Nursing Home Services Research Articles

요양병원 간병비 지급이 건강보험 진료이용량에 미치는 영향

Korean Government had performed three pilot programs to introduce the long term care insurance system. Persons aged 65 or older who are dependent on others for daily living could use long term care services in the pilot program. The long-term care insurance covered nursing home services, home care services and cash benefits. The cash benefits are included that for elderly at home and for patients in geriatric hospital. This study investigated whether there had been any change in the medical care utilization according to cash benefits for geriatric hospitalization. This study used National Health Insurance claims and Long term Care Insurance claims 2003 through 2006. Data were composed of subjects who undertook both insurance coverage. The subjects was divided into two groups. Case group included participants with the cash benefits of geriatric hospitalization. Control group included persons without the cash benefits selected by random sampling according to the distribution of case group. This study showed that the amount of medical care utilization of the case group is more significantly increased than the control group after adjusted their health condition and functional condition. This result will be helpful for making decisions on whether the cash benefit of geriatric hospitalization can be introduced into long term care insurance system.

LTC Community Wants Inclusion in Reform

LTC Community Wants Inclusion in Reform

Organizational factors associated with the use of information systems in nursing homes

The use of information systems (ISs) in nursing homes is gradually increasing, yet little is known about the factors that promote the use of these systems. Using resource dependency theory as the conceptual framework, this study examines how chain membership, ownership status, and innovativeness are associated with ISs use in nursing homes. We analyzed the results of the 2004 National Nursing Home Survey. The sampling process consisted of a stratified probability design. A total of 1,174 nursing homes participated in the survey. The results of the regression analysis revealed that facilities that were members of a chain were significantly more likely to use all types of ISs and ISs for administrative tasks than were nonchain facilities. In addition, nonprofit nursing homes were significantly more likely to use administrative systems. The demand for nursing home services is expected to increase substantially with the aging baby boomers. The use of ISs may assist nursing homes to improve service delivery by collecting and analyzing service, finance, and administrative data that are necessary to achieve operational efficiencies. Membership in a multifacility chain may both increase the need for network-wide communication and provide resources promoting use.

Luck and Happenstance

This qualitative study explores how older adults enroll in a Program of All-Inclusive Care for the Elderly (PACE). PACE is a community-based long-term care program for nursing home eligible older adults. The study includes interviews with older adults (n = 5), families (n = 4), and staff (n = 10). This study identified common circumstances that led to the recognition of a need for help. These circumstances included the following: an acute event or crisis, older adult's or caregiver's drive to avoid entry into the nursing home, and the caregivers' recognition that they need relief from their care demands. Once this need was identified, families typically found out about PACE because of happenstance; they happened to talk to someone who knew about the program. If PACE is going to be a sustainable alternative to nursing home care efforts, it needs to focus on moving the enrollment process beyond happenstance. Professional case managers are positioned to help older adults and families plan for long-term care by understanding the availability of local community services, developing contacts with local community and long-term care services, and considering what information older adults and their families need, especially during acute care discharges, primary care encounters, and queries for nursing home services.

Nurse Preparation and Organizational Support for Supervision of Unlicensed Assistive Personnel in Nursing Homes: A Qualitative Exploration

Nursing supervision of the routine daily care (e.g., grooming, feeding, and toileting) that is delegated to unlicensed assistive personnel (UAP) is critical to nursing home service delivery. The conditions under which the supervisory role is organized and operationalized at the work-unit level, taking into account workloads, registered nurse/licensed practical nurse staffing, and role expectations, are not well understood. The purpose of this paper is to describe the organizational, managerial, and nurse-level factors associated with the nurse's role as supervisor of UAP in nursing homes. An ethnographic approach to data collection included 31 interviews, 170 hr of observation, and organizational document review at three nursing homes. Analysis included micro-coding and content analysis. Findings revealed (a) considerable variation in organizational resources, systems, and processes to support organization and operationalization of the supervisory role; and (b) limited evidence of nurses' estimation of the potential benefits of training and organizational systems to support supervisory practice and the complexity of the supervisory role. Delivery of high-quality nursing home care is a matter of national importance, and these findings offer a call to action for nursing home leaders in policy, academia, and ownership and management positions. Nurses must be equipped with competencies and skills that reflect the complex organizational environments in which they work. Additionally, nursing home administrators and managers must be equipped with the competencies and skills needed to effectively and efficiently organize and operationalize care delivery practices to support nurses' role enactment.

A temporary home to nurture health: lived experiences of older nursing home residents in Taiwan

This study explored the lived experiences of older nursing home residents in Taiwan. With more long-term care institutions in Taiwan, older people are more often placed in nursing homes than in the past. Increased understanding of their lived experience is essential to assess residents' needs and determine the effectiveness of nursing interventions. A qualitative design was used to gain a deeper understanding of the lived experiences of older nursing home residents in Taiwan. Focus groups, followed by in-depth interviews, were used to gather information from 33 older residents at eight nursing homes in northern Taiwan. Participants were asked to describe what was important to them and what impressed them most in their daily lives in the nursing home. Participants (24 females and nine males) were on an average 75.3 years old. Verbatim transcripts of audiotaped focus groups and interviews were analysed by thematic analysis via ATLAS.ti software. The core theme of older residents' nursing home experience was 'a temporary home to nurture health'. This core theme was reflected in participants' descriptions of their overall life in the nursing home as a temporary experience to nurture their health. Their everyday experience was characterised by four subthemes: highly structured lifestyle, restricted activities, safety concerns and social interactions. Our findings may enhance policy makers' and healthcare providers' understanding of the lived experience of older nursing home residents, thus guiding the evaluation and development of nursing home services to improve residents' lives. For example, residents with the same characteristics could be placed in the same room or same floor, thus increasing their interactions with other residents. Residents' interactions with family members could also be developed using the Internet or mobile telephones.

Successfully Managing Attending Physicians

Successfully Managing Attending Physicians

As Health Care Spending Tops $2 Trillion, President Bush Proposes a Freeze for LTC

As Health Care Spending Tops $2 Trillion, President Bush Proposes a Freeze for LTC

Senior services: exploring nursing home services for community‐based seniors

PurposeThis study aims to examine the extent to which certain organizational characteristics of a nursing home impact its decision to target the community‐based seniors' (CBS) market by offering nursing home services to non‐residents. The study aims to hypothesize that service provision would be greater in not‐for‐profit, innovative nursing homes, those with organizational slack, and those that are chain‐affiliated.Design/methodology/approachData came from the 1999 National Nursing Home Survey. There are 1,075 nursing homes in the sample population. The data were analyzed using logistic regression.FindingsThe results show that for‐profit nursing homes were predisposed to offer these services. However, innovative nursing homes were less likely to offer these services. Finally, homes with slack in the form of physical therapists offered these services, but homes with nurse's aide slack were less likely to offer these services.Research limitations/implicationsThe findings support the theoretical propositions that CBS service provision is guided by both customer lifetime value principles and the tenets of relationship marketing. The purpose of establishing a long‐term relationship with a consumer is to achieve long‐term profits. Some nursing homes may be achieving this goal.Practical implicationsThe health care system is steadily undergoing changing consumer behavior. Consumers will be more actively engaged in their own service delivery; therefore, providers will have to create innovative methods to meet consumer needs. The provision of services to non‐residents is an important and necessary response to market demands for services. The key for health care providers is to offer greater service diversity.Originality/valueThe paper provides evidence that for‐profit nursing home providers offer more services to non‐residents than not‐for‐profit providers.

Ownership Form and Consumer Welfare: Evidence from the Nursing Home Industry

This paper compares the likely consumer benefits of higher quality with the potentially greater production costs that result from increased not-for-profit activity in a nursing home services market area. The comparison of consumer benefits and costs is made possible by observing empirically how an increased market penetration of not-for-profit facilities affects the use of private-pay nursing home care. Increased (decreased) use of nursing home care suggests that the consumer benefits associated with additional not-for-profit nursing homes are greater (less) than consumer costs. The empirical results indicate that, from a consumer's perspective, too few not-for-profit nursing homes may exist in the typical market area of the United States. The policy implication is that more quality of care per dollar might be obtained by attracting a greater percentage of not-for-profit nursing homes into many market areas.

Study of American and Chinese Family Members’ Evaluations on Institutionalized Care for Their Older Parents: Potential Development in the Future

The evaluations on institutionalized care facilities from family members, after their loved ones moved into such services, are very different from culture to culture, family to family and person to person. According to a recent survey in the United States and China, it is found that different cultures and the different health conditions of the residents strongly influence family member's viewpoints on institutionalized care services. It is also found that the availability of the institutionalized care facilities plays a significant role, which strongly affects family members’ evaluations on nursing home services.

Cost-effectiveness of Vitamin Therapy for Age-Related Macular Degeneration

To determine the cost-effectiveness of vitamin therapy (antioxidants plus zinc) for all indicated patients diagnosed with age-related macular degeneration (AMD). We compared the impacts of vitamin therapy with those of no vitamin therapy using a computerized, stochastic, agent-based model. The model simulated the natural history of AMD and patterns of ophthalmic service use in the United States in a cohort from age 50 years until 100 or death. The model created 20 million simulated individuals. These individuals each received both the intervention (vitamin therapy after diagnosis) and the control (no vitamin therapy). Expected outcomes generated when vitamins were taken after diagnosis were compared with the expected outcomes generated when they were not. The model created individuals representative of patients in the U.S. Incidence of early AMD was based on published studies, as was vision loss and response to choroidal neovascularization therapies. Post-incident disease progression was governed by previously unpublished data drawn from the Age-Related Eye Disease Study. Extent of disease progression, years and severity of visual impairment, cost of ophthalmic care and nursing home services, and quality-adjusted life years (QALYs). Costs and benefits were considered from the health care perspective and discounted using a 3% rate. The analysis was run for 50 years starting in 2003. Compared with no therapy, vitamin therapy yielded a cost-effectiveness ratio of $21,387 per QALY gained and lowered the percentage of patients with AMD who ever developed visual impairment in the better-seeing eye from 7.0% to 5.6%. Our model demonstrates that vitamin therapy for AMD improves quality of life at a reasonable cost.

Depression as a Risk Factor for Nursing Home Admission Among Older Individuals

Depression is common among those aged 65 and older and has been associated with increased morbidity and mortality. This study investigated whether individuals enrolled in Medicare+Choice with symptoms of depression as measured using the mental health scale from the SF-36 were at increased risk of using nursing home services. A Cox proportional hazards model was used. The study investigated community-based adults aged 65 and older. Participants were individuals aged 65 years and older enrolled in Medicare+Choice who responded to the Health Outcomes Survey and were not institutionalized or incapable of responding for themselves at the time of survey administration. The purpose of the study was to predict the risk of admission to a nursing home over time, controlling for variables related to demographics, comorbidity, age, and functional status. The results indicated that, even after controlling for physical health, functional status, age, demographics, and socioeconomic status, Medicare+Choice enrollees over the age of 65 experiencing symptoms of depression as identified by the SF-36 are at increased risk of using nursing home services. These results have implications for payers of nursing home services such as Medicare and Medicaid as well as for providers and the families of older individuals. While the results do not prove that prevention is possible, they do suggest that better identification and treatment of depression reduce the risk of nursing home admission. Even if nursing home placement cannot be avoided, it is possible that the individual's quality of life could be significantly enhanced by better diagnosis and treatment of depression. These findings have implications beyond the Medicare+Choice population.

How is place of death from cancer changing and what affects it? Analysis of cancer registration and service data

We aimed to compare trends in place of cancer death with the growth of palliative care and nursing home services, and investigate demographic, disease-related and area influences on individual place of death, using registration data for 216404 patients with breast, lung, colorectal and prostate cancer and aggregate data on services in South East England. Between 1985 and 1994 there was a trend away from hospital death (67–44%), to home (17–30%) and hospice death (8–20%). After 1995, this partly reversed. By 2002, hospital death rose to 47%, home death dropped to 23%, hospice death remained stable and nursing home death rose from 3 to 8%. Numbers of palliative care services increased, but trends for hospice and nursing home deaths most clearly followed the beds available. Cancer diagnosis and treatment influenced individual place of death, but between 1998 and 2002, age and area of residence were associated with most variation. Older patients and those living in more deprived areas died more often in hospitals and less often at home. Despite more palliative care services the proportion of people dying at home has not increased. Variation by age, deprivation and area of residence is unlikely to reflect patient preference. More active surveillance and planning must support policies for choice in end of life care.

Factors influencing use of home care and nursing homes

This paper reports a study comparing the characteristics of patients who use home care services and those who are cared for in nursing homes, and identifying the factors that influence the use of these care settings. The increase in the functionally dependent older population has led to an increase in the number of nursing homes and home care agencies. It has become clear that, rather than disputing which is the better of these options, it would be better to determine the characteristics of patients who use the two long-term care services. Gaining an understanding of the unique characteristics of patients who are cared for by home care agencies and those who are cared for in nursing homes will be imperative for reforming and developing long-term care systems. The research model was based on the Anderson Model of Health Services Utilization. Interviews were conducted with 99 stroke survivors from two home care agencies and four nursing homes, and their family members, between May and December 2001. The patient characteristics that predicted greater use of home care rather than nursing home services were: being married, poor physical function, impaired cognitive function, higher rates of comorbidity, various medical complications, and/or number of catheters (e.g. urinary catheter, naso-gastric tube). Contrary to the findings of previous studies conducted in countries with ageing populations, our findings indicate that in South Korea home care agencies, rather than nursing homes, provide care for severely impaired patients. This may be due to differences between countries in their long-term care systems and cultural attitudes toward end-of-life care. Our results will contribute to the development or reformation of long-term care systems in countries with ageing populations, and to the development of strategies for increasing access to these services.

Evaluation and Management Services: Medical Decision Making

Evaluation and Management Services: Medical Decision Making

New AIDS Cases Rise Among Older Patients

ANAHEIM, CALIF. — “The number of individuals 50 and older with a new AIDS diagnosis has risen more than 25% since 1999,” Yelena Gorina, M.S., M.P.H., told attendees at the 2006 joint conference of the American Society on Aging and the National Council on the Aging. In addition, approximately 20% of U.S. residents with HIV that has not progressed to AIDS are aged 50 years and older, she said. That translates to 170,000–190,000 persons aged older than 50 years living with HIV in this country. Approximately 10% of all U.S. individuals diagnosed with AIDS have been 50 or older in the 25 years since the first individual with AIDS was identified. Consequently, the first wave of HIV-infected individuals who have been effectively treated during this period is reaching the age when they may need nursing home services or long-term care. That means medical staff will need to be trained to recognize and manage patients with this disease. There is a distinct racial disparity in HIV/AIDS diagnoses among persons older than age 50, with the number of HIV-infected individuals in the black population being far out of proportion to their percentage of the total U.S. population. After leveling off in the late 1990s, with the introduction of highly active antiretroviral treatment (HAART), the number of individuals older than 50 years of age and diagnosed with HIV/AIDS is rising again, particularly among the black population. A number of risk factors specific to older Americans are fueling the increasing risk of acquiring HIV among individuals over 50. The percentage of elderly individuals with functional imitations and poor health has been decreasing since 1982, based on the National Health Interview Survey. And since the life expectancy for men is generally lower than the life expectancy for women, women outnumber men in many retirement communities. “For sexually active [heterosexual] adults there are more possibilities for multiple partners, and this is a risk factor for HIV,” Ms. Gorina said. In addition, older gay men may forego safe sexual practices, and both heterosexual and homosexual men may be more likely to use performance-enhancing drugs such as sildenafil. Another issue is the fact that HIV prevention messages have not been tailored to older women. To further compound the issue, postmenopausal women do not need contraceptive protection, so many of them do not realize that condoms are still necessary to decrease the risk of acquiring HIV. In fact, the use of condoms is even more important among older women because postmenopausal vaginal thinning actually increases the risk of infection with all sexually transmitted infections. Ms. Gorina said a much smaller percentage of people aged 65 and older even get tested for HIV. It is estimated that 7.1% of women versus 14.3% of men in this age group get tested. That compares with 46.4% of women and 63.8% men ages 25–34. This delay in diagnosis means infected individuals can unknowingly transmit HIV to their sex or drug-sharing partners. In addition, late diagnosis means later initiation of treatment, and late initiation of treatment is especially problematic among older persons because HIV tends to progress faster in older persons. Ms. Gorina also said unrecognized and untreated HIV may lead to AIDS dementia that might be wrongly ascribed to Alzheimer's disease.

Application of quality function deployment launches to enhancing nursing home service quality

Lately, thanks to the prosperity brought by economic development, medical standards are progressing and people are living longer than before. The average lifespan in Taiwan increased to 74.6 years in 1988, an increase of 0.3 years since 1993; simultaneously however, the population of 65 years old or older in Taiwan is rapidly increasing, reaching 1,990,000 in 2002, representing 8.9% of the total population, making Taiwan an ageing society according to definition set out by the World Health Organization (WHO). In the Yunlin County of Taiwan, the proportion of the population over 65 years was 10.8% in 1998; the ageing index is 53.5, which ranked a high fifth among the Taiwan area (the highest is in Penghu County, 70.9, while the lowest is in Taipei County, 27.8). A highly aged population is associated with large-scale health problems, and thus, the need for nursing homes or organizations is rapidly growing. However, the quality of existing nursing homes/institutes is variable. Notably, the main purpose of caring for elderly people in such homes is not only to help elderly people to live long and healthy lives, but also to improve their quality of life and level of dignity. Therefore, this study focuses on a long term nursing home institute located in Yunlin area, examining its service quality and seeking the voice of customers (VOC) by using Quality Function Deployment (QFD), and using the information obtained to assist the organization in improving service quality, weighing costs against benefits, and assigning a weighting to improve service quality; moreover, this study can provide other nursing organizations with a reference basis in promoting service quality. Regarding Quality Function Deployment, this study introduces the concept of fuzzy theory into the calculations used to determine the house of quality. Furthermore, the Fuzzy Analytic Hierarchy Process (FAHP) is introduced to calculate quality based on client requirements. Finally, the fuzzy utility value computation method is used to determine the technical importance. Since the traditional Quality Function Deployment is too subjective and does not consider correlation among quality factors, this breakthrough of adopting the fuzzy utility value computation to determine the technical importance will make the findings of this study much more objective and tending to consider human nature. According to the findings of this study, the first two areas requiring improvement in nursing organizations are the speed to handle the emergency, and the recruitment of specialized medical personnel. Additionally, this study also creates short-term and long-term improvement plans, and allows organizations to use these as a reference in enhancing service quality.

Psychiatry Billing for Nursing Home Services

This article reviews information on coding options, documentation, and payment for both initial and follow-up visits in the nursing home setting. Specific information is provided for both the psychiatry as well as the Evaluation & Management (E&M) code series. Payments are compared for comparable services in order to provide the nursing home psychiatrist with an understanding of the options available. Documentation, background information, and proposed note formatting are also provided. Proper use of the E&M series can provide valuable coding options. This article reviews information on coding options, documentation, and payment for both initial and follow-up visits in the nursing home setting. Specific information is provided for both the psychiatry as well as the Evaluation & Management (E&M) code series. Payments are compared for comparable services in order to provide the nursing home psychiatrist with an understanding of the options available. Documentation, background information, and proposed note formatting are also provided. Proper use of the E&M series can provide valuable coding options.

Psychiatry Billing for Nursing Home Services: Understanding Coding Options

This article reviews information on coding options, documentation, and payment for both initial and follow-up visits in the nursing home setting. Specific information is provided for both the psychiatry as well as the Evaluation & Management (E&M) code series. Payments are compared for comparable services in order to provide the nursing home psychiatrist with an understanding of the options available. Documentation, background information, and proposed note formatting are also provided. Proper use of the E&M series can provide valuable coding options.