Reducing Hospital Readmissions of Older Adults Pursuing Postacute Care at Skilled Nursing Facilities: A Scoping Review

Importance: Unplanned hospital readmissions can profoundly affect older adults’ quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy’s involvement remains unclear. Objective: To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy’s scope of practice. Data Sources: We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. Findings: Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients’ needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. Conclusions and Relevance: Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy’s value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy’s domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.

Covid-19 in Hospitalized Patients Admitted from Skilled Nursing Facilities: Factors Associated with Mortality

Background Nursing home residents were impacted disproportionately by the coronavirus because of their vulnerabilities. Although many studies concentrated on risk factors associated with mortality of hospitalized patients, there were limited studies epitomizing them from skilled nursing facilities to hospitals. The study aims to identify inpatients’ characteristics on demographics, hospital admission types, insurance types, and chronic diseases associated with mortality among our cohort patients in Texas. Methods Individuals above 50 years, diagnosed with Covid-19, and admitted from skilled nursing facilities were included in the retrospective cohort study. Pearson’s Chi-Square and Mann-Whitney tests were applied to measure four major perspectives between survivors and non-survivors. Then, a binary logistic regression was employed to determine the association between independent variables and mortality. Results A total of 218 patients were included in the study, of which 54 (24.8%) died during hospitalization. According to the univariate analysis, expired patients were more likely to be emergency admission (p = 0.001), elective admission (p = 0.02), Medicaid as primary payment (p = 0.034), heart disease (p = 0.027), CKD (p = 0.03), and hypertension (p = 0.002). The binary logistic regression revealed that hypertension (OR = 3.176, 95% CI: 1.200-8.409, p = 0.02) and Medicaid (OR = 2.637, 95% CI: 1.287-5.405, p = 0.008) as primary payment had significantly high odds of mortality. Conclusion Hypertension and Medicaid as primary payment are the strongest predictive factors associated with mortality and suggest that hospitals in Texas distribute critical care and resources while prevent and treat them to increase survival rates.

Sexual Expression, Policy, and Practices in Skilled Nursing Facilities: An Updated Assessment in the State of Kansas

Prior studies have reported barriers to meeting the sexual needs of older adults within skilled-nursing facilities, such as a lack of privacy, lack of supportive practices and policies, and judgement or discomfort on the part of the staff (Doll, 2013; Hajjar & Kamel, 2003). In 2008, Doll and colleagues assessed the scope of sexual behaviors, staff perceptions of and responses to such behaviors, and whether facilities had a sexual policy in place in SNFs in the state of Kansas (Doll, 2013). In the present study, an online survey was distributed to the same population to provide an updated assessment of sexual behaviors, policies, and practices. Of 60 survey respondents, 62.7% reported knowledge of individual sexual acts (e.g., masturbation) within the past year and 34.5% reported interactional (between two or more residents) sexual acts. When encountering a sexual event, staff were most likely to report the incident to an administrator (76.7%) and treat residents with respect (70.0%), while 35.0% and 41.7% were expected to respond with embarrassment and discomfort, respectively. Only 40% of administrators reported having a policy related to sexual expression. Findings indicate that staff are likely to respond differently to LGBTQ residents due to discomfort and those living with cognitive impairment due to concerns related to consent. The proportion of facilities in Kansas with policies related to sexual expression has increased from 26% to 40% in the past 12 years, but there remains a need for greater specificity of sexuality-related policies and trainings.

Leadership among Director of Social Work at Skilled Nursing Facilities (SNFs)

Skilled Nursing Facilities (SNFs) provide ongoing care to the seniors and chronically ill. To maximize the quality of this care, SNF staff must be trained to respond to patient care crises and communicate across departments. Although researchers have studied the leadership styles, strategies, and interactions of facility administrators and nursing directors, little was known about the leadership styles and strategies imployed by the director of social worker (DSW). The aim of this phenomenological study was to explore how DSW influenced leadership policies, prepared subordinated for crisis intervention and management, perceived that social workers influenced patient care decisions, and believed that communication amongst SNF staff about patient care could be improved. The conceptual framework was based on the multilevel leadership model construct, the situational leadership model construct, and the complex adaptive leadership model construct. Participants included a purposive sample of 10 DSW working in a large, corporate SNFs in Virginia. Data were collected via in person, semi structured interviews consisting of open-ended questions. Data were analyzed via Hycner's phenomenological approach. Findings from this investigation helped clarify roles and responsibilities of DSW, thereby improving the leadership they provide to subordinate social workers. Findings may be used to improved communication across professionals within SNFs and in their role in patient decisions.

COVID-19 Vaccines in Skilled Nursing Facilities: Recurring Interviews with Administrators

Skilled nursing facilities (SNFs) are on the front lines of changing policies regarding the COVID-19 pandemic. The most recent development is a potential vaccine mandate for staff working in SNFs. We use ongoing findings from 130 of 160 in-depth, semi-structured interviews in progress with administrators at 40 SNFs in eight diverse healthcare markets across the United States to understand the current landscape of COVID-19 in SNFs. Four repeated interviews at 3-month intervals provide a unique longitudinal perspective on the impact of COVID-19 and SNFs’ response to vaccinations, including the vaccine mandate. Rigorous thematic analysis reveals insights into administrator responses and creative approaches to address vaccine hesitancy, and future expectations for SNF operations in light of the vaccine and the mandate. Administrators express cautious hope that the vaccine will allow SNFs to return to a new normal of daily life for residents in terms of family visitations, communal dining, and resident activities. Overriding questions include how to overcome persistent vaccine hesitancy from SNF staff who cite fear of side effects despite education initiatives and how to stem staff retirement or transition to other healthcare settings. SNFs represent a microcosm of the country’s concerns as a whole. Insight into the evolving and complex dynamics shed important light on national trends and help provide solutions for moving forward. Findings from this study have implications for policymakers and SNF leadership as they consider ways to promote vaccination and retain staff amid vaccine mandates.