Adults In Care Homes Research Articles

Dual registration in Wales questioned

The introduction of a legal duty requiring nurses who manage adult care homes to be regulated twice has been criticised as unnecessary by RCN Wales.

Linking Primary Care With Adult Care Homes

This commentary describes a pilot program wherein a community health center is partnering with Community Care of North Carolina to create a system of integrated care management and "treatment-in-place" visits for aged residents and disabled residents of adult care homes, with the goal of improving the quality of care and reducing unnecessary visits to emergency departments.

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

Use of Transfusion to Treat Acute Chest In Sickle Cell Disease:California Hospital Practice Patterns

AbstractAbstract 253 Introduction:Acute chest syndrome (ACS) is a leading cause of morbidity and mortality in patients with Sickle Cell Disease (SCD). Although the NIH recommends transfusion as standard of care therapy for this diagnosis, practice patterns vary. In 2000, the National Acute Chest Study group found that 72% of patients with ACS were transfused. This study, which was perfomed at academic medical centers with sickle cell treatment programs, used specific diagnostic inclusion criteria. As ACS may be difficult to distinguish from pneumonia, recognition and treatment of the diagnosis may vary by hospital and by presence or absence of a sickle cell specialist. With access to hospital discharge data from all California hospitals seeing SCD patients, we aimed to describe transfusion practices in ACS. Methods:This retrospective cohort study uses 2005–2008 public data from the California Office of Statewide Health Planning and Development (OSHPD). Data included all inpatient and emergency department (ED) discharges from all non-federal California hospitals. Cases were selected based on discharge from or admission via an ED and the presence of a sickle cell disease ICD-9 code in the primary or a secondary diagnosis (282.60-282.69, 282.41–282.42). Further inclusion criteria included presence of ACS (517.3) or respiratory diagnoses including pneumonia, pulmonary edema, acute respiratory distress syndrome, hypoxia and respiratory failure in any primary or secondary diagnosis. Frequency of transfusion, intubation and mortality were described and chi-square tests were performed to determine the statistical significance of differences between groups of patients treated with or without transfusion as well as between groups of adults and children. Results:Between 2005–2008, 4306 ED visits by Californians with SCD were associated with either ACS or a related respiratory diagnosis and only 42.5% of these cases were associated with transfusion. Limiting the diagnosis to ACS only, 1399 cases were identified, and still only 50.4% of these cases were associated with transfusion. Among patients with ACS or a related diagnosis, the majority were admitted to the hospital (90.9%); only 59.2% of intubated cases (n=238) were transfused; and of the 92 deaths during this period, only 46.7% were associated with transfusion. Patients who were 18 and over were transfused more often than young children (43.2% vs. 35.7%; 2(1)=12.37, p<0.001). Conclusions:Despite transfusion being the standard of care for treatment of ACS as well as other sickle–related complications, many ACS cases in California are not being treated in this manner. Surprisingly, the most severely ill patients, those who were either intubated or died during the study period, had a lower transfusion frequency than the cohort as a whole. Although some mild pediatric cases may not be transfused, a minority of the total cohort was under 18 years old. Recent studies imply that patients transitioning out of pediatric SCD programs have an increased risk of dying due to ACS and other serious SCD complications. Our study suggests that underutilization of transfusion may play a role in these poor adult outcomes in SCD. These findings prompt further investigation into the role of transition to adult care and appropriate medical homes in access to quality SCD care. Disclosures:No relevant conflicts of interest to declare.

Dietary and Fluid Intakes of Older Adults in Care Homes Requiring a Texture Modified Diet: The Role of Snacks

To evaluate and compare energy, protein, non-starch polysaccharide, and fluid intakes of a care home population consuming a texture modified diet (TMD) with those on a standard diet and also to evaluate the role of snacks in individuals' diets. Cross-sectional study. Care homes. Thirty residents (n = 15 requiring standard diet: n = 15 requiring TMD). Dietary intakes were assessed using a 3-day weighed plate-wastage method. All snacks and drinks consumed were observed and recorded. Weights of standard portions and volumes were used to determine actual amounts consumed of these items. Estimated intakes were converted to energy and nutrient intakes using WinDiets Dietary analysis software. Residents on a TMD had significantly lower intakes of energy (1312 [326] kcal versus 1569 [260] kcal, P < .024), non-starch polysaccharide (6.3 [1.7] g versus 8.3 [2.7] g, P < .02) and fluid (1196 [288] mL versus 1611 [362] mL, P < .002) when compared with residents on a standard texture diet. Snacks provided significantly less energy (13% or 173 kcal versus 22% or 343 kcal, P = .001) and non-starch polysaccharide (P < .001) in those requiring the TMD. These results suggest that dietary and fluid intakes of older adults in care homes requiring a TMD are significantly less than individuals on a standard texture diet. These are unlikely to be meeting individuals' dietary and nutritional needs. Strategies that maximize provision of appetizing energy and nutrient-dense foods (including snacks) and fluids of suitable textures require further investigation.

Problem-Solving Therapy for Subthreshold Depression in Home Healthcare Patients With Cardiovascular Disease

Randomized trial evaluated problem-solving therapy in home care (PSTHC) for homebound older adults with cardiovascular disease receiving acute home care services. This study hypothesized that compared with usual care plus education intervention, home-based PST-HC would significantly reduce depression and anxiety scores, lead to improved quality of life, and greater satisfaction with treatment among elderly with cardiovascular disease. Thirty-eight participants were recruited from a university-affiliated home healthcare agency for the trial. Six 1-hour PST-HC sessions included depression education, problem-solving skills, pleasurable activity scheduling, homework, and weekly telephone calls over a 6-week period. The control comparison group received usual care plus two sessions of education and a depression brochure. Outcome measures included the Beck Depression Inventory, Hamilton Rating Scale for Depression, Beck Anxiety Inventory, and the short form (SF)-36 health status measure. After the intervention, both groups completed the Patient Satisfaction Questionnaire. Compared with the control group, the PST-HC group showed a significant decrease in depression but not anxiety scores. The PST-HC group generally reported more favorable satisfaction with treatment than the control group. The PST-HC group improved significantly, when compared with the control group in only two of eight SF-36 subscales: mental health and emotional role function. The brief PST-HC intervention demonstrated that depression improved among home care elderly. However, there was no change in six of eight health status measures or anxiety level. Authors discuss integrating interdisciplinary depression care in the home care setting.

An Intervention to Improve Nurse-Physician Communication in Depression Care

Depression in older adult home care recipients is frequently undetected and inadequately treated. Failed communication between home healthcare personnel and the patient's physician has been identified as a barrier for depression care. The purpose of this pilot intervention study was to improve nurse competency for communicating depression-related information to the physician. A single group pre-post experimental design. Two Medicare-certified home healthcare agencies serving an urban and suburban area in New York. Twenty-eight home care nurses, all female Registered Nurses. Two-hour skills training workshop. To evaluate the intervention, pre-post changes in effective nurse communication using Objective Structured Clinical Examinations and nurse survey reports. The intervention significantly improved the ability of the home care nurse to perform a case presentation in a complete and standard organized format pre versus postintervention. The intervention also increased nurse-reported certainty to communicate depression-related information to the physician. Our findings provide support for the ability of a brief, depression-focused communication skills training intervention to improve home care nurse competency for effectively communicating depression-related information to the physician.

Palliative care provision for older people in care homes

There is a paucity of research in relation to district nurses' (DNs) experiences of palliative care provision in adult care homes (CHs) despite their substantial involvement. The aim of this study was to demonstrate the current involvement of DNs in CHs and identify the potential implications for future practice in providing palliative care in this setting. The findings suggested that even experienced DNs, wanted support and education about when to commence palliative care. They also wanted earlier involvement with CH residents who have a life-limiting condition and CH managers were seen as being essential contributors towards planning care. There was concern among DNs as to how the Liverpool Care Pathway could be introduced into CHs with untrained carers and finally, DN alignment to CHs was shown to improve continuity of care for residents and produce more effective partnership working between DNs, general practitioners and CH staff.

Challenges associated with the recognition and treatment of depression in older recipients of home care services

Home care for older adults is a common phenomenon worldwide because it allows older adults to remain in their home environment. Research has shown that depression is frequently found in older recipients of home care services. Nonetheless, it is often poorly recognized and treated. Untreated or poorly treated depression in older home care recipients has been associated with a variety of negative outcomes, including increased morbidity and mortality, greater likelihood of nursing home institutionalization and higher caregiver distress. The present review outlines some of the challenges associated with appropriate recognition and treatment of depression in older home care recipients. Our review demonstrates that more aggressive management of depressive symptoms and the employment of an interdiciplinary team can result in beneficial outcomes. Further research is needed, especially in the area of psychotherapeutic interventions as these should be flexible enough to meet the unique and evolving needs of this frail population of older adults.

Living ‘a life like ours’: support workers' accounts of substitute decision‐making in residential care homes for adults with intellectual disabilities

In England and Wales, the Mental Capacity Act 2005 (MCA) provides a new legal framework to regulate substitute decision-making relating to the welfare of adults who lack the capacity to make one or more autonomous decisions about their care and support. Any substitute decision made on behalf of an adult lacking capacity must be in his/her 'best interests'. However, the value of adopting established principles and procedures for substitute decision-making in practice is uncertain, and little is known about the legal or ethical dynamics of social care support, including the day-to-day residential support provided to adults with intellectual disabilities (ID). Methods This paper reports a qualitative, grounded theory analysis of 21 interviews with support workers working in residential care homes for adults with ID, and observations of care practices. Results In contrast to the narrow legal responsibilities placed upon them, it is argued that support workers interpret substitute decision-making within a broad moral account of their care role, orientating their support towards helping residents to live 'a life like ours'. In so doing, support workers describe how they draw on their own values and life experiences to shape the substitute decisions that they make on behalf of residents. Conclusions Support workers' accounts reveal clear discrepancies between the legal regulation of substitute decision-making and the ways that these support workers make sense of their work. Such discrepancies have implications both for the implementation of the MCA, and for the role of support workers' values in the conceptualisation and delivery of 'good' care.

End-of-life obligations ignored in many care homes in Scotland.

FOUR OUT of ten care homes for adults and older people in Scotland are failing to provide palliative and end-of-life care to residents with life-limiting illnesses, inspectors have found.

How Do SLPs Improve Outcomes in Adults in Home Care?

Home care agencies that have not employed speech—language pathologists (SLPs) may not be aware of their potential to advance other rehab and nursing goals for patients with communication, swallowing, and cognitive impairments. This article provides an overview of the professional requirements and scope of speech—language pathology practice. Quality reporting in health care and various organizations engaged in performance measurement are described. The American Speech-Language-Hearing Association’s National Outcomes Measurement System has developed specific outcomes measures to track SLP intervention. Case studies illustrate how speech—language pathology services can enhance the effectiveness of other rehabilitation services and have an impact on hospital readmission, a primary quality measure in home care.

Patients from care homes who attend the emergency department: could they be managed differently

Aims:To describe the demographics of patients from care homes who attend the emergency department (ED) and to estimate whether appropriate alternative care pathways could have been delivered to this patient...

Using videotelephony to support paediatric oncology-related palliative care in the home: from abandoned RCT to acceptability study

Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours ‘on-call’ service already offered. A 92% participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates. The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis, through outpatient care and support, and for palliative care rather than for palliative care in isolation. Trial registration ACTRN 12606000311550

Enabling independence: restorative approaches to home care provision for frail older adults

This study reviews the 'real world' potential (i.e. efficacy and effectiveness) of restorative approaches towards home care for frail older adults. Such approaches aim to go beyond traditional home care goals of 'maintenance' and 'support' towards improvements in functional status and quality of life. Our review of the literature included searches of health and gerontology databases as well as 'grey literature' across Australia, the UK and the USA. We provide an initial overview of the efficacy of a range of single component restorative interventions, including occupational therapy, physical therapy, health education and social rehabilitation. In order to answer questions about the overall efficacy and cost-effectiveness of restorative home care provision, we also review the nature of in-house programmes across the three nations as well as the evidence base for such programmes, particularly when they have been compared to home care 'as usual'. A range of positive outcomes has emerged, including improved quality of life and functional status and reduced costs associated with a reduction in the ongoing use of home care services postintervention. Questions remain about which components are most beneficial, which clients are likely to receive the greatest benefit, and the appropriate intensity and duration of such interventions.

Investigation and research on needs of home nursing of adult inpatients

Objective To identify the needs of home nursing of adult inpatients, and analyze the re-lated factors of the needs in order to give direction and information for the home care nursing. Methods A self-designed questionnaire was used to investigate the needs of home nursing of 172 adult inpatients. Results Of the 172 patients, 56(32.6%) patients considered the home care was necessary, and 66(38.4%) patients in an indifferent attitude,50(29.0%) patients thought it unnecessary. The need was positively related with the comprehension of home care. The need for home care of patients from different departments, age groups and subjective judgement of self-health had significant difference. Conclusions Home care are necessary for some kind of adult inpatients. We should perfect adult home care system and improve nursing level of community. Key words: Adult patient; Home care; Need

Neither rain nor hail nor sleet nor snow: Provider perspectives on the challenges of weather for home and community care

This paper contributes to the literature on the geographies of care and caregiving by examining the implications of weather for providing home and community care for children and older adults. Integrating research from two previous qualitative studies of formal and informal care provisioning in Ontario, Canada, the authors re-analyzed semi-structured interviews with 83 directors, managers, paid staff, volunteers and family members to examine the challenges they faced when providing care during the winter season. Similar to other settings where winter conditions like snow, ice and cold temperatures are commonplace, the studies were set within a health policy context in which there is not enough recognition of the difficulties of weather for coordinating, managing and providing care to disabled, injured, chronically ill and frail individuals. The re-analysis focused on how winter conditions translate into geographical, administrative, economic, operational, physical, social and psychological barriers within and across different ‘scales of care’. The findings indicate that the problems posed by weather are crucial yet often underestimated aspects of home and community care provided by formal and informal caregivers. The analysis of weather-related challenges for care provisioning needs to be extended to other seasonal conditions (e.g., the challenges of delivering care in extreme heat), to the developing world and even to the burgeoning debates on the health implications of global environmental change.

Predictors of Satisfaction for African-American and White Family Caregivers of Adult Care Home Residents

This study examines satisfaction with care for African-American and White family caregivers of assisted living (adult care and family care homes) residents. Demographic factors, particularly race, caregiving experiences, and structural characteristics, were analyzed. A regression model correcting for design effects was analyzed. Because of the number of significant interactions, separate analyses for each race were completed. Results support the conceptualization of satisfaction with long-term care as a multidimensional process, incorporating demographic characteristics of family caregivers, the caregiving experience, and structural characteristics of the facility. Findings also suggest that predictors of satisfaction with care differ by race. A focus by long-term care administrators and staff on aspects highlighted in this study could improve relationships with family members and marketability of their facility. Findings can also benefit potential residents of adult care homes and/or their family members who need to select a long-term care facility.

Caring for independent lives: Geographies of caring for young adults with intellectual disabilities

This paper engages with the emerging disciplinary clash between ‘care’ and ‘independence’ within disability studies by examining the geography of home care for young adults with intellectual disabilities. The care system as a whole is viewed as central to disablist structures within disability studies (see Thomas, C. (2007). Sociologies of disability and illness: Contested ideas in disability studies and medical sociology. Hampshire: Palgrave Macmillan.). However, despite the theorisation of dependency as being in antipathy to the goals of the disability movement, caregiving at home still continues to dominate community care. The paper attempts to address how family carers are ‘caught-in-the-middle’ between their ‘duty’ to care and at the same time, perpetuating dependency; the reality being that parents have to deal with issues of being overprotective and confronting various social assumptions about disability. It examines the narratives from 25 family caregivers in Ireland who provide personal assistance to young adults with intellectual disabilities.

Continence care for older adults in care homes

Assessment and accurate documentation is paramount to the deilvery of effective and effi cient holistic continence care to all residents in need. Sue Foxley discusses.