Nursing Care Facilities Research Articles

Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States

We queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged ≥18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2%. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation.

Characteristics of disability in activity of daily living in elderly people associated with locomotive disorders

BackgroundAgeing is associated with a decline of motor function and ability to perform daily activities. Locomotive disorders are one of the major disorders resulting in adverse health condition in elderly people. Concept of Locomotive syndrome (LoS) was proposed to tackle the problems and prolong healthy life expectancy of people with locomotive disorders. To develop intervention strategy for LoS it is mandatory to investigate impairments, functional disabilities which people with locomotive disorder experience and to examine relationships among these parameters. For this purpose we have developed Geriatric Locomotive Function Scale-25 (GLFS-25). Though several physical performance tests were reported for identification or monitoring the severity of LoS, there are few studies reported on characteristics of disability which people with locomotive disorders experience.The aim of this study was to report the characteristics of ADL disabilities in elderly people with locomotive disorders in terms of numbers and degree of activity limitations.MethodsWe organized a cohort study and recruited 314 participants aged 65 years and over from five orthopedic clinics or nursing care facilities. This was a cross-sectional study to use the baseline data of such cohort. ADL disabilities were assessed using GLFS-25 scale arranging the GLFS-25 scores in ordinal levels using “R language” program. Numbers and degrees of activity limitations were determined and compared among the levels. Frequency of limitation in activities regarding social activity, housework, locomotion, mobility and self-care was compared among across the disability level.ResultsThe GLFS-25 score was mathematically categorized into 7 levels. The number of activity limitations and the degrees of each activity limitation were significantly greater in high GLFS-25 levels than in low levels. Difficulties in mobility appeared in less severe level, difficulties in domestic and social life appeared in moderately severe level, and difficulties in self-care appeared in advanced level.ConclusionsHigh GLFS-25 score represented high degree of disability on ADLs. Concordant increase of numbers of activity limitation and severity progression in activity limitation may contribute to progression of disability. Activity limitation may occur in the following order: sports activity, walking, transferring, and self-care.

Urgent Visits to Nursing Homes: A General Practitioner's Perspective

Due to demographic changes, home visits to nursing care facilities are increasing. Urgent home visits represent a challenge for general practitioners. There are no recommendations for the implementation of urgent home visits. Therefore, in this study, we investigated how GP practices deal with urgent home visits and what improvements can be made to the medical emergency care. A total of 15 teaching doctors of the Department of Family Medicine at the University of Bonn were interviewed using semi-structured interviews on the subject. We evaluated the interviews with the qualitative content analysis according to Mayring. Urgent house visits were requested by telephone or fax. The home visits were carried out usually after the consultation hours during the lunch break of the doctors. General practitioners consider forwarding the request for a house visit to the rescue service as an absolute exception. At the nursing home, there were waiting times until the responsible nursing staff could do a joint emergency visit. In addition, there were clear differences in the qualifications of nurses and in dealing with emergencies. The physicians therefore saw improvements in their ability to provide further training to the nursing staff, to preventive house visits, and to assess the urgency of home visits. To improve emergency care in elderly homes, the suggestions for improvement proposed by the family doctors should be tested in controlled studies. In addition, the cooperation between general practitioners and nursing homes could be strengthened by joint training in geriatric emergency care.

Post-discharge transitions of care for hospitalized patients with advanced cancer.

6504 Background: Patients with advanced cancer experience frequent hospitalizations and burdensome transitions of care post-discharge. We examined predictors of discharge location for patients with advanced cancer. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations from 9/14 to 3/16. Upon admission, we used the Edmonton Symptom Assessment Scale and Patient Health Questionnaire-4 to assess physical and psychological symptoms, respectively. We used logistic regression models to identify predictors of discharge to location other than home, including post-acute care (PAC) [skilled nursing facility or long term acute care hospital] or hospice [any setting]. We used Cox regression models adjusted for clinical variables to assess the relationship between discharge location and survival. Results: Out of 932 patients, 726 (77.9%) were discharged home, 118 (12.7%) to PAC and 88 (9.4%) to hospice. Compared with patients discharged home, those discharged to PAC or hospice had higher symptom burden, including dyspnea, constipation, low appetite, drowsiness, fatigue, depression, and anxiety (all p < 0.05). Patients discharged to PAC or hospice vs. home were more likely to be older (OR 1.03, p < 0.0001), live alone (OR 1.95, 95% CI: 1.25-3.02, p < 0.003), have impaired mobility (OR 5.08, 95% CI: 3.46-7.45, p < 0.0001), longer length of stay (OR 1.15, 95% CI: 1.11-1.20, p < 0.0001), higher ESAS physical symptoms (OR 1.02, 95% CI: 1.003-1.032, p < 0.017), and higher PHQ-2 depression symptoms (OR 1.13, 95% CI: 1.01-1.25, p < 0.027). Patients discharged to hospice vs. PAC were more likely to receive palliative care consultation (OR 4.44, 95% CI: 2.12 to 9.29, p < 0.0001) and have shorter length of stay (OR 0.84, 95% CI: 0.77 to 0.91, p < 0.0001). Compared with patients discharged home, those discharged to PAC had lower survival (HR 1.53, 95% CI 1.22-1.93, p < 0.0001). Conclusions: Patients with advanced cancer discharged to PAC or hospice have substantial physical and psychological symptom burden and poor physical function. Patients discharged to PAC also have inferior survival compared with those discharged home. They may benefit from targeted interventions to improve their quality of life and care.

Using the Eco-Map and Ecosystems Perspective to Guide Skilled Nursing Facility Discharge Planning

ABSTRACTGrowing numbers of seniors across the United States require skilled nursing facility care after an inpatient hospital stay. Previous studies indicate that roughly 20 percent of all hospitalized Medicare beneficiaries are admitted to a skilled nursing facility following a qualifying hospital stay. Social workers address psychosocial problems, social support, networks, and healthcare needs during transitions in care, particularly discharge planning. Ecosystems perspective and the eco-map as a discharge planning tool is presented. Social workers can use these tools to examine the patient with respect to their transactional relationships with systems. This will further will facilitate provision of wrap-around services upon discharge.

High-Value Home Health Care for Patients With Heart Failure: An Opportunity to Optimize Transitions From Hospital to Home.

In recent years, public reporting, targeted financial penalties, and incentives to develop alternative payment models that include the assumption of financial risk have compelled hospitals to focus on reducing readmission rates for high-cost conditions such as heart failure (HF). When older patients with multiple medical conditions including HF are discharged from the hospital, they are vulnerable to adverse events, which may result in recurrent hospitalization (the post-hospital syndrome).1 In theory, providing home health nursing and therapy could promote recovery in vulnerable HF patients with post-hospital syndrome and potentially reduce readmissions. Within the United States, home health care (HHC) referrals after acute care hospitalization increased by 65% to 3.7 million between 2001 and 2012.2,3 Patients discharged from US hospitals with a primary diagnosis of HF had the highest number of HHC referrals during this time, with ≈200 000 post-acute HHC referrals in 2012.2 In addition, HHC surpassed skilled nursing facilities as the most frequently used post-acute care among Medicare beneficiaries with HF in 2012 (unpublished HCUPnet data). Such an increase in HHC use for patients with HF is likely related to multiple factors, including decreasing length of stay for patients with HF4 and more recent pressures to improve readmission rates for HF after adoption of the Affordable Care Act in 2010, which included the Hospital Readmissions Reduction Program that was implemented in 2012.5,6 Despite substantial growth in post-acute HHC referrals for patients with HF,2 it is unclear whether HHC delivered in real-world settings consistently provides high-value care. Understanding the characteristics of effective post-acute HHC for patients with HF will inform best practices, optimal outcomes for cost, and ultimately high-value care. Because most patients referred for skilled HHC are Medicare beneficiaries, Medicare eligibility and payment policies have important implications for HHC. Patients who …

Comparison of Care Worker’s Work Environment, and Job Satisfaction in Long Term Care Facility

본 연구는 전국의 장기요양 시설과 재가기관에서 근무하는 요양보호사의 업무 환경 및 직무 만족도 정도를 평가하고, 업무환경과 직무 만족도간의 상관관계를 파악하기 위해 시도되었다. 연구결과, 재가기관 근무 요양보호사의 직무만족도가 시설 근무요양보호사 보다 다소 높게 나타났다. 요양보호사의 직무만족도는 업무환경 항목 중 급여명세서 수령여부와 통계적으로 유의한 정적 상관관계가 있는 것으로 나타났다. 시설과 재가기관에 근무하는 요양보호사의 직무 만족도를 향상시키기 위하여 업무환경개선과 대인관계 능력 함양을 위한 교육 프로그램개발과 적용 연구를 제안한다.

Associations between Nursing Care Levels and Nutrition Status in the Elderly in Nursing Care Facilities in Japan

Most of elderly who requires nursing care has chronic disease, and due to a diminished food intake and physical activity, they tend to show decreased skeletal muscle mass. As a result, there is a great increase in the risk of fall and malnutrition in the elderly. Malnutrition is known to worsen the prognosis after infection and delay healing of disease in the elderly due to decreased immune function. In this study, we have examined the associations between nutrition status and blood biochemical parameters, the degree of independence in dementia elderly's activity of daily living, the nursing care levels, and the form of food in 1,823 elderly persons aged 61–106 y (average 86.7 y) who lives in nursing care facilities. The percentages of the elderly at risk of malnutrition according to GNRI (Geriatric Nutritional Risk Index) were 67.0% for men and 66.2% for women. The GNRI scores tended to be lower according to an increase in the nursing care level. In elderly men, the GNRI scores were remarkably lower in the groups categorized as nursing care levels 4 and higher than those in nursing care level 3 or lower. In elderly women, the GNRI scores were greatly decreased in the groups categorized as nursing care levels 2 and higher. The lower the degree of independence in dementia elderly's activity of daily living was, the lower the GNRI, and the GNRI scores of the groups categorized □a and over were significantly lower than those categorized as of □b or under. The GNRI scores were associated with the provided form of food, according to the transition from regular to liquid form. The results of this study suggest that the nutrition status of elderly who requires nursing care in nursing homes was associated with the degree of independence in dementia elderly's activity of daily living, the nursing care level, and the form of food, and it may be attributable to a decrease in physical function required for activity of daily living.

Relationship between functional independence measure and geriatric nutritional risk index in pneumonia patients in long-term nursing care facilities.

The prevention of pneumonia is an urgent issue among Japanese older adults. However, little has been reported on the relationship between a Functional Independence Measure (FIM) and the Geriatric Nutrition Risk Index (GNRI) for the prevention of pneumonia in patients in long-term care facilities in Japan. We aimed to clarify the relevance of FIM and GNRI for inpatients with and without pneumonia. We identified 233 patients who were hospitalized in our long-term nursing hospital from April 2012 to September 2013. We compared differences in FIM among GNRI classes for four groups: (i) pneumonia/high GNRI; (ii) pneumonia/low GNRI; (iii) no pneumonia/high GNRI; and (iv) no pneumonia/low GNRI. To assess the pneumonia predictors, we used a logistic regression for long-term nursing patients. Receiver operating characteristic analysis showed cut-off values and the area under the curve. A total of 88 (37.8%) of 233 inpatients had pneumonia. FIM of the pneumonia/low GNRI groups was significantly lower than that of the no pneumonia/high and low GNRI groups. Logistic regression showed that FIM (P<0.001; OR -1.035, 95% CI -1.019-1.051) and GNRI (P=0.017; OR -1.038, 95% CI -1.007-1.070) were predictors of pneumonia. The cut-off values for FIM and GNRI were 26.6 (P<0.001, the area under the curve 0.70) and 80.5 (P<0.001, the area under the curve 0.65), respectively. Low activity and malnutrition might lead to the development of pneumonia. FIM and GNRI are useful predictor tools that could help to prevent pneumonia in Japanese patients in long-term care facilities. Geriatr Gerontol Int 2017; 17: 1617-1622.

A randomized trial of heart failure disease management in skilled nursing facilities (SNF Connect): Lessons learned.

Conducting clinical trials in skilled nursing facilities is particularly challenging. This manuscript describes facility and patient recruitment challenges and solutions for clinical research in skilled nursing facilities. Lessons learned from the SNF Connect Trial, a randomized trial of a heart failure disease management versus usual care for patients with heart failure receiving post-acute care in skilled nursing facilities, are discussed. Description of the trial design and barriers to facility and patient recruitment along with regulatory issues are presented. The recruitment of Denver-metro skilled nursing facilities was facilitated by key stakeholders of the skilled nursing facilities community. However, there were still a number of barriers to facility recruitment including leadership turnover, varying policies regarding research, fear of litigation and of an increased workload. Engagement of facilities was facilitated by their strong interest in reducing hospital readmissions, marketing potential to hospitals, and heart failure management education for their staff. Recruitment of patients proved difficult and there were few facilitators. Identified patient recruitment challenges included patients being unaware of their heart failure diagnosis, patients overwhelmed with their illness and care, and frequently there was no available proxy for cognitively impaired patients. Flexibility in changing the recruitment approach and targeting skilled nursing facilities with higher rates of admissions helped to overcome some barriers. Recruitment of skilled nursing facilities and patients in skilled nursing facilities for clinical trials is challenging. Strategies to attract both facilities and patients are warranted. These include aligning study goals with facility incentives and flexible recruitment protocols to work with patients in "transition crisis."

Hospital Palliative Care Teams and Post-Acute Care in Nursing Facilities: An Integrative Review.

Although palliative care consultation teams are common in U.S. hospitals, follow up and outcomes of consultations for frail older adults discharged to nursing facilities are unclear. To summarize and critique research on the care of patients discharged to nursing facilities following a hospital-based palliative care consult, a systematic search of PubMed, CINAHL, Ageline, and PsycINFO was conducted in February 2016. Data from the articles (N = 12) were abstracted and analyzed. The results of 12 articles reflecting research conducted in five countries are presented in narrative form. Two studies focused on nurse perceptions only, three described patient/family/caregiver experiences and needs, and seven described patient-focused outcomes. Collectively, these articles demonstrate that disruption in palliative care service on hospital discharge and nursing facility admission may result in high symptom burden, poor communication, and inadequate coordination of care. High mortality was also noted. [Res Gerontol Nurs. 2017; 10(1):25-34.].

A critical systematic review and synopsis of the alignment of scientific developments in surveillance technology in nursing care facilities

Abstract Background: The deficits in the self-care of older people are often associated with a loss of autonomy and if care is not provided in the home environment by relatives or professional caregivers, then the

Surgical Aortic Valve Replacement in the Elderly

Background: Percutaneous aortic valve implantation is increasingly available to elderly patients with aortic stenosis, with potential to reduce hospital length of stay and associated morbidity. We aim to evaluate early clinical outcomes of octogenarians undergoing surgical aortic valve replacement (SAVR) via median sternotomy to determine perioperative risk factors and the impact of surgery on discharge destination. Methods: A retrospective observational study involving 57 consecutive octogenarians who underwent aortic valve surgery between 2011 and 2014. The study assessed preoperative co-morbidities and postoperative outcomes. EUROSCORE II online calculator was used for risk stratification. Results: The average age of patients was 82.6 years (±2.94). Operations performed included: isolated AVR (41.3%), AVR and coronary artery bypass grafting (CABG (48.2%) and other surgery with concomitant AVR (10.3%). Average EUROSCORE II was 7.46 (±6.38). Median length of hospital stay was 10 days. Postoperative outcomes included mortality (5.1%), cerebrovascular event (3.4%), permanent pacemaker (6.9%), residual aortic regurgitation (0%) and prolonged ventilation (15.5%). Discharge home was seen in 74.1% of patients, 18.9% required in-hospital rehabilitation and 2% required placement in a nursing care facility. Conclusion: Age alone should not preclude consideration for SAVR in the octogenarian population with acceptable morbidity and mortality rates despite current risk stratification tools suggesting higher mortality. While transcatheter AVR may offer a reduced length of hospital stay, patients can expect to return to their principle place of residence following SAVR.

Less Intense Postacute Care, Better Outcomes For Enrollees In Medicare Advantage Than Those In Fee-For-Service.

Traditional fee-for-service (FFS) Medicare's prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure. After accounting for differences in patient characteristics at discharge, we found lower intensity of postacute care for Medicare Advantage patients compared to FFS Medicare patients discharged from the same hospital, across all three conditions. Medicare Advantage patients also exhibited better outcomes than their FFS Medicare counterparts, including lower rates of hospital readmission and higher rates of return to the community. These findings suggest that payment reforms such as bundling in FFS Medicare may reduce the intensity of postacute care without adversely affecting patient health.

Development and Application of Glove Type Restraints for Elderly Patients in Nursing Care Facilities: A Pilot Study

Purpose The purpose of this study was to compare newly designed glove type restraints with traditional restraints and to evaluate the applicability for nurses to use the restraints. Methods This study was designed as a one group pretest-posttest study. For this study nurses used both types of restraints with 19 elderly patients to prevent self-extubation. The researcher measured physical indicators, including skin edema, skin temperature, skin moisture and self-extubation, in the elderly patients and evaluated applicability of restraint for nurses. Results There were no significant differences in pretest-posttest for the physical indicators in elderly patients except for circumference of the mid hand (z=2.60, p=.018). There were significant differences between pretest and posttest in evaluating applicability of restraints by nurses. ‘overly restrictive (z=-2.81, p=.005)’ and ‘maintaining (z=-2.75, p=.006)’ were higher in traditional restraints than in the new ones and ‘applicability for skin damaged patients (z=-2.54, p=.011)’ was higher for new restraints than traditional ones. Conclusion The results show that the newly developed restraints do not increase the risk of skin damage in elderly patients. Also nurses need to consider alternative ways for minimizing physical restraint application for patients and continue to develop strategies for a safe environment. 주요어: ì–µì œëŒ€, ë ¸ì¸, 간호사 Key Words: Physical restraint, Aged, Nurses

Technology and Dynamic Pathways: How to Improve Nursing Care, Documentation, and Efficiency

Background: Approximately 60% of adverse events in skilled nursing facilities are likely preventable. This provides an opportunity to improve care and decrease costs for ill, and especially aged, patients. The primary line of defense against adverse events in these facilities are the nurses caring for these patients each day. Nurses are responsible for recognizing early warning signs of illness and preventing falls and other complications. The care of patients with multiple comorbidities requires nurses to attend to an often overwhelming set of interacting details. Objective: Our goal is to operationalize standards of care that can be implemented by nursing staff at skilled nursing and long-term care facilities in a manner complementing their natural workflow and facilitating patient interaction and shift documentation. To improve point of care patient management, nurses require a mobile solution that can guide their patient care unobtrusively. Methods: Nurses at a Boston-area 100-bed skilled nursing/long-term care facility used our solution consisting of an app on a mobile device together with a Web-based administration and reporting system. Our custom software running on an iPod Touch device implements an adaptive methodology for succinctly guiding nurses through a systematic review of systems, a physical exam, a fall risk protocol, and other assessments suitable to their roles in the nursing facility. Dynamically created checklists that prescribe appropriate and immediate nursing interventions are automatically presented to the nurses following each assessment based on the data collected. The software utilizes behavioral “nudges” to nurse-users to minimize errors and improve speed of data entry. Additionally, a custom content creation system allows for high-level abstraction of protocol logic, enabling real-time improvement and customization of complex protocol algorithms without the need for error-prone software programming. These methods facilitate automated reporting that aids the structured thought processes of providers and caregivers. Results: Pilot results were acquired using qualitative surveys and free-form interviews. Nurses reported a high facility after only an initial 15-minute training session. All nurses confirmed that having access to an efficient and mobile care facilitation device improved the likelihood of identifying patient complications. They also felt that a mobile documentation system lowered error rates by encouraging real-time documentation. Furthermore, systematic data gathering provided an improved level of documentation both in terms of comprehensiveness and clarity. Nurses claimed the system increased efficiency and lowered the overall time required for combined patient assessment and documentation. Most importantly, staff satisfaction was highly positive, encouraging continued usage of the intervention. Conclusions: Technological interventions at skilled nursing facilities, when implemented to address the point-of-care needs of nursing personnel, can positively impact quality improvement goals, empower nursing staff, and improve patient care. The suite of tools developed here enables the operationalization of standards of care with sufficient comprehensiveness to address a sufficient portion of the complexity faced in daily nursing duties. We conclude that access to real-time protocols has a highly beneficial effect on nursing care. [iproc 2016;2(1):e31]

US Spending on Personal Health Care and Public Health, 1996-2013

ImportanceUS health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time.ObjectiveTo systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care.Design and SettingGovernment budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis.ExposuresEncounter with US health care system.Main Outcomes and MeasuresNational spending estimates stratified by condition, age and sex group, and type of care.ResultsFrom 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%–2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]).Conclusions and RelevanceModeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.

Skilled nursing home care facilities as key players in integrated care

Introduction : The role of nursing homes has undergone a great change in Spain. Today, far from being facilities that provide shelter for older people, they have become providers of comprehensive and integrated care over the purely social care of the past. Changes in demographic, social and family patterns, the “chronification” of many diseases and the rise of functional dependency have resulted in an increase of specialized care needs and a greater demand for skilled nursing homes. The health care provided in social nursing homes is not currently recognized in Spain and it depends on the region where nursing homes are located. For example, the situation varies depending on whether the region has a social-health system in place (Catalonia) or if nursing homes are attached to hospital pharmacies (Galicia) or if they rely on primary care centers, as it happens in the majority of regions. What is clear, but less known is that skilled nursing home care facilities are qualified health care providers that occupy an important space in the long-term care system in all the Spanish Regions. This care is delivered by health care professionals at the nursing homes (mainly medical and nursing); but the activity is officially registered in primary care or exclusively on the care information system (clinical record) of the nursing homes. Short description of practice : People who are admitted to skilled nursing home care facilities are characterized by multiple clinical conditions, a significant functional and cognitive impairment, loss of autonomy and need for specific cares. All this indicates the high health burden present at this care level. We advocate for a change at a legal and political level so that skilled nursing home care facilities are recognized and financed as an intermediate care level with a key role in the implementation of care ecosystems with a territorial base. We are currently closely connected to acute hospitals and primary care, having access to the primary care and public hospitals’ clinical record. Key findings : In a recent study of Edad&Vida Foundation (2015) entitled profile of nursing homes in which participated up to 111 nursing homes from 15 regions of Spain with capacity to 14,489 users, it was observed that a total of 19,262 people attended with 8,684 new admissions in the period of one year. 76% of new admissions had 3 or more active diagnostics (high comorbidity), 66% of users had 7 or more active drugs (polypharmacy), 54.5% of residents suffered malnutrition or are at risk of suffering it at admission moment and 43% of discharges are due to the death of the person. Highlights : The obtained results bring to light the work carried out in nursing homes of our country, providing meaningful data about the complexity of the clinical condition of their users. With all this, we explicit that, in a significant percentage of nursing homes places of social residences in Spain, is being provided a qualified, integrated and people-centered health care. In this context, multimorbidity and polypharmacy are just two indicators of the complexity of caring for older people. Furthermore, it is necessary for stakeholders to be sensitive to the different needs in terms of gender and in terms of comorbidity users. Conclusion : As stated by David Oliver at The King’s Fundation Blog, “if we are looking at the need for more integrated working to support older people across several sectors, care homes could play a critical role. Nursing homes, or skilled nursing home care facilities, provide round-the-clock nursing care and significant assistance with the activities of daily life. Nursing homes have nursing staff on duty 24 hours a day to help individuals meet their daily physical, social and psychological needs”. Thus, considering the high health burden assumed by nursing homes, it notes that these services contribute greatly to reduce the care burden on other care levels of the long-term care system. In Edad&Vida document aforementioned it is argued that nursing homes accredited by Health and Social Services should be considered an Intermediate Level of Care and not mere substitutes of home, as it is currently assumed.

Integrating Care in Complex Cardiac Care: the Tech Touch

Integrating Care in Complex Cardiac Care: the Tech Touch

Person-centered care models in integrated care systems: The role of nurse assistants as “keepers of likes and preferences” in skilled nursing home care facilities

Introduction: Caring for older people in vulnerable situations requires the coordinated work of different professionals in order to assess and identify their needs, wishes and preferences for care.Among the professionals of the interdisciplinary team, the figure of nurse assistants is particularly important. They are in permanent contact with residents, have significantly more interactions with them and their families and, therefore, they have valuable information regarding their overall situation, daily routines, perceived wellbeing and changes in their condition.Paradoxically, while it is recognized that this professional should play a central role in the interdisciplinary team since they are able to customize the care provided to the needs and preferences of the residents; in practice, for several reasons, this is not always the case.Short description of practice: After a year and a half of research and conceptualization, SARquavitae put in place an applied project to revise its care model: the INTEGRA Project. One of the key areas of the project has to do with the figure of the reference professional (RP) as keeper of users’ likes and preferences and a source of relevant daily care information for the family.After a process of care reorganization and training, the function of "reference professionals" was implemented. It meant daily close supervision by the nurse coordinator and leadership by the director or the nursing home.Objective: The RP is responsible for the continued support and attention to the detail of a small and limited number of users (7-8). In addition, RP will get to know perfectly their assigned users, and thus may provide a closer and individualized care in accordance with their life plan.The RP should be proactive: in communicating and dealing with both their assigned users and their relatives.This professional is responsible for communicating the relevant information about users and their relatives to the interdisciplinary team in order to assist in the definition and/or adjustment of the Personalized Care Plan with special attention to the details which can improve the user’s wellbeing and quality of life.Implantation procedure: Different assessment tools and records have been developed for the RP and, hey had been included in SARquavitae care information system (GCR). The aim is to provide this professional with instruments of their own that allow them to share information and evaluate results.The allocation of RP is performed according to care and organizational criteria, so that a RP will have the residents in their group of care, allowing them to establish a strong relational link. Once assigned, it is communicated both to the resident and their relatives through a letter and a formal meeting. This meeting is attended by at least one professional of themanagement team to make the official presentation of this professional and clarify their roles and responsibilities.Key findings: Preliminary results after one month of fully implementation show that the change in the nurse assistants is generating high levels of satisfaction to professionals, users and relatives.As expected, professionals recognize the usefulness of the information provided by this figure insofar as it helps to individualize and personalize the therapeutic plan adapted to each user.Residents and their relatives appreciate the RP proactive role and their close and constant contact to solve any situation. They acknowledge, like PR themselves, that the stronger relation facilitates and optimizes the quality of care. This leads to an increased sense of security and confidence, which impacts on subjective wellbeing.Highlights: The launch of this figure requires a revision of SARquavitae care model, the roles of different professionals, care organization and to conduct a training process with potential RP to explain them their functions and develop social and communication skills that facilitate interactions with residents and their relatives.An indicative time frame for consultation and interaction with the RP is recommended in order to assure a quick and adequate response.Conclusion: In light of the results obtained, it is considered appropriate to continue with this figure in SARquavitae centers and deepen its assessment. In total it will be deployed in 74 nursing homes and 22 day care centers where more than 9,500 workers attending 11,000 users across the whole country.