Term Care Providers Research Articles

IMPROVING SERVICES TO LGBTQ+ OLDER ADULTS: NEEDS OF MICHIGAN LONG-TERM CARE PROVIDERS

Abstract Long term care (LTC) providers need information about providing competent care to LGBTQ+ older adults. Providers who are not educated can inadvertently provide biased care. Our research identified preferences for education among providers of LTC services in Michigan (MI). In this descriptive cross sectional study we used an online survey to collect data from MI facilities (N= 429). Survey items included facility characteristics, diversity training history, perceived need for training on LGBTQ+ older adults, barriers to training, interest in additional training on LGBTQ+ older adults and LTC, and training preferences. Results were obtained from 71 facilities. Thirty-seven percent of responses came from direct care workers, 63% from administrators. There was good support for diversity training, with 24% stating diversity training was “somewhat important” and 74% stating it was “very important”. A majority (63%) had had some diversity training in the past year. Most (72%) endorsed the need and desire for more training on LGBTQ+ aging. More content on transgender older adults and concerns such as room assignments, dementia, and use of pronouns were identified. Barriers to training included: cost, availability of trainers with the appropriate expertise, ability to reach large numbers of employees, staff turnover, bias and ignorance among staff and residents, and need to provide rationale for this type of training. Most endorsed a mixed type of training and a training length between 1 and 3 hours. Diversity training is critical to LTC and needs to be expanded to include needs of the aging LGBTQ+ community.

Impact of a pharmacist in an interdisciplinary post-cardiac intensive care unit clinic

BackgroundThe complex needs of cardiac patients shortly after discharge from a cardiac intensive care unit (CICU) provides a unique opportunity for a pharmacist to help optimize medication management and guideline-directed medical therapy (GDMT). ObjectiveThis study describes the impact of a pharmacist in a multidisciplinary post-CICU clinic. MethodsWe performed a retrospective cohort study of patients ≥18 years of age who completed a visit in the University of Michigan Post Intensive Cardiac Care Outpatient Long-Term Outreach (PICCOLO) Clinic from July 2018 to May 2020. ResultsOne hundred and six CICU survivors were referred. Of these 12 chose to follow-up with long term care providers. A total of 70 of the remaining 94 (74%) completed a visit. The median age was 65 (54–72) years, 71.4% were male, and 85.7% were Caucasian. The median number of pharmacist interventions at each visit was 4 (3–5), all patients had at least 1 intervention. Interventions included medication dose adjustment (n = 46); GDMT optimization (n = 42); medication change (n = 18); medication addition (n = 23) and cessation (n = 21); lab monitoring (n = 97); refill assistance (n = 16); pillbox provision (n = 8); and medication cost assistance (n = 8). ConclusionsPharmacist led interventions in a post CICU clinic resulted in medication changes to optimize therapy, increased laboratory monitoring, medication cost savings for patients, and interventions to facilitate GDMT adherence.

Human Immunodeficiency Virus in Octogenarians, Lessons for Long Term Care Providers

Human Immunodeficiency Virus in Octogenarians, Lessons for Long Term Care Providers

Reducing Hospital Lengths of Stay by Discharge Status

This study evaluated the impact of length of stay reduction by discharge status in the hospitals of Syracuse, New York. It focused on the two largest inpatient services, adult medicine and adult surgery, between 2008 and 2018. In the Syracuse hospitals, the adult medicine mean length of stay declined by 0.12 days, resulting in a savings of 14,154 patient days during the ten year period. The adult surgery mean stays declined by 0.91 days, resulting in a savings of 22,639 patient days. The reductions in stays were accompanied by differences in utilization by discharge status. For discharges to self care, the changes in mean stays increased the number of days saved for adult medicine from 5111 to 13,264 and the number of days saved for adult surgery from 4355 to 13,862. These changes were brought about through internal efficiencies within the hospitals. For discharges to nursing homes, the reductions in stays caused the number of excess days to decline from 13,631 to 8695 for adult medicine and from 9150 to 5075 for adult surgery. These changes were brought about through cooperative efforts with long term care providers in the community.

Instrumental social support for the rural elderly: study of a rural block a costal district of Odisha

Background: The objectives of the study were to find out the social support extended to the rural elderly and to find out the trust worthy and long term support providers for them.Methods: An exploratory descriptive research design was adopted where 1088 subjects were interviewed (517 males and 571 females) with variables of age, sex and standard of living. As per the response to the questionnaires, the quality of social support for the rural elderly, the trustworthy and long term support providers were evaluated.Results: Out of 1088 elderly people participated in the study only 15% had someone trustworthy care providers where as 84.5% reported to have no trustworthy care providers. 34.4% of respondents had trust on their son as the old age care providers where as 30.4% had trust on their spouse. Similarly 94.4% reported to have long term care giver. 67.3% respondents were confident of receiving indefinite long term care where as 24.9% reported to have “now and then” care and 6.5% have short term care. The study also revealed that the middle aged (60-79 age groups) is less confident in securing instrumental social support than the very old. (80 above age group). It has also been observed that there is shrinkage in the number of long term care providers with increasing age.Conclusions: Instrumental social support plays a strategic role in the domain of health care, particularly in old age. The study found that rural elderly have less trustworthy care providers in old age. There is variation with regard to age, sex and standard of living. With regard to long term care, it is found that family comes to the centre stage where the core family members like son and spouse engineer the support service. Son is the most trusted care provider and males prefer spouse and females prefer their son as the trusted care provider in long term care. In order to enlarge the support system and raise the quality, support services need to be equipped. Instrumental social support can be both preventive of expansion of morbidity and protective of healthy ageing.

Reducing Hospitalization for Long Stay Patients

This case study described the structure and preliminary impact of a hospital program to improve efficiency by reducing long stays for adult medicine inpatients. The program focused resources on these patients, including an experienced case management staff, effective relationships with long term care providers, and Subacute and Complex Care services. The program caused the total number of adult medicine patient days associated with these patients to decline by 1593, or 4780 on an annual basis.

Development of Subacute and Complex Care Programs at the Community Level

Patients requiring Subacute and Complex Care services continue to challenge hospitals attempting to reduce inpatient stays and improve efficiency. In recent years, numbers of high severity of illness patients in hospitals have increased, adding to this challenge. Nurse care managers have a major responsibility for supporting the care of these patients. This study described the development of services for Subacute and Complex Care patients in the hospitals of Syracuse, New York. These hospitals used their own resources to develop programs including high cost medications, intravenous therapy, extensive wound care, and bariatric care in settings where they had not been available. In the absence of third party funding of another level of care, the hospitals provided program development funds for limited time periods in order to initiate these services. The Syracuse hospitals were able to phase out support for these programs after they were operational in the nursing homes for an extended period of time. The study data indicated that implementation of these programs limited the rate of increase of adult medicine stays and reduced adult surgery stays. The severity of illness for both major services increased in the Syracuse hospitals during this time. This process required acute and long term care providers who were interested in making the process work for the benefit of the patient populations involved, as well as for the needs of their own organizations.

Myths and beliefs of long-term care providers towards starting inhaled medications in children with bronchial asthma

Introduction: Management of persistent forms of asthma needs long term use of inhalers. Myths and beliefs of long term care providers influence compliance with inhaled medications. Objective: To assess the presence of myths and beliefs of long term care providers towards starting inhaled medications in children with bronchial asthma and the influence of socio-demographic factors on them. Method: A prospective cross-sectional descriptive study was carried out in clinics and in-ward patients of paediatric units at 3 Base Hospitals using a self-administered questionnaire. The patients selected were those who were newly planned to start or those already on inhaled medications for bronchial asthma. Care providers who were educated by our team and short term care givers were excluded. Results: The study included 242 long term caregivers of children with bronchial asthma. Of them, 98% had education beyond Grade 5 and 75% had a family income greater than Rs.30, 000/- per month. Majority (59.4%) were already informed regarding the use of inhalers and of them, more than 95% received it from a health care worker. The most prevalent myth among them was that ‘the cost of inhalers is very high’ (n=99, 41%). Among the other myths, a significant percentage of parents believed that ‘inhalers may damage the lungs’ (n=92, 38%) and in ‘inhaler dependency’ (n=86, 35.5%). The proportions of parents having myths were more with the more educated and higher income groups. Previous use of inhalers by the patient or a family member did not significantly influence the presence of myths. Conclusions: A significant proportion of parents / long term care-givers of children with bronchial asthma had myths and false beliefs towards starting inhaled medications. The most prevalent myth was that ‘the cost of inhalers is very high’. Sri Lanka Journal of Child Health , 2015; 44 (4): 202-208

Evolution of Programs to Improve Transfers between Hospitals and Nursing Homes at the Community Level

This study described the evolution of programs to improve the efficiency of patient movement between hospitals and nursing homes in the metropolitan area of Syracuse, New York. These programs were needed in order to improve coordination among providers in the absence of networks that included both acute and long term care providers. The mechanisms included the exchange of data and monitoring the movement of Difficult to Place patients from hospitals to nursing homes. Between 2006 and 2014, the annual number of Difficult to Place patients increased from 983 to 1836. During this period, annual hospital medical/surgical discharges increased by 7.5 percent, severity of illness increased by 13.7 percent, and the population aged 65 years and over increased by 9.8 percent. Most of the Difficult to Place patients were admitted by the four largest facilities in the community, which accounted for 60 percent of the nursing home beds. The initiatives also included Subacute and Complex Care Programs that provided financial incentives for admission of certain types of patients, such as intravenous therapy and extensive wound care. The programs described how these programs were implemented using minimal financial resources and without adding positions to the participating provider organizations.

A Process to Self-Audit Opioid Prescribing Practices in Skilled Nursing Facility Patients

Background: Opioid medications are associated with adverse events, particularly falls and consequent injury, in elders, including those in the long term care setting. However, uncontrolled pain is also a major issue in long term care. A single, 182-bed skilled nursing facility associated with a tertiary academic medical center. All long-term residents (short-term rehabilitation residents were excluded) who resided at the skilled nursing facility between July 1st and September 30th, 2013. Objective/Aim: To describe a quick and reproducible process by which long term care providers can self-audit their opioid prescribing practices in long term care patients. Quality Improvement Methods: Data regarding individual provider opioid prescribing practices in Medicare Part D patients, reported as a percentage (frequency), was obtained from the ProPublica website (propublica.org). Review of the skilled nursing facility’s electronic medical record (Point Click Care) was completed to determine frequency of opioid use by the same providers in their long term care patients. The two data sets were compared to determine correlation. Results: 38.7% (36/93) of long term care patients examined were prescribed at least one opioid medication. Rates of opioid use in long term care patients per provider ranged from 36.7% to 42.4%. Rates of opioid use in Medicare Part D patients for the same providers ranged from 11% to 13%, with a ratio of opioid prescription frequency in long term care versus Medicare Part D patients of approximately 3:1 for all providers. Conclusion: Opioid prescribing frequency differs significantly based on the patient population considered, with frequency of opioid use significantly higher in long term care versus all Medicare Part D patients. In this small study, frequency of opioid use in the long term care setting was approximately three times that in all Medicare Part D patients, and this ratio was consistent across all prescribers examined. If confirmed in a larger study, this would indicate that ProPublica data represents a quick, efficient metric by which providers can estimate their frequency of opioid use in long term care patients, which is not readily accomplished with many current long term care medical records. Increased awareness of one’s opioid prescribing practices may lead to more thoughtful opioid use, with improved patient quality and safety. Author Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.

Attitudes Toward Death, Dying, End-of-Life Palliative Care, and Interdisciplinary Practice in Long Term Care Workers

BackgroundBesides personal and professional experiences, long term care providers' own attitudes toward death may affect the care given to dying residents. ObjectivesTo assess beliefs, values, and attitudes toward death, dying, palliative, and interdisciplinary care in long term care workers and identify any differences between different job categories and places of work. DesignDescriptive cross-sectional survey study. SettingFive public long term care facilities. ParticipantsOne thousand one hundred seventy volunteers, clinical managers, and all categories of residential long term care workers. Measurements and MethodsAn anonymous paper or electronic self-administered survey questionnaire consisting of 24 items, answered on a 4-point bipolar Likert scale. Between-group differences were compared with the analysis of variance test after adjustment for the multiple post-hoc comparisons. ResultsHealthcare workers had a relatively positive attitude toward more than one-half of the selected aspects of interdisciplinary practice and end-of-life palliative care for long-term residents. However, attitudes were more mixed about 10 other aspects and a higher percentage of respondents indicated negative attitudes toward them. Overall, there are significant differences between upper-level professionals and managers (registered nurses, physicians, rehabilitation staff, and clinical managers) vs the hands-on caregivers (nursing assistants, patient assistants, and volunteers) with regard to some aspects of the care of the dying. ConclusionsThe results suggest that healthcare workers' attitudes need to be taken into account in long term care facilities. Patient assistants, volunteers, and nursing assistants seem most likely to above all benefit from training and support programs.

Economic Evaluation of a Handheld Charge Capture Application for Long Term Care Providers

Introduction/Objective: Previous research has shown that a point-of-care handheld charge capture program can improve coding accuracy and satisfaction for long-term care providers. The objective of this quality improvement project was to determine the impact of a point-of-care handheld charge capture program on the number of charges submitted, payments received, charge lag, and return on investment in a group of long-term care providers.

A Modest Proposition to align Geriatrics and Long Term Care Medicine

A Modest Proposition to align Geriatrics and Long Term Care Medicine

COLLABORATIVE RESEARCH PARTNERSHIPS: THE CONSORTIUM TEN YEARS LATER

This article describes the potential problems and principles inherent in developing a research component in a community - based consortium of long - term care providers and educational institutions. The Consortium for Gerontological Education in Long - term Care was designed to share educational resources among member institutions. In the last several years the Consortium has developed a collaborative research agenda and undertaken specific training in field research techniques. Meeting the needs of divergent members of the Consortium by introducing research that integrates students, academics, and health care providers working in the field is discussed in a way that clarifies the challenges as well as the success of the endeavor.

State Regulation of the Supply of Long Term Care Providers

After the removal of the federal reguirements for certificate of need (CON) in 1986, the majority of states (40) and the District of Columbia retained their CON and/or added a moratorium on new nursing facilities and beds. Some states were also regulating the growth of other types of long term care (LTC) facilities and home health agencies. States with a CON and/or moratoria were more likely to have a greater non- White population, to have liberal politicians, and to have a lower capacity to raise taxes. When state financial budgets are limited, policymakers are likely to continue to regulate the supply of LTC providers.

Ethical challenges for Jewish long term care providers.

ABSTRACT This article discusses the particular ethical challenges and opportunities facing Jewish long term care providers. The discussion begins with background on Jewish healthcare ethics generally and then notes several problems in applying traditional principles in concrete situations today. Specific ethical dilemmas characterizing long term care are described, and their implications for practice within Jewish facilities are explicated. Finally, suggestions are offered regarding special contributions that can be made to both the Jewish community and the larger society by bringing the perspective of Jewish healthcare ethics to the arena of long term care provision and policy-making for aging citizens.