Nursing Home Facilities Research Articles

Prevalence and Description of Palliative Care in US Nursing Homes: A Descriptive Study.

To describe rates and policies in U.S. Nursing Homes (NH) related to palliative care, comfort care, and hospice care based on a nationwide survey of directors of nursing. A national survey was distributed online and was completed by 316 directors of nursing of NHs (11% response rate). The directors of nursing were asked about availability and policies in their facilities. Specifically, questions were related to policies, referral patterns, discussion about such care, and types of medical conditions qualifying for such services. Hospice is significantly more available than palliative or comfort care programs; also, for-profit facilities, compared to non-profits, are significantly more likely to have palliative care programs and medical directors for palliative care. Social workers and nurses were most likely to suggest palliative type programs. Only 42% of facilities with palliative program provide consultation by a palliative certified physician. Residents with non-healing pressure ulcers, frequent hospitalizations, or severe/uncontrolled pain or non-pain symptoms were less likely to be referred. There is limited availability of palliative type programs in NH facilities and underutilization in those NH with programs.

Differential responses of individuals with late-stage dementia to two novel environments: a multimedia room and an interior garden.

The purpose of this study was to determine the responses of individuals with advanced dementia to two novel sensory environments in a nursing home facility. The first was a multisensory Snoezelen room; the second was a temporary Japanese garden. Subjects viewed each environment twice a week for 15 minutes during the study. Stress was measured using heart rate and informant-based behavioral changes. By these criteria, the garden-viewing group showed positive behavioral changes while the responses of the subjects in the Snoezelen group were more negative. The response of the subjects' pulse rate was most dramatic. During the 15 minutes in the garden, the average rate (all subjects/all visits) was significantly less than in their residential room. In the Snoezelen room, we detected little or no change. The impact of the garden could also be seen in the negative behavioral signs elicited upon returning the subjects to the garden room after the installation had been replaced with plants and furniture arranged with no formal design. We propose that exposure to a small interior Japanese garden could be an effective intervention for individuals suffering from late stage Alzheimer's disease.

노인요양시설의 스마트 기술 도입에 대한 탐색적 연구 -요양시설 종사자 답변을 중심으로-

본 연구는 노인요양시설에 도입가능한 스마트 기술을 탐색해봄으로 시설입소노인들의 삶의 질 향상을 꾀하기 위해 시도되었다. 조사대상자는 노인요양시설에서 노인의 직 간접적 케어에 종사하는 요양보호사, 사회복지사, 간호사 등을 대상으로 실시되었으며 총 6개의 요양시설에 근무하는 종사자들을 통해 총 127명의 자료가 수집되었다. 수집방법은 설문지를 이용하되 4명의 노인복지전공자들이 스마트기기에 대한 설명을 병행했다. 수집된 자료를 바탕으로 평균 및 표준편차를 통한 요구도를 분석한 결과 스마트 기술을 요양시설에 적용할 경우 가장 유용한 영역으로는 가족관계지원 영역, 건강지원 영역, 여가지원 영역, 물리적환 경적응지원 영역의 순으로 나타났다. 구체적 항목별로는 물리적환경적응지원 영역에서는 시설직원익히기, 특정공간 방향찾기였으며, 건강지원영역에서는 안전센서, 프로그램 알람이, 가족관계 지원영역에서는 가족 사진보기, 자신의 사진/동영상 앨범 활용이, 여가 지원영역에서는 음악듣기, 영화/텔레비젼 시청이 상대적으로 높게 나타났다. 이러한 결과는 응답자의 인구 사회적 특성 및 스마트기기 특성에 따라 다르게 나타났는데, 이를 토대로 향후 연구에서는 노인을 대상으로 스마트 기술에 대한 욕구를 파악함으로 좀 더 심도깊은 연구가 이루어져야 할 것이다. The purpose of this exploratory study is to examine if the application of smart technology(ST) would assist adjustment to the nursing home facilities in the elderly. Since there is not much previous research on this subject, we generated survey questionnaires on our own. Data were collected from the survey of 127 employees at 6 nursing homes including geriatric care workers, social workers and nurses who provide direct as well as indirect care services. Results showed that the utilization of ST would benefit the areas of family relationship support, health support, leisure support, and physical environment adjustment. As for physical environment adjustment, study participants reported that ST would help elders familiarize employees and find directions for specific space the most. As for health support, ST would be best utilized as a security sensor and program alarm system. As for support for family relationship, ST was expected to be utilized as looking at family pictures and playing with self pictures/videos. As for leisure support, ST was expected to assist elders to listen to music and watch movies/TV. These results were different according to the characteristics of the participants and the smartifacts. These results of the study will show the direction for more in-depth studies on application of smart technology for the elderly in the future.

Perspectiva de los psiquiatras españoles respecto a la atención de las demencias. La encuesta PsicoDem

Mental health services are not systematically involved in the care of dementias in Spain. Nevertheless, many patients with dementia attend these services. The perspective of psychiatrist as regards this situation has not been evaluated at the national level to date, and it may be of interest to determine their actual involvement and the strategies to foster it.A survey was conducted on 2,000 psychiatrists on a range of mental health care services. Respondents provided socio-demographic data and information about clinical aspects, together with their opinions regarding the management of dementia. Responses were described by their raw frequencies and measures of association for cross-tabulations resulting from selected pairs of questions. Inferences were made by calculating their 95% confidence intervals.Psychiatrist involvement in the management of dementias was limited, aside from those involved in psycho-geriatric units or nursing homes facilities. However, there were wide, regional differences. Nearly all respondents (81%) were ready to augment their knowledge and skills in the area of dementia. In particular, the insufficient medical education, together with other organizational factors, such as the difficulties in ordering diagnostic tests (i.e. neuroimaging), or prescribing anti-dementia drugs in some regions, were common barriers psychiatrists faced when approaching patients with dementia.Increasing psychiatrist involvement and boosting coordinated efforts with other specialists in a form of integrated care may advance the care of dementias in Spain to a more valuable level.

Design of nursing homes of the future

There is an increasing call in society for improvementof the well-being of nursing home residents and support of health care professionals through a wide array of architectural and technological solutions that are available in modern nursing homes. The design of nursing home facilities calls for new approaches that are designed to maximise the needs of the stakeholders..

What happens to patients with COPD with long-term oxygen treatment who receive mechanical ventilation for COPD exacerbation? A 1-year retrospective follow-up study

We performed a retrospective cohort study of patients with chronic obstructive lung disease (COPD) on long-term oxygen treatment (LTOT) who received invasive mechanical ventilation for COPD exacerbation. Of the 4791...

Effect of the Bathing Without a Battle Training Intervention on Bathing‐Associated Physical and Verbal Outcomes in Nursing Home Residents with Dementia: A Randomized Crossover Diffusion Study

To evaluate the effectiveness of the Bathing Without a Battle intervention in reducing physical and verbal aggressive behaviors for nursing home residents with dementia. A randomized crossover diffusion study, with one group receiving the intervention after one round of baseline observations and a delayed intervention group receiving the intervention after two rounds of baseline observations. Six nursing home facilities in the state of New York. Nursing home residents with dementia (N = 240). The Bathing Without a Battle educational program, designed for direct-care staff members responsible for bathing residents diagnosed with dementia and implemented through a train-the-trainer model. Rates of verbal and physical aggressive and agitated behaviors were measured using the Care Recipient Behavior Assessment; secondary measures of effect included bath duration, bath modality, and antipsychotic medication use. In spite of implementation obstacles (consent delays and change in leadership at one facility), a significant change was observed in how residents were bathed that translated into a significant reduction in the rate of aggressive and agitated behaviors, particularly verbal, during residents' baths. The use of in-bed baths increased 17%, and average bath duration decreased significantly (average 1.5 minutes less) in the postintervention period, particularly for in-bed baths. Verbal behaviors declined 17.8% (P = .008), combined verbal and physical behaviors declined 18.6% (P = .004), and antipsychotic use declined 30% (P = .002) after the intervention. The Bathing Without a Battle educational program, delivered through a train-the-trainer format, is an effective means of improving the bathing experience of residents with dementia in nursing homes. This research supports broadly adopting this intervention, especially for nursing homes serving many residents with dementia.

Emergency Department Visit Rates and Patterns in Canada’s Vancouver Coastal Health Region

This study used administrative health data to describe emergency department (ED) visits by residents from assisted living and nursing home facilities in the Vancouver Coastal Health region, British Columbia. We compared ED visit rates, the distribution of visits per resident, and ED dispositions of the assisted living and nursing home populations over a 3-year period (2005-2008). There were 13,051 individuals in our study population. Visit rates (95% confidence interval) were 124.8 (118.1-131.7) and 64.1 (62.9-65.3) visits per 100 resident years in assisted living and nursing home facilities respectively. A smaller proportion of ED visits by assisted living residents resulted in hospital admission compared to nursing home residents (45% vs. 48%, p < .01). The ED visit rate among assisted living residents is significantly higher compared to that among nursing home residents. Future research is needed into the underlying causes for this finding.

Family care experiences in nursing home facilities

To explore relatives' involvement in the care of older adults admitted to residential settings. A qualitative approach using semi-structured interviews was adopted. Data were analysed using content thematic analysis. Content thematic analysis revealed that participants experienced a change in role when their relatives were admitted to residential care. Three major themes emerged: family involvement, family-centred care, and communication. The importance of communicating with staff was emphasised by relatives. The transition from home to residential care is a challenging time for residents and families. Nurses need to communicate with families and adopt a collaborative, integrated approach to care.

Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: Cross-sectional secondary data analysis

BackgroundIn the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training. ObjectivesThis study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants. DesignCross-sectional secondary data analysis. SettingsThis study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training. Participants2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US. MethodsState regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics. ResultsCertified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p=0.02) and were more satisfied with their jobs (OR=1.51, 95% CI=1.09–2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR=1.91, 95% CI=1.41–2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR=1.36, 95% CI=0.99–1.84). ConclusionsCertified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover.

Nursing Home Characteristics Associated with Resident Transfers to Emergency Departments

This study examined how nursing home facility ownership and organizational characteristics relate to emergency department (ED) transfer rates. The sample included a retrospective cohort of nursing home residents in the Vancouver Coastal Health region (n = 13,140). Rates of ED transfers were compared between nursing home ownership types. Administrative data were further linked to survey-derived data of facility organizational characteristics for exploratory analysis. Crude ED transfer rates (transfers/100 resident years) were 69, 70, and 51, respectively, in for-profit, non-profit, and publicly owned facilities. Controlling for sex and age, public ownership was associated with lower ED transfer rates compared to for-profit and non-profit ownership. Results showed that higher total direct-care nursing hours per resident day, and presence of allied health staff--disproportionately present in publicly owned facilities--were associated with lower transfer rates. A number of other facility organizational characteristics--unrelated to ownership--were also associated with transfer rates.

Improving hip fracture care in ireland: a preliminary report of the irish hip fracture database.

Introduction. Hip fractures are common injuries in the older persons, with significant associated morbidity and mortality. The Irish Hip Fracture Database (IHFD) was implemented to monitor standards of care against international standards. Methods. The IHFD is a clinically led web-based audit. We summarize the data collected on hip fractures from April 2012 to March 2013 from 8 centres. Results. There were 843 patients with the majority being (70%) female. The 80–89-year age group accounted for the majority of fractures (44%). Most (71%) sustained a fall at home. Intertrochanteric fractures (40%) were most common. Only 28% were admitted to an orthopaedic ward within 4 hours. The majority (97%) underwent surgery with 44% having surgery within 36 hours. Medical optimization (35%) and lack of theatre space (26%) accounted for most of the surgical delay. While 29% were discharged home, 33% were discharged to a nursing home or other long-stay facilities. There was a 4% in-hospital mortality rate. Conclusions. Several key areas in both the database and aspects of patient care needing improvement have been highlighted. The implementation of similar databases has led to improved hip fracture care in other countries and we believe this can be replicated in Ireland.

Adherence of pain assessment to the German national standard for pain management in 12 nursing homes.

Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic⁄acute pain-affected persons and highly recommended for practice. To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.

Description of a systematic pharmaceutical care approach intended to increase the appropriateness of medication use by elderly patients.

Background & AimsThe pharmaceutical care practice represents a model of responsible pharmacist involvement in the pharmacotherapy optimization of various population groups, including the elderly, known to be at risk for drug-related problems. Romanian pharmacists could use validated pharmaceutical care experiences to confirm their role as health-care professionals.This descriptive research presents the application in two real and different environments of practice of a structured pharmaceutical care approach conceived as the basis for a medication review activity and aiming at the identification and resolution of the drug related problems in the elderlyPatients and methodsTwo patients with similar degree of disease-burden complexity, receiving care in different health-care environments (The Geriatric Ward of the Royal Victoria Hospital from the McGill University Health Centre in Montréal, Québec, Canada, in November 2010, and an urban nursing-home facility in Cluj-Napoca, Romania, in March 2011), were chosen for the analysis. One clinical pharmacist suggested solutions for the management of each of the active drug-related problems identified, using the systematic pharmaceutical care approach and specific published geriatric pharmacotherapy recommendations. The number of the drug-related problems identified and the degree of the care-team acceptance of the pharmacists’ solutions were noted for each patient.ResultsThe pharmacist found 6 active drug-related problems for the hospitalized patient (72 year-old, Chronic Disease Score 9) and 7 potential ones for the nursing-home resident (79 year-old, Chronic Disease Score 8), involving misuse, underuse and overuse of medications. Each patient had 3 geriatric syndromes at baseline. The therapy changes suggested by the pharmacist were implemented for the hospitalized patient, through collaboration with the health-care team. For the nursing home resident, the pharmacist identified the need for additional 6 medications and safety and efficacy arguments to cease 7 initial therapies, simplifying the therapeutic daily schedule (from 24 daily doses to 15).ConclusionThe pharmacist’s potential contribution to the optimization of the Romanian elderly patients’ pharmacotherapy needs further exploration, as potential drug related problems reported as characteristic for this population were easily identified. The presented structured and validated model of pharmaceutical care approach could be used to this end. Its dissemination and use could be encouraged along with the enhancement of pharmacotherapy information and care team collaboration skills.

Hospitals Seek to Better Understand Nursing Facilities

Hospitals Seek to Better Understand Nursing Facilities

An assessment of cultural values and resident-centered culture change in U.S. nursing facilities

Culture change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how culture change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements. The aim of this study was to evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the competing values framework and to determine whether organizational values are related to membership in resident-centered culture change initiatives. We collected reports of cultural values using a well-established competing values framework instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not differ significantly in their reports of culture and facility measures combined their responses. Nursing facilities favored market-focused cultural values on average, and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of the facilities reported that all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture change facilities were not different from non-culture change facilities in the promotion of employee focus as organizational culture, as emphasized in group culture values. Likewise, culture change facilities were also not more likely to have hierarchical or market foci than non-culture change facilities. Our results counter the argument that culture change facilities have a stronger internal employee focus than facilities more generally but do show that culture change facilities report stronger developmental cultures than non-culture change facilities, which indicates a potential to be innovative in their strategies. Facilities are culturally ready to become resident centered and may face other barriers to adopting these practices.

A survey on physicians’ knowledge and attitudes toward clinical use of opioids in nursing home facilities in The Netherlands

A survey on physicians’ knowledge and attitudes toward clinical use of opioids in nursing home facilities in The Netherlands

Effectiveness of nursing discharge planning interventions on health-related outcomes in elderly inpatients discharged home: a systematic review protocol

Review question/objective The aim of this systematic review is to determine the best available evidence of the effectiveness of discharge planning interventions involving at least one nurse on health related outcomes, including, but not limited to, functional limitations, symptom management, unmet needs and/or health related quality of life for elderly inpatients discharged home. Furthermore, the objective of this study is to assess the relative impact of individual components of discharge planning interventions Inclusion criteria Types of participants This review will consider studies that included elderly inpatients, aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals (including skilled nursing home facilities) to home. Types of intervention(s)/phenomena of interest This review will consider studies that assess the following nursing discharge planning interventions: 1. Early geriatric assessment 2. Discharge preparation: education/teaching medication self-management, developing self-care management skills, symptoms management, effective communication and information about discharge plan, effective multidisciplinary communication 3. Patient or caregivers participation/involvement to the discharge planning and decision making related to discharge destination 4. Continuity of care (coordination and effective communication between hospital staff, primary care and health care providers, coordination of the patient’s discharge/transitional plan, management of patient’s transition and post discharge needs 5. Day of discharge assessment regarding discharge planning (medication reconciliation, completion and explanation to the patient of the discharge summary) and 6. Post discharge follow-up (home care follow up/visits, follow-up phone calls). This systematic review will focus on discharge planning interventions: i) provided by at least one nurse; and ii) which are incorporated into a multidisciplinary and/or interdisciplinary model of care. Types of outcomes This review will consider studies that include the following outcome measures: 1.) Functional ability/functional limitations 2.) Symptoms/medical condition management/adverse outcomes 3.) Unmet needs after hospital discharge 4.) Coping with disease /coping difficulties 5.) Health related quality of life 6.) Satisfaction with care during the discharge planning process 7.) Health care utilization (eg number of hospital visits).

The feasibility of measuring social networks among older adults in assisted living and dementia special care units

Studies indicate that social integration has a significant influence on physical and mental health. Older adults experience an increased risk of social isolation as their social networks decline with fewer traditional opportunities to add new social relationships. Deaths of similar aged friends, cognitive and functional impairments, and relocating to a nursing home (NH) or assisted-living (AL) facility contribute to difficulties in maintaining one's social network. Due to the paucity of research examining the social networks of people residing in AL and NH, this study was designed to develop and test the feasibility of using a combination of methodological approaches to capture social network data among older adults living in AL and a dementia special care unit NH. Social network analysis of both egocentric and sociocentric networks was conducted to visualize the social networks of 15 residents of an AL neighborhood and 12 residents of a dementia special care unit NH and to calculate measures network size, centrality, and reciprocity. The combined egocentric and sociocentric method was feasible and provided a robust indicator of resident social networks highlighting individuals who were socially integrated as well as isolated.

Frailty and health-related quality of life among residents of long-term care facilities.

To determine the prevalence and relationship of frailty and health-related quality of life (HRQOL) among residents of long-term care [nursing homes (NH) and assisted living (AL)] facilities. Residents of NH and AL facilities in La Crosse County, Wisconsin, were recruited 1/2009-6/2010 and assessed for frailty (gait speed, unintended weight loss, grip strength), comorbidity (Charlson index), and HRQOL [Short Form (SF)-36]. Among 137 participants, 85% were frail. Frail residents were older, had more comorbidities (2.0 vs. 0, p < .001) and lower mean SF-36 Physical Component Score (PCS, 32 vs. 48, p < .001). Following adjustments for age, sex, and comorbidities, compared to nonfrail residents, frail residents had lower SF-36 PCS (mean difference -14.7, 95% CI. -19.3,-10.1, p < .001). Frailty, comorbidity, and HRQOL did not differ between NH and AL facilities. Frail residents had lower HRQOL, suggesting that preventing frailty may lead to better HRQOL among residents of long-term care facilities.