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1
Basnet, Prasanna, Gayle Acton, and Jane D. Champion. "MANAGEMENT OF NONCOGNITIVE NEUROPSYCHIATRIC SYMPTOMS OF DEMENTIA IN NURSING HOME RESIDENTS." Innovation in Aging 3, Supplement_1 (November 2019): S507. http://dx.doi.org/10.1093/geroni/igz038.1874.
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Abstract Background: It is challenging for nursing home (NH) staff to manage non-cognitive neuropsychiatric symptoms (NPS) of dementia. There is a need for an assessment of staff knowledge regarding non-pharmacological approaches to manage NPS of dementia. This assessment will inform development of policies/procedures to assist NH staff for management of problematic behaviors in residents with dementia (RWD) using non-pharmacological approaches thereby complying with CMS directives to reduce psychotropic medication use. Methods: NH staff members were interviewed using semi-structured interview methods. Interviews continued until thematic saturation was reached. A total of 17 interviews were completed. Findings: Forgetfulness, hallucinations, anger, agitation, combativeness are the most common problematic dementia behaviors. Participants reported that these behaviors make activities of daily living (ADL) care challenging and time-consuming. Redirection, distraction, and recreational activities are the most common approaches identified by participants to manage non-cognitive NPS using non-pharmacological techniques. Participants reported rushing residents to get things done hinders cooperation and escalate problematic behavior. Some participants believed the use of a low dose PRN benzodiazepine is effective as this calms the resident with dementia and reduces NH staff time requirements for assistance with ADL care. Participants described adverse reactions such as weight loss, and general decline as an outcome of somnolence secondary to psychotropic medications use. Implications: NH staff who participated in this project had not received any formal education or instruction concerning non-pharmacological approaches for the management of non-cognitive NPS. NH protocols are indicated for non-pharmacologic behavior management techniques prior to the administration of psychotropic medications.
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Veldwijk-Rouwenhorst, Annelies E., Martin Smalbrugge, Sytse U. Zuidema, Suzan A. J. Hanssen, Raymond T. C. M. Koopmans, and Debby L. Gerritsen. "210 - Palliative Care in Dementia." International Psychogeriatrics 32, S1 (October 2020): 53–54. http://dx.doi.org/10.1017/s1041610220002008.
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Introduction:Extreme neuropsychiatric symptoms (NPS) can be a heavy burden for nursing home (NH)-residents, relatives and caregivers. When conventional treatments are ineffective or have intolerable side effects, extreme NPS can be considered refractory. In these situations, continuous palliative sedation (CPS) is sometimes administered. We explored the trajectory leading to CPS and its application in NH-residents with dementia and refractory NPS.Methods:A qualitative interview study was performed in 2017. Relatives, elderly care physicians and other staff members involved with three NH-residents with dementia and extreme refractory NPS who received CPS were interviewed. These NH-residents lived on dementia special care units of three NHs in the Netherlands. We used consecutive sampling to select participants. Medical files were studied. Semi-structured interviews were conducted. Transcriptions were analyzed with thematic analysis, including directed content analysis.Results:Nine in-depth interviews with fourteen participants were held. Analysis resulted in five main themes with several subthemes reflecting phases of the trajectory leading to CPS and the CPS application itself, a sixth main theme concerned evaluations thereof. According to the first theme (run-up), the suffering of the NH-resident was described as unbearable/an inner struggle. Participants still had hope for improvement. Concerning the second theme (turning point), hope was lost, participants were convinced they had tried everything and experienced feelings of powerlessness and failure. Regarding theme three (considering CPS), intermittent sedation was applied in all three cases and peer consultation was employed. Honoring the wish of the NH-resident and therapeutic uncertainties, among others, were important subthemes. According to theme four (decision to start CPS), in each case one specific aspect was a decisive trigger for administering CPS. Concerning theme five (applying CPS) feelings of relief were experienced after starting with CPS.Conclusions:The trajectory leading up to CPS in NH-residents with dementia and extreme refractory NPS was complex and burdensome, but the application led to relief and contentment of all those involved. We recommend to include external consultation in the decision process and to apply intermittent sedation as a preceding step when CPS is considered.
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Faraday, James, Clare Abley, Catherine Exley, and Joanne Patterson. "Mealtime Care for People With Dementia: What Do Nursing Home Staff Think?" Innovation in Aging 4, Supplement_1 (December 1, 2020): 182–83. http://dx.doi.org/10.1093/geroni/igaa057.591.
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Abstract More and more people with dementia are living in nursing homes (NH). Often, they depend on NH staff for help with eating and drinking. It is important that staff have the skills and support they need to provide good care at mealtimes. This qualitative study explores mealtime care for people with dementia, from the perspective of NH staff. Semi-structured interviews with NH staff (n=16) were carried out in two nursing homes. The homes were chosen to have diverse characteristics: one home had a large number of beds and was part of a small local organization; the other had a small number of beds and was part of a large national organization. Various staff members were interviewed, including direct care staff, senior carers, nurses, managers, and kitchen staff. Interviews were audio-recorded and transcribed verbatim. A constant comparison approach was taken, so that data from early interviews were explored in more depth subsequently. From the analysis, five themes emerged as important in mealtime care for people with dementia living in nursing homes: Setting the right tone; Working well as a team; Knowing the residents; Promoting autonomy and independence; Gently persevering. This work forms part of a larger ethnographic study on the topic, which includes data from residents with dementia, and family carers. Results will inform the development of a staff training intervention to optimize mealtime care for this population.
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Caldera, Selena. "UNDERSTANDING RACIAL AND ETHNIC DISPARITIES IN NURSING HOME CARE IN COOK COUNTY, IL." Innovation in Aging 6, Supplement_1 (November 1, 2022): 149. http://dx.doi.org/10.1093/geroni/igac059.593.
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Abstract Nursing facility data from the Illinois Department of Public Health reveals significant racial disparities in access to high quality nursing homes (NH) for older Black and Latino Illinoisans. While half of all Illinois NH residents live in a 1- or 2- star rated nursing home, 68% of Black NH residents live in such facilities. This study seeks to understand racial and ethnic disparities in access to, quality of, and experiences with care in Cook County, Illinois NHs and develop community-identified solutions to close quality, access, and equity gaps. We employ key informant interviews in a two-stage process that begins by developing a current state analysis of the experience with care through interviews with community stakeholders, including advocacy groups, policy and community leaders and public agencies. Those findings then guide interviews with older Black, Latino, and Chinese NH residents and their caregivers where we identify community-grounded solutions to closing equity gaps.
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Carter, Eileen, Christine E. DeForge, Monika Pogorzelska-Maziarz, Grace Mackson, Patricia W. Stone, and Jingjing Shang. "149. Unmet Informational Needs among Nursing Home Residents Receiving Antibiotics: A Qualitative Study." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S84—S85. http://dx.doi.org/10.1093/ofid/ofaa439.194.
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Abstract Background Antibiotics are commonly used in the nursing home (NH) setting and increase residents’ risk for opportunistic and painful infections. Existing evidence of NH residents’ experiences and attitudes towards antibiotic use is limited. We aimed to explore NH residents’ experiences and perceptions of the benefits and risks to antibiotic treatment. Methods Two researchers conducted one-on-one semi-structured interviews with residents residing in a large not-for-profit NH in New York City. Interviews were audio-recorded and transcribed verbatim. Researchers coded the transcripts using thematic analysis in NVivo 12. Results A total of 26 residents engaged in individual interviews. Participants had a mean age of 76. Most were white (81%), female (58%) and had attended college (58%). Four thematic findings emerged: 1) participants’ involvement in antibiotic treatment decisions; 2) perceived benefits and risks to antibiotics; 3) unmet informational needs; and 4) suggestions to overcome informational needs. Participants described varied involvement in antibiotic treatment decisions, in which some participants described insisting antibiotics from their clinicians and others described leaving antibiotic treatment decisions entirely to the judgement of clinicians. Benefits of antibiotics were well-articulated, yet risks (side effects including antibiotic resistance) to antibiotics were poorly described. Participants reported unmet information needs, including concerns regarding potential drug interactions. Information needs were described to result from a lack of communication with NH staff and/or poor memory among NH residents. Participants suggested that NH residents receive written material regarding their antibiotic prescriptions and provided the types of information that would be helpful for NH residents to know. Descriptions of themes and representative quotes are provided in Figure. Table. Thematic Findings and Representative Quotes Conclusion NH residents expressed a lack of understanding of risks to antibiotic use, unmet informational needs regarding their antibiotic treatments and articulated suggestions to address these information needs. Disclosures All Authors: No reported disclosures
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Davila, Heather, Tetyana P. Shippee, Young Shin Park, Daniel Brauner, and R. Tamara Konetzka. "INS, OUTS, AND UNINTENDED CONSEQUENCES OF THE CMS NURSING HOME QUALITY MEASURES." Innovation in Aging 3, Supplement_1 (November 2019): S155. http://dx.doi.org/10.1093/geroni/igz038.556.
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Abstract Ongoing concerns about the quality of care provided to nursing home (NH) residents have led the federal government to develop quality measures (QMs) for NHs. Many of these QMs are included in the NH 5-star ratings and reported online via Nursing Home Compare. However, we know little about how NH providers view the QMs, challenges they experience in addressing the measures, and strategies they use to achieve better scores. As part of a broader mixed-methods study to understand how NHs are responding to the 5-star ratings, we conducted interviews with NH personnel (n=110) and observed organizational processes in 12 NHs in three states. We also interviewed policy and industry leaders (n=34) to gain their perspectives. Interviews focused on perceptions of the 5-star ratings, organizational strategies to improve 5-star scores, experiences with the survey/regulatory process, and perceptions and responses to individual QMs. Key themes show that a) NH providers view the QMs as important indicators of quality, but there is variability across indicators; b) providers face challenges related to measurement and definitions for certain QMs (e.g., pain, restraints); and c) there are potentially conflicting goals, where some QMs aim to promote safety at the expense of resident autonomy and quality of life and vice versa. This work provides organizational context to the 5-star measures and the balancing act providers engage in to assess and improve their scores. The findings also identify several potentially unintended consequences related to the QMs, which can adversely affect residents, particularly those with more complex care needs.
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Van Voorden, Gerrie, Mijke Lips, Sytse Zuidema, Richard Christiaan Oude Voshaar, Martin Smalbrugge, Anne M. A. Van Den Brink, Anke Persoon, Raymond T. Koopmans, and Debby L. Gerritsen. "423 - Characteristics of specialized units for people with dementia and very severe challenging behavior in the Netherlands: a mixed method study." International Psychogeriatrics 33, S1 (October 2021): 45. http://dx.doi.org/10.1017/s1041610221001824.
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Introduction:Little is known about the raising number of specialized units for patients with dementia and very severe challenging behavior in the Netherlands. This study describes organizational and treatment characteristics of a sample of these units.Methods:The organizational and treatment characteristics were studied with digital questionnaires completed by the unit managers, interviews with the main physician(s) and observation of the physical environment. The questionnaire consisted of questions about general patient characteristics, unit characteristics and staff characteristics. Furthermore, an interview was held with the main/treating physician often together with another physician or psychologist. The interview guide consisted of questions about admission criteria, the role of staff involved and the treatment process.Results:Thirteen units participated. Five units were part of a mental health (MH) institution, seven units were part of a nursing home (NH) organization and one unit was a cooperation of MH and NH. Unit sizes ranged from 10 to 28 places. Ten of thirteen units started in 2010 or later. The age of patients admitted was estimated at 75 years. The percentage of involuntary admitted patients was 53% at MH-units and 18% at NH-units. Unit managers mentioned that due to a difference in reimbursement between MH and NH units had difficulty providing the specialized care. Another problem managers faced was recruiting nursing staff. Units strived for expertise in general staffing from both MH and NH. The education level of the nursing staff was comparable between MH and NH. At every unit a physician with background in elderly care medicine or geriatrics and a psychiatrist was involved. Interviewees stressed the role of the nursing staff in the treatment. They were key in providing the care and treatment that, since the main goal of interventions is treatment of and coping with challenging behavior.Conclusion:The main finding of this study is that units caring for patients with dementia and challenging behavior, despite barriers in regulations and staffing shortage, search for combining expertise from nursing home care and psychiatry in their treatment.
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Polk, Brian K., Farida Ejaz, and Miriam Rose. "LEARNING FROM LIFE STORIES: RECRUITING NURSING HOME RESIDENTS FOR A LIFE STORY WORK PROGRAM." Innovation in Aging 3, Supplement_1 (November 2019): S306. http://dx.doi.org/10.1093/geroni/igz038.1122.
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Abstract Recruiting nursing home (NH) residents to participate in program evaluations is a consistent challenge. This was evident in a federally supported project to improve person-centered care of long-stay NH residents enrolled in Medicaid. Evaluators sought to examine the impact of a life story work intervention using a pre-post study design involving interviews of NH residents and surveys of their family members and staff. Other resident eligibility criteria included willingness to participate in both research and life story interviews, age 60+, a Brief Inventory Mental Status (BIMS) score of 8 or higher, English-speaking, and consent from a legal guardian, if applicable. A total of 16 NHs agreed to participate in the implementation and evaluation of the program, which developed complimentary, individualized life story booklets for residents and a companion summary for staff. Of the homes’ combined population of 1,817 residents, 569 met eligibility criteria for the research study. Non-response from legal guardians excluded 37 residents, and 174 residents approached for recruitment declined to have their names released to the researchers. During baseline interviews, 20 residents failed the BIMS, 21 were unavailable, and 79 refused when approached by a research interviewer. Ultimately, 238 resident interviews were completed at baseline. Common themes for refusals included disinterest in participating in life story work, statements that theirs was not a good life worth talking about, and doubts that quality of care would improve. Strategies for addressing such challenges included displaying sample life story materials during recruitment and providing residents additional time to consider participation.
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Hicks, Nytasia, Katherine Abbott, Allison Heid, Kendall Leser, and Kimberly Van Haitsma. "Patterns of preference importance ratings among African-American and White nursing home residents." Innovation in Aging 4, Supplement_1 (December 1, 2020): 836. http://dx.doi.org/10.1093/geroni/igaa057.3063.
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Abstract Background: The Preferences for Everyday Living Inventory (PELI) was developed to assess the psychosocial preferences of older adults receiving home care (PELI-HC) and then revised for nursing home residents (PELI-NH). While the PELI-HC has been tested to identify patterns in preference ratings by race, the PELI-NH has not. We sought to explore whether the PELI-NH tool captures differences in preference ratings of African-American and White NH residents. Methods: Preference assessment interviews were conducted with NH residents (n = 317). Analysis via a Mann-Whitney U test, results show that 46 of 72 (63.88%) a preference importance items were not statistically different between African-American and White NH residents. Additionally, African-Americans reported greater importance than White older adult NH residents in 26 of 72 (36%) preference importance items. Conclusion/Implications: It appears that the PELI-NH can test group differences in preference importance among African-American and White NH residents; implications for practice will be discussed. Part of a symposium sponsored by the Research in Quality of Care Interest Group.
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Davila, Heather, Tetyana P. Shippee, Weiwen Ng, Odichinma C. Akosionu, and Beth Virnig. "GENDER DIFFERENCES IN NURSING HOME RESIDENT QUALITY OF LIFE: WHY WOMEN DO BETTER." Innovation in Aging 3, Supplement_1 (November 2019): S504—S505. http://dx.doi.org/10.1093/geroni/igz038.1866.
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Abstract Despite research documenting gender differences in numerous outcomes in later life, we know little about gender differences in quality of life (QoL) for older adults who receive institutional long-term care. To address this gap, this study examines the relationship between gender and nursing home (NH) residents’ QoL, including possible reasons for differences observed. We used a mixed methods design including surveys with a random sample of Minnesota NH residents using a multidimensional measure of QoL (n=8,870), resident clinical data, facility-level characteristics, and qualitative interviews with NH residents (n=64). We used mixed models and thematic analysis of resident interviews to examine possible differences in resident QoL based on gender. After controlling for individual and facility characteristics, women reported higher overall QoL than men, with men reporting significantly lower QoL in 4 of 8 QoL domains. In interviews, men noted being especially dissatisfied with facility activities, whereas women more frequently described having friends in the facility and relying on family for support. Some women viewed the NH as a place of respite and described wanting to stay long-term, even though their families asked them to return home. In contrast, men more often described the NH as necessary due to physical needs, but undesirable for long-term living. Our findings provide preliminary evidence that men and women experience QoL differently, with men reporting lower QoL in several domains. Tailoring more activities for men and finding ways to strengthen relationships for men within the facility may help reduce the gender disparities in QoL we observed.
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Stephens, Caroline, Elizabeth Halifax, Nhat Bui, Sei J. Lee, Charlene Harrington, Janet Shim, and Christine Ritchie. "Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life." Current Gerontology and Geriatrics Research 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/893062.
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Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED).Methods. Multiple stakeholder focus groups (n=35participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach.Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care.Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers.
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Peterson, Lindsay, David Dosa, and Patricia D’Antonio. "Vulnerable Older Adults in Disasters: Effects of Hurricane Irma on Nursing Homes and Assisted Living." Innovation in Aging 4, Supplement_1 (December 1, 2020): 733–34. http://dx.doi.org/10.1093/geroni/igaa057.2607.
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Abstract Preparedness of residents in long-term care (LTC) in the face of hurricane emergencies is a contested and largely unanswered question. Our prior work involving the U.S. Gulf Coast hurricanes of 2005-08 showed that exposure to various storms on nursing home (NH) residents resulted in significantly more deaths than reported by health care officials. This work also highlighted that evacuation of NH residents, compared to sheltering in place, was independently associated with morbidity and mortality. Hurricane Irma struck Florida on Sept. 10, 2017, prompting the evacuation of thousands of NH and assisted living community (ALC) residents. This symposium will discuss the effects of Hurricane Irma on vulnerable older adults residing in NHs and ALCs using mixed quantitative and qualitative methodologies. The first presentation will discuss morbidity and mortality of NH residents exposed to Hurricane Irma and will stratify by long stay/short stay status and hospice enrollment. The second presentation will discuss improvements and continued barriers to NH preparedness based on interviews with 30 administrators following Hurricane Irma. Using a novel methodology to identify residents of ALCs using secondary data sources, the third presentation will document AL resident morbidity and mortality risk following Hurricane Irma. The final presentation will highlight results of interviews with 70 stakeholders from small and large ALCs concerning the hurricane experiences of residents, including those with dementia. This symposium offers a multi-faceted view of a disaster’s effects on LTC residents across Florida, including novel data from the NH environment and lesser-examined ALCs.
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Miller, Edward Alan, Stefanie Gidmark, Emily Gadbois, James L. Rudolph, and Orna Intrator. "Nursing Home Referral Within the Veterans Health Administration: Practice Variation by Payment Source and Facility Type." Research on Aging 40, no. 7 (September 13, 2017): 687–711. http://dx.doi.org/10.1177/0164027517730383.
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Veterans enrolled within the Veterans Health Administration (VHA) of the U.S. Department of Veterans Affairs (VA) may receive nursing home (NH) care in VHA-operated Community Living Centers (CLCs), State Veterans Homes (SVHs), or community NHs, which may or may not be under contract with the VHA. This study examined VHA staff perceptions of how Veterans’ eligibility for VA and other payment impacts NH referrals within VA Medical Centers (VAMCs). Thirty-five semistructured interviews were performed with discharge planning and contracting staff from 12 VAMCs from around the country. VA staff highlights the preeminent role that VA priority status played in determining placement in VA-paid NH care. VHA staff reported that Veterans’ placement in a CLC, community NH, or SVH was contingent, in part, on potential payment source (VA, Medicare, Medicaid, and other) and anticipated length of stay. They also reported that variation in Veteran referral to VA-paid NH care across VAMCs derived, in part, from differences in local and regional policies and markets. Implications for NH referral within the VHA are drawn.
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Riley, Lorinda, Anamalia Suʻesuʻe, Kristina Hulama, Scott Kaua Neumann, and Jane Chung-Do. "Ke ala i ka Mauliola: Native Hawaiian Youth Experiences with Historical Trauma." International Journal of Environmental Research and Public Health 19, no. 19 (October 1, 2022): 12564. http://dx.doi.org/10.3390/ijerph191912564.
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Native Hawaiians (NH), like other Indigenous peoples, continue to experience the subversive impacts of colonization. The traumatic effects of colonization, especially the forced relocation from land that sustained their life and health, have led to complex, interconnected health disparities seen today. NHs have described a collective feeling of kaumaha (heavy, oppressive sadness) resulting from mass land dispossession, overthrow of the Hawaiian Kingdom, cultural loss, and early loss of loved ones. Although historical trauma is linked to high rates of substance misuse, depression, suicidality, and other mental health disparities in American Indian populations. However, the link between NH historical trauma and health disparities among NHs has been less explored. This qualitative study used Indigenous talk story interviews with 34 NH ʻōpio (youth) and ka lawelawe (service providers) to explore how NH ʻōpio understand and experience historical trauma. Eight themes and 35 sub-themes were identified covering individual, community, and systemic domains representing the first step in addressing NH historical trauma.
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Halifax, Elizabeth, Nhat Minh Bui, Lauren J. Hunt, and Caroline E. Stephens. "Transitioning to Life in a Nursing Home: The Potential Role of Palliative Care." Journal of Palliative Care 36, no. 1 (February 27, 2020): 61–65. http://dx.doi.org/10.1177/0825859720904802.
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Background and Objectives: Transitioning to a nursing home (NH) is a major life event for 1.4 million NH residents in the United States. Most post-acute NH admissions plan for rehabilitation and discharge home, but with nearly 70% of NH residents being palliative care (PC) eligible, many evolve into long-term placements secondary to poor health and associated decline in function and/or cognition. This article describes the perceptions of NH PC-eligible residents and families transitioning to life in a NH. Methods: Residents at 3 NHs in Northern California (N = 228) were screened for PC eligibility. A convenience sample of PC-eligible residents and their family members (n = 28) participated in qualitative interviews that explored the experience of living as a NH resident with serious illness. Data were analyzed using grounded theory methodology. Results: Our study provides insights into the experiences of transitioning to a NH from the perspectives of PC-eligible residents and their families. These data describe how PC-eligible residents and their families experienced disempowerment as they perceived being left out of decisions to go to a NH, loss of autonomy once at the NH, dealt with the realization that they would not be going home, and described perceived barriers to going home. Discussion and Implications: The inclusive and person-centered model of care that PC provides naturally empowers residents and family members. Adequate provision of PC services, together with changes in policy related to NH culture and benefit management, could improve the experience of transitioning to a nursing home.
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McCreedy, Ellen, Roee Gutman, James Rudolph, Rosa Baier, Kali Thomas, Faye Dvorchak, Jessica Ogarek, and Vincent Mor. "Addressing Under-Detection in Minimum Data Set Behavioral Measures Using NIH Stage III/IV Embedded Trial Design." Innovation in Aging 4, Supplement_1 (December 1, 2020): 485–86. http://dx.doi.org/10.1093/geroni/igaa057.1570.
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Abstract Using the National Institutes of Health (NIH) Stage Model framework, we are conducting a Stage III/IV embedded trial to evaluate the effects of personalized music on agitated behaviors in nursing home (NH) residents with dementia under two research conditions--less pragmatic, more researcher involvement (Stage III) and more pragmatic, less researcher involvement (Stage IV). We are conducting a three-year trial in 81 NHs, with 27 NHs receiving the intervention per year. Behavior frequency is assessed via resident MDS assessments, staff interviews, and direct observations of residents. During the first year, researchers interview NH staff and observe residents with dementia in 54 randomly selected NHs (27 treatment and 27 control, parallel design). MDS assessments are available for all 81 NHs throughout the three-year study (stepped-wedge design). In the 54 NHs in the parallel design, we compare staff interview and NH-conducted resident assessments and, using multiple imputation methods, we impute staff interview data for eligible residents of all 81 NHs in order to estimate the effect of the intervention under the step-wedge design. There are four key features of this trial: 1) combination of parallel and stepped-wedge designs; 2) equilibrating researcher-collected behavior data to NH-collected behavior data to impute research-collected behavior data for some residents; and 3) simulated resident selection process in control facilities to improve comparisons of effects across treatment groups. This design has the potential to shorten the research timeline by iteratively assessing real-world efficacy and large-scale effectiveness. Our design will inform pragmatic testing of other interventions with limited efficacy evidence.
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Baker, Hannah. "EXPLORING INTERSECTIONS OF NURSING HOME CULTURE, IMPROVEMENT, AND DOCUMENTATION-RELATED ATTITUDES." Innovation in Aging 6, Supplement_1 (November 1, 2022): 738. http://dx.doi.org/10.1093/geroni/igac059.2687.
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Abstract Documentation of patient care and characteristics is an important part of nursing home (NH) operations, affecting financial aspects, quality improvement (QI) efforts, inter-provider communication, and potential for medical errors. However, relationships among NH culture, QI, and documentation-related attitudes are unclear. This study explored Wisconsin NH staff and administrator perspectives on these variables (n = 10 in 8 NHs), using interviews structured on a composite of Schein’s organizational culture typology and Shortell’s Quality Improvement Implementation Survey concepts. Interview questions related to perspectives and emotions about NHs’ documentation quality, OC, QI efforts, and nursing staff turnover. Verbatim transcription, member checks, and team-based transcript coding and analysis ensured good data quality. Thematic analysis was used to construct a “storyline” and refine the original theoretical model. Sample data fit the model well, supporting the perception of pairwise relationships between NH OC, QI, and documentation. One of Schein’s culture types was not represented in the sample. Attitudes and perceived influences on documentation-related quality were mostly negative. This research contributes to knowledge on long-term care and could point future research toward (1) similar work in dissimilar NHs to replicate results, (2) closer examination of staffing variability, (3) quantitative work on effects of education and auditing on documentation-related attitudes, and (4) strategies to improve attitudes without increasing staff stress levels.
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Beynon, Cynthia, Katherine Supiano, Elena Siegel, Linda Edelman, Connie Madden, and Sara Hart. "Undergirding CNAs in LTC: The Experience of Collaborative LN-CNA Caregiving Pairs." Innovation in Aging 5, Supplement_1 (December 1, 2021): 242–43. http://dx.doi.org/10.1093/geroni/igab046.937.
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Abstract This research explores support provided by licensed nurses (LNs) to certified nurse aide (CNA) coworkers in the nursing home (NH). Using purposive sampling, we interviewed 12 LN and 12 CNA participants individually and as part of an LN/CNA caregiving pair. Semi-structured interviews were recorded, transcribed verbatim, and coded for meaning using NVivo software. LN and CNA participants described anticipated and unanticipated holistic support for CNAs. We applied the term undergirding to this phenomenon , and we present descriptions and examples of undergirding in nine categories: listen and respond, show respect, help with resident care and answer call lights, protect the CNA, support physical needs, and provide emotional support. Undergirding promotes work success for the CNA and the LN, as the LN job includes oversight of CNA responsibilities. Most notably, participants report undergirding facilitates high-quality resident care. These findings may be helpful for educators and administrators, but perhaps are most important for policymakers. CNAs need additional support to decrease turnover, improve retention, and elevate NH residents' quality of care. The study design identified and explored optimal collaboration as it is possible in the current NH setting. It does not represent all LN/CNA caregiving pairs.
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Stephens, Caroline E., Elizabeth Halifax, Daniel David, Nhat Bui, Sei J. Lee, Janet Shim, and Christine S. Ritchie. "“They Don’t Trust Us”: The Influence of Perceptions of Inadequate Nursing Home Care on Emergency Department Transfers and the Potential Role for Telehealth." Clinical Nursing Research 29, no. 3 (April 21, 2019): 157–68. http://dx.doi.org/10.1177/1054773819835015.
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In this descriptive, qualitative study, we conducted eight focus groups with diverse informal and formal caregivers to explore their experiences/challenges with nursing home (NH) to emergency department (ED) transfers and whether telehealth might be able to mitigate some of those concerns. Interviews were transcribed and analyzed using a grounded theory approach. Transfers were commonly viewed as being influenced by a perceived lack of trust in NH care/capabilities and driven by four main factors: questioning the quality of NH nurses’ assessments, perceptions that physicians were absent from the NH, misunderstandings of the capabilities of NHs and EDs, and perceptions that responses to medical needs were inadequate. Participants believed technology could provide “the power of the visual” permitting virtual assessment for the off-site physician, validation of nursing assessment, “real time” assurance to residents and families, better goals of care discussions with multiple parties in different locations, and family ability to say goodbye.
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Berg-Weger, Marla. "STRATEGIES FOR SUPPORTING NURSING HOMES IN THE PANDEMIC RECOVERY AND BEYOND." Innovation in Aging 6, Supplement_1 (November 1, 2022): 16. http://dx.doi.org/10.1093/geroni/igac059.058.
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Abstract Best practice strategies are needed to address current and ongoing COVID-19 challenges for nursing home (NH) staff, residents, and families, including vaccine-related issues and staff, resident, and family mental health. Saint Louis University and University of Iowa Geriatrics Workforce Enhancement Programs along with Show-Me ECHO have engaged NH, community, and clinician stakeholders to identify and prioritize gaps in education/support needs, target audiences, and delivery methods. We conducted interviews with stakeholders at all levels of NH staff, community professionals, family members, and professional organizations to identify and prioritize needs. Guided by these findings and advisory groups at partner organizations, the collaborative developed outreach and curriculum strategies targeted to prioritized needs. This presentation emphasizes strategies for stakeholder engagement, identifying education/support needs, and outreach to NH workforce and care partners, and experiences and lessons learned in increasing staff vaccination rates will be shared. Implications for future policy and advocacy are highlighted.
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Moore, Reese, Megan Kelley, Miranda Kunkel, Kamryn Kasler, Julia Baker, Alexandra Heppner, Katherine Abbott, and Kimberly Van Haitsma. "IT'S A VERY MANIPULATABLE TOOL: CHARACTERISTICS OF PAL CARD USE THAT IMPACT SUCCESSFUL IMPLEMENTATION." Innovation in Aging 6, Supplement_1 (November 1, 2022): 111–12. http://dx.doi.org/10.1093/geroni/igac059.443.
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Abstract Understanding the barriers and facilitators of an intervention can inform implementation efforts. The purpose of this study was to understand the characteristics associated with the PAL Card intervention that led to successful implementation in nursing home (NH) settings. Qualitative telephone interviews were conducted with n=11 NH champions who completed the PAL Card QIP. Interviews were recorded, transcribed verbatim, and coded using the CFIR Intervention Characteristics domain in Dedoose. Three main themes regarding the intervention characteristics emerged including, relative advantage (i.e., advantage of using PAL Cards versus an alternate intervention), adaptability (i.e., how well the PAL Cards can be altered to meet community needs), and complexity (i.e., perceived difficulty of PAL Card usage). Participants voiced the simplicity and benefit of PAL Card implementation within their communities for both staff and residents alike. Implications for policy and practice will be discussed.
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Pramesona, Bayu Anggileo, and Surasak Taneepanichskul. "Factors influencing the quality of life among Indonesian elderly." Journal of Health Research 32, no. 5 (September 10, 2018): 326–33. http://dx.doi.org/10.1108/jhr-08-2018-037.
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Purpose In spite of being a significant public health concern, quality of life (QoL) amongst elderly in nursing home (NH) settings is rarely analyzed. The purpose of this paper is to examine the level of QoL and factors influencing QoL amongst elderly NH residents in Indonesia. Design/methodology/approach A survey was conducted amongst 181 elderly at three NHs in three districts in Yogyakarta province, Indonesia. Purposive sampling was used for the study site and sample collection. Face-to-face interviews were performed using the WHO Quality of Life BREF Indonesian version questionnaire to assess elderly QoL. Multivariate linear regression was performed to determine the factors influencing the QoL amongst elderly NH residents. Findings The response rate was 66.3 percent. A total of 64.1 percent of elderly had a fair level of QoL, whereas 16.6 percent still had a poor level of QoL. A total of 86.7 percent of elderly lived in an NH due to compulsion, and more than half (53.6 percent) perceived inadequacy of care. The QoL was significantly low amongst those who live in NHs due to compulsion, no social support resources, not receiving any kind of support, having three chronic diseases and perceived inadequacy of care (p<0.05). Multivariate analysis revealed that perceived adequacy of care reasons for living in NH was associated with QoL (p<0.001). Originality/value Perceived adequacy of care and reason for living in an NH were highlighted as predictors of QoL amongst elderly NH residents. Improving adequate healthcare services and developing treatment strategies to enforce the adaptation process is required in order to maintain the QoL in elderly NH residents.
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Ingravallo, Francesca, Veronica Mignani, Elena Mariani, Giovanni Ottoboni, Marie Christine Melon, and Rabih Chattat. "Discussing advance care planning: insights from older people living in nursing homes and from family members." International Psychogeriatrics 30, no. 4 (October 9, 2017): 569–79. http://dx.doi.org/10.1017/s1041610217001983.
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ABSTRACTBackground:Evidence concerning when and in which manner older people living in nursing homes (NHs) would prefer to discuss advance care planning (ACP) is still scarce. This study explored the attitudes of NH residents and family members toward ACP and their opinions as to the right time to broach the subject, the manner in which it should be approached, and the content of ACP.Methods:This was a qualitative study using face-to-face interviews with 30 residents (age range 66–94), and 10 family members from 4 Italian NHs. The interviews were analyzed using content analysis.Results:Three main themes were identified: (1) life in the NH, including thoughts about life in a nursing home, residents’ concerns, wishes and fears, and communication barriers; (2) future plans and attitudes toward ACP, including attitudes toward planning for the future and plans already made, and attitudes toward and barriers against ACP; (3) contents and manner of ACP, including contents of ACP discussions, the right moment to introduce ACP, with whom it is better to discuss ACP, and attitudes toward advance directives.Conclusions:ACP was a welcome intervention for the majority of participants, but an individualized assessment of the person's readiness to be involved in ACP is needed. For people with dementia, it is essential to identify the right time to introduce ACP before NH admission. Participants in our study suggested that ACP should include palliative care and practical issues, and that in the NH setting all staff and family members may have a valuable role in ACP.
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Gonella, Silvia, Paola Di Giulio, Marianna Angaramo, Valerio Dimonte, Sara Campagna, Kevin Brazil, and MySupport Study Group. "Implementing a nurse-led quality improvement project in nursing home during COVID 19 pandemic: A qualitative study." International Health Trends and Perspectives 2, no. 2 (August 1, 2022): 175–92. http://dx.doi.org/10.32920/ihtp.v2i2.1631.
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Background: There is broad consensus that the quality of nursing home (NH) care is a research priority to advance NH practice. However, NHs often fail to implement quality improvement (QI) research projects and complex circumstances such as Coronavirus disease 19 (COVID-19) pandemic may further hinder compliance. This study aims to describe the challenges associated with implementing a nurse-led QI project in NH during COVID-19 pandemic and potential strategies for their overcoming. Methods: A descriptive qualitative study was performed, and three data collection strategies employed, including: 1. semi-structured, open-ended interviews with follow-up questions (one NH manager, three members of the NH staff, and two family caregivers of people with advanced dementia); 2. research diary; and 3. in-the-field-notes. A combined deductive and inductive content analysis was adopted to analyze data. Results: Challenges may be anticipated or unanticipated. QI projects should include preliminary assessments to identify the willingness to change and establish partnerships at multiple levels with all stakeholders, adjust the implementation plan to the organizational context, and be open to ongoing changes. Conclusions: Early and regular engagement of stakeholders strengthen relationships. Moreover, an ongoing reflective practice throughout the entire implementation process promotes openness to change, and finally learning and improvement.
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Drageset, Jorunn, Geir Egil Eide, and Solveig Hauge. "Symptoms of depression, sadness and sense of coherence (coping) among cognitively intact older people with cancer living in nursing homes—a mixed-methods study." PeerJ 4 (June 9, 2016): e2096. http://dx.doi.org/10.7717/peerj.2096.
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Background:Symptoms of depression are often reported among patients with a cancer diagnosis. Strong sense of coherence (SOC) is shown to be associated with less depression in the general older population and among nursing homes (NH) residents in particular. Knowledge about mixed-methods perspectives that examine symptoms of depression and SOC among cognitively intact NH residents with cancer is scarce.Aim:To investigate symptoms of depression and SOC among NH residents who are cognitively intact and have cancer.Methods:We used a quantitatively driven mixed-methods design with sequential supplementary qualitative components. We facilitated the collection of quantitative survey data of 60 NH residents (≥ 65 years) with cancer using the Geriatric Depression Scale (GDS) and SOC scale. The supplementary psychosocial component comprised qualitative research interviews about experiences related to depression with nine respondents from the same cohort.Results:In fully adjusted multiple regression analysis of the sociodemographic variables, the GDS was significantly correlated with SOC (P< 0.001). The experience of sadness was identified by the following theme: sadness. Coping with the experience of symptoms of depression was dominated by coping with sadness.Conclusion:More than half the NH residents reported symptoms of depression, and the SOC was associated with reduced symptoms. A mixed-methods design contributed to nuanced and detailed information about the meaning of depression, and the supplementary component informs and supports the core component. To improve the situation of NH residents with cancer, more attention should be paid to the residents’ experience of symptoms of depression and their SOC.
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Rose, Miriam, Farida Ejaz, and Brian Polk. "Developing Life Stories for Nursing Home Residents and Examining the Impact on Residents and Staff." Innovation in Aging 4, Supplement_1 (December 1, 2020): 44. http://dx.doi.org/10.1093/geroni/igaa057.144.
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Abstract A life story program was implemented in 16 nursing homes (NHs) in Ohio with partners including a company specializing in life story work and a gerontological institute. The aim was to evaluate the impact of the life story program on residents and staff. NH sites were selected from an urban/suburban and a rural county using sampling procedures ensuring variation in auspice, quality star ratings and bed size. A longitudinal design was used to conduct in-person interviews with residents at baseline (prior to the life story interview), immediately after the interview, and approximately a month after most life story books were delivered to a NH. Resident eligibility criteria included being age 60 or older, Medicaid-eligible, long-stay and having no to moderate cognitive impairment. Residents’ (n=238) average age was 77 years, 66% were female, and 52% had resided in the NH for 1-5 years. Cognitive scores declined over time, but depressive symptomatology improved significantly. Residents had very high levels of satisfaction with care, enjoyed telling their life stories and would recommend the program; these findings did not change. A pre-post study design was used with staff (n=198), who included nurse aides, nurses, administrators, social workers and activity staff. Their average age was 44 years. Although staff job satisfaction did not change significantly, the vast majority enjoyed learning about residents’ life stories and used them in care planning. The findings demonstrate that life story work may be useful in promoting person-centered care, although further testing is needed with a more generalizable sample.
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Zúñiga, Franziska, and Sabine Hahn. "ORGANIZATIONAL FACTORS RELATED TO RESIDENT-REPORTED QUALITY OF LIFE IN NURSING HOMES." Innovation in Aging 3, Supplement_1 (November 2019): S381. http://dx.doi.org/10.1093/geroni/igz038.1397.
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Abstract Few studies so far take a broader perspective at staffing in nursing homes (NH) including e.g. the impact of activity staff on quality outcomes. Moreover, few assess resident-reported quality of life (QoL). Examining the relationship of organizational and resident factors with QoL, we report the results from a questionnaire survey of organizational characteristics from 51 Swiss nursing homes and of structured interviews with 863 residents. Residents rated their quality of life with a single item. A logistic regression model was applied. At the organizational level, a higher number of activity staff was significantly related to QoL, while at resident level, both the possibility to select their NH and less care dependency were significant predictors. Meaningful activities as well as autonomous decision-making concerning one’s living place seem of paramount importance for residents’ better perception of their QoL. NH staff mix needs to address the possibility to offer enjoyable activities.
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Lopez, Ruth, Ashley Roach, Meghan Hendricksen, Anita Rogers, Fayron Epps, and Ellen McCarthy. "Impact of Race on Decision Making for Nursing Home Residents With Advanced Dementia: Can We Disrupt and Transform?" Innovation in Aging 5, Supplement_1 (December 1, 2021): 412. http://dx.doi.org/10.1093/geroni/igab046.1595.
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Abstract Despite 20 years of research and numerous experts and associations advocating a palliative approach to care for nursing home (NH) residents with advanced dementia, research consistently demonstrate striking and persistent racial differences in the use of burdensome interventions such as feeding tubes and hospital transfer. Most notable is that Black NH residents experience more burdensome interventions at the end of life. The reasons for these differences are poorly understood. The purpose of this study was to examine NH staff members’ perceptions of advance care planning with proxies of Black and White residents. We conducted thematic analysis of semi-structured interviews with 158 NH staff members gathered as part of the ADVANCE study. This is a large qualitative study in 13 NHs in 4 regions of the country aimed at explaining regional and racial factors influencing feeding tube and hospital transfer rates. We found that NH staff, regardless of region of the country, held several assumptions about Black proxies including: being attached or not wanting to let go; not wanting to talk about death, believing everything must be done; not wanting to play God; having large conflicted families, not trusting; putting on attitude, and tending not to use NHs. We found that these assumptions led some NH staff to feel that rather than engaging in shared decision making, they were engaged in a battle with proxies leading them to pick and choose their battles and at times even giving up trying. Whether these assumptions can be disrupted and transformed will be discussed.
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Bertrand, Rosanna M., Gabrielle R. Katz, Teresa M. Mota, Terry Moore, Jennifer Pettis, Katherine T. Fillo, Katherine C. Saunders, and Chiara S. Moore. "EVALUATING AN INNOVATIVE USE OF CIVIL MONETARY PENALTY FUNDS: THE MA SUPPORTIVE PLANNING AND OPERATIONS TEAM (SPOT)." Innovation in Aging 3, Supplement_1 (November 2019): S508. http://dx.doi.org/10.1093/geroni/igz038.1877.
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Abstract The Office of the Inspector General reported in 2014, that one in three NH residents experienced an adverse event within 35 days of admissions causing lasting or temporary harm. Thus, state departments of public health (DPH) were implored to invest in improving NH quality and safety. Using Civil Monetary Penalty funds, the Massachusetts DPH, developed the SPOT Initiative to innovatively provide NH teams with technical assistance and training to enhance their federally required Quality Assurance & Performance Improvement (QAPI) programs. Selection criteria included NH Compare 5-Star and MA scorecard ratings and geographic spread. To assess program effectiveness, the SPOT Team collected a range of data in each of the three SPOT years (e.g., QAPI assessments, leadership interviews and surveys, and training evaluations). Results demonstrated the success of the Initiative. Assessment data indicated an increase in QAPI readiness in each subsequent year overall and within of the each QAPI assessment domains (Design and Scope; Governance and Leadership; Feedback, Data Systems, and Monitoring/Systematic Analysis; Performance Improvement Projects and Systematic Analysis/Systemic Action). In Year 1, the overall data collected from the assessments demonstrated that 78% of the NHs that engaged with SPOT had “Not Started” or “Just Started” (1.8/5) implementation of the key QAPI measures. By Year 3, only 13% of NH teams rated themselves in these initial categories, whereas, 57% rated themselves as “Almost There” or “Doing Great” (3.92/5). Further, feedback from most SPOT NH teams was extremely positive as evidenced by high evaluation rankings following initiative learning sessions.
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Reinhardt, Joann P., Orah Burack, Verena Cimarolli, and Audrey Weiner. "DEMENTIA-FOCUSED PERSON-DIRECTED CARE TRAINING IN THE NURSING HOME: FIDELITY AND OUTCOMES." Innovation in Aging 3, Supplement_1 (November 2019): S380. http://dx.doi.org/10.1093/geroni/igz038.1394.
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Abstract To address the behavioral health of nursing home (NH) residents living with dementia, training direct care staff (DCS) is essential, for the well-being of both residents and staff. We evaluated a training for DCS focused on providing care for persons with advanced dementia who are at-risk of not having care needs met, largely due to communication deficits. Staff were trained in promoting comfort and reducing distress through person-directed care (PDC), deeply knowing each resident, and anticipating needs. Subsequent fidelity interviews with staff showed a higher number of PDC practices utilized by staff in the intervention communities compared to usual care. We also compared the impact of the PDC model versus a traditional model of NH care on resident clinical outcomes, finding a significant interaction where those in the intervention group had fewer clinical symptoms over a 6-month period. Implications for training in the NH setting will be discussed.
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Volkert, Dorothee, Lioba Pauly, Peter Stehle, and Cornel C. Sieber. "Prevalence of Malnutrition in Orally and Tube-Fed Elderly Nursing Home Residents in Germany and Its Relation to Health Complaints and Dietary Intake." Gastroenterology Research and Practice 2011 (2011): 1–9. http://dx.doi.org/10.1155/2011/247315.
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Objective. To investigate the prevalence of malnutrition in orally and tube-fed nursing home (NH) residents in Germany and its relation to common health complaints and dietary intake.Methods. In 350 NH residents, subjects' characteristics, Mini Nutritional Assessment (MNA), and several health problems were inquired with the nursing staff using standardised interviews. In a subset of 122 residents, dietary intake was assessed by 3-day weighing records.Results. 7.7% of the participants were tube fed. 24.1% of orally nourished and 57.7% of tube-fed residents were malnourished (MNA < 17 p.). Malnutrition was significantly related to nausea/vomiting, constipation, pressure ulcers, dehydration, infections, antibiotic use, and hospitalisation. Mean daily energy intake was 1535 ± 413 kcal and mean protein intake was 54.2 ± 0.9 g/d irrespective of the nutritional state.Conclusion. In Germany, malnutrition is widespread among NH residents and is related to common health problems. The MNA rather reflects health condition than currently reduced dietary intake.
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Bucy, Taylor, Kelly Moeller, John Bowblis, and Tetyana Shippee. "Meaningful Assessment or Minimum Compliance: PASRR for Nursing Home Residents with Mental Illness." Innovation in Aging 5, Supplement_1 (December 1, 2021): 841–42. http://dx.doi.org/10.1093/geroni/igab046.3080.
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Abstract The Omnibus Budget Reconciliation Act (OBRA) of 1987 included provisions for the Preadmission Screening and Resident Review (PASRR) program, which requires states to create and maintain systems to assess persons with serious mental illness (SMI) seeking NH care. The prevalence of SMI in NHs is increasing, and little is known about the effectiveness of the PASRR program intervention. We conducted 20 interviews with state and national PASRR stakeholders, including assessors, hospital discharge planners, mental health advocates, geriatricians and geriatric psychiatrists. Interview data were triangulated with state provided materials on PASRR collection and implementation. Based on these interviews, we identified four themes: 1) variation in the implementation of federal PASRR legislation across states and jurisdictions, 2) the need for investment in professional development and workforce capacity, 3) lack of usefulness of PASRR in ongoing care planning, and 4) the need to consider the role of age, race/ethnicity, and stigma on quality of care for NH residents with SMI. Stakeholders agree that PASRR legislation was well intentioned, but also expressed concern regarding the completion of PASRR as an issue of compliance versus meaningful assessment. More work is needed to determine how best to develop and support the care needs of people with SMI, while being mindful of the original goals of deinstitutionalization that prompted OBRA passage. In order to assess the impact of the PASRR program on quality of care and mental health outcomes, further research should take an evaluative approach through meaningful use of PASRR data.
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Kaelen, Sanne, Wilma van den Boogaard, Umberto Pellecchia, Sofie Spiers, Caroline De Cramer, Gwennin Demaegd, Edouard Fouqueray, et al. "How to bring residents’ psychosocial well-being to the heart of the fight against Covid-19 in Belgian nursing homes—A qualitative study." PLOS ONE 16, no. 3 (March 26, 2021): e0249098. http://dx.doi.org/10.1371/journal.pone.0249098.
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Background Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. Methods A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. Results NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. Conclusion This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.
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Powell, Kimberly R., and Gregory L. Alexander. "Consequences of Rapid Telehealth Expansion in Nursing Homes: Promise and Pitfalls." Applied Clinical Informatics 12, no. 04 (August 2021): 933–43. http://dx.doi.org/10.1055/s-0041-1735974.
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Abstract Background Expectations regarding use and potential benefits of telehealth (TH) in nursing homes (NHs) are high; however, unplanned and unexpected consequences can occur as a result of major policy and technological changes. Objectives The goal of this study was to elicit stakeholder perspectives of consequences of rapid TH expansion in NHs. Methods Using a qualitative descriptive design, we drew a sample based on findings from a national study examining trends in NH information and technology (IT) maturity, including TH use. We used maximum variation sampling to purposively select participants who (1) participated in our IT maturity survey for two consecutive years, (2) completed year 1 of the IT maturity survey prior to TH expansion (before March 6, 2020) and year 2 after TH expansion (after March 6, 2020), (3) represented a broad range of facility characteristics, and (4) were identified as an end user of TH or responsible for TH implementation. Using six questions from the IT maturity survey, we created a total TH score for each facility and selected participants representing a range of scores. Results Interviews were conducted with (n = 21) NH administrators and clinicians from 16 facilities. We found similarities and differences in perceptions of TH expansion according to facility TH score, NH location, and participant role. Desirable consequences included four subthemes as follows: (1) benefits of avoiding travel for the NH resident, (2) TH saving organizational resources, (3) improved access to care, and (4) enhanced communication. Undesirable consequences include the following five subthemes: (1) preference for in-person encounters, (2) worsening social isolation, (3) difficulty for residents with cognitive impairment, (4) workflow and tech usability challenges, and (5) increased burden on NH staff/infrastructure. Participants from rural NHs perceived lack of training, poor video/sound quality, and internet/connectivity issues to be potential pitfalls. Conclusion Clinicians and NH administrators should consider leveraging the desirable consequences of rapid TH expansion and implement mitigation strategies to address the undesirable/unanticipated consequences.
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Chang, Nai-Chung, Karim Khader, Molly Leecaster, Lindsay Visnovsky, Scott Fridkin, Morgan Katz, Philip Polgreen, et al. "Evaluation of Care Interactions Between Healthcare Personnel and Residents in Nursing Homes Across the United States." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s36—s38. http://dx.doi.org/10.1017/ice.2020.516.
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Background: Certain nursing home (NH) resident care tasks have a higher risk for multidrug-resistant organisms (MDRO) transfer to healthcare personnel (HCP), which can result in transmission to residents if HCPs fail to perform recommended infection prevention practices. However, data on HCP-resident interactions are limited and do not account for intrafacility practice variation. Understanding differences in interactions, by HCP role and unit, is important for informing MDRO prevention strategies in NHs. Methods: In 2019, we conducted serial intercept interviews; each HCP was interviewed 6–7 times for the duration of a unit’s dayshift at 20 NHs in 7 states. The next day, staff on a second unit within the facility were interviewed during the dayshift. HCP on 38 units were interviewed to identify healthcare personnel (HCP)–resident care patterns. All unit staff were eligible for interviews, including certified nursing assistants (CNAs), nurses, physical or occupational therapists, physicians, midlevel practitioners, and respiratory therapists. HCP were asked to list which residents they had cared for (within resident rooms or common areas) since the prior interview. Respondents selected from 14 care tasks. We classified units into 1 of 4 types: long-term, mixed, short stay or rehabilitation, or ventilator or skilled nursing. Interactions were classified based on the risk of HCP contamination after task performance. We compared proportions of interactions associated with each HCP role and performed clustered linear regression to determine the effect of unit type and HCP role on the number of unique task types performed per interaction. Results: Intercept-interviews described 7,050 interactions and 13,843 care tasks. Except in ventilator or skilled nursing units, CNAs have the greatest proportion of care interactions (interfacility range, 50%–60%) (Fig. 1). In ventilator and skilled nursing units, interactions are evenly shared between CNAs and nurses (43% and 47%, respectively). On average, CNAs in ventilator and skilled nursing units perform the most unique task types (2.5 task types per interaction, Fig. 2) compared to other unit types (P < .05). Compared to CNAs, most other HCP types had significantly fewer task types (0.6–1.4 task types per interaction, P < .001). Across all facilities, 45.6% of interactions included tasks that were higher-risk for HCP contamination (eg, transferring, wound and device care, Fig. 3). Conclusions: Focusing infection prevention education efforts on CNAs may be most efficient for preventing MDRO transmission within NH because CNAs have the most HCP–resident interactions and complete more tasks per visit. Studies of HCP-resident interactions are critical to improving understanding of transmission mechanisms as well as target MDRO prevention interventions.Funding: Centers for Disease Control and Prevention (grant no. U01CK000555-01-00)Disclosures: Scott Fridkin, consulting fee, vaccine industry (spouse)
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Dosa, David, Ross Andel, and Lisa Brown. "Multiple Perspectives on Disaster Preparedness in Long-Term Care: From Heat to Hospice." Innovation in Aging 5, Supplement_1 (December 1, 2021): 283–84. http://dx.doi.org/10.1093/geroni/igab046.1100.
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Abstract Preparedness of residents in long-term care (LTC) exposed to disasters continues to warrant concern. Prior work by our research team highlights explicit evidence of the profound vulnerability of Florida nursing home (NH) residents exposed to Hurricane Irma in 2017. This research adds to our knowledge of the profound effect of disasters on long term care residents. This symposium will utilize mixed methodologies to discuss the varied effects of Hurricane Irma on vulnerable older adults residing in Florida NHs and Assisted Living communities (ALCs). Using a novel methodology for identifying a cohort of ALC residents, the first presentation will present the morbidity and mortality effects of Hurricane Irma on Florida ALC residents and identify high risk groups by health condition. The second presentation will document the effect of Hurricane Irma on NH Residents previously enrolled in Hospice and expound on the effect of the disaster on hospice enrollment after the storm. The third presentation will present qualitative results of interviews with ALC administrators highlighting the effect of the storm on both large and small ( <25 beds) facilities. The fourth presentation will address the issue of heat exposure in the days after Hurricane Irma and consider the preventative effect of generators on morbidity and mortality. Finally, a fifth presentation will examine NH staffing level variation in the days leading to the hurricane. To conclude, this symposium offers a multi-faceted view of a disaster’s effects on LTC residents across Florida, including novel data from the NH environment and lesser-examined ALCs.
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Burack, Orah, Joann Reinhardt, Wingyun Mak, and Ruth Spinner. "A NURSING HOME–BASED COVID-19-ONLY REHAB PROGRAM: VARIABLES RELATED TO SUCCESSFUL COMMUNITY DISCHARGE." Innovation in Aging 6, Supplement_1 (November 1, 2022): 465. http://dx.doi.org/10.1093/geroni/igac059.1807.
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Abstract Many COVID-19 patients continue to test positive for COVID-19 beyond the typical quarantine period. Persistent positive testing complicated hospital discharges to nursing home (NH) based rehabilitation facilities when (in May 2020) New York State (NYS) required a negative COVID result prior to NH admissions. To meet the needs of medically stable persistent positive patients, NYS approved 19 NHs as COVID-only facilities (COF). These facilities provided rehabilitation services and allowed hospitals to regain critical space for incoming acute care patients. In the present study we describe the (1) establishment of a 100 bed COF, (2) patients admitted to the COF and care provided, and (3) predictors of successful discharge to the community.Information on the establishment of the COF was obtained from interviews with NH leadership and clinical staff. Patient, treatment, and outcome data were obtained from the NH’s electronic health record. Of 319 COF admissions over four months, 54% were female and the mean age was 80 years (SD=10.56). 51% had cognitive impairment and the mean number of comorbidities was 6.75 (SD=2.47). All patients received physical and occupational therapy while 37% received speech therapy. Medical treatment included: anticoagulants (52%), oxygen (37%), antibiotics (35%), inhaler/nebulizers (31%), and oral steroids (15%). 59% of COF stays resulted in successful community discharges. This outcome was more likely for patients who had fewer comorbidities, less speech therapy, and did not require antibiotics. Implications for COVID care as well as leveraging NH potential during crisis will be discussed.
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Lethin, Connie, Ingalill Rahm Hallberg, Emme-Li Vingare, and Lottie Giertz. "Persons with Dementia Living at Home or in Nursing Homes in Nine Swedish Urban or Rural Municipalities." Healthcare 7, no. 2 (June 25, 2019): 80. http://dx.doi.org/10.3390/healthcare7020080.
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The methodology from the “RightTimePlaceCare” study of dementia care was tested locally in terms of relevance, acceptability and attrition. Comparing persons with dementia (PwDs) receiving home care (HC) with PwDs living in nursing homes (NHs), in urban versus rural areas, regarding their health conditions and informal caregiver burden was also done. Standardized measurements regarding sociodemographic, and physical and mental health was used. Questions related to legal guardianship were added. Interviews were conducted with PwDs and their caregivers in HC (n = 88) and in NHs (n = 58). Bivariate and multivariate logistic regression analysis was used. The attrition rate was higher in HC. In the bivariate regression model, for HC and NH, living at home was significantly associated with more severe neuropsychiatric symptoms (p ≤ 0.001) and being cared by a spouse (p = 0.008). In NH, the informal caregivers were significantly younger (p = 0.003) and living in rural areas (p = 0.007) and more often in paid work (p ≤ 0.001). In the multivariate regression model, informal caregivers were significantly younger (p = 0.007) when caring for a PwD in an NH and caregiver burden was significantly higher in HC and in urban areas (p = 0.043). Legal guardianship was very low. Professionals should acknowledge that PwDs in HC have more behavioural problems and caregivers in urban areas report higher caregiver burden.
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French, H. K., H. O. Eggestad, J. Øvstedal, and P. E. Jahren. "Climate conditions and consequences for de-icing operations as exemplified by the situation on a motorway and airport at Gardermoen, Norway." Hydrology Research 41, no. 3-4 (April 1, 2010): 269–81. http://dx.doi.org/10.2166/nh.2010.003.
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Large amounts of de-icing chemicals are used in the northern hemisphere to maintain winter safety on roads and airports every year. At Gardermoen, potassium formate (KFo) is used on runways, sodium chloride (NaCl) on roads and propylene glycol (PG) for aeroplanes. The total use of de-icing chemicals is an important part of the risk assessment related to water contamination at Gardermoen. The objective of this paper is to examine how climatic factors affect the use of de-icing chemicals through interviews with de-icing operators and by statistical methods using data on climate variables and de-icing operations. A multiple linear regression model shows a good relationship between daily dew point temperature, precipitation, wind speed, number of departures and the use of PG. The results were less promising for the prediction of KFo. This might be explained by the human factor and insufficiency of the standard climate variables to represent the situation near the runway. An analysis of daily downscaled climate change scenarios for the Gardermoen area revealed insufficient detail for any accurate estimates of change in total consumption of de-icing chemicals. The predicted mean increase of 7.6°C during winter does, however, suggest a reduced need for de-icing chemicals in the long term (2071–2100).
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McEwen, Lindsey, and Owain Jones. "Building local/lay flood knowledges into community flood resilience planning after the July 2007 floods, Gloucestershire, UK." Hydrology Research 43, no. 5 (June 5, 2012): 675–88. http://dx.doi.org/10.2166/nh.2012.022.
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A UK Cabinet Office review after the 2007 floods highlighted different types of knowledge needed for effective flood risk management, along with knowledge gaps. This paper explores key, emerging aspects of this expanded knowledge base, namely relationships between expert and local/lay knowledges, the changing nature of local knowledge of community flood risk, and how attempts are being made to incorporate local knowledge into science, policy and practice. Sustainable flood knowledge, as an aspiration, integrates expert, local and political knowledge to build community flood resilience. The research involved stakeholder interviews undertaken before and after the 2007 floods, Severn catchment, UK and examination of policy documentation. The paper focuses on scale issues in relation to knowledge types suggesting that local knowledge can be ‘expert’ in large-scale mapping of flood processes. It reflects on how local flood knowledges can be captured, shared, harnessed and used, and assimilated into governance structures for flood resilience planning. The paper recognises progress in integrating local knowledges in flood science and governance, but also highlights challenges. It concludes that the 2007 UK flood experience is generating new understandings of the value of local knowledges, and how these might be successfully used in flood risk management practice.
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Jang, Hye-Young, and Eun-Ok Song. "Development and Validation of the Scale for Partnership in Care—for Family (SPIC-F)." International Journal of Environmental Research and Public Health 17, no. 6 (March 13, 2020): 1882. http://dx.doi.org/10.3390/ijerph17061882.
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This study aims to develop and validate the Scale for Partnership in Care between staff and families of older adult nursing home (NH) residents—for Family (SPIC-F). The components of partnership were identified on the basis of literature reviews and focus group interviews. The content validity of 41 preliminary items was verified by 10 experts, and a pilot study was conducted. The reliability and validity of the instrument was tested on 330 families of older adult NH residents. The final instrument comprised 20 items in three categories: professional caring and support, cooperative relationship and information sharing, and participation in care. Each item is rated on a four-point Likert scale, with total scores ranging from 20–80. The reliability of the instrument was 0.95, and test–retest ICC was 0.83. This instrument could be utilized to develop interventions to establish an efficient partnership and assess its outcomes.
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Popejoy, Lori, Megan Hiltz, Marilyn Rantz, and Amy Vogelsmeier. "The Influence of MOQI APRNs on the COVID-19 Response in Nursing Homes." Innovation in Aging 5, Supplement_1 (December 1, 2021): 552–53. http://dx.doi.org/10.1093/geroni/igab046.2123.
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Abstract During the COVID-19 pandemic Missouri Quality Initiative APRNs worked in 16 nursing homes (NHs) providing clinical expertise and support. To understand their influence on the NH COVID-19 response, we conducted four group interviews with APRNs from 13 of the 16 NHs. Using thematic analysis, we identified similarities and differences between NH groups and then compared groups by COVID-19 infection rates. Leaders from NHs with high COVID-19 rates were unwilling to report infections and were resistant to resident/staff testing. In contrast, leaders from NHs with low COVID-19 rates were strategic about acquiring supplies, held daily huddles, and initiated CDC recommendations almost immediately. All reported residents lost weight, and experienced mood and physical decline resulting from quarantine/isolation. APRNs worked with providers to identify potentially ill residents/staff, improve isolation/quarantine procedures, manage ill residents, and supported efforts to mitigate viral spread. We will discuss implications for broader infection prevention in NHs.
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Akosionu, Odichinma, Janette Dill, Manka Nkimbeng, Tricia Skarphol, and Tetyana Shippee. "Race, Class, and the Nursing Home Workforce: Experiences of Staff of Color in High-Minority-Proportion Nursing Homes." Innovation in Aging 4, Supplement_1 (December 1, 2020): 689. http://dx.doi.org/10.1093/geroni/igaa057.2409.
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Abstract The long-term services and supports workforce is an important part of delivering quality care for nursing home (NH) residents – and increasingly includes staff who are from diverse communities. Our study captured staff (n=61) perspectives on resident quality of care and quality of life through semi-structured interviews, using thematic analysis in six Minnesota high proportion minority NHs. Findings show that although staff of color are valued for the diversity they contribute to the workforce, and the culturally sensitive care they provide, they are also exposed to discriminatory events. In addition, tensions exist between U.S. and non-U.S. born staff of color in NHs. Overall, staff of color who are lower ranked may feel less empowered. Research is needed to explore the impact of negative and discriminatory exposures on staff wellbeing and related outcomes in addition to the direct and indirect impact on the quality of care delivered to NH residents.
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Garrison, Nanibaa' A., Krysta S. Barton, Kathryn M. Porter, Thyvu Mai, Wylie Burke, and Stephanie Russo Carroll. "Access and Management: Indigenous Perspectives on Genomic Data Sharing." Ethnicity & Disease 29, Supp (December 12, 2019): 659–68. http://dx.doi.org/10.18865/ed.29.s3.659.
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As genomic researchers are encouraged to engage in broad genomic data sharing, American Indian/Alaska Native/Native Hawaiian (AI/AN/NH) leaders have raised questions about ownership of data and biospecimens and concerns over emerging challenges and potential threats to tribal sovereignty. Using a community-engaged research approach, we conducted 42 semi-structured interviews with tribal leaders, clinicians, researchers, policy makers, and tribal research review board members about their perspectives on ethical issues related to genetics in AI/AN/NH communities. We report findings related to perspectives on genetic research, data sharing, and envisioning stronger oversight and management of data. In particular, participants voiced concerns about different models of data sharing, infrastructure and logistics for housing data, and who should have authority to grant access to data. The results will ultimately guide policy-making and the creation of guidelines and new strategies for tribes to drive the research agenda and promote ethically and culturally appropriate research.Ethn Dis.2019;29(Suppl 3):659-668;doi:10.18865/ed.29.S3.659
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Owen, Donna, Alyce Ashcraft, Kyle Johnson, Huaxin Song, and John Culberson. "Technology Guided Assessment for Urinary Tract Infection: Creating a Common Interprofessional Language." Innovation in Aging 5, Supplement_1 (December 1, 2021): 879. http://dx.doi.org/10.1093/geroni/igab046.3202.
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Abstract The Shared Meaning Model (SMM) is a grounded theory, derived in a previous study. This model demonstrates pathways for communication between nurse and primary care providers (PCPs) in the nursing home (NH), In this study we used the SMM for feasibility testing of a clinical decision support app (CDS app) using a descriptive, structured observational design. This study also provided a forum for initial testing of the SMM. The CDS app algorithm provided a common language to assess a resident with the goal of sharing this information with a PCP. The CDS app guided licensed vocational nurses (LVNs) (N=10) in assessing a standardized nursing home resident in a simulation setting experiencing symptoms of a potential urinary tract infection (UTI). Interviews with LVNs provided details of CDS app usability and concerns about using the CDS app with NH residents. Videos recorded LVNs interacting with the resident while using the CDS app on an iPad®. Time-stamps logged duration of the assessment. Bookmarked segments were used for discussion in LVN interviews. Videos were coded for eye contact, conversation, and touch between LVN and resident and documented personalized interactions. Findings indicated areas (lab values, drug names) for changes to language in the algorithm. In less than 12 minutes the CDS app enabled LVNs to collect information based on language used by PCPs to make decisions about the presence of a UTI. Relationships between initial constructs in the SMM were supported. This CDS app holds promise for building a common language to enhance interprofessional communication.
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Lopez, Ruth, Ellen McCarthy, Meghan Hendricksen, Susan McLennon, Anita Rogers, LaKeva Harris, Ashley Roach, and Susan Mitchell. "Aging and Advanced Dementia Matters: End-of-Life Care in Nursing Homes." Innovation in Aging 4, Supplement_1 (December 1, 2020): 520–21. http://dx.doi.org/10.1093/geroni/igaa057.1679.
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Abstract Over 5 million Americans have dementia, and the majority will die in nursing home (NHs). While comfort is the main goal of care for most NH residents with advanced dementia, they commonly receive burdensome and costly interventions such as hospital transfers and feeding tubes that are of little clinical benefit. Despite 20 years of research and numerous experts and associations advocating a palliative approach to care, quantitative studies continue to demonstrate striking and persistent regional, facility, and racial differences, including: greater intensity care among African American versus White residents; greater intensity of care in the Southeastern US; and wide variation in care among NHs in the same region of the country. The reasons for these differences are poorly understood. Assessment of Disparities and Variation for Alzheimer’s disease in Nursing home Care at End of life (ADVANCE) is a 3-year, NIA funded qualitative study of 16 NHs in 4 regions of the country which aims to explain regional and racial factors influencing feeding tube and hospital transfer rates. The purpose of this presentation is to present the methodology established in this study and to highlight factors challenging and enabling implementation of the study protocol. To date, data have been collected in 11 NHs, and include 135 staff interviews, 40 proxy interviews, and nearly 800 hours of observation. These findings demonstrate that although challenging, large qualitative research is possible and holds promise as an effective method to illuminate complex processes influencing end-of-life care for NH residents with advanced dementia.
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Hermesch, Abigail, Da Jung Chang, Chelsea Goldstein, Kimberly Van Haitsma, and Katherine Abbott. "PARTNERING WITH NURSING HOME PROVIDERS FOR PERSON-CENTERED QUALITY IMPROVEMENT." Innovation in Aging 3, Supplement_1 (November 2019): S50. http://dx.doi.org/10.1093/geroni/igz038.194.
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Abstract The purpose of this study was to assist Ohio NH providers in implementing PAL Cards. Providers were recruited to utilize the recreation and leisure items from the PELI to assess resident important preferences and create PAL cards for 15-20 residents. A total of n=43 providers registered and n=26 (60%) providers completed the project, which involved monthly coaching calls and an end of project telephone interview. Participating providers were not for profit 46% (n=12), for-profit 46% (n=12), and government-owned 8% (n=2). Their average bed size was 87 and 50% (n=13) of providers had five-star ratings with a range from 1-5. Participants attempted n=439 PAL card interviews with residents and completed n=414 (94.31%) PAL Cards. Providers received over 1,428 minutes of coaching support from the Project Manager over the phone. The majority of providers were successful in implementing PAL Cards for residents with substantial support from the project manager.
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Thao, Mai See, Odichinma C. Akosionu, Heather Davila, and Tetyana P. Shippee. "A CASE STUDY: THE INVISIBLE LABOR OF CULTURALLY SENSITIVE CARE." Innovation in Aging 3, Supplement_1 (November 2019): S699—S700. http://dx.doi.org/10.1093/geroni/igz038.2574.
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Abstract Nursing homes are increasingly becoming more racially/ethnically diverse yet racial disparities in resident’s quality of life and quality of care continue to persist. One reason for these disparities is lack of culturally-sensitive care and racial/ethnic similarity between residents and staff. This study examines a case of a high proportion minority nursing home with racially/ethnically diverse staff to understand how shared culture among direct care staff and residents may influence care delivery. We used three months of participant observation, supplemented by in-depth qualitative interviews with 8 Hmong residents and 5 Hmong staff to explore the labor of culturally sensitive care in a large, urban NH. We discovered four themes: 1) Culturally sensitive care was often equated to fulfilling language needs for residents who didn’t speak English. 2) Hmong staff members had to take the initiative to inform non-Hmong staff members how to care for Hmong residents. 3) Hmong staff members also had to communicate the culture of NH care and its limitations to Hmong residents and their families. 4) Hmong staff members have to advocate for the culturally relevant needs of Hmong residents. The findings of this case study illuminate that having staff members from diverse cultural backgrounds and meeting language needs of residents does not reflect the everyday practices of culturally sensitive care. This type of emotional labor can also result in higher levels of burn-out for staff of color. Additional research into what constitutes culturally sensitive care to NH residents and staff is needed.
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Port, Cynthia Lindman. "Informal Caregiver Involvement and Illness Detection Among Cognitively Impaired Nursing Home Residents." Journals of Gerontology: Series A 61, no. 9 (September 1, 2006): 970–74. http://dx.doi.org/10.1093/gerona/61.9.970.
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Abstract Background. The participation of informal caregivers in the care of nursing home (NH) residents has the potential to positively impact care, especially for cognitively impaired residents whose own ability to advocate for their care is often limited. This study examined relationships between the level of informal caregiver involvement (ICI) in the NH and the degree to which residents' common medical conditions were detected by facility staff. Methods. One hundred pairs of cognitively impaired residents and their primary informal caregivers were enrolled from three facilities in the Baltimore, Maryland area. Data collection involved interviews with informal caregivers and facility staff, as well as a medical evaluation and chart review of residents. A measure of illness detection was created by comparing a medical examination of the resident with chart review information. ICI was measured via staff rating and informal caregiver self-report. Results. Correlations between illness detection and ICI were significant, with r = −.46 (p <.001) and r = −.39 (p <.001), for staff rating and self-reports, respectively. In regression models taking into account resident characteristics (age, race, gender, comorbidities, payment status, duration of stay, and cognitive impairment) and facility differences, higher ICI and being female predicted higher rates of illness detection. Conclusions. Though the cross-sectional nature of the study prevents the analysis of causal relationships, the involvement level of informal caregivers in the NH care of cognitively impaired residents was statistically related to higher rates of illness detection. Ramifications for the role of informal caregivers in long-term care are discussed.
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Tyler, Denise, Cleanthe Kordomenos, and Melvin Ingber. "Stakeholder Perspectives on Reducing Hospitalizations Among Nursing Home Residents." Innovation in Aging 4, Supplement_1 (December 1, 2020): 85. http://dx.doi.org/10.1093/geroni/igaa057.280.
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Abstract Organizations in seven states have been participating in the Center for Medicare and Medicaid Innovation (CMMI) initiative aimed at reducing potentially avoidable hospitalizations among long-stay nursing home (NH) residents. The purpose of this study was to identify market and policy factors that may have affected the initiative in those states. Forty-seven interviews were conducted with key stakeholders in the seven states (e.g., representatives from state departments of health, state Medicaid offices, and nursing, hospital and nursing home associations) and qualitatively analyzed to identify themes across states. Few policies or programs were found that may have affected the initiative; only New York (NY) was found to have state policies or programs specifically aimed at reducing hospitalizations. Market pressures reported in most states were similar. For example, stakeholders reported that the increased availability of home and community-based services and the growing presence of managed care are contributing to higher acuity among both long and short stay residents and that reimbursement rates and staffing have not kept up. Stakeholders suggested greater presence of physicians and nurse practitioners in NHs, better training around behavioral health issues for frontline staff, and more advance care planning and education of families about end of life may help further reduce NH hospitalizations. We also found that all states, except NY, had regional coalitions of health care related organizations focused on improving some aspect of care, such as reducing hospital readmissions. These coalitions may suggest ways that organizations can work together to reduce hospitalizations among NH residents.