Nursing Home Research Articles

Kegiatan Skrining Kadar Air Dan Minyak Kulit Pada Populasi Lanjut Usia

The largest organ in the human body, the epidermis, serves as the primary barrier against environmental factors that may arise from the outside. Xerosis cutis is a skin condition that causes dry skin. It's caused by a number of things, including the activity of sebaceous and sweat glands decreasing with age, which lowers the amount of water in the stratum corneum and causes moisture loss. This can lead to disturbances in daily activities and a decline in sleep quality. In France, mild to moderate-severe dry skin is prevalent at a rate of 55.65%, while its prevalence is 9%. At Hana Nursing Home, sixty people attended the geriatric population screening activity, with a mean age of 78 years. During this activity, the left hand demonstrated an average water and oil content of 36.6% and 16.4%, respectively. In contrast, the right hand displayed an average water and oil content of 33.7% and 15.1%, respectively. The aim of this activity is to enhance participants' understanding of the significance of maintaining an optimal level of hydration in their epidermis.

Predictive health monitoring: Leveraging artificial intelligence for early detection of infectious diseases in nursing home residents through discontinuous vital signs analysis

This research addresses the problem of detecting acute respiratory, urinary tract, and other infectious diseases in elderly nursing home residents using machine learning algorithms. The study analyzes data extracted from multiple vital signs and other contextual information for diagnostic purposes. The daily data collection process encounters sampling constraints due to weekends, holidays, shift changes, staff turnover, and equipment breakdowns, resulting in numerous nulls, repeated readings, outliers, and meaningless values. The short time series generated also pose a challenge to analysis, preventing the extraction of seasonal information or consistent trends. Blind data collection results in most of the data coming from periods when residents are healthy, resulting in excessively imbalanced data. This study proposes a data cleaning process and then builds a mechanism that reproduces the basal activity of the residents to improve the classification of the disease. The results show that the proposed basal module-assisted machine learning techniques allow anticipating diagnostics 2, 3 or 4 days before doctors decide to start treatment with antibiotics, achieving a performance measured by the area-under-the-curve metric of 0.857. The contributions of this work are: (1) a new data cleaning process; (2) the analysis of contextual information to improve data quality; (3) the generation of a baseline measure for relative comparison; and (4) the use of either binary (disease/no disease) or multiclass classification, differentiating among types of infections and showing the advantages of multiclass versus binary classification. From a medical point of view, the anticipated detection of infectious diseases in institutionalized individuals is brand new.

Factors impacting community living outcomes among former long-term nursing home residents using the interdependence-Human Activity Assistive Technology (i-HAAT) model

ABSTRACT Despite an increased application of social theory in assistive technology (AT) outcomes research, there continues to be a gap in integrating AT conceptual models in research design, data analysis, and results interpretation. This paper merged two preexisting AT models, the Human Activity Assistive Technology model (HAAT) and the interdependence frame for AT into a novel framework, the interdependence-HAAT model (i-HAAT). This model was used to examine the outcomes of former long-term nursing home residents using AT. The model was also used as a framework to facilitate quantitative variable identification and categorization, emphasize the interconnectivity between domain variables, and explore the infrastructural supports necessary for the successful community reintegration of deinstitutionalized AT users. Meaningful integration of theory into practice is the essential next step in generating socially responsive research that addresses AT consumer needs and moves the field forward.

Nursing home residents’ perspectives on oral health: An in-depth interview study

BackgroundOral health is associated with general health and care dependency, but is often neglected in nursing homes. Integration of oral care into general care is necessary, but is hampered by multiple barriers at different levels. This study is part of research into the implementation of the new Oral Health Section for use within the interRAI Long-Term Care Facilities instrument, which is used to assess care needs of nursing home residents. This new Oral Health Section evaluates nine aspects of oral health and results in two Collaborative Action Points. ObjectiveTo identify residents' perspectives on oral health, oral care, and on the assessment of their oral health using the new Oral Health Section DesignQualitative design using in-depth interviews. Setting(s)Three nursing homes ParticipantsResidents were selected using purposeful sampling in nursing homes participating in research evaluating the use of the new Oral Health Section. The selection was based on their oral status for maximum variation and on their cognitive performance score. Twenty-two residents from three Flemish nursing homes agreed to participate. MethodsResidents’ oral health was assessed using the new Oral Health Section and dental indices. In-depth interviews were conducted, including the validated short-form Oral Health Impact Profile to evaluate the impact of oral conditions on residents’ well-being. The interviews were coded and analysed by three researchers and mapped into a model to understand participants’ oral health behaviours. ResultsLow Oral Health Impact Profile scores indicated a low impact of oral health issues on participants’ lives. However, despite 77.3 % of the participants reporting satisfaction with their oral health, 86.4 % had poor oral hygiene and 68.2 % required referral to a dentist, suggesting a tendency to overestimate their oral health. Their oral health behaviour was determined by a lack of oral health knowledge (Capability), positive attitudes towards oral health and autonomy (Motivation), upbringing and social support (Opportunity). Participants considered assessments with the new Oral Health Section acceptable. ConclusionsThis study shows how older people perceive their oral health and oral healthcare. Understanding their wishes and needs will not only facilitate their involvement in their oral care, but is also likely to enable the improvement of their oral hygiene and the development of effective oral care strategies for the future. Policy makers and managers of care organisations may use these results to foster integration of oral care guidelines into care protocols within nursing homes, including collaboration with dentists and dental hygienists. Tweetable abstractOral health assessments with the new Oral Health Section for use within interRAI were positively perceived by nursing home residents.

Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study.

Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation.

Home nursing and self-administered outpatient parenteral antimicrobial treatment: a comparison of demographics and outcomes from a large regional hospital in Queensland, Australia.

Outpatient parenteral antimicrobial treatment (OPAT) is a safe and effective therapy used in several settings across Australia. As OPAT services expand their inclusion criteria to include complex patient populations, there is an increased need for selecting appropriate patients to receive either healthcare-administered OPAT (H-OPAT) or self-administered OPAT (S-OPAT). To describe patient demographics, diagnosis, microbiology and outcomes of patients treated by H-OPAT and S-OPAT within the Sunshine Coast Hospital and Health Service, Australia. Data on demographics, diagnoses, treatment and outcomes on all patients treated by H-OPAT and S-OPAT from March 2017 to December 2019 were collected retrospectively. One hundred and sixty-five patients (62.26%) were enrolled in H-OPAT and 100 patients (37.74%) in S-OPAT. S-OPAT patients were significantly younger. H-OPAT patients were more comorbid. Bone and joint infections were the most treated infections and were more likely to be treated by S-OPAT. There was no difference in treatment duration, cure and complication rates between S-OPAT and H-OPAT. Longer duration of therapy was associated with more complications. Treatment failure was associated with infections due to multiple organisms, number of comorbidities and treatment of surgical site, skin and soft tissue infections. There were significant differences in demographics between H-OPAT and S-OPAT without any difference in outcomes. Overall failure and complication rates were low. Higher rates of treatment failure were predicted by the diagnosis, number of comorbidities and number of organisms treated.

Potentially Inappropriate Prescribing Practices Among Nursing Home Residents with Parkinson’s Disease in the End-of-life Period (P8-3.015)

Potentially Inappropriate Prescribing Practices Among Nursing Home Residents with Parkinson’s Disease in the End-of-life Period (P8-3.015)

The impact of outdoor soundscapes at nursing homes on physiological indicators in older adults

This research explores the impact of outdoor soundscapes at nursing homes on the physiological health of older adults. Using virtual reality, the study recreated the outdoor environments at nursing homes for 57 seniors in a lab setting, continuously monitoring physiological indicators such as skin conductance level, heart rate, low to high-frequency heart rate variability ratio, respiratory frequency, blink frequency, and pupil diameter. The comparison of these indicators with corresponding soundscapes revealed the diverse effects of different nursing home outdoor scenarios on the physiological health of older adults. Furthermore, analysis of the temporal marginal effects of these indicators highlighted the significant influence of time on the physiological responses of seniors in various soundscapes, showing fluctuations in each indicator at different times. Finally, to understand the channels of impact, the study examined how acoustic features at nursing homes affect seniors' physiological indicators. The findings suggest that increased loudness and roughness in soundscapes elevate seniors' heart rates and cardiovascular risks, while a moderate increase in LAeq and fluctuation strength in dynamic scenarios might have positive stimulative effects on the physiological functions of the older adults.

Being Seen as a Unique Person is Essential in Palliative Care at Home and Nursing Homes: A Qualitative Study With Patients and Relatives.

Incorporation of a palliative care approach is increasingly needed in primary care and nursing home care because most people with a life-limiting illness or frailty live there. To explore patients' and relatives' experiences of palliative care at home and in nursing homes. Generic qualitative research in a purposive sample of patients with an estimated life expectancy of <1 year, receiving care at home or in a nursing home, and their relatives. Data is collected through semi-structured interviews and thematically analyzed by a multidisciplinary research team. Seven patients and five relatives participated. Three essential elements of palliative care and their contributing factors emerged: 1) be seen (personal attention, alignment to who the patient is as a person, and feeling connected) 2) information needs (illness trajectory and multidimensional symptoms and concerns, and 3) ensuring continuity (single point of contact, availability of HCPs, and coordination of care). Patients and relatives experienced loss of control and safety if these essentials were not met, which depended largely on the practices of the individual health care professional. In both primary care and nursing home care, patients and relatives expressed the same essential elements of palliative care. They emphasized the importance of being recognized as a unique person beyond their patient status, receiving honest and clear information aligned with their preferences, and having care organized to ensure continuity. Adequate competence and skills are needed, together with a care organization that enables continuity to provide safe and person-centered care.

Impact of the validation method on job satisfaction and motivation in nursing homes: a pilot study

ABSTRACT The Validation Method (VM) is a specific communication method for older people with dementia. The aim of this study was to analyze the effect of an introductory training course on the Bases of the Validation Method (BVM) on job satisfaction and motivation in healthcare professionals working in nursing homes (NHs) and its influence on self-efficacy, perceived personal competence, organizational commitment, attitudes toward dementia and burnout. A quasi-experimental pilot study was conducted during the COVID-19 pandemic (September 2020–February 2021). Participants were divided into two groups: experimental group (who did 16 hours of training on BVM), and a control group (no intervention). Assessments were made at baseline, one week and 4 months after starting the intervention through validated questionnaires to assess job satisfaction, work motivation, self-efficacy, perceived competence, organizational commitment, attitudes toward people with dementia and burnout. A paired Student’s t-test was used to check intragroup differences, and unpaired Student’s test and multilevel mixed-effects linear regression model were used to assess the impact of the intervention; Hedges’g was used to determine the effect size. The sample consisted of 31 NH professionals, assigned to an experimental group (n = 11) or a control group (n = 20). The BVM training had a positive moderate effect size on job satisfaction, work motivation, self-efficacy, perceived competence and organizational commitment (Hedges’g > 0.30). In contrast, there was a smaller effect on attitudes toward people with dementia (Hedges’g = –0.21), and a moderate negative effect on burnout (Hedges’g = –0.38). BVM training had a positive moderate effect on all variables 4 months after finishing training, except for attitudes toward dementia, for which the effect size was smaller.

Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services.

This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180days after SNF discharge. We found that higher HCBS generosity was associated with an increased likelihood of remaining in the community. HCBS breadth and intensity were both significantly associated with reduced risks of NH admission, while higher HCBS intensity was related to a reduced risk of acute hospitalizations within 30days after discharge. Our findings suggest that more generous HCBS programs may facilitate smoother transitions and sustainable community living following SNF discharge.

Nursing home finances associated with real estate investment trust and private equity investments.

In 2021, real estate investment trusts (REITs) and private equity (PE) held investments in 1915 (16%) and 1569 (13%) US nursing homes (NHs), respectively. We created a database of REIT and PE investments in NHs, merged it with Medicare Cost Report data (2011-2019), and used a difference-in-differences approach within an event-study framework to compare NH spending and financial performance before and after REIT or PE investment to NHs that did not receive REIT or PE investment. REIT investments were associated with higher total wages (3%), total nursing wages (3%; both logged, per resident day [PRD]), and current ratio (81%). PE investments were associated with lower net patient service revenue (7%), total expenses (7%), and total wages (8%; all logged, PRD). The impact of REIT and PE investments in NHs may vary in different market conditions, as may occur in the current environment of low, falling NH profits, potentially higher minimum staffing requirements, and rising interest rates. Therefore, it is important for stakeholders to understand the impact of these large, growing investments on the financial performance of NHs.

Does the Design of Welfare Programs Stipulate Nursing Home Utilization? A Comparative Analysis of Long-Term Care Systems in Japan and Germany

Abstract Japan and Germany are both facing a rapidly aging population and have similar social insurance-based long-term care systems. However, there are significant differences in utilization and costs. This paper presents a microeconomic decision model validated by regression analysis, Blinder-Oaxaca decomposition, and Data Envelopment Analysis to contrast the utilization patterns in the Japanese and German long-term care sectors. The design of the welfare programs for low-income families has been identified as one of the main reasons. In Germany, the welfare system leads to a demand curve for nursing home care that is comparable to that of an inferior good which makes external long-term care in nursing homes the more attractive, the poorer the respective households are. In addition, the resulting inelastic demand of the population groups in need of social benefits seem to reduces competition among Germany’s long-term care providers, which is associated with a loss of efficiency in how they use production factors. In Japan, this negative outcome is avoided by a comfort segmentation in the nursing home market.

Effectiveness of Sleep Hygiene Intervention on the Sleep Quality of the Elderly in Nursing Homes in Salatiga City

The aging process, physiologically, brings about changes and increases the risk of disease. Twenty-eight older adults in three different nursing homes in Salatiga City had difficulty sleeping at night. Poor sleep quality can cause disorders, such as being at higher risk of diseases, forgetfulness, confusion, disorientation, and decreased concentration ability. This research contributed to identifying the effectiveness of sleep hygiene on elderly sleep disorders in Salatiga City nursing homes. The research method is a quasi-experiment with a one-group pretest-posttest design research design among 28 older people who lived in the nursing home from April to July 2023. Sleep hygiene intervention in the form of aerobic exercise and education was carried out five times in five weeks. Sleep quality was measured through the Pittsburgh Sleep Quality Questionnaire (PSQI), and data was analyzed using descriptive statistics (percentage and mean). The results of the pre-experiment study revealed a 33.21% prevalence of sleep disturbances among older individuals, with the majority falling into the category of moderate sleep quality (64%). After receiving a sleep hygiene intervention, there was a reduction of 2.89 in the number of elderly individuals experiencing sleep disturbances. Additionally, 36% of the elderly were found to be sleeping without any disorders, while 64% experienced only mild sleep disturbances. This means that there will be a significant change after the intervention. Conclusion Sleep hygiene effectively improves sleep quality in older people in nursing homes. Future research is expected to conduct physical and laboratory examinations to support the respondent's sleep quality results

Anticipatory prescribing of injectable controlled drugs (ICDs) in care homes: a qualitative observational study of staff role, uncertain dying and hospital transfer at the end-of-life

BackgroundThe anticipatory prescribing of injectable controlled drugs (ICDs) by general practitioners (GPs) to care home residents is common practice and is believed to reduce emergency hospital transfers at the end-of-life. However, evidence about the process of ICD prescribing and how it affects residents’ hospital transfer is limited. The study examined how care home nurses and senior carers (senior staff) describe their role in ICDs prescribing and identify that role to affect residents’ hospital transfers at the end-of-life.Methods1,440 h of participant observation in five care homes in England between May 2019 and March 2020. Semi-structured interviews with a range of staff. Interviews (n = 25) and fieldnotes (2,761 handwritten A5 pages) were analysed thematically.ResultsSenior staff request GPs to prescribe ICDs ahead of residents’ expected death and review prescribed ICDs for as long as residents survive. Senior staff use this mechanism to ascertain the clinical appropriateness of withholding potentially life-extending emergency care (which usually led to hospital transfer) and demonstrate safe care provision to GPs certifying the medical cause of death. This enables senior staff to facilitate a care home death for residents experiencing uncertain dying trajectories.ConclusionSenior staff use GPs’ prescriptions and reviews of ICDs to pre-empt hospital transfers at the end-of-life. Policy should indicate a clear timeframe for ICD review to make hospital transfer avoidance less reliant on trust between senior staff and GPs. The timeframe should match the period before death allowing GPs to certify death without triggering a Coroner’s referral.

Can a prolonged healing pressure injury be benefited by using an AI mattress? A case study

BackgroundPressure injuries are a common and serious issue for bedridden residents in long-term-care facilities. Areas of bony prominences, such as the scapula, sacrum, and heels, are more likely to develop pressure injuries. The management of pressure injury wounds include dressing changes, repositioning, away from moisture, decreasing the occurrence of friction and shear, and more. Some supportive surfaces are also used for pressure injury cases such as gel pads, alternating pressure air mattresses, and air-fluidized beds. The aim of this case study was to determine whether the use of an artificial intelligent mattress can improve a nursing home resident with prolonged pressure injury.Case presentationA retrospective study design was conducted for this case study. A 79-year-old male developed a pressure injury in the sacrum. His pressure injury was initially at stage 4, with a score of 12 by the Braden scale. The PUSH score was 16. During 5.5 months of routine care plus the use of the traditional alternative air mattress, in the nursing home, the wound stayed in stage 3 but the PUSH score increased up to 11. An artificial intelligence mattress utilizing 3D InterSoft was used to detect the bony prominences and redistribute the external pressure of the skin. It implements a color guided schematic of 26 colors to indicate the amount of pressure of the skin.ResultsThe wound size was decreased and all eczema on the resident’s back diminished. The PUSH score was down to 6, as the artificial intelligent mattress was added into the routine care. The staff also reported that the resident’s quality of sleep improved and moaning decreased. The hemiplegic side is at greater risk of developing pressure injury.ConclusionsThis novice device appeared to accelerate wound healing in this case. In the future, more cases should be tested, and different care models or mattress can be explored.

Emergency department resource utilization among nursing home residents, a National Cross-Sectional Study

ObjectivesPersons 65 years and older (older persons), particularly residents of nursing homes (NHs), disproportionately access the emergency department (ED) and utilize more medical resources. The goal of this study is to provide a contemporary description of healthcare utilization patterns and disposition decisions for United States (US) NH residents presenting to EDs. MethodsOlder persons presenting to EDs in the US were identified in the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2017, 2018 and 2019 datasets. We examined demographic, clinical, and resource use characteristics and outcomes. After survey weighting, we compared the frequency of different imaging, medications, clinical interventions, and outcomes in the ED between NH residents and those residing outside NHs. ResultsFrom 2017 to 2019, older persons made 24,441,285 annual visits to the ED, comprising 17.5% of all visits. Among these, 1,579,916 visits (6.5%) were by NH residents. Compared with non-NH residents, NH residents were older (mean age: 81.2 [95%CI 81.5–82.9] vs 76.1 [95%CI 75.8–76.4]), underwent more imaging (82.8% [95%CI 79.5–86.1] vs 71.6% [95%CI 69.9–73.3]), were administered fewer potentially inappropriate medications (PIMs) in the ED or upon discharge (9.5% [95%CI 6.2–2.7] vs 17.1% [95%CI 15.8–18.4]), and had a higher proportion of visits resulting in hospital admission (44.1% [95% CI 38.2–49.9] vs 26.0% [95%CI 23.3, 28.7]). ConclusionsOlder NH residents presenting to the ED use more resources and are more likely to be hospitalized compared to older persons residing outside NHs. The resource-intensive nature of these visits highlights the importance of targeted, multi-disciplinary interventions that optimize ED care for this population.

Clinician and Family Caregiver Perspectives on Deprescribing Chronic Disease Medications in Older Nursing Home Residents Near the End of Life.

Nursing home (NH) residents with limited life expectancy (LLE) who are intensely treated for hyperlipidemia, hypertension, or diabetes may benefit from deprescribing. This study sought to describe NH clinician and family caregiver perspectives on key influences on deprescribing decisions for chronic disease medications in NH residents near the end of life. We recruited family caregivers of veterans who recently died in a Veterans Affairs (VA) NH, known as community living centers (CLCs), and CLC healthcare clinicians (physicians, nurse practitioners, physician assistants, pharmacists, registered nurses). Respondents completed semi-structured interviews about their experiences with deprescribing statin, antihypertensive, and antidiabetic medications for residents near end of life. We conducted thematic analysis of interview transcripts to identify key themes regarding influences on deprescribing decisions. Thirteen family caregivers and 13 clinicians completed interviews. Key themes included (1) clinicians and caregivers both prefer to minimize drug burden; (2) clinical factors strongly influence deprescribing of chronic disease medications, with differences in how clinicians and caregivers weigh specific factors; (3) caregivers trust and rely on clinicians to make deprescribing decisions; (4) clinicians perceive caregiver involvement and buy-in as essential to deprescribing decisions, which requires time and effort to obtain; and (5) clinicians perceive conflicting care from other clinicians as a barrier to deprescribing. Findings suggest a need for efforts to encourage communication with and education for family caregivers of residents with LLE about deprescribing, and to foster better collaboration among clinicians in CLC and non-CLC settings.

Reducing Hospitalizations and Multidrug-Resistant Organisms via Regional Decolonization in Hospitals and Nursing Homes

Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections. To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths. This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California. Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP). Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs). Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%). Associated hospitalization costs per 1000 resident-days changed from $64 651 to $55 149 among participating NHs and from $55 151 to $59 327 among nonparticipating NHs (group × period interaction reduction, 26.8%; 95% CI, 26.7%-26.9%). Associated hospitalization deaths per 1000 resident-days changed from 0.29 to 0.25 among participating NHs and from 0.23 to 0.24 among nonparticipating NHs (group × period interaction reduction, 23.7%; 95% CI, 4.5%-43.0%). A regional collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in CP was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths.

Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement

ObjectivesAssess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. Design2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for up to 2 years to track their NH placement. We used data from the Medicare Enrollment Database, the Medicare Beneficiary Summary File, Minimum Data Set, and a national directory of state-licensed AL communities. AL residents were identified using a validated, previously reported 9-digit zip code methodology. Setting and ParticipantsA cross-sectional study sample included 289,350 Medicare beneficiaries in 17,265 AL communities across 50 states and in the District of Columbia. MethodsThe outcome was permanent NH placement: a continuous stay for more than 90 days. Key independent variable was presence of SMI—schizophrenia, bipolar disorder, and major depression. Other covariates included sociodemographic factors and presence of other chronic conditions, including ADRD. A linear probability model with robust SEs, and AL-level random effects, was used to test the association between SMI diagnoses, ADRD, and their interactions on NH placement. ResultsMore than half (55.65%) of AL residents had a diagnosis of SMI, among them 93.2% had major depression, 28.5% schizophrenia, and 22.2% bipolar disorder. Individuals with schizophrenia and bipolar disorder had a significantly lower probability of NH placement, a 32% and a 15% decrease relative to the cohort mean, respectively. Placement risk was significantly greater for residents with ADRD compared to those without, increasing for those who also had schizophrenia or bipolar disorder, 12.9% and 1.5% relative to the sample mean, respectively. Conclusion and ImplicationsPresence of schizophrenia and bipolar disorder, in conjunction with ADRD, significantly increases the risk of long-term NH placement, suggesting that ALs may not be well prepared to care for these residents.