Nursing Home Care Research Articles

Withdrawal of life‐sustaining treatment in Japanese home care: A cross‐sectional survey

AbstractBackgroundIn Japan, legal and social concerns exist about withdrawing life‐sustaining treatment (LST) even at the end of life. This study aimed to investigate the experience of physicians and nurses involved in home care with LST withdrawal.MethodsA web‐based questionnaire survey was conducted among physicians and nurses who were members of the Japanese Association for Home Care Medicine in 2020. The survey collected data on the experience of respondents with withdrawing LST, the decision‐making processes involved in withdrawing treatment, and their experience with patients attempting voluntarily stopping eating and drinking (VSED).ResultsResults from 203 respondents, including 150 physicians and 53 nurses, showed that the most commonly withdrawn LSTs were intravenous infusions (115 respondents), tube feeding (69 respondents), and oral administration of medicine (74 respondents). A few respondents withdrew respiratory management, such as mechanical ventilation (11 respondents) or home oxygen therapy (12 respondents). The main diagnoses of patients who had LSTs withdrawn were malignancy, senility, and dementia. Many respondents made decisions through discussions with the families of patients (117 respondents) or multidisciplinary discussions at their facilities (80 respondents). There were 23 respondents who made the decision alone, and they were all physicians. Thirty‐two respondents had experience with patients who had completed VSED.ConclusionIt was found that many Japanese home care physicians and nurses had experienced withdrawal of LSTs, and a significant number among them had experienced patients attempting VSED. Given this situation, there is an urgent need to provide ethics support in Japanese home care.

Effects of Nursing Home Changes in Antipsychotic Use on Outcomes among Residents with Dementia.

Little information exists on whether nationwide efforts to reduce antipsychotic use among nursing home (NH) residents with Alzheimer's disease and related dementias improved mortality and hospitalization outcomes for residents. Our objective was to examine the effect of NH decreases in antipsychotic use on outcomes for residents with Alzheimer's disease and related dementias. Observational nationwide study that emulated a series of cluster randomized trials. Long-stay NH residents with Alzheimer's disease and related dementias in US NHs. The study used data from Medicare claims to emulate cluster randomized trials in which NHs were assigned to either decrease or maintain/increase antipsychotic use. Outcome ascertainment for the first trial began on April 1, 2012 (ie, following the announcement of the National Partnership to Improve Dementia Care in NHs). The last day of follow-up was December 31, 2017. Outcomes measured included 12-month all-cause mortality, all-cause hospitalization, and hospitalization for stroke, myocardial infarction, fracture, and psychiatric conditions. Use of other psychotropic medications was also evaluated. Inverse-probability-of-treatment-weighted pooled Poisson regression models estimated covariate-adjusted risk ratios (RRs). The adjusted risks of death (RR, 1.01; 95% CLs, 1.00, 1.01), all-cause hospitalization (RR, 1.00; 95% CLs, 1.00, 1.01), and hospitalization for specific causes were similar between resident-trials in NHs that decreased vs maintained/increased antipsychotic use. Use of antidepressants, anxiolytic/sedative-hypnotics, anticonvulsant/mood stabilizers, and antidementia medications was slightly higher among resident-trials in NHs that decreased antipsychotic use. Decreases in NH antipsychotic use do not appear to improve resident outcomes. Intensive initiatives focused predominantly on achieving a decrease in antipsychotic use may not be effective at improving mortality and hospitalization outcomes for residents with Alzheimer's disease and related dementias. These findings suggest the need for better strategies that incorporate safe and effective nonpharmacological or pharmacological alternatives for managing neuropsychiatric symptoms of dementia.

Sociodemographic Disparities in the Use of Hospice by U.S. Nursing Home Residents: A Systematic Review.

Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs). However, only one-third of eligible residents enroll, and substantial variation exists within and across NHs related to resident-, NH-, or community-level factors. We conducted a review of English-language, peer-reviewed articles 2008 to 2023 describing this variation in NH hospice use to characterize disparities and inform educational and quality initiatives to improve EOL care in NHs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We screened 1595 records, reviewed 82 articles and included 13 articles. Eleven used pre-2009 data. Six evaluated national data and 7 used regional (n = 1), state (n = 4), or local (n = 2) data. One assessed hospice referral, 10 hospice use, and 3 length-of-stay. Twelve conducted regression analyses; 1 stratified by race, another evaluated interaction terms, and a third compared racial differences within-and between-facilities. Unadjusted and adjusted differences were evaluated by resident race-and-ethnicity (n = 6 unadjusted, n = 10 adjusted, respectively), sex (n = 5, n = 9), or payor (n = 1, n = 4), or by NH race-mix (n = 1, n = 2), ownership (n = 1, n = 7), payor-mix (n = 1, n = 5), or urban/rural location (n = 1 adjusted). Unadjusted differences showed lower hospice use by Non-White residents and varied results by sex. Studies adjusting for resident-, NH-, and community-level factors found lower hospice use among male residents, Black/Non-White residents, and residents of rural NHs, with mixed results by payor and ownership. Results were mixed for hospice referral and length-of-stay. These findings suggest complex influences on NH hospice use. Further study is warranted to identify targets for improving hospice access.

How did home care nurses support COVID-19 patients in Japan? A qualitative study.

Home care nurses support patients with COVID-19 with mild to moderate symptoms at home due to the lack of community-based support. Little is known about how nurses initiated and maintained support for patients with COVID-19. This study explored the experiences of home care nurses in supporting patients with COVID-19 at home. Using snowball sampling, 21 home care nurses participated in semi-structured interviews conducted either in person or online between September 2021 and February 2023. A qualitative study using a grounded theory approach was conducted. Home care nurses faced a situation where "suffering patients are overflowing" due to inadequate support from public health centers and designated hospitals. Despite their anxiety, they acted as a "flexible safety net by quickly compensating for uncertain support systems" for patients, families, and local health workers. They "built tentative support systems immediately" and "updated tentative support systems, own knowledge, skills, and mindset." Home care nurses also "rushed to patient/family" to provide timely support and "avoided preventable death." Home care nurses act as a flexible safety net, preventing patient deaths by quickly compensating for uncertain support systems before and after initiating care. Their efforts complemented the inadequacies of traditional infectious disease control systems, typically managed by public health centers. Strengthening secondary and tertiary prevention systems is essential for home care nurses to save lives while delivering individualized care during the COVID-19 pandemic.

Home Care Patient's Experiences and Medication Burden Related to High-Risk Medication Use: A Cross-Sectional Study.

Age, polypharmacy and comorbidity are examples of known factors that increase the risk of adverse drug reactions in patients. The use of high-risk medication also entails a heightened risk of harm. There is currently no information available on the home care patients' experiences and medication burden experienced due to their high-risk medication use and how they manage their medication. Further investigation with regard to this combination is necessary. The patient's experiences and medication burden related to high-risk medication use can be taken into account when drawing up guidelines and standards of care for healthcare professionals. To describe home care patients' experiences and medication burden related to high-risk medication use, more specifically how patients manage their high-risk medication use, which professional support they receive and which potential adverse drug reactions they experience. A cross-sectional study of home care patients in Belgium, aged 65 years and older who took at least one high-risk medication. In our population of 106 home care patients, a median use of 8 medications per patient is reported, of which 2 can be considered high-risk medication. Metformin, insulin and lormetazepam are the most frequently used high-risk medications. Home care patients believe their medication is important to them, are able to manage the intake and seem to have a high level of therapy adherence. Most patients do not believe their medication intake implies a certain risk. Most patients are supported by a home care nurse for the preparation of their medication. A mean number of 5 symptoms/potential adverse drug reactions is reported out of the 21 potential adverse drug reactions questioned. The potential adverse drug reaction most frequently attributed to medication use was bleeding. Practice guidelines with detailed medicine-specific protocols are needed to enhance (high-risk) medication-related care in an overall high-risk medication policy. Understanding the patient's risk experiences and communicating with the patient is important to ensure safe medication care but also to identify patients at risk for nonadherence and adverse reactions. The patient's experiences with their medication intake provide rich information for healthcare providers and should therefore be included in patient observations. Home care nurses should closely follow up on the home care patient's medication therapy with respect for the patient's autonomy.

RURAL HEALTH AND FAMILY CAREGIVING: IDENTIFYING CHARACTERISTICS AND ADDRESSING NEEDS ACROSS POPULATIONS

Abstract The rural population in the U.S. is growing and aging faster, and they have more comorbidities, than the overall aging population. Despite the greater need for resources and supports, rural residents may experience the most barriers to formal services (e.g., hospital, hospice/palliative care, nursing home care) and may lack available family caregivers. Unfortunately, there is a dearth of population-based research comparing the characteristics and needs of older adults living and dying in rural vs. urban areas, particularly related to availability of family. This symposium includes 4 presentations focused on rural health and family caregiving and identifying the characteristics and addressing needs across populations. The first presentation uses a retrospective population cohort design with cancer registry and state-wide claims data to examine urban/rural differences in palliative care-related service claims among older adult cancer patients diagnosed with metastatic breast, lung, colorectal, head and neck, bladder, and melanoma cancers. The next two presentations use data from the Utah Caregiving Population Study (Utah C-PopS) to examine how family size and characteristics impact EOL care utilization for urban vs. rural NH residents and for persons with dementia. The last presentation describes a program evaluation of an interagency collaboration to support caregivers in rural communities. Together, these presentations shed light on the diverse characteristics, gaps in care, and novel strategies to address the needs of rural populations to better inform rural health practice and policy considerations.

Advantages of Strengthening the Long-Term Care Facilities’ Networking with Hospitals and Community Services

Although people live longer in developed countries, it may not be the quality metric for healthy living. This rapid aging is concerning due to the unmet psychosocial needs and the diagnosed and potential chronic disease conditions. Furthermore, despite the government, policymakers, and researchers tirelessly trying to design modern long-term care services to meet the dual needs of the aging population, such as psychosocial and medical needs, progress is being limited. Unfortunately, as much as every person wishes to age in their comfort home, community living is not ideal for everyone due to their complex needs and family circumstances. Therefore, at present, around 1.3 million elderly and other dependent populations are living in more than united states certified nursing homes. Where these nursing homes serve as temporary residences for some of them until they recover and for some as permanent residences due to homelessness and poverty [1]. However, most of these nursing homes in the United States are cited as a concern for the quality. Therefore, the author wants to gain insight into strengthening long-term care networking with broader healthcare settings such as hospitals and community-based services contribution to the quality of nursing home care.

Caregiving for LGBTQIA+ Older Adults: Religious Exemptions and Cultural Discord in Long-Term Care

ABSTRACT Religious and moral exemptions have burgeoned since the U.S. Supreme Court affirmed marriage equality in 2015. These laws allow individuals to refuse services based on religious or moral beliefs. LGBTQIA+ advocates have raised concerns regarding exemptions to deny care to LGBTQIA+ individuals with heightened health needs. Research suggests that LGBTQIA+ individuals have higher anticipated needs for nursing home care; however, a gap in empirical research exists on how nursing home staff understand religious exemptions in the context of their caregiving. This study, thus, employs a qualitative case approach to examine this question: How do nursing home staff make sense of staff refusal to provide care to LGBTQIA+ residents because of religious or moral beliefs? Data includes semi-structured interviews of nursing home staff (n = 90) and was analyzed with thematic analysis. While dominant narratives present religious exemptions as a conflict between religious liberty and equality, staff employed a variety of cultural frames to reconcile cultural discord and achieve social coherence about whether to accommodate a colleague who refused care to an LGBTQIA+ resident. Cultural frames included individual rights, individual religious belief, fairness, job obligations, resident safety and comfort, and legal compliance.

Service Utilization and Consumer-Reported Unmet Needs in Medicaid Home- and Community-Based Services for Older Adults

ABSTRACT Home- and community-based services (HCBS) are increasingly favored over nursing home care by older consumers and by policymakers. Consumer-reported unmet service needs in HCBS are important service quality and person-centeredness indicators. Yet, we know little about consumer-reported unmet needs among HCBS users. Therefore, we evaluated consumer-reported unmet needs (i.e. that the services they receive currently were not meeting their needs and goals) for 9,693 Medicaid HCBS beneficiaries (age ≥65 years) in the National Core Indicators-Aging and Disability survey (2016–2019). Personal care (59.7%) and homemaker (24.4%) services were the most utilized HCBS. Prevalence of unmet needs was highest in transportation (12.2%) and homemaker (11.7%) services. Consumers with poorer self-rated health, dementia, or mental illness; ndividuals living alone; and people of color were more likely to report unmet needs in HCBS such as personal care, caregiver support, adult day, or transportation. Proxy survey respondents were more likely to report unmet needs in caregiver support and personal care services and less likely to report unmet needs in transportation services. Consumer-reported unmet needs might indicate barriers to accessing HCBS. Our findings indicate differences in predictors of unmet needs by service categories, which should inform future targeted policymaking by state agencies and service providers to improve HCBS.

Validation of a simplified oral indicator for home care nurses to refer older people to dental care professionals.

This study aims to explore the identification of older people in need of dental consultation, with a Simplified Oral Indicator (SOI) used by home care nurses (HCNs) and with the Geriatric Oral Health Assessment Index (GOHAI-NL) completed by older people themselves, compared with the Oral Health Assessment Tool (OHAT-NL), performed by dental hygienists. The HCNs completed SOI based on their professional view, knowledge and experience; scores red/orange/green were given to older people for oral health and oral hygiene. Older people completed the GOHAI-NL and dental hygienists completed the OHAT-NL. Data from 141 older people were analysed. Sensitivity and specificity of SOI -OHAT-NL were low (0.45 and 0.64, respectively); SOI scored only few older people as 'red', while only 11 older people did not need a dental referral according to the OHAT-NL. OHAT-NL and GOHAI-NL correlation was significant, but low (r = -0.226, p = 0.012). Simplified Oral Indicator is currently not sensitive enough to identify older people in need of dental consultation. Additional education to HCNs and/or adjusting SOI may be needed. The GOHAI-NL seems not useful in dental triage.

Serious Mental Illness, Substance Use Disorder, and Nursing Home Care: A Narrative Review of the Literature.

The prevalence of serious mental illness (SMI) and substance use disorders (SUD) among residents in skilled nursing homes is increasing yet staff are generally not equipped to care for these residents. There is a pressing need to identify and assess practices, including training, intervention, screening, and service integration, that can support nursing home staff to better support residents with SMI and SUD. This narrative literature review examines the literature to identify what is known about this population as well as the current state of care, barriers to better care, and promising practices to support improved outcomes. Using the evidence from the peer-reviewed literature, the authors make recommendations to advance research and practice for this growing population of residents. Strategies to integrate behavioral health services into the nursing home and provide more holistic programmatic social support, behavioral health, and community integration strategies in nursing homes appear to be promising practices.

A Narrative Exploration of Family Members' Perspectives of Life Story Phases Following Transition of an Older Family Relative Into Long-Term Care.

The transition of an older person from a home environment into long-term care is frequently unplanned and complex. Little is known about how relatives make sense of supporting the transition of their relatives to long-term care. This study explored family members' narratives of the process of supporting the transition of their older relative into long-term care. Life stories of six relatives who supported transitioning their older family relatives into a nursing home were collected using open narrative questioning in accordance with the Biographical Narrative Interpretive Method. Data was analysed using a dialogic/performance analysis narrative analytic method. Four key life story phases were identified: before transition, crisis event, transition and after transition. These phases varied in time duration and involvement of healthcare providers. The longest phase was 'before transition' where a process of slow deterioration became more apparent to the participants retrospectively. This was followed by the shortest period 'crisis event' where the older person was admitted to tertiary care. Two permeating themes: family dynamics and knowledge/understanding underpinned all life story phases. Relatives' knowledge, family dynamics and positioning of self-informed the duration of the life story phases of participants as they navigated the transition. Understanding nuanced differences in relatives' life story phases highlights how timing of information provision can affect the emotional adjustment of relatives experiencing this challenging process. Both community and gerontological nurses' offer real potential to provide tailored and effective responses to relatives depending on each life phase. Sequencing of information appropriate to the life phase could potentially ease the stress associated with transitioning to nursing home care, possibly preventing a crisis event from occurring. Anticipatory conversations also offer potential to alleviate relatives' concerns through life story phases.

Incorporating staffing instability in the nursing home Five-Star Staffing Composite.

Staffing is an important indicator of nursing home quality and resident health outcomes. The Five-Star staffing ratings in Nursing Home Care Compare, the report card published by the Centers for Medicare and Medicaid Services, is based on average hours per resident-day and turnover measures. Studies have shown that a new measure of staffing instability, capturing day-to-day staffing variation, is associated with resident outcomes and provides additional information about quality not reflected in the current Five-Star staffing ratings. In this paper we simulate the impact of including the new staffing instability measure on staffing ratings for 13 641 nursing homes nationwide, using data for the third quarter of 2023. We found that, under a conservative scenario, 21% of nursing homes perform well or poorly enough on instability that this addition would change their current staffing rating, providing consumers with additional information about quality for these facilities, with minimal disruptions to the rating system as a whole. We also demonstrate that the choice of weights for each of the measures included in the Five-Star ratings matters. These weights should reflect policy priorities. We conclude that the Centers for Medicare and Medicaid Services can and should add staffing instability to its Five-Star staffing ratings.

From the Past to Present to Create a Workforce for the Future: The Teaching Nursing Home Collaborative

The Teaching Nursing Home (TNH) initiative exposes future nurses to career opportunities and ignites excitement around working with older adults living in nursing homes (NHs). The NH environment remains an important setting for teaching students about the complex needs of older adults. Fostering strong partnerships between nursing programs and NHs enhances the educational experience for not only students and faculty, but NH staff. As part of the revitalized TNH collaborative, evidence-based frameworks, including experiential learning, person-centered care, the American Association of Colleges of Nursing Essentials, and Age-Friendly Care, are used to enhance nursing education and improve care in NHs. The TNH initiative has proven to be a transformative approach to nursing education and plays a vital role in addressing the growing needs of the aging population to ensure a more competent nursing workforce. [ Journal of Gerontological Nursing, 50 (12), 47–49.]

Understanding Family Caregiver Experience and Satisfaction with Nursing Home Care: A Conceptual Model

Understanding Family Caregiver Experience and Satisfaction with Nursing Home Care: A Conceptual Model

Optimizing Mealtime (OPTIMAL): A Pilot Trial of a Person‐Centered Care Program in Nursing Home Care Staff and Residents with ADRD

Optimizing Mealtime (OPTIMAL): A Pilot Trial of a Person‐Centered Care Program in Nursing Home Care Staff and Residents with ADRD

THE INFLUENCE OF SELF-CARE NURSING THEORY DEVELOPMENT IN PRENATAL HOME CARE SERVICES WITH HEALTH EDUCATION AND GIVING OF DATES PALM JUICE TOWARD ANEMIA CASE

Indonesia has the fourth-highest anemia rate in Southeast Asia, at 30%. Prenatal home care nurses can manage anemia using a self-care approach that includes giving dates juice and health education. The purpose of this study was to determine the effect of developing self-care nursing theory in prenatal home care services with health education and the provision of date palm juice on anemia at the Batujajar Public Health Center assisted area. This study method is a pre-experiment with a one-group pre and post-test without a control group design. The sample studied was 20 people using a purposive sampling technique using the marginal homogeneity and Wilcoxon statistical tests. The results of the study with the Marginal Homogeneity test obtained p-value = 0.001 < α (0.05), and the Wilcoxon test results obtained the result ρ = 0.000 < α (0.05). This study concludes that the development of self-care nursing theory in antenatal home care services, along with health education and giving date palm juice to anemia cases at Batujajar Health Center assisted area, influences it. This study is expected to be the basis for the method of developing self-care nursing theory in providing health education and interventions to overcome anemia, especially in pregnant women.Keywords: Anemia, dates palm juice, health education, self care nursing theory.

Regional variation in the utilization of nursing home care in Germany.

Approximately 32 percent of individuals aged over 64years old, with care needs, are residing in nursing homes in Germany. However, this percentage exhibits significant regional disparities, ranging from under 15 percent in certain counties to over 50 percent in others. The purpose of this study is to elucidate the underlying factors explaining this regional variation in nursing home utilization. We employed comprehensive administrative data encompassing the entire elderly care-dependent population and all nursing homes. Our analytical approach involves the use of linear regression models at the county level, accounting for an extensive array of control variables and fixed effects. Additionally, we analyzed regional dependencies by applying spatial lag models. In summary, our model successfully predicts up to 73 percent of the observed regional variation in nursing home utilization. Key factors include care needs, the presence of informal care support and the supply of professional care. Spatial dependencies can be detected but exhibit a minor influence on these variations controlling for care needs. Noteworthy, enabling factors, such as a region's wealth or rurality, have a very limited impact in a country with a generous social insurance system that covers care for those with limited financial resources.

Low-value and high-value care recommendations in nursing: Asystematic assessment of clinical practice guidelines.

The World Health Organization defines quality of care as providing effective, evidence-based care, and avoiding harm. Low-value care provides little or no benefit to the patient, causes harm, and wastes limited resources. In 2017, shortly after the start of the International Choosing Wisely campaign, the first Dutch nursing "Do-not-do" list was published and has become a widely used practical tool for nurses working in daily practice. However, over the last years new guidelines are published. Therefore, an update of the list is necessary with an addition of high-value care recommendations as alternative care practices for low-value care. In this study, a combination of designs was used. First, we searched Dutch clinical practice guidelines for low-value or high-value care recommendations. All nursing care recommendations were assessed and specified to several healthcare sectors, including hospital care, district care, nursing home care, disability care, and mental health care. Second, a prioritization among nurses regarding low-value care recommendations was done by a cross-sectional survey for each healthcare sector. In total, 66 low-value care recommendations were found, for example, "avoid unnecessary layers under the patient at risk of pressure ulcers" and "never flush the bladder to prevent urinary tract infection." Furthermore, 414 high-value care recommendations were selected, such as "use the Barthel Index to assess and to evaluate the degree of ADL independence" and "application of cold therapy may be considered for oncological patients with pain." In total, 539 nurses from all healthcare sectors prioritized the low-value care recommendations, resulting in a top five low-value care practices per healthcare sector. The top five low-value care recommendations differed per healthcare sector, although "do not use physical restraints in case of a delirium" was prioritized by four out of five sectors. Assessing low-value and high-value care recommendations for nurses will help and inspire nurses to deliver fundamental care for their patients. These initiatives regarding low-value and high-value care are essential to generate a culture of continuous quality improvement based on evidence. This is also essential to meeting the current challenges of the healthcare delivery system. This paper provides an update of low-value care recommendations for nurses based on Dutch guidelines from 2017 to 2023, specified to five healthcare sectors, including hospital care, district care, nursing home care, disability care and mental health care, with an accompanying prioritization of these low-value care recommendations to facilitate de-implementation. This paper provides a first overview of high-value care recommendations to reflect on and create alternative care practices for low-value care. The recommendations regarding low-value and high-value care are essential to generate a culture of continuous improvement of appropriateness based on evidence, finally leading to better quality of care and improving patient outcomes.

Nurses’ perspectives on old age and caring for adults aged 80 years and older: a cross-sectional study in long-term care

BackgroundOlder care receivers of long-term care at home or in residential care are in sustained and close contact with nurses. Consequently, nurses’ attitudes towards older adults and their care influences the quality of the delivered care. There is a dearth of research on long-term care nurses’ attitudes towards older adults. We aimed to investigate Austrian long-term care (residential care and home care) nurses’ attitudes towards adults 80 + and towards geriatric care, as well as possible influencing factors like personal and professional contact with older adults.MethodsAn online survey using a cross-sectional design was carried out in fall 2023 with a convenience sample of 875 Austrian nurses (qualified nurses, specialised nurses, nurses without diploma). The questionnaire included three scales: (1) The Aging Semantic Differential which measures general attitudes towards older adults, (2) the Perspectives on Caring for Older People Scale, and (3) the Positive/Negative Contact Scales.ResultsNurses were found to hold neutral to positive attitudes towards adults 80 + and their care. Attitudes towards older adults and their care were positively influenced by positive contact experiences and few negative experiences in their work environment. Nurses in home care had significantly more positive contact with care receivers and held more positive attitudes towards adults 80 + than residential care nurses.ConclusionThese results suggest that intergenerational contact can positively impact attitudes of nurses towards older care receivers. In order to further facilitate positive attitudes, it is recommended to create positive contact opportunities between nurses and care receivers by, for example, implementing intergenerational educational interventions.