Home Quality Research Articles

Association Between Discontinuity in Clinicians and Outcomes of Nursing Home Residents

Abstract Little is known about the impact of clinician discontinuity on quality of care for nursing home residents. We examined the association between clinician discontinuity and outcomes of residents with long-term care stays up to three years using claims for a national 20% sample of Medicare fee-for-service beneficiaries from 2014 through 2019. We used an event study analysis that accounted for staggered treatment timing. Estimates were adjusted for resident, clinician, and nursing home characteristics. Three sensitivity analyses were conducted. The first excluded small nursing homes, which were in the lowest quartile based on the number of beds. The second attributed residents to clinician practices rather than individual clinicians. The third removed the three-year long-term care stay restriction. We found that, compared to residents who did not experience a clinician change, those with a clinician change had a 0.7 percentage point higher likelihood of an ambulatory care sensitive hospitalization in a given quarter (a 36.8% relative increase). Clinician discontinuity was not associated with ambulatory care sensitive emergency department visits. Results from our three sensitivity analyses were consistent with those from the primary analysis. Policymakers may consider using continuity in clinicians as a marker of nursing home quality.

A participatory study of indoor environment quality in homes of children and youth in Kanehsatake First Nation

Indoor air quality is an important determinant for the health of children and youth, but the conditions within Indigenous communities are understudied. We collaborated with Kanehsatake First Nation in Quebec, Canada, to address this gap using a community-based participatory research approach. Levels of key indoor air indicators, including particulate matter (PM2.5), CO2, and relative humidity, were measured in 31 randomly selected households between June 2021 and January 2022. Questionnaires were administered remotely to collect information on housing conditions. Excessive humidity was common, with 52% of households having a relative humidity above 55%. The mean PM2.5 concentration was 21.0 (standard deviation 38.5) µg/m3, with higher mean levels observed in smoking compared to non-smoking households (36.1 µg/m3 and 10.1 µg/m3, respectively). The mean CO2 level in participating households was 881 ppm (standard deviation 256), with 30% (n = 9) of homes exceeding 1000 ppm. Flooding rates were high, with 55% of households reporting at least one past flood. One-third of houses were inadequately ventilated relative to occupancy, and over one-quarter reported needing major repairs. The results indicate the value and importance of characterizing the indoor environment in First Nations households and the viability of data collection through community-based participatory research in environmental health research.

Indoor Air Quality System: A Design of Monitoring CO and CO2 Substances for Elderly Home Using IoT

The use of an IoT-based monitoring system for CO and CO2 gases in elderly homes is a necessary innovation for remotely monitoring air quality. This work was successful in establishing a remote monitoring system that can measure CO and CO2 gases utilizing IoT technology combined with Blynk software. The MQ-7 sensors detect CO gas, while the MQ-135 sensors detect CO2. Data from these sensors is delivered to a central server, which then sends it to the I2C 16X2 LCD panel and Blynk software, allowing data visualization via an internet connection. The study's findings indicate that this system can detect and monitor CO and CO2 gas levels with a high degree of precision. This device can also monitor air quality in real time using the Blynk software. As a result, users may accurately monitor air quality (CO and CO2 gases) in elderly homes.

Understanding Older Persons' Experiences of Care Encounters in the Home Environment: A Hermeneutic Study.

To explore and gain a deeper understanding of older persons' experiences of care encounters when their home becomes a workplace. Worldwide healthcare services are increasingly being provided in older persons' homes by registered nurses. This presents new challenges as the home environment of older persons now doubles as a workplace for healthcare professionals. However, there is limited research available on how older persons experience care encounters when their homes serve as workplaces and how this influences their overall well-being and quality of life. A qualitative hermeneutic study. In-depth face-to-face interviews were conducted in Sweden from October 2023 to January 2024 with 10 purposefully selected older persons (aged 65+). Each participant received regular visits from a home care nurse in their home to address specific care needs, such as wound care, medication administration, blood sampling and general supervision. The interviews were audiotaped, transcribed verbatim and analysed using a hermeneutic interpretation. The hermeneutic analysis emerged with one main theme: 'Experiencing care encounters at home as a lottery', with two underlying themes: 'Adapting to loss of control in the private sphere' and 'Striving for independence while navigating daily living'. Older persons try to control their lives despite the challenges associated with ageing and receiving care at home. They strive to maintain their independence and autonomy, which reflects their desire for self-determination. Supporting these efforts in an interdependent relationship can enhance their well-being and quality of life. Findings were reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. Data were collected by patient interviews. This study emphasises the importance of supporting older persons in maintaining control over their lives while being cared for in their homes. In the care encounters with home care nurses, their well-being and quality of life can be improved by respecting their autonomy, involving them in decision-making and offering tailored support.

Emission rates of particle-bound heavy metals and polycyclic aromatic hydrocarbons in PM fractions from indoor combustion sources

Indoor combustion sources significantly affect the air quality in homes, emitting both airborne particles and related particle-bound chemical compounds, such as heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs). The emission of particle-bound HMs and PAHs from indoor sources has been poorly investigated by the scientific community.This paper aims to fill this knowledge gap by providing emission rates of particle-bound HMs and PAHs in various PM fractions (PM1, PM1-10, and PM10) from typical indoor combustion sources: incense, candle, and mosquito coil combustions and cooking activities.To this end, two experimental analyses were carried out to obtain (i) the emission rates of PM fractions and (ii) the mass fraction of each particle-bound HM and PAH in the PM fractions.Results of the study revealed high PM fraction emission rates, with a significant contribution of PM1 fraction, and high HM and PAH mass fractions with a main contribution of the sub-micrometric range (from 61 % to 100 % for Group 1 carcinogenic compounds). The emission rates of HMs and PAHs were determined based on these measurements, with Group 1 carcinogenic compound emission rates in PM10 ranging from about 3 to >100 ng min−1.Using the emission rate data, indoor concentrations and the corresponding non-carcinogenic and carcinogenic lifetime risks for a typical daily exposure scenario were estimated. The expected concentrations from the use of the investigated sources were higher than those typically measured in homes, and significant carcinogenic risks were associated with the use of sources emitting Group 1 carcinogenic HMs.

Enhancing nursing home quality through electronic health record implementation.

Background: The quality of care in nursing homes (NHs) in the United States has long been a matter of policy concern. Although electronic health records (EHRs) are argued to improve quality, implementation has lagged due to various factors such as financial constraints and limited research on their impact on NH quality. Objective: This study examined the relationship between EHR implementation and NH quality using Donabedian's structure-process-outcome model. Method: Data on EHR implementation were collected via a 2018 survey of all Federally certified Arkansas NHs (n = 223). Of the 63 responding NHs, 48 reported EHR implementation. Survey data were merged with secondary sources such as Certification and Survey Provider Enhanced Reporting. A total of 744 NH-years for the period 2008-2020 were included in the final sample. A pre-post negative binomial panel data regression was used to examine the relationship between EHR implementation (dichotomous variable) and NH deficiencies (dependent count variable) with facility/community-level control variables. Results were reported as incidence rate ratios (IRR). Results: NHs that had implemented EHR experienced an 18% reduction in the rate of deficiencies compared to those without EHR systems (IRR = 0.82, 95% CI [0.70, 0.99], p = 0.035). Conclusion: EHR implementation had a favourable impact on NH quality. Implications: Past research suggests that higher NH quality may be associated with improved financial performance. Therefore, EHR implementation has the potential to address two critical challenges: enhancing care quality and improving financial outcomes. However, government financial incentives may be necessary to address the high-cost of implementing EHR systems.

"I feel like a caged pig in here": Language, Race, and Ethnic Identity in a Case Study Hmong Nursing Home Resident Quality of Life.

Racial disparities in nursing home (NH) quality of life (QOL) are well established, yet, little is understood about actual experiences shaping QOL for Black, indigenous, and people of color (BIPOC) residents in NHs. This gap extends to BIPOC residents with limited English proficiency (LEP). Drawing on Kane's (2001) and Zubristky's (2013) QOL frameworks, this case study examined QOL experiences for Hmong NH residents, an ethnic and refugee group from Southeast Asia, in a NH with a high proportion of BIPOC residents. Methods include four months of observation, interviews with eight Hmong residents and five NH staff, and one community focus group. Thematic analysis revealed significant challenges in QOL. Exacerbated by language barriers and racism, many residents reported neglect, limited relationships, lack of meaningful activities, and dissatisfaction with food. These experiences fostered a sense of resignation and diminished QOL among Hmong residents, highlighting the need for additional supports for this group.

Does outsourcing enable the survival of good care homes? A longitudinal analysis of all care homes in England, 2011–2023

BackgroundIt is unclear whether outsourcing has enabled the growth and survival of the best care homes, as intended. We aimed to test whether ownership (for-profit, public and third sector (non-profit))...

Nursing Home Compare star ratings before versus after a change in nursing home ownership.

Efforts to increase transparency and accountability of nursing homes, and thus improve quality, now include information about changes in nursing home ownership. However, little is known about how change in ownership affects nursing home quality. We conducted a retrospective cohort study of 15,471 U.S. nursing homes between January 2016 and December 2022, identifying all changes in ownership during that period. We used logistic regression to measure the association between nursing home characteristics and the odds of a change in ownership. A difference-in-differences model with multiple time periods was used to examine the impact of a change in ownership on the Medicare Nursing Home Compare 5-star ratings. One in five (23%) facilities changed ownership between 2016 and 2022. Nursing homes that were urban, for-profit, part of a chain, located in the South, had >50 beds, lower occupancy, higher percentage of stays covered by Medicaid, higher percentage of residents with non-white race, or a 1-star (poor) rating were more likely to undergo a change in ownership. There was a small statistically significant decrease in 5-star ratings after a change in ownership (-0.09 points on a 5-point scale; 95% CI -0.13 to -0.04; p < 0.001), driven primarily by a decrease in staffing ratings (-0.19 points; 95% CI -0.24 to -0.14; p < 0.001), and health inspections ratings (-0.07 points; 95% CI -0.11 to -0.03; p = 0.001). This was mitigated by an increase in quality measure ratings (0.15 points; 95% CI 0.10-0.20; p < 0.001). Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.

Efficacy of phytoremediation in improving indoor air quality in homes in Alexandria, Egypt

Efficacy of phytoremediation in improving indoor air quality in homes in Alexandria, Egypt

Nursing Home Star Ratings and End-Of-Life Care Quality: Lessons Learned From the Veterans Health Administration

ObjectivesMore than 25% of deaths among older adults occur in nursing homes. Thus, assessments of nursing home quality, including the widely used 5-star rating systems, should reflect quality of end-of-life (EOL) care. Our objective was to examine the associations between Veterans Affairs (VA) nursing home star ratings and quality of EOL care as measured by the VA's Bereaved Family Survey (BFS). DesignNational, retrospective observational study. Setting and ParticipantsVA nursing homes, known as Community Living Centers (CLCs). All veterans who died in a CLC from October 2018 to September 2019 whose next of kin completed a BFS. MethodsUsing linked VA data sources, we examined the BFS-Performance Measure (BFS-PM) (ie, the % of BFS respondents who provided an “excellent” overall rating) by the Overall Star Rating and domain star ratings (unannounced survey, staffing, and quality) for the 133 CLCs in our sample. Logistic and linear regression was used to examine the associations between CLC Overall Star Rating and individual-level BFS outcomes. Outcomes included the BFS-PM (primary), the 3 BFS factor scores of Respectful Care and Communication, Emotional and Spiritual Support, and Death Benefits, and 2 symptom management items. ResultsDifferences in the BFS-PM by CLC star rating were small to none and not statistically significant across all star rating domains. The relationship between a higher CLC Overall Star Rating and odds of an “excellent” BFS global rating was not statistically significant. Similarly, no significant associations were observed between a higher CLC Overall Star Rating and scores on the BFS factor scores and symptom management items. Conclusions and ImplicationsOur findings suggest that the current CLC star rating system is not sufficient to assess the quality of EOL care. BFS scores, or a comparative EOL quality of care measure, should be integrated into CLC quality rating systems.

Tahapan Pelaksanaan Program Bantuan Stimulan Perumahan Swadaya (BSPS) Sumatera Utara

Poverty in Indonesia has resulted in many people who still have not achieved their welfare, one of which is in the fulfillment of habitable houses. In order to achieve community welfare through the fulfillment of habitable houses, the government through the Ministry of Public Works and Public Housing held a Self-Help Housing stimulant Assistance program for low-income communities, so as to improve the quality of people's homes to be habitable. To receive this program, there are several stages of implementation that need to be done, ranging from identification of potential beneficiaries to monitoring and evaluation reports. In the approach to the community of prospective beneficiaries, the method of community organization and community development is carried out by empowering the community with a direct approach as an approach to social work techniques that can be done to address the community or group of beneficiaries of macro programs. Several stages of intervention are Assessment, program Planning, Intervention, evaluation and termination stages. The focus of solving the problem is to empower the recipient group to be able to be empowered and independent in following the implementation of the BSPS program from the beginning to the end of the program. The purpose of this empowerment is also considered successful with the increasing enthusiasm of the recipient group community in completing the accountability for the implementation of the BSPS program and following the various stages of coordination and socialization of the BSPS program.

Leadership Matters: Investigating the Association Between Nursing Home Administrator Turnover and Quality.

Existing research has associated nursing home (NH) staff turnover with poor performance, yet the impact of nursing home administrator (NHA) turnover remains relatively understudied. This study aimed to explore the relationship between NHA turnover and NH quality, and to determine if this relationship was mediated by registered nurse (RN) turnover. Utilizing data from multiple secondary sources, including the Care Compare: Skilled Nursing Facility Quality Reporting Program (SNF QRP) and LTCFocus.org, this study employed a longitudinal analysis covering the period 2021-2022 (n = 19,645). The dependent variable was quality star ratings from SNF QRP, whereas the independent variable was NHA turnover, reflecting the number of administrators who left each facility annually. We used Baron and Kenny's mediation testing method, incorporating 2-way fixed effects (state and year level) with appropriate organizational and market level control variables. The results affirmed that NHA turnover negatively affected quality, decreasing the likelihood of a higher star rating by 14% with one departure and 25% with multiple departures (p = .001). Additionally, NHA turnover correlated with an increase in RN turnover by 7% and 11%, respectively, for one and multiple departures (p = .001). RN turnover fully mediated the impact of NHA turnover on quality, nullifying the direct effect of NHA turnover. The results of this study highlight the synergistic relationship between administrators and caregivers in NHs. To enhance NHA retention, NHs should improve compensation and benefits. Nonetheless, broader governmental support and interventions might be necessary to sustain these improvements.

Efficacy of Parent Training Programme in Enhancing Quality of Home and Community Living of Individuals with Intellectual Disability in Haryana (India)

Intellectual Disabled (ID) person has a right to live and received recognition and importance. There is a strong need to strengthen the social, emotional, physical and personal support systems among the families of these ID people and the society at large. The purpose of the study was to assess the effectiveness of parents training program in quality of life of children with ID on its dimension Quality of Home &amp; Community Living. Binet-Kamat Test of Intelligence and Quality of Life Scale for Persons with Disabilities was applied. Analysis of covariance (ANCOVA) was applied on the pre test scores and post test scores obtained by the participants in the experimental and control group before and after the Parent Training Programme. Parent training programme of individual with intellectual disability is effective and important interventional approach for enhancing better quality of life of parents as well as person with ID.

Home- and community-based care in the new generation of Medicaid administrative data

AbstractThis study aimed to assess the quality of Home and Community-Based Services (HCBS) data elements within the Transformed Medicaid Statistical Information System Analytical File (TAF) and to devise strategies for improving its research usability. Analyzing Medicaid TAF data from 2016 to 2018, we conducted a retrospective data quality analysis, focusing specifically on HCBS-related data elements. Through secondary data analysis, we identified significant challenges, including considerable missingness and inconsistencies that hamper the effective use of TAF for research purposes. Despite these issues, we developed three approaches that enabled us to identify 94% of known 1915(c) waiver claims as HCBS. Our study also revealed considerable cross-state variations in data quality, prompting specific recommendations for utilizing HCBS data within TAF. Ultimately, the study concludes that while challenges exist, applying our recommended strategies can yield data of acceptable quality for most states, particularly in identifying HCBS usage and classifying them into service categories. Given the growing importance of home-based care, there is a pressing need to prioritize improvements in TAF’s HCBS data quality to better inform policy and practice.

Workforce thresholds and the non-linear association between registered nurse staffing and care quality in long-term residential care: A retrospective longitudinal study of English care homes with nursing

BackgroundCare needs amongst 425,000 dependent older residents in English care homes are becoming more complex. The quality of care in these homes is influenced by staffing levels, especially the presence of registered nurses (RNs). Existing research on this topic, often US-focused and relying on linear assumptions, has limitations. This study aims to investigate the non-linear relationship between RN staffing and care quality in English care homes using machine learning and administrative data from two major care home providers. MethodsA retrospective observational study was conducted using data from two English care home providers. Each was analysed separately due to variations in data reporting and care processes. Various care quality indicators and staffing metrics were collected for a 3.5-year period. Regression analysis and machine learning (random forest) were employed to identify non-linear relationships. Ethical approval was obtained for the study. ResultsUsing linear methods, higher skill mix – more care provided by RNs – was associated with lower incidence of adverse outcomes, such as urinary tract infections and hospitalisations. However, non-linear skill mix–outcome relationship modelling revealed both low and high skill mix levels were linked to higher risks. The effects of agency RN usage varied between providers, increasing risks in one but not the other. DiscussionThe study highlights the cost implications of increasing RN staffing establishments to improve care quality, suggesting a non-linear relationship and an optimal staffing threshold of around one-quarter of care provided by nurses. Alternative roles, such as care practitioners, merit exploration for meeting care demands whilst maintaining quality. This research underscores the need for a workforce plan for social care in England. It advocates for the incorporation of machine learning models alongside traditional regression-based methods. Our results may have limited generalisability to smaller providers and experimental research to redesign care processes effectively may be needed. ConclusionRNs are crucial for quality in care homes. Contrary to the assumption that higher nurse staffing necessarily leads to better care quality, this study reveals a nuanced, non-linear relationship between RN staffing and care quality in English care homes. It suggests that identifying an optimal staffing threshold, beyond which increasing nursing inputs may not significantly enhance care quality may necessitate reconsidering care system design and (human) resource allocation. Further experimental research is required to elucidate resource-specific thresholds and further strengthen evidence for care home staffing. Tweetable abstractHow much nursing care is needed to assure quality in care homes? Evidence from 2 English care home providers shows that nurse sensitive outcomes (an indicator of quality) are better when ~25 % of care is provided by nurses. Nurse shortages increase risks for residents.

Quality in care homes: How wearable devices and social network analysis might help.

Social network analysis can support quality improvement in care homes but traditional approaches to social network analysis are not always feasible in care homes. Recalling contacts and movements in a home is difficult for residents and staff and documentary and other sources of individual contacts can be unreliable. Bluetooth enabled wearable devices are a potential means of generating reliable, trustworthy, social network data in care home communities. In this paper, we explore the empirical, theoretical and real-world potential and difficulties in using Bluetooth enabled wearables with residents and staff in care homes for quality improvement. We demonstrate, for the first time, that a relatively simple system built around the Internet of Things, Bluetooth enabled wearables for residents and staff and passive location devices (the CONTACT intervention) can capture social networks and data in homes, enabling social network analysis, measures, statistics and visualisations. Unexpected variations in social network measures and patterns are surfaced, alongside "uncomfortable" information concerning staff time spent with residents. We show how technology might also help identify those most in need of social contact in a home. The possibilities of technology-enabled social network analysis must be balanced against the implementation-related challenges associated with introducing innovations in complex social systems such as care homes. Behavioural challenges notwithstanding, we argue that armed with social network information, care home staff could better tailor, plan and evaluate the effects of quality improvement with the sub-communities that make up a care home community.

Disparate home range dynamics reflect nutritional inadequacies on summer range for a large herbivore

AbstractThe spatial distribution of animals has consequences for nutrition, predator–prey dynamics, spread of diseases, and population dynamics in general. Animals must establish a home range to secure adequate resources to fuel their energy needs. Home ranges, therefore, are temporally and spatially dynamic, given the changing requirements of an animal and the availability of resources on the landscape. We used data from two populations of bighorn sheep with contrasting population dynamics following pneumonia epizootics and different habitat quality on their summer range to test the hypothesis that the distribution and size of home ranges are influenced by environmental conditions and reproductive status. We used a combination of data from 768 vegetation transects and remotely sensed metrics to index forage quality of consecutive biweekly home ranges for 27 bighorn sheep, June–August 2019–2021. There were population differences in home range dynamics that were consistent with resource limitations in the population declining in abundance. Animals in both populations increased the size of their home range through the summer in association with declining forage quality indexed by plant phenology. Furthermore, animals in the Whiskey Mountain population without offspring had home ranges more than twice the size of animals with offspring, whereas there were no differences in the home range size between animals with and without offspring in Jackson. We demonstrated that limitations young offspring impose on space use of a mother may have consequences for animals living where larger home ranges are needed to secure adequate resources—sheep on Whiskey Mountain had to travel 1000 m from escape terrain to access the same amount of biomass that the Jackson sheep could access directly adjacent to escape terrain. Forage quality and availability influence movement and space use. In the presence of disease, movement and space use may influence pathogen transmission and persistence. Thus, forage availability may play an indirect role in population dynamics in the presence of disease, which is another line of evidence for how environmental and nutritional conditions may influence population dynamics when coping with disease.

Associations Between Veterans Health Administration Nursing Home Star Ratings and Quality End of Life Care (RP301)

Associations Between Veterans Health Administration Nursing Home Star Ratings and Quality End of Life Care (RP301)

Estimating Nursing Home Quality with Selection

Abstract We use variational inference (VI), a technique from the machine learning literature, to estimate a mortality-based Bayesian model of nursing home quality accounting for selection. We demonstrate how one can use VI to quickly and flexibly estimate a high-dimensional economic model with large datasets. Using our facility quality estimates, we examine the correlates of quality and find that public report cards have near-zero correlation. We then show that in contrast to prior literature, higher quality nursing homes fared better during the pandemic: a one standard deviation increase in quality corresponds to 2.5% fewer Covid-19 cases.