMMARYThe US Center for Medicare and Medicaid Services (CMS) requires nursing homes and long-term-care facilities to document residents' vaccination status on the Resident Assessment Instrument (RAI). Vaccinating residents can prevent costly hospital admissions and deaths. CMS and public health officials use RAI data to measure vaccination rates in long-term-care residents and assess the quality of care in nursing homes. We assessed the accuracy of RAI data against medical records in 39 nursing homes in Florida, Georgia, and Wisconsin. We randomly sampled residents in each home during the 2010–2011 and 2011–2012 influenza seasons. We collected data on receipt of influenza vaccination from charts and RAI data. Our final sample included 840 medical charts with matched RAI records. The agreement rate was 0·86. Using the chart as a gold standard, the sensitivity of the RAI with respect to influenza vaccination was 85% and the specificity was 77%. Agreement rates varied within facilities from 55% to 100%. Monitoring vaccination rates in the population is important for gauging the impact of programmes and policies to promote adherence to vaccination recommendations. Use of data from RAIs is a reasonable approach for gauging influenza vaccination rates in nursing-home residents.

scholarly journals The Effects of Evacuation on Nursing Home Residents With Dementia

2012 ◽  
Vol 27 (6) ◽  
pp. 406-412 ◽  
Author(s):  
Lisa M. Brown ◽  
David M. Dosa ◽  
Kali Thomas ◽  
Kathryn Hyer ◽  
Zhanlian Feng ◽  
...  
Keyword(s):  
At Risk ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Steady Increase ◽  
Cognitively Impaired ◽  
Severe Dementia ◽  
Data Set ◽  
Percent Increase ◽  
Resident Assessment

Background: In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired. Methods: Nursing homes in counties located in the path of Hurricane Gustav were identified. The Minimum Data Set resident assessment files were merged with the Centers for Medicare enrollment file to determine date of death for residents in identified facilities. Difference-in-differences analyses were conducted adjusting for residents' demographic characteristics and acuity. Results: The dataset included 21,255 residents living in 119 at risk nursing homes over three years of observation. Relative to the two years before the storm, there was a 2.8 percent increase in death at 30 days and a 3.9 percent increase in death at 90 days for residents with severe dementia who evacuated for Hurricane Gustav, controlling for resident demographics and acuity. Conclusions: The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility.

scholarly journals Mortality and Morbidity Among Nursing Home Residents Exposed to Hurricane Irma

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 734-734
Author(s):  
David Dosa ◽  
Julianne Skarha ◽  
Lindsay Peterson ◽  
Dylan Jester ◽  
Nazmus Sakib ◽  
...  
Keyword(s):  
Nursing Home ◽  
Administrative Data ◽  
Nursing Home Residents ◽  
Minimum Data Set ◽  
Control Group ◽  
Short Stay ◽  
Data Set ◽  
Mortality And Morbidity ◽  
Minimum Data ◽  
Hurricane Irma

Abstract We combined Medicare claims and nursing home (NH) administrative data to determine the mortality and morbidity effect of Hurricane Irma on nursing home residents. We utilized the Centers for Medicare and Medicaid Services (CMS) Standard Analytical Files (SAFs) combined with the Minimum Data Set (MDS) to create an exposure cohort of NH residents residing in Florida facilities immediately prior to Hurricane Irma’s landfall on September 10, 2017. We created a control group of residents who resided in the same NHs over the same dates in 2015, a year when there were no hurricanes. Outcome variables included 30/90-day mortality and first hospitalizations post storm. Compared to the control, an additional 260 more NH deaths were identified at 30 days and 429 more deaths at 90 days. Long stay residents (≥100 days) were at particular risk for mortality compared to short stay residents (<100 days). Hospitalization was also markedly increased.

scholarly journals Is there any correlation between Magnesium status and depression in elderly people? A descriptive-analytical study among Tehran-nursing home residents

2021 ◽  
Vol 12 (2) ◽  
pp. 632-639
Author(s):  
Lyly Nazemi ◽  
Ingmar Skoog ◽  
Ingvar Karlsson ◽  
Margda Waern ◽  
Agneta Yngve ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Elderly Population ◽  
Analytical Study ◽  
Depression Scale ◽  
Nursing Home Residents ◽  
Mini Nutritional Assessment ◽  
The Elderly ◽  
Flame Atomic Absorption ◽  
Significant Difference

Background: Very few studies have shown the possible relationship between magnesium (Mg) status and depression. In the present study, the intracellular Mg status of the elderly population living in nursing homes (NHs) was assessed to determine its relationship with depression. Methods: A descriptive-analytical study was conducted on the elderly population living in nursing homes (Tehran-Iran; 2010-2012). Participants' demographic and clinical characteristics were collected and recorded in a checklist. Evaluating the participants’ nutritional status, Mini Nutritional Assessment Method was implemented. Determining participant's depressive symptoms, 15-item Geriatric Depression Scale was used. Final scores were classified into4 categories not depressed, mild, moderate, and severe depression. Mg level in leukocytes was also measured by flame atomic absorption spectrometry. Results: Totally 113 elderly were included and only 9.8% of subjects were not depressed. About 21% of the subjects were well nourished. Of participants who suffered from heart disease, 80.2% were depressed (p=0.03). Regarding correlations between Mg status and depression, results showed no significant difference in Mg levels of two depressed and non-depressed participants (p=0.73). Conclusion: The results of the present study showed notable prevalence rates of depression and malnutrition among nursing home residents. It was also found that the relationship between intracellular Mg levels and depression was not significant. Further studies are needed to determine the major factors related to these preventable psychological and nutritional disorders among elderly NH residents.

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