Residents In Need Research Articles

The Role of Women’s Farmer Groups as An Alternative Solution to Food Insecurity during The Covid -19 Pandemic

Research on the Az Zahra Women's Farmer Group in the Buaran South Tangerang area which was carried out from March 2021 to August 2021 with the title The Role of Women's Farmer Groups as Alternative Solutions to Food Insecurity during the Covid-19 Pandemic in Buaran, Serpong, South Tangerang. The data taken are primary and secondary data, primary data is taken from observations and interviews with officials, supervisors and members of the women's farmer group. The results of environmental observations and interviews conducted can be seen that the group has succeeded in achieving group managerial effectiveness. The results of the observations are seen from the data at the time of the initial formation (in 2018) and the data at the time the research was conducted (in 2021). The initial data for the formation of the Women Farmers Group are: The area of cultivated land is 300m2, with 29 members, 2 types of plants that can be harvested, the value of the harvest is Rp. 1,740,000. a year. While the results of operations in 2021, the number of plants will be 25 types of plants, the area of land being cultivated will be 10,000 m2 and the welfare level of members will be Rp. 12,500,000 a year. In terms of organizational management, this group has proven that it has carried out managerial effectiveness in order to achieve the group's goals as indicated by the increasing area of land planted, growing crop yields and increasing welfare of members although they do not have the land. This group that has performed its management functions well, such as planning, organizing, directing and controlling. The role of the Women Farmers group in preventing food insecurity is very effective, because the harvest obtained can prevent food insecurity in the family as well as the surrounding community by providing food in the form of vegetables and health plants, as well as by making donations to local residents in need.

501. Implementation and Outcomes of a Program to Coordinate and Administer Monoclonal Antibody Therapy to Long-Term Care Facility Residents with COVID-19

BackgroundLong-term care facility (LTCF) residents are at increased risk of severe COVID-19, with CMS data indicating > 20% mortality. BLAZE-1 trial noted lower hospitalization rates in high-risk patients receiving monoclonal antibody (mAb) vs placebo (4.2% vs 14.6%) for mild to moderate infections, making it a treatment option for LTCF residents; however, many LTCF lack staff to prepare and administer mAb therapy. To address this need, Region VII Disaster Health Response Ecosystem (R7DHRE) coordinated via NE Medical Emergency Operations Center (NEMEOC) an ASPR pilot project to facilitate infusion of COVID-19 mAb therapeutics for LTCF residents in the state.MethodsR7DHRE partnered with Great Plains Health, Nebraska DHHS, Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) and Infection Control Assessment and Promotion Program (ICAP) to surveil cases in the state, establish distribution/administration pathways, and educate providers on mAb therapeutics. A multi-hub-and-spoke model was created to allow LTCF to work with regional hospitals or pharmacy services to administer drug in their facilities, reducing time to therapy and transmission risk associated with patient transport. A centralized request process was created using a REDCap platform and verification of patient eligibility by ASAP. This request link, informational documents, fact sheets, and custom-built order form templates were hosted on a dedicated ASAP webpage, and details were shared during weekly ICAP LTCF webinars. Outcomes data, including 14- and 28-day COVID-related hospitalizations and mortality, were collected using databases from Nebraska Health Information Initiative and Nebraska DHHS.ResultsThrough this program, 513 doses were administered to LTCF residents. Average time from symptom onset to infusion was 2.6 days. COVID- related hospitalization and mortality rates were lower than previously reported for LTCF residents (Table 1). Table 1. Debographics and Outcomes of mAb Infusions ConclusionBy utilizing existing relationships with LTCFs in the region, we established a program to promptly distribute, prepare, and administer monoclonal antibody therapy to LTCF residents in need, preventing COVID-related hospitalizations and deaths.Disclosures James Lawler, MD, MPH, FIDSA, Kinsa Health (Advisor or Review Panel member)Takeda Pharmaceuticals (Advisor or Review Panel member) M. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract)

Mental health crisis and spatial accessibility to mental health services in the city of Toronto: A geographic study

Abstract: Mental illness includes a wide range of disorders that affect mood, thinking, behaviour and overall wellbeing. One in five Canadians has mental health care needs, many of which are unmet. Within the City of Toronto, the provision of specialized mental health care is delivered by over 100 public and private community service organisations and over 700 physicians with a psychiatric specialization - each providing community-based general or specialised care to residents in need. Research has shown that travel distance is an enabling factor of health service utilisation, thus equitable spatial access to services remains a key priority. Using spatial quantitative methods, this study examines potential spatial accessibility to both general and specialized mental health services within the City of Toronto, and levels of statistical association between access to care and prevalence of mental health crisis events. The main datasets analyzed including geo-referenced Census data and occurrence data on mental health crisis (represented by apprehensions under the Mental Health Act undertaken by the Toronto Police Service). The enhanced two-step floating catchment area (E2SFCA) method is used to model spatial accessibility to mental health services based four modes of transportation: driving, walking, cycling and public transit. Areas that are underserved by mental health specialists and mental health community services are identified and shown to have different socioeconomic characteristics. The study reveals spatially explicit patterns of access to various mental health services in Toronto, providing detailed data to inform the planning of and policy on mental health care delivery concerning severe mental health crisis.

Housing Vienna: The Socio-Spatial Effects of Inclusionary and Exclusionary Mechanisms of Housing Provision

The provision of housing plays a decisive role in segregation processes. In a European context increasingly influenced by variegated neo-liberal housing policies, Vienna’s approach is characterised by generous access to social housing. This inclusive strategy aims at actively preventing segregation and the isolation of certain groups. Over the last 30 years, however, reconfigured multi-level arrangements and wider contextual changes have transformed Vienna’s housing governance. This article explores how. In particular, it aims at disentangling the relationship between housing policy reforms at multiple policy levels and the changes of the mechanisms shaping the access to tenure segments and residential segregation in Vienna. Through the use of process tracing, we identify critical junctures of housing governance and relate them to housing segmentation and segregation measures over a period of approximately 30 years. Our findings show that reforms on multiple levels produce an increasingly deregulated private rental market and an increasingly fragmented access to a diversified provision of social housing. From a spatial point of view, persistent patterns of segregation blend with new ones, leading to decreasing segregation characterised by a more even spatial distribution of low and high-status groups. At the same time, both groups show very low, but slightly increased levels of isolation. Tenant profiles in social housing are, however, generally still very mixed. Balancing the trade-off between a social mix and social targeting without excluding residents in need will remain the main challenge for Vienna’s social housing model.

Further Inspection: Integrating Social Services and Housing Code Enforcement to Improve Community Health

Background: As a result of working inside homes, city housing inspectors witness hidden and serious threats to individual and community health. However, they lack systems and means to respond to the range of problems they encounter. Objective: The objective of this study is to describe the impact and enabling environment for integrating a novel Social Service Referral Program within the Inspectional Services Department in Chelsea, Massachusetts, USA. Through this program, when inspectors identify a threat that cannot be resolved through code enforcement alone, they contact a local social service agency that provides support to residents in need. Methods: To evaluate the first eight months of the program (July 2019-February 2020), we used a mixed-methods approach combining quantitative data from 15 referrals and qualitative interviews with six key informants (inspectors, a case manager, and city leadership). Results: The most common services provided were for fuel, food, and rent assistance; healthcare; hoarding; and homelessness prevention. Referred residents received three types of services on average. Half of referred residents were not receiving other social services. Inspectors reported increased work efficiency and reduced psychological burden as a result of the program. Interviewees described how quality of life improved not only for referred residents but also for others throughout the surrounding neighborhood. Two primary enabling conditions of the program were identified: 1) A simple referral process that made inspectors’ jobs easier, and 2) a trusted, well-connected service provider funded to carry out the work. Conclusion: Housing inspectors’ encounters with residents present a unique opportunity to reach otherwise hidden populations and expand the public health impact of code enforcement. The study demonstrates how existing encounters and networks can be leveraged to connect at-risk populations with community resources and improve population health.

C-L Psychiatrists Launch Innovative Model of Mental Health Care for Residents

C-L Psychiatrists Launch Innovative Model of Mental Health Care for Residents

Investigation on social security of pneumoconiosis patients in Chongqing

Objective: To investigate the living conditions, insurance coverage, and assistance of pneumoconiosis patients diagnosed in Chongqing from May 2006 to May 2018. Methods: A cross-sectional survey was conducted in July 2018, and 40 890 pneumoconiosis patients from occupational diseases report management agency were obtained. 34 625 cases meeting the inclusion criteria were investigated, and descriptive statistical analysis was performed on the data. Results: There were 34 625 cases of pneumoconiosis patients alive in Chongqing, and 22730 (65.6%) had participated in work-related injury insurance, 6 308 (18.2%) had participated in basic medical insurance for urban employees which were still effective. 27 056 (78.1%) had participated in cooperative insurance for urban and rural residents which were still effective. 4 393 (12.7%) received assistance for the residents in need in urban and rural areas. 5827 (16.8%) benefited the policy of "Xiangyu Railway". There were 7 961 cases (2.4%) whose work-related injury insurance had expired did not get one-off compensation, and did not receive any assistance. Conclusion: Most of the patients with pneumoconiosis in Chongqing obtained protection in terms of work-related injury insurance, medical insurance, civil assistance and poverty alleviation to a certain extent, but the strength of the guarantee is not enough. Patients with pneumoconiosis might suffer from poverty caused by illness. It is recommended to improve the system of work-related injury insurance benefits, establish special funds for pneumoconiosis patients, strengthen health education and health promotion for pneumoconiosis patients, and strengthen the management of pneumoconiosis patients.

Pengaruh Informasi Managemen Dalam Pengelolaan Dana dan Pemberdayaan Masyarakat Gampong

The purpose of this study was to describe the management of Gampong Fund Management Information in empowering the gampong community and to find out some of the possible and hindering influences in managing gampong funds. This study used descriptive qualitative method. This activity was carried out in Ulee Pata Village, Jaya Baru Subdistrict, Banda Aceh Regency, by conducting interviews and observations to obtain the necessary data and collect information relating to the management of gampong fund management information that had been interpreted. The results of this study indicate that the gampong fund management process carried out by the gampong government has not been completely transparent, the gampong community has not actively participated, and village government officials are more dominant in planning activities and the implementation of gampong funds from 3 hamlets has not been active and still struggling on infrastructure development. The management of village funds has not been aligned towards community empowerment in the context of giving birth to economic income sources, but is still very large for infrastructure development. Empowerment activities are prioritized for physical empowerment such as road construction, rental housing, opening new roads and multi-purpose buildings, while empowering non-physical is associated with minimal training for residents in need. The results of the study indicate that the supporting factors of village fund management in empowering the village community in Ulee Pata Village are support for policy / regulation, socialization, facilities, and infrastructure. The inhibiting factor is a lack of human resources and a lack of community participation in the village.

An Interview With Psychiatry Residency Program Director Toni L. Johnson, M.D.

An Interview With Psychiatry Residency Program Director Toni L. Johnson, M.D.

The Quadruple Aim: Improving Working Conditions for Health Care Providers

The Quadruple Aim: Improving Working Conditions for Health Care Providers

In This Issue: Food Systems Resilience

In This Issue: Food Systems Resilience

Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model

BackgroundNursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. ObjectivesThis study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. DesignMinimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload percentile based on resident ADL care needs and compare the simulated staffing projections to the NH reported staffing levels. MeasuresThe percentage of scheduled care time that was omitted was estimated by the simulation model for each of the 65 workload scenarios using optimistic assumptions about staff productivity and efficiency. ResultsThere was a low correlation between ADL workload and reported nurse aide staffing (Pearson = .11; P < .01), which suggests that most of the 13,500 NHs were not using ADL acuity to determine nurse aide staffing levels. Based on the DES model, the nurse aide staffing required for ADL care that would result in a rate of care omissions below 10% ranged from 2.8 hours/resident/day for NHs with a low workload (5th percentile) to 3.6 hours/resident/day for NHs with a high workload (95th percentile). In contrast, NHs reported staffing levels that ranged from an average of 2.3 to 2.5 hours/resident/day across all 5 workload percentiles. Higher workload NHs had the largest discrepancies between reported and predicted nurse aide staffing levels. ConclusionsThe average nurse aide staffing levels reported by NHs falls below the level of staffing predicted as necessary to provide consistent ADL care to all residents in need. DES methodology can be used to determine nurse aide staffing requirements to provide ADL care and simulate management interventions to improve care efficiency and quality.

Are there more positive alternative celebration opportunities to Schoolies Week?

Schoolies week is purported to have started in 1979 on the Gold Coast by graduates of private single-sex schools.* During the early 1980s the Gold Coast attracted schoolies from all over Australia, with this phenomena spreading to many popular tourist spots around the country, and more recently to overseas destinations, especially Bali. Over the years schoolies week has become synonymous with beaches, sun, alcohol, drugs and sex – and also community concern, thanks to the high media presence it attracts.

Continence care for older adults in care homes

Assessment and accurate documentation is paramount to the deilvery of effective and effi cient holistic continence care to all residents in need. Sue Foxley discusses.

Observational Tools Counter Weight Loss

NEW YORK — A nursing facility resident's medical record says she eats 75% of her meals with 5 minutes or more of feeding assistance 100% of the time, but she still loses weight unintentionally. How can that be? According to Sandra Simmons, Ph.D., who spoke at the New York Medical Directors Association recent education meeting, “medical record documentation overestimates care quality, feeding assistance,” supplements offered, and the oral intake of meals. Dr. Simmons, associate professor of medicine at the Vanderbilt University School of Medicine division of general internal medicine and public health, noted residents' unintentional weight loss has adverse clinical outcomes such as increase in pressure ulcers, hospitalizations, and mortality rates, and offered key care process measures of food and fluid consumption: ▸ Accuracy of medical record documentation (a resident who eats less than 50% of meals requires assistance); ▸ Adequacy of feeding assistance (spend at least 15–20 minutes assisting residents at risk of weight loss); ▸ Quality of assistance (give residents physical assistance in addition to verbal cueing and social stimulation). To improve facility feeding programs, Dr. Simmons conducted direct observational studies at 40 California facilities. Comparing resident charts and researcher observations of food consumption, she found that residents received assistance 40% of the time, versus the 100% charted. She also found residents were offered supplements once daily, rather than three times daily as listed in their charts. They also ate 20% less than documented. Additionally, observation indicated each resident received less than 10 minutes of feeding assistance, and little or no verbal cueing or social interaction. During snack time, foods and fluids were offered less than once a day and supplements ordered by physicians were rarely given. In another study, Dr. Simmons introduced feeding assistance programs for 134 residents with low oral intake. Such assistance required 35 minutes per resident per meal to significantly increase meal intake. Staff spent 13 minutes per resident, offering snacks between meals, versus less than 1 minute for the average nursing facility. “While it may be impractical in the typical nursing home to spend as much time with residents as feeding assistants did during the program, grouping three to four residents during meals” or grouping eight during snacks has the same effect, Dr. Simmons said. Results were striking: 90% of residents improved their food/fluid intake. To determine optimal staffing for such programs, Dr. Simmons used expert consensus panels, computerized simulations, and a validation study. The findings show: ▸ Staffing levels are consistently a significant predictor of quality; ▸ 5–7:1 ratio support for nurse aides; ▸ 5:1 ratio is necessary to consistently provide care to residents in need; ▸ Eighty percent of physically dependent residents got 5 minutes or more of feeding assistance per meal, versus 55% with traditional care; ▸ Staffing below the 5–7:1 level may require targeting residents who are most in need and/or using non-nursing staff for some daily mealtime tasks. Direct observational studies are critical to Continuous Quality Improvement (CQI) and to CMS' sponsorship of studies evaluating such programs. CMS funding of pilot studies of paid feeding assistants to cost-effectively augment nursing staff's efforts have shown that results with feeding assistants were at least comparable to results with nursing assistants. Dr. Simmons also presented results of a 4-month CQI pilot study in one skilled nursing facility targeting high-risk residents who ate less than 50% of most meals and had a history of weight loss. Results were dramatic (see graphic). According to Dr. Simmons, plans for improving care should be based on realistic assumptions about reimbursement and staff shortages. A pillar of change is “Train the Trainer” programs, in which supervisory-level RNs and dieticians train feeding assistants and explore other staffing models.

Residents’ care preferences as targeting criteria: Measurement issues functional incidental training: Applicability and feasibility in the Veterans Affairs nursing home patient population

In this issue of JAMDA, Ouslander and colleagues describe the applicability and feasibility of an intervention designed to improve incontinence and prevent physical functioning decline in Veterans Affairs (VA) nursing home residents. The behavioral intervention (FIT) has proven efficacious with community nursing home residents, and the results of this study suggest that the intervention is also efficacious with VA nursing home residents. Unfortunately, the VA study also found that implementing the FIT intervention would require additional staff. Furthermore, the FIT study conducted with community nursing home residents showed that the staffing costs of the intervention could not be offset by cost savings in other areas, such as the prevention of acute illnesses that might be related to incontinence and immobility. So, now we have an efficacious behavioral intervention that improves resident outcomes in both community and VA nursing home settings but that is staff time intensive and, thus, potentially not feasible to provide in daily care practice for all residents in need. Given the limited staffing resources that exist in many community and VA nursing homes, one possible solution is to target a time-intensive intervention such as FIT based on a combination of resident need (who is most likely to benefit?) and preferences (who really wants it?). Both of these objectives can be determined best by offering a trial of FIT and monitoring the resident’s response (compliance, appropriate toileting frequency) and reported preferences. The alternative approach of assessing residents’ preferences before a trial, during which they experience the intervention, could be misleading. Sixty-four percent of the VA participants reported that four offers of toileting assistance per day

Use of formal and informal sources of mental health care among older African-American public-housing residents.

Elderly residents of public housing have high rates of psychiatric disorders, but most of those in need of care do not use any mental health service. This study examines the use of formal and alternative informal sources of mental health care in a sample of elderly African-American public-housing residents. Data from an epidemiological survey of six Baltimore public-housing developments for the elderly (weighted N = 818) were analysed to examine the utilization of mental health services by older African-American residents. Logistic regression analyses were used to determine correlates of using formal and informal sources by those needing mental health care. Thirty-five per cent of subjects needed mental health care. Less than half (47%) of those in need received any mental health care in the previous 6 months. Residents in need were more likely to use formal (38.5%) than informal sources (18.6%) for care. The strongest correlates of using formal providers were substance use disorder (OR = 15.62), Medicare insurance (OR = 10.31) and psychological distress (OR = 10.27). The strongest correlates of using informal sources were perceiving little or no support from religious/spiritual beliefs (OR = 21.65), cognitive disorder (OR = 19.71) and having a confidant (OR = 15.07). Contrary to elderly African-Americans in general, those in public housing rely more on formal than informal sources for mental health problems. Nevertheless, both sources fail to fill the gap between need and met need. Interventions to increase identification, referral and treatment of elderly public-housing residents in need should target general medical providers and clergy and include assertive outreach by mental health specialists.

Because no one should go to bed hungry: How to create your own hunger awareness day

On a crisp autumn day in October 1991, Hunger Awareness Day (HAD) volunteers collected $6,000 worth of food in only 8 hours in Rockland County, NY, for area residents in need. That success tripled in 1992 to $20,000 worth of food and supplies. The Pennsylvania Dietetic Association's similar effort, described in the Journal (1994;94:254–255), collected more than 8,000 lb of food. With hunger becoming more prevalent in all geographic areas of this country, HAD's success in raising money and awareness is much needed.