Personal Care Facilities Research Articles

PRACTITIONER APPLICATION: New Factors in the Antitrust Regulation of Hospital Mergers

PRACTITIONER APPLICATION: New Factors in the Antitrust Regulation of Hospital Mergers

Angelman syndrome: Are the estimates too low?

More than 300 cases of Angelman Syndrome (AS) have been reported. AS is still considered a clinical diagnosis because only approximately 80% of those individuals who meet the clinical criteria will have a maternal deletion of chromosome 15q11-13. Of the reported cases of AS, very few are of adults with AS. We present our findings on 11 adults with AS identified in a long-term residential care facility for persons with severe developmental disabilities. The diagnosis of AS was not recognized at the time of their admission but was established as part of our evaluation. Thus, there may be an underestimate of the true incidence of AS especially in adults with severe developmental disabilities.

Efficacy of total parenteral nutrition in a series of end-stage AIDS patients: a case-control study.

The aims of this study were to document the risks and benefits of total parenteral nutrition (TPN) by comparing two groups of patients with advanced HIV disease. This case-control study took place from June 1992 through June 1994. Medical Records were the primary source of data. Bailey-Boushay House, a 24-h skilled nursing facility in Seattle, Washington was the resident location of participating patients. TPN was commonly used in this long-term care facility for persons with AIDS. Eighty patients with AIDS, 40 of whom were receiving TPN and 40 of whom were not receiving TPN but who had central venous access (control group) were chosen. No significant differences were found between the two groups in the number of positive blood cultures (10% vs. 3%), however, the number of abnormal lab values was higher in the TPN group (6 vs. 4) (p < 0.05). The TPN group also gained an average of 2.2 kg in weight compared to an average loss of 1.4 kg in the control group (p < 0.05); the control group had a higher number of patients with weight loss > 10% of admit weight (28% vs. 8%) (p < 0.05). The length of stay was similar between groups (91 vs. 77 days), as were several quality of life indicators. The conclusions of the investigators was that TPN did not appear to lead to clinically important positive or negative health effects when compared to a group not receiving TPN but with central venous access. Benefits or detriments to certain sub-groups of AIDS patients may well exist that were not apparent in this study.

Impact of a psychotropic medication and physical restraint review process on adults with mental retardation, psychiatric diagnoses, and challenging behaviors

We examined the impact of a medication and physical restraint review process at an intermediate care facility for persons with mental retardation (ICF/MR) in Hawaii. The process was established in 1987 to review, approve, and monitor client programs that utilize medication, physical restraints, and time-out rooms to manage challenging behaviors, with a primary goal of establishing minimum effective use of restraints. Five variables were examined: (a) sample demographics; (b) psychotropic medication; (c) medication side effects; (d) physical restraints/time out; and (e) targeted behaviors. The study sample consisted of all current and former residents of the facility who participated in the review process and for whom an initial report and a follow-up report were available for examination (N=80). Results indicated a decrease in (a) the number of psychotropic medications prescribed, (b) reported medication side effects, and (c) frequency and duration of use of physical restraints/time out. There was an increase in the number of subjects for whom targeted challenging behaviors and behavioral counts were documented. In all behavioral categories except for physically aggressive behaviors, there was a decrease in the maximum number of incidents. In all behavioral categories, there was a decrease in the average number of incidents.

Effects of a three-year exercise therapy program on cognitive functioning of elderly personal care home residents

The purpose of this study was to examine the effects of the Intense Exercise Therapy (IET) on the cognitive levels offunctioning of elderly persons monitored for three years. The study was based on the premise that daily group exercise enhances physiological as well as psychological processes and consequently may improve cognitive abilities for elderly persons. The study hypothesized that the cognitive functioning level of elderly persons participating in the IET would be significantly higher than the level of those persons in the no treatment control group. A previous study by Lindenmuth and Moose' indicated a positive effect of exercise therapy on cognitive functioning for Alzheimer patients. The sample consisted of 82 elderly (64-98 years old) residents of eight separate personal care facilities in Pennsylvania. Residents who volunteered attended by choice either group exercise therapy or a no treatment control group. A pretest, posttest experimental design was utilized in an attempt to control extraneous variables. Pretreatment, during treatment, and posttreatment measures were collected on the Cognitive Abilities Screening Test (CAST). After participating in the IET, elderly persons were found to have significantly higher (2 &lt; .001) cognitivefunctioning levels. Thesefindings lead to the conclusion that effects of the IETincluded an improvement in cognitive levels offunctioningfor the elderly participants in the treatment group. In addition, elderly persons in the control group showed Alzheimer-like symptoms and demonstrated CAST scores indicative of moderate impairment and organic brain disease. The implication is that a strategy such as the IET used by personal care homes and other institutions caring for the elderly would be of benefit in assisting elderly residents to maintain and improve cognitive levels. The IET is especially practical due to ease of use, low cost, and brevity of actual exercise sessions.

Liver cirrhosis deaths within occupations and industries in the California occupational mortality study

Mortality rates were drawn from the California Occupational Mortality Study (COMS) to analyze liver cirrhosis deaths within occupations and industries from 1979 to 1981. Age-adjusted Standardized Mortality Rates (SMRs) were made available by the State of California for separate analyses of women, men, blacks and whites. Rankings of occupations with narrow confidence intervals were strikingly similar for blacks and whites. Within occupations, the highest female SMRs were for waitresses, telephone operators, cosmetologists, dress makers, hospital orderlies, textile workers, and laborers. The lowest female SMRs were for skilled crafts workers and teachers. High male occupations included water transportation workers, bartenders, loggers, laborers, roofers, construction workers, farm workers, iron workers, and painters. Low male occupations included teachers, physicians and dentists, managers, factory supervisors, business sales workers, heavy equipment operators, and other professionals. High female industries included eating and drinking places, laundry/dry cleaning, nursing and personal care facilities, aerospace, beauty shops, and entertainment. Low female industries included wholesale trades and education. High male industries included water transportation, military, guard services, eating and drinking places, iron and steel mills, and railroads. Low male industries included research/engineering labs, education, and computer manufacturing. This study was descriptive. It remains unknown whether certain jobs cause excessive drinking and cirrhosis, or whether people who are prone to develop cirrhosis select certain jobs.

Hazards for health care workers.

America's nearly seven million health care workers (54a) face essentially all of the hazards found throughout our nation's business and industry, and more. These workers confront dangers normally associated with the construction and manufacturing industries, restaurants, research laboratories, boiler rooms, print shops, and even agriculture. Thus, they contend with heavy lifting, asbestos, and ethylene oxide (ETO); cuts, burns, and hepatitis; radia­ tion, exotic chemicals, and infectious organisms; noise and corrosives; sol­ vents; and pesticides. They also face the very special challenges presented by patient care. And they may work in shifts that sometimes rotate. It is not surprising then, that 6. 23 per 100 full-time health care workers had occupa­ tional injuries or illnesses in 1984 with a loss of 57.1 work days per 100 full-time workers. These figures are high, compared to other service occupa­ tions, except, for example, hotel workers (l4b). These data represent all health care workers, including those in ambulatory settings who have a low incidence of accidents. Sixty-five percent of health care personnel work in nursing and personal care facilities and hospitals: 1 1.6 per 100 full-time nursing and personal care facilities workers and 7.3 per 100 full-time hospital workers are hurt or sickened by work per year and lose 121 and 63 work days per 100 full-time workers, respectively. The high incidence

Gender Integration and Unit Deployment: A Study of GI Jo

This study reports on women and men performing operational combat support functions alongside each other in a field-deployed military unit. The research specifically focuses on the gender integration process. Several major issues are addressed: (1) What feelings does one experience in a field environment under simulated combat conditions and are these feelings gender-specific? (2) What about feminine hygiene concerns and availability of personal care facilities for women in the field? (3) Are women capable of surviving and working effectively under these kinds of conditions? (4) How does incorporating women into a unit affect its combat readiness? After surveying the current literature on these issues, the author reports her own findings as a participantobserver in this combat exercise. Major findings include an explanation of the awareness and experience of the salience of gender in this environment (the "gender consciousness" phenomenon) and the "commonality of experience" hypothesis, which suggests that bonding and cohesion are based on commonality of experience, shared risk, and mutual experiences of hardship, not on gender distinctions. Questions and suggestions for future research are also presented.