scholarly journals Care Deficiencies and Super-Organization of American Nursing Homes in Hospital Referral Region

2021 ◽  
Vol 8 ◽  
Author(s):  
Tyler Pittman
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Ownership ◽  
Open Data ◽  
Nursing Home Residents ◽  
The United States ◽  
Care Quality ◽  
Hospital Referral Region ◽  
Hospital Referral ◽  
Open Datasets

Super-organization has been associated with worse care quality in nursing homes. Previous research on the chain ownership of American nursing homes excluded government facilities in public-private partnerships, and focused on corporate entities. This longitudinal study proposes a novel method of demarcating the latent ownership networks of for-profit, government and non-profit nursing homes in the United States through use of open data and social network analysis. Facility characteristics and care quality measures were analyzed from an ecological cohort of 9,001 American nursing homes that had a registered organization for owner, and were reimbursed through Medicare or Medicaid. Information was obtained from the Nursing Home Compare open datasets at five semi-annual processing dates from March 2016 to March 2018. Ownership networks of American nursing homes were constructed using the exact legal name of registered organizations. As hospital discharge is a routine admission source of nursing home residents, hospital referral region was actualized to demarcate focal area. Utilizing Bayesian hierarchical models, the association between nursing home super-organization in hospital referral region (inferred by degree-based centrality and Herfindahl-Hirschman Index) to scope of cited care deficiencies (denoted by Total Weighted Health Survey Score) was explored. The percentage of nursing homes having super-organization increased from 56.8 to 56.9% over the 2-year period. During this interval, the mean size of nursing home ownership group in hospital referral region increased from 3.11 to 3.23 facilities. Overall, super-organization in hospital referral region was not associated with care deficiencies in American nursing homes. However, being part of an ownership group with more facilities was beneficial for care quality among nursing homes with super-organization.

scholarly journals Care deficiencies and super-organization of American nursing homes in hospital referral region: an ecological cohort study

2020 ◽  
Author(s):  
Tyler Pittman
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Ownership ◽  
Nursing Home Residents ◽  
Care Quality ◽  
Bayesian Hierarchical ◽  
Non Profit ◽  
Hospital Referral Region ◽  
Hospital Referral ◽  
Open Datasets

Abstract Background Super-organization has been associated with worse care quality in nursing homes. Previous research on the chain ownership of American nursing homes excluded government facilities in public-private partnerships, and focused on corporate entities. This longitudinal study proposes a novel method of demarcating the latent ownership networks of for-profit, government and non-profit nursing homes in hospital referral region. Methods Facility characteristics and care quality measures were analyzed from an ecological cohort of 9,001 American nursing homes that had a registered organization for owner and were reimbursed through Medicare and Medicaid. Information was obtained from the Nursing Home Compare open datasets at five semi-annual processing dates from March 2016 to March 2018. Ownership networks of American nursing homes were constructed through application of social network analysis, using the exact legal name of registered organizations. As hospital discharge is a routine admission source of nursing home residents, hospital referral region was actualized to demarcate focal area. Utilizing Bayesian hierarchical models, the association between nursing home super-organization in hospital referral region (inferred by degree-based centrality and Herfindahl-Hirschman Index) to scope of cited care deficiencies (denoted by Total Weighted Health Survey Score) was explored. Results The percentage of nursing homes having super-organization increased from 56.8–56.9% over the two-year period. During this interval, the mean size of nursing home ownership group in hospital referral region increased from 3.11 to 3.23 facilities. Conclusions Overall, super-organization in hospital referral region was not associated with care deficiencies in American nursing homes. However, among nursing home with super-organization, being part of an ownership group with more facilities was beneficial for care quality. Evidence suggests that super-organization is detrimental for government nursing homes.

Tuberculosis in Long-Term Care Facilities

1990 ◽  
Vol 11 (1) ◽  
pp. 42-46 ◽  
Author(s):  
David W. Bentley
Keyword(s):  
United States ◽  
Nursing Home ◽  
Nursing Homes ◽  
Age Groups ◽  
Nursing Home Residents ◽  
The United States ◽  
High Risk Group ◽  
Elderly Persons ◽  
Tuberculosis Case ◽  
Term Care

Persons age 65 and over constitute the largest reservoir of Mycobacterium tuberculosis infection in the United States today. During 1987, 6,150 tuberculosis cases were reported among this high-risk group. These cases represent 27% of the total US tuberculosis morbidity, although this age group constitutes only 12% of the US population. Tuberculosis case rates in the United States are higher among the elderly (20.6 per 100,000) than among all other age groups (average 9.3 per 100,000).More Americans live in nursing homes than in any other type of residential institution; on any given day approximately 5% of all elderly persons are living in a nursing home. Elderly nursing home residents are at greater risk for tuberculosis than elderly persons living in the community. In a Centers for Disease Control (CDC)-sponsored survey of 15,379 routinely-reported tuberculosis cases from 29 states, 8% of the 4,919 cases that occurred among elderly persons occurred among residents of nursing homes. The incidence of tuberculosis among nursing home residents was 39.2 per 100,000 person years, whereas the incidence of tuberculosis among elderly persons living in the community was 21.5 per 100,000. The observed rate of tuberculosis among nursing home employees was three times the rate expected in employed adults of similar age, race and sex (CDC, unpublished data).

scholarly journals Mortality in Nursing Home Evacuations in the United States from 1995-2017

2019 ◽  
Vol 34 (s1) ◽  
pp. s2-s2
Author(s):  
Sharon Mace ◽  
Daniel Caicedo ◽  
Aishwarya Sharma
Keyword(s):  
United States ◽  
Nursing Home ◽  
Nursing Homes ◽  
Natural Disasters ◽  
Nursing Home Residents ◽  
The United States ◽  
Loss Of Life ◽  
External Events ◽  
Analyze Data

Introduction:There are an estimated 15,600 nursing homes with a total of 1.4 million residents in the United States. The number of residents will continue to increase due to the aging population, and the associated morbidities will make it difficult to evacuate them safely.Aim:This study is the first of its kind to provide an analysis of the number of nursing home deaths caused by external and internal events following evacuations.Methods:Information from the databases Lexis Nexis and PubMed were compiled and limited to news articles from 1995-2017. The gathered information included the reason for evacuation, injuries, deaths, and locations within the United States.Results:From 1995 to 2017, there was a total of 51 evacuations and 141 deaths in nursing homes. 27 (53%) evacuations were due to external events which resulted in a combined 121 (86%) deaths, and 24 (47%) evacuations were due to internal events which resulted in a combined 20 (14%) deaths. Hurricanes were responsible for the majority of deaths during evacuations, followed by fires and floods. The number of evacuations and deaths increased the greatest between 2005 to 2008.Discussion:External events have the greatest impact on loss of life. Internal disasters are about equal in the number of incidents, however, external events have a much greater mortality rate. Exact numbers on injuries, morbidity, and mortality are difficult to ascertain, but it appears to be related to natural disasters. In view of the increasing likelihood of natural disasters related to global warming, a drastic improvement of standard evacuation procedures of long-term nursing homes is critical to decreasing mortality of nursing home residents. There also needs to be a nationally standardized method of reporting evacuations in order to better analyze data on nursing homes.

scholarly journals Facility Characteristics and Quality Deficiencies of Florida Nursing Homes With COVID-19 Cases and Deaths

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 945-945
Author(s):  
Xiaochuan Wang ◽  
Courtney Wilson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Infection Control ◽  
Nursing Home Residents ◽  
The United States ◽  
Future Research ◽  
Staffing Level ◽  
Policy And Practice ◽  
Staff Shortage ◽  
Facility Size

Abstract The Coronavirus disease 2019 (COVID-19) has been disproportionately affecting nursing homes throughout the United States, resulting elevated risk for COVID-19 morbidity and mortality to nursing home residents. Given the high percentage of aging population, large number of nursing homes, and staggering surge of COVID-19 cases in Florida, it’s critical to understand factors that may affect Florida nursing homes’ vulnerability to the COVID-19 pandemic. Using Nursing Home COVID-19 Dataset as of July 26, 2020 obtained through Centers for Medicare and Medicaid Services (CMS), and Provider Info Dataset and Health Deficiencies Dataset available through CMS Nursing Home Compare data, we constructed a database of Florida nursing facilities with confirmed COVID-19 cases and deaths, with corresponding facility characteristics and quality deficiencies. We examined the facility characteristics (e.g. facility size, ownership state, chain affiliation, staffing level) and quality deficiencies (e.g. infection control deficiencies) of Florida nursing homes with and without publicly reported COVID-19 cases and deaths. Results indicated that, as of July 26, 2020, 73.3% and 40.8% of Florida nursing homes had resident COVID-19 cases and death, respectively (N=701). Findings also suggested that Florida nursing homes of large facility size, chain affiliated, and for profit, were significantly more likely to have documented resident COVID-19 cases (p<.05). Larger facility size (120 beds or more), staff shortage, and having prior infection control deficiency citation, were significantly related to the odds of having resident COVID-19 deaths (p<.05). Policy and practice implications and future research directions will be addressed to better protect the at-risk nursing home residents.

scholarly journals Nursing home care quality: a cluster analysis

2017 ◽  
Vol 30 (1) ◽  
pp. 25-36 ◽  
Author(s):  
Vigdis Abrahamsen Grøndahl ◽  
Liv Berit Fagerli
Keyword(s):  
Cluster Analysis ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Well Being ◽  
Care Quality ◽  
Nursing Home Care ◽  
Healthcare Personnel ◽  
Content Type ◽  
Quality Perceptions

Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients’ perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents (n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ2 tests and one-way between-groups ANOVA were performed to characterise the clusters (p<0.05). Findings Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents’ care quality perceptions.

Variability of total phenytoin serum concentrations within elderly nursing home residents

Neurology ◽  
2003 ◽  
Vol 60 (4) ◽  
pp. 555-559 ◽  
Author(s):  
A. Birnbaum ◽  
N. A. Hardie ◽  
I. E. Leppik ◽  
J. M. Conway ◽  
S. E. Bowers ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Resident ◽  
Nursing Home Residents ◽  
The Elderly ◽  
The United States ◽  
Serum Concentrations ◽  
Minimum Concentration ◽  
Elderly Nursing Home Resident ◽  
The Mean

Background: Approximately 6% of all elderly nursing home residents receive phenytoin. Phenytoin concentrations are often measured to guide therapy.Objective: To evaluate the intraresident variability among multiple measurements of total phenytoin serum concentrations in nursing home residents.Methods: This was an observational study of 56 elderly (≥65 years) nursing home residents from 32 nursing homes who had at least 3 phenytoin concentrations measured while on the same dose of phenytoin for at least 4 weeks and who were not taking any interfering concomitant medications. These were a subset of 387 elderly nursing home residents from 112 nursing homes across the United States who had total phenytoin concentration measurements between June 1998 and December 2000.Results: The mean age was 80.1 years (range, 65 to 100 years) and 58.9% were women. The mean daily dose of phenytoin per resident was 4.9 ± 1.5 mg/kg. Total phenytoin concentrations within an elderly nursing home resident varied as much as two- to threefold, even though there was no change in dose. The person with the smallest variability had a minimum concentration of 10.0 μg/mL and a maximum of 10.4 μg/mL. The person with the largest variability had a minimum concentration of 9.7 μg/mL and a maximum of 28.8 μg/mL.Conclusions: There is considerable variability in the total phenytoin concentrations in the elderly nursing home resident and measurement of a single total phenytoin concentration should not be used to guide treatment.

scholarly journals Mathematical modeling to inform vaccination strategies and testing approaches for COVID-19 in nursing homes

2021 ◽  
Author(s):  
Rebecca Kahn ◽  
Inga Holmdahl ◽  
Sujan Reddy ◽  
John Jernigan ◽  
Michael J Mina ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Vaccination Coverage ◽  
Nursing Home Residents ◽  
The United States ◽  
Limited Data ◽  
Agent Based ◽  
Symptomatic Disease ◽  
Testing Strategies ◽  
Protection Against Infection

Background: Nursing home residents and staff were included in the first phase of COVID-19 vaccination in the United States. Because the primary trial endpoint was vaccine efficacy (VE) against symptomatic disease, there are limited data on the extent to which vaccines protect against SARS-CoV-2 infection and the ability to infect others (infectiousness). Assumptions about VE against infection and infectiousness have implications for possible changes to infection prevention guidance for vaccinated populations, including testing strategies. Methods: We use a stochastic agent-based SEIR model of a nursing home to simulate SARS-CoV-2 transmission. We model three scenarios, varying VE against infection, infectiousness, and symptoms, to understand the expected impact of vaccination in nursing homes, increasing staff vaccination coverage, and different screening testing strategies under each scenario. Results: Increasing vaccination coverage in staff decreases total symptomatic cases in each scenario. When there is low VE against infection and infectiousness, increasing staff coverage reduces symptomatic cases among residents. If vaccination only protects against symptoms, but asymptomatic cases remain infectious, increased staff coverage increases symptomatic cases among residents through exposure to asymptomatic but infected staff. High frequency testing is needed to reduce total symptomatic cases if the vaccine has low efficacy against infection and infectiousness, or only protects against symptoms. Conclusions: Encouraging staff vaccination is not only important for protecting staff, but might also reduce symptomatic cases in residents if a vaccine confers at least some protection against infection or infectiousness.

scholarly journals Malnutrition Prevalence Rates among Dutch Nursing Home Residents: What Has Changed over One Decade? A Comparison of the Years 2009, 2013 and 2018

2021 ◽  
Author(s):  
Irma H. J. Everink ◽  
J. C. M. van Haastregt ◽  
M. Manders ◽  
M. A. E. de van der Schueren ◽  
J. M. G. A. Schols
Keyword(s):  
Diabetes Mellitus ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Secondary Data ◽  
Binary Logistic Regression ◽  
Total Sample ◽  
Care Quality ◽  
Background Characteristics ◽  
Nursing Home Population

Abstract Objectives To assess changes in prevalence of malnutrition and its associated factors among people living in Dutch nursing homes in 2009, 2013 and 2018. Design Secondary data analysis of the International Prevalence Measurement of Care Quality (LPZ) study. Setting Dutch nursing homes. Participants Residents living at a psychogeriatric or somatic ward in Dutch nursing homes in 2009, 2013 or 2018. Measurements weight and height, unintentional weight loss over the last month and last six months, age, sex, length of stay up to the measurement day, care dependency, and the presence of various diseases (dementia, diabetes mellitus, stroke, diseases of the respiratory system, respiratory diseases and pressure ulcers). Results In total, 14,317 residents were included in this study with a mean age of 82.2, 70.9 female and 66.8% was living on a psychogeriatric ward. Results of this study show relative stability in background characteristics of the nursing home population over the last decade. In the total sample, 16.7% was malnourished and these percentages were 16.6% in 2009, 17.5% in 2013 and 16.3% in 2018. Multiple binary logistic regression analyses revealed having a pressure ulcer, female sex and living on a psychogeriatric department to be positively associated and having diabetes mellitus to be negatively associated with malnutrition throughout the years. These associations were strong and similar across years. Conclusion Even though much attention has been paid to prevent malnutrition in Dutch nursing homes over the last decades, results show a relatively stable malnutrition prevalence rate of around 16%. This leads to the question if nursing staff is able to sufficiently recognize residents with (a risk of) malnutrition, and if they are aware of interventions they could perform to decrease this rate.

scholarly journals Visitation Access to U.S. Nursing Homes: An Analysis of Facility Locations, Ratings, and Disparities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 114-114
Author(s):  
Mary Helander
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Population Data ◽  
Well Being ◽  
Care Quality ◽  
Term Care ◽  
Facility Locations ◽  
Research Findings ◽  
Regular Family

Abstract Research findings suggest that family visits to nursing home residents are important for countering depression, increasing residents’ well-being and quality of life (Miller, 2019; Durkin et al., 2014), maintaining physical function (Shankar et al., 2017), and improving general health (Parmenter et al., 2012). Presence by family can directly impact a resident’s care quality, since family members may take a role in monitoring their older relative’s status (Miller, 2019). Unfortunately, regular family visits to nursing homes may be difficult, or impossible, due to challenges that include distance, travel time, lack of transportation, and cost (Fields et al., 2019) (Miller, 2019). These same challenges may translate to socio-economic barriers for families, eliminating long-term-care as an option for older relatives (Ferraro et al., 2017), (Angel and Berlinger, 2018). This paper considers the issue of nursing home visitation access and examines related disparities through spatial and demographic analysis of 15,000+ US facilities monitored by the Centers for Medicare the Medicaid Services. Mathematical models are used to analyze facility and population data, using access measures adapted from the geography discipline (Lou and Wang, 2003; Paez et al., 2019). Analysis explores whether higher rated nursing homes are more likely to be closer to affluent populations, and whether socioeconomic status is a significant factor in overall access. Analysis reveals patterns of access disparity with respect to nursing home ratings and geographies. For example, proximity to higher rated facilities increases monotonically with median household income. Specific policy recommendations are discussed.

Long-Term Care

2019 ◽  
pp. 606-614
Author(s):  
Joan Carpenter ◽  
Mary Ersek
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Developed Countries ◽  
The United States ◽  
Nursing Home Population ◽  
Care Services ◽  
Challenges And Opportunities ◽  
Palliative Care Services

This chapter examines palliative care across residential care settings with a focus on nursing homes. It reviews the environment of nursing homes, describes the residents who live there, and provides details about the interdisciplinary team providers who care for the residents. It also discusses the challenges and opportunities for delivering palliative care services to nursing home residents with life-limiting illness. Quality end-of-life care in nursing homes is important because more than 1.4 million Americans live in nursing homes, and more than half of these residents require extensive assistance with bathing, dressing, toileting, and mobility. Of those nursing home residents over 65 years of age, 80% are 75 years or older. Despite the efforts to keep frail elders in the community, the nursing home population is expected to increase as the numbers of older persons in the United States and other developed countries increase. The chapter concludes with a description of models for delivering palliative care in nursing homes.

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