The Effects of the Opioid Epidemic on Prescribing Practices in Long-Term Care Residents

2019 ◽  
Vol 34 (4) ◽  
pp. 258-267
Author(s):  
Lisa Yamagishi ◽  
Olivia Erickson ◽  
Kelly Mazzei ◽  
Christine O'Neil ◽  
Khalid M. Kamal
Keyword(s):  
Severe Pain ◽  
Long Term Care ◽  
Care Facility ◽  
The United States ◽  
Self Report ◽  
Prescribing Practices ◽  
Term Care ◽  
Data Set ◽  
Opioid Prescribing

OBJECTIVE: Evaluate opioid prescribing practices for older adults since the opioid crisis in the United States.<br/> DESIGN: Interrupted time-series analysis on retrospective observational cohort study.<br/> SETTING: 176-bed skilled-nursing facility (SNF).<br/> PARTICIPANTS: Patients admitted to a long-term care facility with pain-related diagnoses between October 1, 2015, and March 31, 2017, were included. Residents discharged prior to 14 days were excluded. Of 392 residents, 258 met inclusion criteria with 313 admissions.<br/> MAIN OUTCOME MEASURE: Changes in opioid prescribing frequency between two periods: Q1 to Q3 (Spring 2016) and Q4 to Q6 for pre- and postgovernment countermeasure, respectively.<br/> RESULTS: Opioid prescriptions for patients with pain-related diagnoses decreased during period one at -0.10% per quarter (95% confidence interval [CI] -0.85-0.85; P = 0.99), with the rate of decline increasing at -3.8% per quarter from period 1 and 2 (95% CI -0.23-0.15; P = 0.64). Opioid prescribing from top International Classification of Diseases, Ninth Revision category, "Injury and Poisoning" decreased in prescribing frequency by -3.0% per quarter from Q1 to Q6 (95% CI -0.16-0.10; P = 0.54). Appropriateness of pain-control was obtained from the Minimum Data Set version 3.0 "Percent of Residents Who Self-Report Moderate to Severe Pain (Short Stay)" measure; these results showed a significant increase in inadequacy of pain relief by 0.28% per quarter (95% CI 0.12-0.44; P = 0.009).<br/> CONCLUSION: Residents who self-report moderate- to severe pain have significantly increased since October 2015. Opioid prescriptions may have decreased for elderly patients in SNFs since Spring 2016. Further investigation with a larger population and wider time frame is warranted to further evaluate significance.

scholarly journals FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Rebecca L Mauldin ◽  
Kathy Lee ◽  
Antwan Williams
Keyword(s):  
Long Term Care ◽  
Federal Policy ◽  
Care Facility ◽  
Well Being ◽  
The United States ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.

Palliative Management of Parkinson Disease: Focus on Nonmotor, Distressing Symptoms

2008 ◽  
Vol 21 (4) ◽  
pp. 262-272 ◽  
Author(s):  
Jack J. Chen ◽  
Dominick P. Trombetta ◽  
Hubert H. Fernandez
Keyword(s):  
Parkinson Disease ◽  
Long Term Care ◽  
Functional Dependence ◽  
Care Facility ◽  
The United States ◽  
Elderly Persons ◽  
Motor Complications ◽  
Term Care ◽  
Increased Risk

Parkinson disease is a progressive neurodegenerative disease that commonly affects elderly persons. In the absence of neuroprotective or curative therapies, currently available therapies only provide symptomatic benefit. Progression to advanced Parkinson disease is often accompanied by functional dependence with increased risk of admission to a long-term care facility. The prevalence of Parkinson disease in long-term care facilities, within the United States, has been estimated to be between 5.2% and 10%. Patients with advanced Parkinson disease also experience other distressing motor and nonmotor conditions, such as motor complications, dementia, depression, gastrointestinal distress, orthostatic hypotension, pain, and psychosis, which can be a challenge for clinicians to manage. The presence of distressing symptoms along with the fact that Parkinson disease remains incurable necessitate discussion on a palliative care approach to this disorder. This article discusses the symptomatic management of distressing symptoms encountered in the long-term care resident with Parkinson disease, including motor complications and nonmotor features.

scholarly journals Long-term Care Facility Variation in the Incidence of Pneumonia and Influenza

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Elliott Bosco ◽  
Andrew R Zullo ◽  
Kevin W McConeghy ◽  
Patience Moyo ◽  
Robertus van Aalst ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Long Term Care ◽  
Care Facility ◽  
Physician Assistants ◽  
Incidence Rates ◽  
Short Stay ◽  
Term Care ◽  
Data Set ◽  
Facility Level

Abstract Background Pneumonia and influenza (P&I) increase morbidity and mortality among older adults, especially those residing in long-term care facilities (LTCFs). Facility-level characteristics may affect the risk of P&I beyond resident-level risk factors. However, the relationship between facility characteristics and P&I is poorly understood. To address this, we identified potentially modifiable facility-level characteristics that influence the incidence of P&I across LTCFs. Methods We conducted a retrospective cohort study using 2013–2015 Medicare claims linked to Minimum Data Set and LTCF-level data. Short-stay (&lt;100 days) and long-stay (100+ days) LTCF residents were followed for the first occurrence of hospitalization, LTCF discharge, Medicare disenrollment, or death. We calculated LTCF risk-standardized incidence rates (RSIRs) per 100 person-years for P&I hospitalizations by adjusting for over 30 resident-level demographic and clinical covariates using hierarchical logistic regression. Results We included 1 767 241 short-stay (13 683 LTCFs) and 922 863 long-stay residents (14 495 LTCFs). LTCFs with lower RSIRs had more licensed independent practitioners (nurse practitioners or physician assistants) among short-stay (44.9% vs 41.6%, P &lt; .001) and long-stay residents (47.4% vs 37.9%, P &lt; .001), higher registered nurse hours/resident/day among short-stay and long-stay residents (mean [SD], 0.5 [0.7] vs 0.4 [0.4], P &lt; .001), and fewer residents for whom antipsychotics were prescribed among short-stay (21.4% [11.6%] vs 23.6% [13.2%], P &lt; .001) and long-stay residents (22.2% [14.3%] vs 25.5% [15.0%], P &lt; .001). Conclusions LTCF characteristics may play an important role in preventing P&I hospitalizations. Hiring more registered nurses and licensed independent practitioners, increasing staffing hours, and higher-quality care practices may be modifiable means of reducing P&I in LTCFs.

scholarly journals BETTER LIVING THROUGH TECH: TECHNOLOGY-MEDIATED RECREATION AND LONG-TERM CARE FACILITY RESIDENTS’ QUALITY OF LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S442-S442
Author(s):  
Ethan A McMahan ◽  
Marion Godoy ◽  
Abiola Awosanya ◽  
Robert Winningham ◽  
Charles De Vilmorin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Data Set ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract Empirical research on long-term care facility resident engagement has consistently indicated that increased engagement is associated with more positive clinical outcomes and increased quality of life. The current study adds to this existing literature by documenting the positive effects of technologically-mediated recreational programing on quality of life and medication usage in aged residents living in long-term care facilities. Technologically-mediated recreational programming was defined as recreational programming that was developed, implemented, and /or monitored using software platforms dedicated specifically for these types of activities. This study utilized a longitudinal design and was part of a larger project examining quality of life in older adults. A sample of 272 residents from three long-term care facilities in Toronto, Ontario participated in this project. Resident quality of life was assessed at multiple time points across a span of approximately 12 months, and resident engagement in recreational programming was monitored continuously during this twelve-month period. Quality of life was measured using the Resident Assessment Instrument Minimum Data Set Version 2.0. Number of pharmacological medication prescriptions received during the twelve-month study period was also assessed. Descriptive analyses indicated that, in general, resident functioning tended to decrease over time. However, when controlling for age, gender, and baseline measures of resident functioning, engagement in technologically-mediated recreational programming was positively associated with several indicators of quality of life. The current findings thus indicate that engagement in technology-mediated recreational programming is associated with increased quality of life of residents in long-term care facilities.

Cycling Without Age Program: The Impact for Residents in Long-Term Care

2019 ◽  
Vol 42 (9) ◽  
pp. 728-735 ◽  
Author(s):  
Paula McNiel ◽  
Judith Westphal
Keyword(s):  
Lived Experience ◽  
Long Term Care ◽  
Care Facility ◽  
The United States ◽  
Structured Interviews ◽  
Term Care ◽  
Long Term Care Facility ◽  
Centered Care ◽  
The Impact

Long-term care facilities seek ways to enhance the quality of life for residents. Cycling Without Age (CWA), a new international cycling program, is gaining momentum for older adults. This study explored resident riders’ and trishaw pilots’ lived experience of their participation in the CWA program using a qualitative approach at a long-term care facility in the United States. Researchers conducted 27 face-to-face, semi-structured interviews with riders and pilots. For resident riders, the three themes identified included (a) breath of fresh air; (b) wave, chat, and remember; and (c) sit back and relax. Two themes were identified for the pilots: (a) change in frame of mind, and (b) mental and physical rewards. CWA can be as a new strategy for person-centered care. The CWA program provides nursing an opportunity to advocate, recommend, and obtain an order for residents to participate in the program.

The burden of gastroenteritis outbreaks in long-term care settings in Philadelphia, 2009–2018

2020 ◽  
Vol 41 (11) ◽  
pp. 1310-1314
Author(s):  
Hansol Kang ◽  
Yvette Khachadourian ◽  
Dana Perella ◽  
Tiina M. Peritz ◽  
Kristen A. Feemster ◽  
...  
Keyword(s):  
Long Term Care ◽  
Gastrointestinal Symptoms ◽  
Care Facility ◽  
The United States ◽  
Cross Sectional Study ◽  
Quality Data ◽  
Cross Sectional ◽  
Term Care ◽  
Outbreak Management

AbstractObjective:Gastroenteritis causes significant morbidity and mortality in long-term care facility (LTCF) residents, a growing population within the United States. We set out to better understand gastroenteritis outbreaks in LTCF by identifying outbreak and facility characteristics associated with outbreak incidence as well as outbreak duration and size.Design:We conducted a retrospective cross-sectional study on LTCFs in Philadelphia County from 2009 to 2018. Outbreak characteristics and interventions were extracted from Philadelphia Department of Public Health (PDPH) database and quality data on all LTCFs was extracted from Centers for Medicare and Medicaid Services Nursing Home Compare database.Results:We identified 121 gastroenteritis outbreaks in 49 facilities. Numbers of affected patients ranged from 2 to 211 patients (median patient illness rate, 17%). Staff were reported ill in 94 outbreaks (median staff illness rate, 5%). Outbreak facilities were associated with higher occupancy rates (91% vs 88%; P = .033) and total bed numbers (176 vs 122; P = .071) compared to nonoutbreak facilities. Higher rates of staff illness were associated with prolonged outbreaks (13% vs 4%; P < .001) and higher patient illness rates (9% vs 4%; P = .012). Prolonged outbreaks were associated with lower frequency of cohorting for outbreak management (13% vs 41%; P = .046).Conclusion:This study is the largest published analysis of gastroenteritis outbreaks in LTCFs. Facility characteristics and staff disease activity were associated with more severe outbreaks. Heightened surveillance for gastrointestinal symptoms among staff and increased use of cohorting might reduce the risk of prolonged gastroenteritis outbreaks in LTCF.

scholarly journals LONG-TERM CARE FACILITY VARIATION IN THE INCIDENCE OF PNEUMONIA AND INFLUENZA HOSPITALIZATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S821-S822
Author(s):  
Elliott Bosco ◽  
Andrew Zullo ◽  
Kevin McConeghy ◽  
Patience Moyo ◽  
Robertus van Aalst ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Long Term Care ◽  
Care Facility ◽  
Incidence Rates ◽  
Short Stay ◽  
Term Care ◽  
Data Set ◽  
Facility Level ◽  
Physician Extenders

Abstract Pneumonia and influenza (P&I) increase morbidity and mortality among older adults, especially those residing in long-term care facilities (LTCFs). Facility-level characteristics may affect P&I risk beyond resident-level determinants. However, the relationship between facility characteristics and P&I is poorly understood. We therefore identified potentially modifiable facility-level characteristics that might influence the incidence of P&I across LTCFs. We conducted a retrospective cohort study using 100% of 2013-2015 Medicare claims linked to Minimum Data Set 3.0 and LTCF-level data. Short-stay (&lt;100 days) and long-stay (≥100 days) LTCF residents aged ≥65 were followed for the first occurrence of hospitalization, LTCF discharge, Medicare disenrollment, or death. We calculated LTCF risk-standardized incidence rates (RSIRs) per 100 person-years for P&I hospitalizations by adjusting for over 30 resident-level demographic and clinical covariates using hierarchical logistic regression. The final study cohorts included 1,767,241 short-stay (13,683 LTCFs) and 922,863 long-stay residents (14,495 LTCFs). LTCFs with lower RSIRs had more Physician Extenders (Nurse Practitioners or Physician’s Assistants) among short-stay (44.9% vs. 41.6%, p&lt;0.001) and long-stay residents (47.4% vs. 37.9%, p&lt;0.001), higher Registered Nurse hours/resident/day among short-stay and long-stay residents (Mean (SD): 0.5 (0.7) vs. 0.4 (0.4), p&lt;0.001), and fewer residents prescribed antipsychotics among short-stay (21.4% (11.6) vs. 23.6% (13.2), p&lt;0.001) and long-stay residents (22.2% (14.3) vs. 25.5% (15.0), p&lt;0.001). LTCF characteristics may play an important role in preventing P&I hospitalizations. Hiring more Registered Nurses and Physician Extenders, increasing staffing hours, and reducing antipsychotic use may be modifiable means of reducing P&I in LTCFs. Funding provided by Sanofi Pasteur.

Control of Influenza in the Long-Term–Care Facility: A Review of Established Approaches and Newer Options

2000 ◽  
Vol 21 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Nancy H. Arden
Keyword(s):  
Influenza Vaccine ◽  
Long Term Care ◽  
Antiviral Agents ◽  
Care Facility ◽  
The United States ◽  
Elderly Persons ◽  
Term Care ◽  
Long Term Care Facility ◽  
Live Attenuated Influenza Vaccine

AbstractInfluenza infections pose a serious threat to residents of nursing homes and other long-term–care facilities. Annual vaccination of residents and staff with the currently licensed inactivated influenza vaccine continues to be the mainstay of prevention. Live attenuated influenza vaccine, which is expected to be licensed in the United States in the near future, may offer added protection for elderly persons when administered in conjunction with inactivated vaccine. Antiviral agents also can be useful as an adjunct to vaccination, especially for control of institutional outbreaks. Two new antiviral agents that appear to be less toxic than amantadine and rimantadine have recently been approved.

Namaste Care™: A Person-Centered Care Approach for Alzheimer’s and Advanced Dementia

2016 ◽  
Vol 40 (1) ◽  
pp. 37-51 ◽  
Author(s):  
Paula McNiel ◽  
Judith Westphal
Keyword(s):  
Long Term Care ◽  
Hospital Readmissions ◽  
Care Facility ◽  
The United States ◽  
Term Care ◽  
Long Term Care Facility ◽  
Staff Members ◽  
People With Dementia ◽  
The Impact

New methods of care are required to meet the needs of people with dementia and their caregivers. The Namaste Care™ program provides a person-centered approach through meaningful activities and loving touch. The purpose of this qualitative study was to explore the experiences of residents, staff, and family involved in the Namaste Care™ program at a long-term care facility in the United States. A descriptive approach was used to interview 14 staff members. The findings revealed six themes: peaceful sanctuary, relating their way, transforming experiences, connections and community, positive moments, and awakened to the possibilities. Results suggest that Namaste Care™ may be useful for individuals no longer able to participate in traditional long-term care setting activities. Further studies are indicated to confirm the impact on hospital readmissions, therapy enhancement, and medication use in relationship to Namaste Care™ program participation.

scholarly journals Impact of Antimicrobial Prescribing Practices on Urinary Resistance at a Veteran's Affairs Long-Term Care Facility

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Christopher Cooper ◽  
Ryan Kuhn ◽  
Laxmi R. Chigurupati ◽  
Barbara Siepierski ◽  
Keith S. Kaye ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Prescribing Practices ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Antimicrobial Prescribing ◽  
Veteran's Affairs
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