Residential Care Research Articles

Qualitative Comparative Analysis of exercise interventions for fall prevention in residential aged care facilities

BackgroundExercise interventions are highly effective at preventing falls in older people living in the community. In residential aged care facilities (RACFs), however, the evidence for effectiveness is highly variable, warranting exploration of drivers of successful trials. This study aims to identify the conditions of randomised controlled trials (RCTs) that are associated with reducing falls in RACFs and test whether it can explain the variability.MethodsRCTs testing exercise interventions in RACFs compared to usual care, reporting rate or risk of falls from the 2018 Cochrane Collaboration review and a search update to December 2022 were included. Two authors independently extracted and coded trial conditions and outcomes according to a theory developed from prior Intervention Component Analysis. Trial outcomes were coded as successful or unsuccessful based on point estimates for the rate or risk ratio for falls, or p value. Qualitative Comparative Analysis (QCA), utilising Boolean minimisation theory, was conducted to determine the key conditions driving trial success. A subgroup meta-analysis and the GRADE approach was applied to the final theory.ResultsEighteen trials undertaken in 11 countries with 2,287 residents were included. Participants were predominately ambulant females aged 70 to 80 with cognitive impairment. Most interventions were fully supervised or supervised at the start of the intervention. QCA identified two configurations as drivers of successful exercise falls prevention programs: (i) group exercise that is moderate or low intensity, or (ii) for independent ambulatory residents, exercise for more than 1 h per week. The combination of configuration (i) and (ii) had consistency and total coverage scores of 1, indicating all trials were explained. This combination was associated with a reduction in falls (rate ratio 0.45, 95%CI 0.34 to 0.59; risk ratio 0.66, 95%CI 0.53 to 0.82; low certainty evidence).ConclusionTo successfully reduce falls in RACFs, exercise programs should provide continuous supervised moderate-intensity group exercise. For programs that mostly include independent ambulatory residents, exercise for at least 80 min per week should be provided. As many current residents are frail, tailored exercise is likely necessary and an individualised dose may be required. Future trials should test exercise interventions for less mobile residents.

Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns

IntroductionDuring 2020–2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings.MethodsA longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality.ResultsDuring the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0–4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19–1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12–1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86–1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates.ConclusionThese findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents’ care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.

Medical director presence and time in U.S. nursing homes, 2017-2023.

Federal regulations require all nursing homes to have a medical director, where medical directors oversee resident medical care and develop, implement, and evaluate resident care policies and procedures that reflect current standards of practice. This descriptive study examined medical director: (1) presence or absence and the amount of time spent from 2017 to 2023; (2) presence and time by ownership type; (3) variations in presence and time across states; and (4) overall CMS deficiencies for violations of medical director regulations. This study used federal Payroll-Based Journal (PBJ) data on staffing positions for the period of 2017-2023, along with federal nursing home ownership data and deficiencies data for 2023. More than a third of U.S. nursing homes (36.1%) reported zero medical director presence in Quarter 1, 2023. Medical director presence fluctuated between 2017 and 2023 with a decline over the past 4 years. Among nursing homes reporting a medical director, the medical director was on payroll for an average 36 min per day or 4.2 h per week per facility, and less than 1 min per resident day. Medical director presence and time varied significantly by ownership type and state. For-profit nursing homes reported a lower rate of medical director presence (61.4%) compared to non-profit (71.3%) and government (66.5%) nursing homes and reported that medical directors spent less time in the facilities. Facilities seldom (0.2%) receive regulatory deficiencies for medical director requirements. Though medical directors have a critical role in overseeing clinical care, some nursing homes report no medical director time and those that do report about 4 h per week. Together, these findings may indicate the need for improvement. More research is needed to understand these variations and the extent to which medical director regulations are being followed by nursing homes and enforced by regulators.

Tax-free benefits for staff: what nursing and residential care home managers can provide

In this article, Helen Thornley and Adam Bernstein discuss how managers of nursing or residential care homes can provide tax-free benefits for their staff.

Spirituality and ageing: how to support older people in nursing or residential care homes

In this article, Chris Barber discusses how care home staff can help residents to keep practicing their faith or spiritual beliefs.

Long-Term Care Use Among Older Migrants in the Netherlands: What to Expect in the Next Decade?

ABSTRACT The number of older adults in the Netherlands is growing rapidly, and an increasing share of them is foreign-born. This may have implications for long-term care (LTC) demand. This study provides insights into older migrants’ current and future use of LTC provisions under the Dutch long-term care act (LTCA). We distinguish three types of LTC and six groups of older migrants and analyze register data of all foreign-born older adults. Descriptive statistics for the 2016–2022 period and logistic regression analyses show considerable heterogeneity regarding the LTC-services used and the origin of care users. Most notably, Moroccan and Turkish older adults are least likely to use residential care and more likely to use personal care budgets. By combining our models’ results with population projections, we project that older migrants’ use of home-based care and personal budgets will increase rapidly in the next decade. Migrants with western and Surinamese origin will most often use LTC. Although the demand for residential care will rise less markedly, residential care will remain most used by older migrants under the LTCA. The rising demand for home-based care calls for policy efforts accommodating flexibility, room for differences, and grounds for establishing trustworthy relationships between all involved actors.

Building a culture of safety in Australian residential aged care facilities: protocol for a longitudinal mixed methods research programme

IntroductionThe quality and safety of care within residential aged care facilities (RACFs) have been linked to their organisational culture. However, evidence for understanding and improving culture in this setting is...

Dual-Eligible Nursing Home Residents: Enrollment Growth In Managed Care Plans That Coordinate Care, 2013-20.

Dual-eligible beneficiaries have insurance through two distinct and uncoordinated programs: Medicaid, which pays for long-term care; and Medicare, which pays for medical care, including hospital stays. Concern that this system leads to poor quality and inefficient care, particularly for dual-eligible nursing home residents, has led policy makers to test managed care plans that provide incentives for coordinating care across Medicare and Medicaid. We examined enrollment in three such plans among dual-eligible beneficiaries receiving long-term nursing home care. Two of those plans, Medicare-Medicaid plans and Fully Integrated Dual Eligible Special Needs Plans, are integrated care plans that establish a global budget including Medicare and Medicaid spending. The third, Institutional Special Needs Plans, puts insurers and nursing homes at risk for Medicare spending but not Medicaid spending. Among dual-eligible nursing home residents, enrollment in these plans increased from 6.5percent of residents per month in 2013 to 16.9percent in 2020. Enrollment varied across counties but did not vary appreciably with respect to nursing home characteristics, including the share of residents with Medicaid. As policy makers pursue strategies to coordinate medical and long-term care for dual-eligible beneficiaries, it remains critical to evaluate how these plans influence the care of dual-eligible nursing home residents.

Quality indicators to monitor the quality and safety of care for older people: a scoping review protocol.

The objective of this review is to identify quality indicators used to monitor the quality and safety of care provided to older people (≥ 65 years old) in 8 care settings: primary care; hospital/acute care; aged care (including residential aged care and home or community care); palliative care; rehabilitation care; care transitions; dementia care; and care in rural areas. There is a need for high-quality, holistic, person-centered care for older people. Older people receive care across multiple care settings, and population-level monitoring of quality and safety of care across settings represents a significant challenge. National and international quality indicators used to monitor and evaluate the quality and safety of care at the population level for older individuals in the 8 key care settings will be considered for inclusion. English-language quantitative and mixed method studies published from 2012 will be considered. Academic (MEDLINE, Embase) and gray (government websites, clinical guidelines, Google) literature searches will be conducted. A standardized data extraction tool will be used to describe the identified quality indicators and associated tools. Quality indicators will be categorized by key domains (ie, pain, function, consumer experience, service delivery); quality indicator type (structure, process, outcome); and the Institute of Medicine's 6 dimensions of care quality (eg, efficiency, effectiveness, appropriateness, accessibility, acceptability/person-centered, safety). The scoping review will be conducted in accordance with the JBI methodology for scoping reviews and will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Open Science Framework https://osf.io/8czun.

Disparities in Rates of Multitarget Stool DNA Test Completion for Colorectal Cancer Screening.

The aim was to assess patient adherence to multitarget stool DNA testing as well as factors associated with adherence. In the United States, disparities in colorectal cancer screening exist along racial and socioeconomic lines. While some studies suggest that stool-based screening tests may help reduce the screening gap, the data for multitarget stool DNA testing is unclear. We conducted a single-center retrospective cohort study on multitarget stool DNA testing ordered between April 2020 and July 2021. We calculated the proportion of patients who completed testing and used multivariate logistic regression to identify covariates associated with test adherence. Among 797 patients ordered for multitarget stool DNA testing, 481 patients (60.4%) completed testing. Adherence rates by patient subgroups ranged from 35.8% to 78.1%. Higher test adherence was found in Asian patients (odds ratio 2.65, 95% CI 1.36-5.18) and those who previously completed colorectal cancer screening (OR 1.45, 95% CI 1.01-2.09), while Black patients (OR 0.58, 95% CI 0.39-0.87), patients with resident primary care physicians (OR 0.34, 95% CI 0.21-0.56), and patients contacted through an outreach program (OR 0.47, 95% CI 0.25-0.87) had lower adherence. A significant proportion of patients ordered for multitarget stool DNA testing did not complete testing. Differences in adherence rates among patient subgroups may be reflective of underlying disparities in health care access.

Predictors and shared traits of longevity within 1 year before death in patients with schizophrenia receiving long-term care: 3-year retrospective cross-sectional study.

Research on schizophrenia and life expectancy has mainly focused on premature mortality. This study investigates factors associated with longevity in patients with schizophrenia receiving long-term care and identifies shared traits among these individuals. A retrospective cross-sectional study analysing the clinical records of 138 patients with schizophrenia who died between 2015 and 2017 in a psychiatric long-term care facility was conducted. Longevity was defined by life tables drawn from the national health database. Variables were compared between longevity and control groups to determine predictors of longer lifespans. Cluster analysis was employed to identify shared traits among individuals with longevity. Causes of death by age were compared. In the long-term care setting, of the 138 participants, 45 were in the longevity group. This group had more males, lower antipsychotic doses, but more mobility issues. Significant predictors of longevity included older age at onset, longer length of stay, lower activities of daily living scores and a hypertension diagnosis. Cluster analysis revealed two patterns, suggesting that poorer health indicators did not necessarily lead to shorter lives. Fatalities caused by pneumonia were associated with a higher age, compared to those from cancer and choking. Addressing modifiable risk factors enhances life expectancy in patients with schizophrenia, especially for males, while the age at onset may play a significant role. An integrated long-term care model with close monitoring and timely provision of mental and general healthcare may help extend lifespans. Further research is needed to balance long-term residential care and community-based care for elderly patients with schizophrenia.

Ambivalent Purview of Kinship Care: Insights from Stakeholders

The realm of alternative care for children covers a variety of care systems, which include residential care, small group homes, mother and child shelters, transit homes, adoption, foster care and kinship care. The United Nations General Assembly’s 2019 resolution on children’s rights emphasises the significance of family-based environments for children, particularly those without parental care, and underlines their right to grow up in a family setting. In light of this resolution, kinship care emerges as a crucial family-based care avenue for children lacking parental care. In India, kinship care stands as the predominant form of care for children lacking sufficient parental support and is the most common form of care in almost all regions, religions, castes and ethnic groups due to the tradition of the joint family system and close ties among relatives. While this care option is the most common form of out-of-home care, it is also the least systematically recorded, monitored or supported structure. The study, through the lens of kinship carers, ward and village-level child protection committees and community workers, focuses on the important aspects of support, motivation, love, responsibility and challenges that underlie providing care for children without parental care. This qualitative study employs ethnographic interview techniques to understand the most authentic experiences of kinship carers. Families were initially identified based on secondary data captured from the assessment and intervention planning done using the Thrive Scale™ tool as part of the case management process. Subsequently, semi-structured interviews were conducted with six families from two different communities (one urban community in the state of Maharashtra and one rural community located in the state of Gujarat in India) to assess the existing support structures available for kinship carers and their families, identifying gaps and measures being taken to address them to ensure meaningful well-being of children and kinship families. The study discusses various challenges of kinship families, from financial struggles to familial disconnection, lack of housing infrastructure or access to healthcare, family issues like alcoholism or child labour, lack of education or livelihood and social isolation. The study further recommends increased attention and resources directed towards supporting kinship carers, acknowledging their invaluable role in providing love, support and stability to children without parental care, and also emphasises the importance of recognising and formalising kinship care within a broader framework of alternative care for children. Miracle Foundation India is committed towards ensuring that every child has an opportunity to grow up in a family, to become a healthy, happy, income-producing person and to experience a true sense of belonging. The paramount significance of kinship care is recognised by Miracle India in its sphere of both the prevention of child separation from family and reintegration work. After a thorough assessment of these families on the five key domains of well-being—physical and mental health, education, family and social relationships, household economy and living conditions—and continuous monitoring and follow-up, Miracle India provided a comprehensive support service to these families, strengthened them and ensured sustained access to support services, ultimately promoting child welfare. During this study, the focus remained on prioritising the implementation of supportive policies and resources for kinship caregivers to ensure that every child in vulnerable circumstances thrives within the warmth and stability of a loving and caring family.

Do Attachment, Educator Characteristics and Youth-Educator Relationship Matter in 6-Month Changes of Institutionalized Adolescents?

This longitudinal study involved youths in residential care due to previous adverse experiences and their educators, aiming to investigate the role of youths and educators' attachment, educators' psychopathology, and the quality of youth-educator relationship on change scores of youths' symptoms and youth-educator relationship security over 6 months. Participants were 36 institutionalized youths (Mage = 16.50 ± 2.13) and their 25 main educators (Mage = 38.48 ± 5.75), assessed at baseline (T1) and 6 months later (T2). Youths were assessed in total, internalizing and externalizing problems via a multi-informant approach, and educators in psychopathology levels. Attachment representations of youths and educators were assessed through validated attachment interviews (Friends and Family Interview and Adult Attachment Interview), and both separately rated the youth-educator relationship. (1) Most cases remain stable over 6 months. (2) Educator narrative coherence and the quality of youth-educator relationship at baseline were correlated but not predictive of change in youths' symptoms. (3) Youths' higher attachment disorganization at baseline was the unique predictor of 14% variance of positive change in the youth-educator relationship security perceived by the youth. (4) Youth attachment avoidance uniquely predicted 37% of positive change variance in the youth-educator relationship security perceived by educators. In conclusion, attachment-based assessment of youths and educators can inform intervention to foster youth improvement.

Renewable Energy and Sustainability Convergence

The change to renewable energy in the development of senior citizens homes is crucial as professionals in the built environment and organizations are getting more conscious of environmental conservation. The need to cut energy billing costs, raising energy efficiency, and emit little or no greenhouse gases known to be dangerous to human living makes this very imperative. Solar, wind, and geothermal energy sources are gaining ground. This study seeks to examine the benefits of incorporating renewable energy in housing facilities that accommodate senior citizens. The survey research design, employing qualitative and quantitative data from respondents, was analyzed using descriptive statistics and inferential analysis. The study revealed that structures integrated with solar photovoltaic (PV) systems, solar panels and wind power can reduce dependence on conventional power systems, having a notable positive influence on the greenhouse effect through a reduction in the emission of greenhouse gases, providing satisfactory indoor conditions to have a positive impact on elderly health. Favourable government policies and regulations in terms of subsidies, grants and regulation enforcement of regulations would help greatly. The research concluded that in addition to improving the quality of care for elderly residents, the generation of renewable energy promotes the concept of sustainability.

Effects of I AM TAP Program on Executive Function of Children 3-5 years in Bangkok Metropolitan Region Residential Care Homes: A Quasi-experimental Study

Executive function is important to the success of an individual. Children who have a history of being abused mentally and physically before entering a residential care home may have executive function deficits. They often face fear, stress, and a lack of interpersonal interaction, which affects their executive function. This quasi-experimental study aimed to increase children’s executive function through the I AM TAP Program. This program integrates sensory and physical activities, including working memory, inhibitory control, and cognitive flexibility. Two residential care homes of young children aged 3-5 years in the Bangkok Metropolitan Region were randomly assigned to experimental and control groups. Then, 36 children from each setting and 11 caregivers were selected according to the inclusion criteria. The experimental group received I AM TAP Program training twice weekly for 9 weeks, 20-30 minutes each session. The control group attended the routine activities provided in a residential care home. Executive function was assessed with the Mahidol University Executive Function-101 instrument. The data were analyzed using independent t-tests, paired t-tests, and covariance analysis. The results of this study, a testament to the effectiveness of the I AM TAP Program, revealed a significant increase in the mean scores of executive functions on 3 subscales in the experimental group. These scores not only improved from the pre-program levels but also surpassed those of the control group, as measured one week after program completion. This promising outcome suggests that the I AM TAP Program has the potential to enhance executive function in young children. Nurses can potentially apply this program to promote executive function, and caregivers can be equipped with information on how to support the children in the residential care home. However, it is crucial to conduct further testing with various groups of children in different settings before considering widespread implementation

Developing an Ordered Logistics Regression Model for Denture Hygiene among Elderly in Residential Care Homes

Developing an Ordered Logistics Regression Model for Denture Hygiene among Elderly in Residential Care Homes

A model-based assessment of social isolation practices for COVID-19 outbreak response in residential care facilities

BackgroundResidential aged-care facilities (RACFs, also called long-term care facilities, aged care homes, or nursing homes) have elevated risks of respiratory infection outbreaks and associated disease burden. During the COVID-19 pandemic, social isolation policies were commonly used in these facilities to prevent and mitigate outbreaks. We refer specifically to general isolation policies that were intended to reduce contact between residents, without regard to confirmed infection status. Such policies are controversial because of their association with adverse mental and physical health indicators and there is a lack of modelling that assesses their effectiveness.MethodsIn consultation with the Australian Government Department of Health and Aged Care, we developed an agent-based model of COVID-19 transmission in a structured population, intended to represent the salient characteristics of a residential care environment. Using our model, we generated stochastic ensembles of simulated outbreaks and compared summary statistics of outbreaks simulated under different mitigation conditions. Our study focuses on the marginal impact of general isolation (reducing social contact between residents), regardless of confirmed infection. For a realistic assessment, our model included other generic interventions consistent with the Australian Government’s recommendations released during the COVID-19 pandemic: isolation of confirmed resident cases, furlough (mandatory paid leave) of staff members with confirmed infection, and deployment of personal protective equipment (PPE) after outbreak declaration.ResultsIn the absence of any asymptomatic screening, general isolation of residents to their rooms reduced median cumulative cases by approximately 27%. However, when conducted concurrently with asymptomatic screening and isolation of confirmed cases, general isolation reduced the median number of cumulative infections by only 12% in our simulations.ConclusionsUnder realistic sets of assumptions, our simulations showed that general isolation of residents did not provide substantial benefits beyond those achieved through screening, isolation of confirmed cases, and deployment of PPE. Our results also highlight the importance of effective case isolation, and indicate that asymptomatic screening of residents and staff may be warranted, especially if importation risk from the outside community is high. Our conclusions are sensitive to assumptions about the proportion of total contacts in a facility accounted for by casual interactions between residents.

Optimizing Response Rates to Examine Health IT Maturity and Nurse Practitioner Care Environments in US Nursing Homes: Mixed Mode Survey Recruitment Protocol.

Survey-driven research is a reliable method for large-scale data collection. Investigators incorporating mixed-mode survey designs report benefits for survey research including greater engagement, improved survey access, and higher response rate. Mix-mode survey designs combine 2 or more modes for data collection including web, phone, face-to-face, and mail. Types of mixed-mode survey designs include simultaneous (ie, concurrent), sequential, delayed concurrent, and adaptive. This paper describes a research protocol using mixed-mode survey designs to explore health IT (HIT) maturity and care environments reported by administrators and nurse practitioners (NPs), respectively, in US nursing homes (NHs). The aim of this study is to describe a research protocol using mixed-mode survey designs in research using 2 survey tools to explore HIT maturity and NP care environments in US NHs. We are conducting a national survey of 1400 NH administrators and NPs. Two data sets (ie, Care Compare and IQVIA) were used to identify eligible facilities at random. The protocol incorporates 2 surveys to explore how HIT maturity (survey 1 collected by administrators) impacts care environments where NPs work (survey 2 collected by NPs). Higher HIT maturity collected by administrators indicates greater IT capabilities, use, and integration in resident care, clinical support, and administrative activities. The NP care environment survey measures relationships, independent practice, resource availability, and visibility. The research team conducted 3 iterative focus groups, including 14 clinicians (NP and NH experts) and recruiters from 2 national survey teams experienced with these populations to achieve consensus on which mixed-mode designs to use. During focus groups we identified the pros and cons of using mixed-mode designs in these settings. We determined that 2 mixed-mode designs with regular follow-up calls (Delayed Concurrent Mode and Sequential Mode) is effective for recruiting NH administrators while a concurrent mixed-mode design is best to recruit NPs. Participant recruitment for the project began in June 2023. As of April 22, 2024, a total of 98 HIT maturity surveys and 81 NP surveys have been returned. Recruitment of NH administrators and NPs is anticipated through July 2025. About 71% of the HIT maturity surveys have been submitted using the electronic link and 23% were submitted after a QR code was sent to the administrator. Approximately 95% of the NP surveys were returned with electronic survey links. Pros of mixed-mode designs for NH research identified by the team were that delayed concurrent, concurrent, and sequential mixed-mode methods of delivering surveys to potential participants save on recruitment time compared to single mode delivery methods. One disadvantage of single-mode strategies is decreased versatility and adaptability to different organizational capabilities (eg, access to email and firewalls), which could reduce response rates. DERR1-10.2196/56170.

Overview of Post-acute and Long-term Care Providers and Services Users in the United States, 2020.

This report presents national results from the National Post-acute and Long-term Care Study to describe providers and services users in seven major settings of paid, regulated post-acute and long-term care services in the United States. Data are from the 2020 National Post-acute and Long-term Care Study, which includes surveys of adult day services centers and residential care communities and administrative data from the Centers for Medicare and Medicaid Services on home health agencies, hospices, inpatient rehabilitation facilities, long-term care hospitals, and nursing homes. The findings show variation in characteristics of the seven post-acute and long-term care settings. About 68,150 providers served roughly 7.3 million people in the United States; about one-half of these providers were residential care communities, and about one-quarter were nursing homes. The Northeast had a higher percentage of adult day services centers than other settings, the Midwest had a higher percentage of nursing homes, the South had a higher percentage of long-term care hospitals, and the West had a higher percentage of residential care communities. Among the settings, more registered nurses were employed in inpatient rehabilitation facilities and long-term care hospitals, and more licensed practical nurses in home health agencies and long-term care hospitals. The most common services were skilled nursing and therapeutic services. Adult day services centers had the highest percentage of users younger than age 65, while nearly one-half of hospice and nursing home users were age 85 and older. Adult day services centers had the highest percentage of other non-Hispanic and Hispanic users among the settings. The percentage of users with selected diagnoses and activities of daily living difficulties varied by setting. The providers described in this report comprise a large share of the U.S. post-acute and long-term care industry. This report provides the most recent nationally representative information on these providers and services users and updates findings from previous National Center for Health Statistics reports.

Factors Promoting a Sense of Home Among Older Adults in Residential Care Facilities in Italy.

Understanding the housing needs of older adults is crucial for policy makers, service providers, and professional carers. Evidence about the factors that contribute to older adults' "sense of home" and their practical and policies implications are lacking. Semi-structured interviews were conducted with 78 community-dwelling older adults to investigate which structural and organizational requirements and relational-affective environments could contribute to their experiencing a sense of home. Through inductive content analysis 119 subcategories were derived and grouped into eight main categories: being considered as a person; a safe, quiet, welcoming, and personalizable environment; meaningful relationships; optional and stimulating activities; active involvement in the organization within the facility; competent care personnel; preserving life memories; facility open and integrated with the community. Findings suggest that multiple factors might influence "feeling at home," and many strategies can be adopted to facilitate older adults' successful adaptation. It is important that healthcare organizations consider these factors from a person-centered care perspective, and that care staff are trained in this type of care to enhance staff decision-making and older adults' wellbeing.