Nursing Home Death Research Articles

The in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway

Objective Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death. Design and subjects Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009–2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals. Results There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death. Conclusion Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.

The role of functioning in predicting nursing home placement or death among older home care patients

Objective There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. Design A prospective one-year follow-up study. Settings and subjects Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). Main outcome measures Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). Results Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62–0.86), IADL (0.75, 0.65–0.87) MMSE (0.92, 0.87–0.96), and TUG (1.02, 1.01–1.03). NHP alone was predicted by BADL (0.62, 0.50–0.78), IADL (0.57, 0.45–0.73), and MMSE (0.88, 0.82–0.94) and mortality by TUG (1.02, 1.01–1.03). Conclusion Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.

The Dedication

In 2020, the COVID-19 pandemic exploded and nursing homes rapidly became overwhelmed with disease, death, and despair. During this time, I learned Sylvia, an old woman with dementia I had befriended, was one of the many old and disabled people confined in nursing homes who did not survive. In this reflective and part personal, part scholarly essay, I leave evidence of and for Sylvia and the nearly 200,000 old and disabled people and care workers who contracted COVID-19 and died within the confines of neoliberal, profit-driven long-term care institutions. Disability justice activist Mia Mingus writes, "We must leave evidence. Evidence that we were here, that we existed, that we survived and loved and ached." Leaving evidence is a political act, a form of resistance in an ableist word. And yet leaving evidence is particularly challenging in the context of dementia, care, confinement, and death—making it even more important, more urgent. Building on Ellen Samuels’ assertion, "Crip time is grief time," I consider how mourning Sylvia and countless other nursing home deaths, interwoven with my own experiences of distress, yet also solidified my need to survive, might leave evidence and keep working toward an abolitionist future—one in which old and disabled women like Sylvia, like my future self, might thrive.

Covid in the nursing homes: the US experience

Abstract The death toll in nursing homes accounted for almost 30 per cent of total Covid-19 deaths in the US during 2020. We examine the course of the pandemic in nursing homes focusing especially on whether nursing homes could have been better shielded. Across all nursing homes the key predictor of infections and deaths was community spread, i.e. a factor outside of the control of nursing homes. We find that higher-quality nursing homes, as measured by the CMS Five-Star Rating system, were not better able to protect their residents. Policy failures from the CDC and FDA, especially in the early stages of the pandemic, created extended waiting times for Covid-19 tests and slowed attempts to isolate infectious residents. But once infections were widespread, testing would have had to have been much greater to have had an appreciable effect on nursing home deaths. We find, however, that starting vaccinations just 5 weeks earlier could have saved in the order of 14,000 lives and starting them ten weeks earlier could have saved 40,000 lives.

Counting: How We Use Numbers to Decide What Matters

Counting: How We Use Numbers to Decide What Matters

Relationship between nursing home COVID-19 outbreaks and staff neighborhood characteristics.

The COVID-19 pandemic has been particularly deadly for residents of nursing homes and other long-term care facilities. This paper analyzes COVID-19 deaths at nursing homes during the first wave of the pandemic in the United States during the spring and early summer 2020. By combining data on facility-level COVID-19 deaths during this period with data on the neighborhoods where nursing home staff reside for a sample of eighteen states, this paper finds that staff neighborhood characteristics were a large and significant predictor of COVID-19 nursing home deaths. Even after controlling for the county where a facility is located, one standard deviation increases in average staff neighborhood (Census tract) population density, public transportation use, and non-white share were associated with 1.3 (p < .001), 1.4 (p < .001), and 0.9 (p < .001) additional deaths per 100 beds, respectively. These effects are larger than all facility management or quality variables, and larger than the effect of the nursing home’s own neighborhood characteristics. These results suggest COVID-19 outbreaks in staff communities can have large consequences for the facilities where they work, even in highly-rated facilities, and that disparities in nursing home outbreaks may be related to differences in the types of neighborhoods nursing home staff live in.

Disparities in place of death (PoD) in patients with gastrointestinal (GI) cancers.

645 Background: PoD is an important determinant of patient and caregiver experience. Differences in PoD may reflect disparities in care, including aggressive end-of-life (EOL) care, and access to palliative care/hospice services and caregiver support/resources. We sought to describe sociodemographic disparities in PoD in patients dying from GI cancers between 2003-2019. Methods: We used deidentified death certificate data via the CDC Wonder database. We included decedents with an underlying cause of death of GI cancer (identified through ICD codes) from 2003-2019. We stratified findings by ethnicity, race, gender, and age (&lt; or ≥ 65 years). We classified PoD as (1) medical facility (2) nursing home, (3) home, or (4) hospice facility. We estimated Annual Percentage Change (APC) in PoD across sociodemographic groups. Results: We included 2,347,754 decedents in the analysis (43.6% women, 68.4% ≥65 years, 7.6% Hispanic, 12.7% non-Hispanic Black [NHB], 75.4% non-Hispanic White [NHW]). From 2003– 2019, across all groups, deaths in medical facility reduced from 45,046 (33.4% of all deaths in the year) to 38,673 (23.3%) (APC -2.2%), and deaths in hospice increased from 871 (0.6%) to 24,092 (14.8%) (APC 26.1%). In 2019, men more frequently died in a medical facility than women (25.5% vs. 21.1% of deaths), and women were more likely to die in a nursing home facility than men (12.6% vs. 9.8%). In 2019, individuals aged&lt;65 years died in a medical facility more frequently than those aged ≥65 years (29.8% vs. 21.0%), and also had lower APC for medical facility deaths from 2003– 2019 (APC -1.8% vs. -2.4%). Among groups, NHWs were least likely to die in a medical facility in (21.0% of deaths in 2019) and most likely to die in a hospice facility (15.5% of deaths in 2019). Hispanic individuals (vs. non-Hispanic individuals) had higher rates of home deaths, and lower hospice and nursing home deaths. Conclusions: Despite overall reductions in deaths in medical facilities for people with GI cancers over time, there remain significant sociodemographic disparities. Targeted interventions for care access, economic stability, and social communities are needed to address these findings. PoD for patients with GI cancer.[Table: see text]

COVID-19 Death in High-Medicaid Nursing Homes: The Role of Employment Empowerment

This study examines the association between COVID-19 death and employee empowerment in under-resourced nursing homes (70% or higher Medicaid census). Employee empowerment captures elements of participative decision making, autonomy, responsibility, open communication, decentralization, and decision-making flexibility within an organization. Survey data from 391 Directors of Nursing (response rate of 37%) from 2017-2018, were merged with secondary data from CMS Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. A Poisson regression was used to examine reported COVID-19 death and employee empowerment. The independent variable employee empowerment was the mean score of summated Likert scale questions. Control variables included organizational (size, location, ownership, chain affiliation, quality, payer mix, acuity, occupancy, and race/ethnicity, staffing mix), and county factors (Medicare Advantage penetration, per capita income, poverty, unemployment, education, 65+ population, and competition). Employee empowerment was associated with a lower number of COVID-19 cases (p < 0.05). Rural, not-for-profit, and payer-mix were also significantly associated with a lower number of COVID-19 deaths. Employee empowerment captures the decentralization of authority and an employee’s ability to make decisions without approval. In light of this crisis, empowerment may have helped under-resourced nursing homes be more agile and faster in their response. High-Medicaid nursing homes may need to consider different decision-making practices when faced with a crisis, such as, COVID-19.

COVID-19 Nursing Home Deaths in Cook County: Predictors and Modifiable Risks

Investigators at the University of Illinois Chicago, the Illinois Department on Aging (IDOA), the Illinois Department of Public Health, and the Health and Medicine Policy Research Group are collaborating to examine comparative rates of Covid-19-related deaths among older adults who reside in nursing homes vs. the community in Illinois. As a first step, we have examined data from the Cook County Medical Examiner’s office to compare nursing home resident fatalities to those who died in the community. Deaths with Covid-19 listed as primary or secondary cause of death that occurred between January 1, 2020 to September 30, 2020 among older adults ages 60 and over were identified from the Cook County Medical Examiner’s Office case archive file. Location at death and race/ethnicity were obtained from the same source. Location at death was matched with data in the Center for Medicare and Medicaid Services (CMS) Covid-19 Nursing Home Data to identify persons who died in skilled nursing facilities (SNFs) as well as facility and staff characteristics. We found that the 3,937 deaths among persons over the age of 60 comprised 75% of total deaths in Cook County. Of the total older adult deaths, 2,090 (53%) died in the community and 1,837 (47%) died in SNFs. Regression analyses that controlled for CMS quality ratings found that larger, for-profit nursing homes, with high levels of staff infected with Covid-19 were associated with higher mortality. The policy implications of these findings will be discussed.

Measuring the COVID-19 Mortality Burden in the United States : A Microsimulation Study.

Fully assessing the mortality burden of the COVID-19 pandemic requires measuring years of life lost (YLLs) and accounting for quality-of-life differences. To measure YLLs and quality-adjusted life-years (QALYs) lost from the COVID-19 pandemic, by age, sex, race/ethnicity, and comorbidity. State-transition microsimulation model. Health and Retirement Study, Panel Study of Income Dynamics, data on excess deaths from the Centers for Disease Control and Prevention, and nursing home death counts from the Centers for Medicare & Medicaid Services. U.S. population aged 25 years and older. Lifetime. Individual. COVID-19 pandemic through 13 March 2021. YLLs and QALYs lost per 10000 persons in the population. The estimates account for the age, sex, and race/ethnicity of decedents, along with obesity, smoking behavior, lung disease, heart disease, diabetes, cancer, stroke, hypertension, dementia, and nursing home residence. The COVID-19 pandemic resulted in 6.62 million QALYs lost (9.08 million YLLs) through 13 March 2021, with 3.6 million (54%) lost by those aged 25 to 64 years. The greatest toll was on Black and Hispanic communities, especially among men aged 65 years or older, who lost 1138 and 1371 QALYs, respectively, per 10000 persons. Absent the pandemic, 38% of decedents would have had average or above-average life expectancies for their subgroup defined by age, sex, and race/ethnicity. Accounting for uncertainty in risk factors for death from COVID-19 yielded similar results. Estimates may vary depending on assumptions about mortality and quality-of-life projections. Beyond excess deaths alone, the COVID-19 pandemic imposed a greater life expectancy burden on persons aged 25 to 64 years, including those with average or above-average life expectancies, and a disproportionate burden on Black and Hispanic communities. National Institute on Aging.

Is there a future for nursing homes in Canada?

The high rates of nursing home deaths in the wake of COVID-19 have led to calls for their elimination and their replacement by home care. Based on years of research in Canada and abroad, this article argues that nursing homes are not just necessary, they provide significant benefits for those living in, working in, and visiting in them. In developing this argument, the article begins by setting out why long-term residential care is necessary before moving on to consider the benefits of such care, benefits that go beyond the clinical. It concludes by identifying factors that can make nursing homes a positive option while helping to avoid pandemic horrors in the future.

Place of death in Parkinson’s disease: trends in the USA

BackgroundParkinson’s disease (PD) is a significant cause of mortality but little is known about the place of death for patients with PD in the USA, a key metric of end-of-life...

Mapping and Identifying Community Risk Factors for COVID‐19 Nursing Home Deaths

Research ObjectiveAlthough emerging research has identified facility‐level or community‐level risk factors for nursing home COVID‐19 infection cases, little research has been conducted to understand the risk factors for nursing home COVID‐19 death rates. This study has two aims: 1) identify geographic clusters with high nursing home COVID‐19 death rates; 2) understand facility‐level and community‐level risk factors for facilities residing within the hot spots versus those not in the hot spots.Study DesignThis is a cross‐sectional research design. We utilized nursing home COVID data from Centers for Medicare & Medicaid Services (as of November 13th, 2020) linked with Brown University's LTCfocus data and Nursing Home Compare, along with zip code‐level data from American Community Survey. Geospatial hot spot analysis (Getis‐Ord Gi*) was applied to identify statistically significant hot spots of COVID‐19 death rates in nursing homes. We compared facility‐level and community‐level factors associated with COVID death rates by performing multivariate regressions stratified by whether the nursing home was located in the hot spot area identified.Population StudiedThe sample included 15,341 nursing homes.Principal Findings322 zip code areas were identified as having a significantly high level of nursing home COVID death rates at the 95% confidence level. We found statistically significant clustering of COVID‐19 death rates in nursing homes in Northeastern United States (New Jersey, Massachusetts, Connecticut, and New York), South Carolina, Georgia, Florida, Kentucky, and parts of Texas, Mississippi and Louisiana. The hot spot areas tend to be communities with lower household income, higher household sizes, and higher unemployed rates. Regression results indicated common facility‐level risk factors as low total nursing staffing levels, high proportion of Medicaid residents, and low deficiency/quality ratings. Significant zip code‐level factors included household income, average household size, unemployed rate, and proportion of Hispanic residents. However, among nursing homes residing in hot spot zip code areas, total nursing staffing levels (β = −0.04, p < 0.001) and proportion of Medicaid residents (β = 0.03, p < 0.001) had greater effects on death rates.ConclusionsNursing homes located in communities of lower social‐economic status were hit the hardest in terms of having high death rates. Among nursing homes located in hot spot communities, nurse staffing and facility resources (i.e. proportion of Medicaid) play more critical roles in preventing further damage to residents.Implications for Policy or PracticePolicymakers should target resources to nursing homes in the hot spot areas identified, particularly nursing homes with low staffing and high Medicaid census in those areas.

Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

BackgroundThe proportion of hospital deaths has declined in the past few decades, while the proportions of nursing home deaths have increased. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs. Under these circumstances, a comprehensive understanding of end-of-life care preferences in local nursing home residents can help healthcare professionals and policymakers develop strategies to increase the advance directive completion rate and quality of care. This study aimed to explore and compare advance directive and end-of-life care preferences of nursing home residents in Hong Kong and Taiwan.MethodsA structured questionnaire was developed by the research team to investigate advance directive and end-of-life care preferences in older Chinese nursing home residents. Nursing home residents with frail or pre-frail status and over the age of 64 were invited to participate in the study, and information on demographics, functional status, advance directive experiences, and end-of-life care expectations was collected through questionnaire interviews.ResultsA total of 325 eligible participants from 32 facilities completed the survey, including 238 older residents in Hong Kong and 87 in Taiwan. A significantly lower proportion of the Hong Kong residents had completed an advance directive compared with the Taiwanese (3 vs. 13%, p = 0.001). Among participants who did not have an advance directive, 46% of the Taiwanese participants said they would consider completing one in the future, compared with 20% of the Hong Kong participants (p < 0.001). A total of 79% of the Hong Kong participants and 80% of the Taiwanese participants responded that prolonging life in the given hypothetical dying scenario was “not important” (p = 0.76). Only 14% of participants in Hong Kong and 18% of participants in Taiwan reported prior occurrence of end-of-life care discussions with family members or health professionals (p = 0.37).ConclusionsThis paper adds evidence in support of improving end-of-life communication and the advance directive completion rate in nursing homes in Hong Kong and Taiwan. Further research is necessary to explore cross-cultural differences in end-of-life preferences and its applications in predicting decision-making and the quality of end-of-life care.

Medicaid patients more likely to die at home without hospice during the pandemic versus before, exacerbating disparities with commercially insured patients.

6502 Background: The COVID-19 pandemic dramatically reduced family access to hospitals and created new barriers to home hospice care, raising concerns about how the pandemic has impacted cancer patients’ place of death and end of life home hospice support. Hypothesizing that Medicaid-enrolled cancer patients may be at greater risk of disruptions in end-of-life care compared to commercially insured patients, we examined changes in place of death and home hospice support for Medicaid and Commercial enrollees following the pandemic. Methods: We linked WA State cancer registry records with claims from Medicaid and approximately 75% of commercially insured cancer patients in the state. Patients ages 18-64 with solid-tumor malignancies who died March-June 2020 (COVID) were compared to those who died March-June 2017-2019 (Pre-COVID). Place of death was categorized as hospital, home with hospice, and home without hospice; nursing home deaths were excluded. Given our sample size, we examined differences in the likelihood of place of death with Fisher’s exact tests and multinomial logistic regressions stratified by payer and by COVID period, controlling for age, gender, race, stage, cancer type, and census tract-level neighborhood deprivation. We report marginal effects. Results: In Fisher’s exact analyses, Medicaid but not commercial patients were significantly less like to die in hospital and more likely to die at home without hospice during COVID (Table). In pre-post adjusted analysis of Medicaid patients, the probability of dying in the hospital was 12.3% (p=0.03) percentage points lower during the pandemic versus before, while the probability of dying at home without hospice was 11.1% (p=0.04) greater. Place of death did not change significantly pre-post for commercial patients. In addition, Pre-COVID, the probability of dying in the hospital was 10.7% (p=0.03) greater for Medicaid than commercial patients. During COVID, the probability of dying at home without hospice was 15.8% (p=0.04) greater for Medicaid versus commercial patients but lower for women (ME=20.2%; p=0.01) and colorectal versus breast cancer patients (ME=39.2%; p=0.01). Conclusions: Following COVID, Medicaid patients place of death shifted from hospital to homes, but without an increase in the use of home hospice services. In contrast, place of death and hospice use among commercial patients did not significantly change. This widening disparity in home deaths without hospice services raises concerns that the pandemic disproportionately worsened end of life experience for low income patients with cancer.[Table: see text]

Dying well in nursing homes during COVID‐19 and beyond: The need for a relational and familial ethic

This paper applies a relational and familial ethic to address concerns relating to nursing home deaths and advance care planning during Covid‐19 and beyond. The deaths of our elderly in nursing homes during this pandemic have been made more complicated by the restriction of visitors even at the end of life, a time when families would normally be present. While we must be vigilant about preventing unnecessary deaths caused by coronavirus outbreaks in nursing homes, some deaths of our elders are inevitable. Thus, it is essential that advanced care planning occurs in a way that upholds the familial and relational aspects of elders’ lives that often matter to them the most. We invoke concepts from feminist ethicists like Hilde Lindemann and Eva Kittay and introduce Avery Weisman and Thomas Hackett’s concept of “appropriate death” to suggest better ways of planning for those deaths of our elderly that cannot be avoided. Our hope is to allow for deaths that are as meaningful as possible for both the elderly and the family members who survive them.

Reform influences location of death: Interrupted time-series analysis on older adults and persons with dementia.

Norway instituted a Coordination Reform in 2012 aimed at maximizing time at home by providing in-home care through community services. Dying in a hospital can be highly stressful for patients and families. Persons with dementia are particularly vulnerable to negative outcomes in hospital. This study aims to describe changes in the proportion of older adults with and without dementia dying in nursing homes, home, hospital and other locations over an 11-year period covering the reform. This is a repeated cross-sectional, population-level study using mortality data from the Norwegian Cause of Death Registry hosted by the Norwegian Institute of Public Health. Participants were Norwegian older adults 65 years or older with and without dementia who died from 2006 to 2017. The policy intervention was the 2012 Coordination Reform that increased care infrastructure into communities. The primary outcome was location of death listed as a nursing home, home, hospital or other location. The trend in the proportion of location of death, before and after the reform was estimated using an interrupted time-series analysis. All analyses were adjusted for sex and seasonality. Of the 417,862 older adult decedents, 61,940 (14.8%) had dementia identified on their death certificate. Nursing home deaths increased over time while hospital deaths decreased for the total population (adjusted Relative Risk Ratio (aRRR) 0.87, 95% CI 0.82-0.92) and persons with dementia (aRRR: 0.93, 95%CI 0.91-0.96) after reform implementation. This study provides evidence that the 2012 Coordination Reform was associated with decreased older adults dying in hospital and increased nursing home death; however, the number of people dying at home did not change.

Changes in the place of death for older adults with cancer: Reason to celebrate or a risk for unintended disparities?

BackgroundPlace of death is important to patients and caregivers, and often a surrogate measure of health care disparities. While recent trends in place of death suggest an increased frequency of dying at home, data is largely unknown for older adults with cancer. MethodsDeidentified death certificate data were obtained via the National Center for Health Statistics. All lung, colon, prostate, breast, and pancreas cancer deaths for older adults (defined as >65 years of age) from 2003 to 2017 were included. Multinomial logistic regression was used to test for differences in place of death associated with sociodemographic variables. ResultsFrom 2003 through 2017, a total of 3,182,707 older adults died from lung, colon, breast, prostate and pancreas cancer. During this time, hospital and nursing home deaths decreased, and the rate of home and hospice facility deaths increased (all p < 0.001). In multivariable regression, all assessed variables were found to be associated with place of death. Overall, older age was associated with increased risk of nursing facility death versus home death. Black patients were more likely to experience hospital death (OR 1.7) and Hispanic ethnicity had lower odds of death in a nursing facility (OR 0.55). Since 2003, deaths in hospice facilities rapidly increased by 15%. ConclusionHospital and nursing facility cancer deaths among older adults with cancer decreased since 2003, while deaths at home and hospice facilities increased. Differences in place of death were noted for non-white patients and older adults of advanced age.

Association Between Exposure to Hurricane Irma and Mortality and Hospitalization in Florida Nursing Home Residents

Nursing home residents are at heightened risk for morbidity and mortality following an exposure to a disaster such as a hurricane or the COVID19 pandemic. Previous research has shown that nursing home resident mortality related to disasters is frequently underreported. There is a need to better understand the consequences of disasters on nursing home residents and to differentiate vulnerability based on patient characteristics. To evaluate mortality and morbidity associated with exposure to Hurricane Irma, a Category 4 storm that made landfall on September 10, 2017, in Cudjoe Key, Florida, among short-stay (<90-day residence) and long-stay (≥90-day residence) residents of nursing homes. Cohort study of Florida nursing home residents comparing residents exposed to Hurricane Irma in September 2017 to a control group of residents residing at the same nursing homes over the same time period in calendar year 2015. Data were analyzed from August 28, 2019, to July 22, 2020. Residents who experienced Hurricane Irma were considered exposed; those who did not were considered unexposed. Outcome variables included 30-day and 90-day mortality and first hospitalizations after the storm in both the short term and the long term. A total of 61 564 residents who were present in 640 Florida nursing home facilities on September 7, 2017, were identified. A comparison cohort of 61 813 residents was evaluated in 2015. Both cohorts were mostly female (2015, 68%; 2017, 67%), mostly White (2015, 79%; 2017, 78%), and approximately 40% of the residents in each group were over the age of 85 years. Compared with the control group in 2015, an additional 262 more nursing home deaths were identified at 30 days and 433 more deaths at 90 days. The odds of a first hospitalization for those exposed (vs nonexposed) were 1.09 (95% CI, 1.05-1.13) within the first 30 days after the storm and 1.05 (95% CI, 1.02-1.08) at 90 days; the odds of mortality were 1.12 (95% CI, 1.05-1.18) at 30 days and 1.07 (95% CI, 1.03-1.11) at 90 days. Among long-stay residents, the odds of mortality for those exposed to Hurricane Irma were 1.18 (95% CI, 1.08-1.29) times those unexposed and the odds of hospitalization were 1.11 (95% CI, 1.04-1.18) times those unexposed in the post 30-day period. The findings of this study suggest that nursing home residents are at considerable risk to the consequences of disasters. These risks may be underreported by state and federal agencies. Long-stay residents, those who have resided in a nursing home for 90 days or more, may be most vulnerable to the consequences of hurricane disasters.

The need for home care physicians in Japan \u2013 2020 to 2060

BackgroundJapan faces the most elderly society in the world, and the Japanese government has launched an unprecedented health plan to reinforce home care medicine and increase the number of home care physicians, which means that an understanding of future needs for geriatric home care is vital. However, little is known about the future need for home care physicians. We attempted to estimate the basic need for home care physicians from 2020 to 2060.MethodsOur estimation is based on modification of major health work force analysis methods using previously reported official data. Two models were developed to estimate the necessary number of full-time equivalent (FTE) home care physicians: one based on home care patient mortality, the other using physician-to-patient ratio, working with estimated numbers of home and nursing home deaths from 2020 to 2060. Moreover, the final process considered and adjusted for future changes in the proportion of patients dying at home. Lastly, we converted estimated FTE physicians to an estimated head count.ResultsResults were concordant between our two models. In every instance, there was overlap of high- and low-estimations between the mortality method and the physician-to-patient method, and the estimates show highly similar patterns. Furthermore, our estimation is supported by the current number of physicians, which was calculated using a different method. Approximately 1.7 times (1.6 by head count) the current number of FTE home care physicians will be needed in Japan in the late 2030’s, peaking at 33,500 FTE (71,500 head count). However, the need for home care physicians is anticipated to begin decreasing by 2040.ConclusionThe results indicate that the importance of home care physicians will rise with the growing elderly population, and that improvements in home care could partially suppress future need for physicians. After the late 2030’s, the supply can be reduced gradually, accounting for the decreasing total number of deaths after 2040. In order to provide sufficient home care and terminal care at home, increasing the number of home care physicians is indispensable. However, the unregulated supply of home care physicians will require careful attention in the future.