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Automatic Home Nursing Activity Recommendation
Luo, Gang; Tang, Chunqiang
The rapid deployment of Web-based, consumer-centric electronic medical records (CEMRs) is an important trend in healthcare. In this paper, we incorporate nursing knowledge into CEMR so that it can automatically recommend home nursing activities (HNAs). Those more complex HNAs are made clickable for users to find detailed implementation procedures. We demonstrate the effectiveness of our techniques using USMLE medical exam cases. PMID:20351888
... our e-newsletter! Aging & Health A to Z Nursing Homes Basic Facts & Information Nursing homes have changed ... physical health and/or mental disabilities. Is a Nursing Home Right for You? Almost half of all ...
Nursing home checklist Name of nursing home: ____________________________________________________ Address: ________________________________________________________________ Phone number: __________________________________________________________ Date of visit: _____________________________________________________________ Basic information Yes No Notes Is the nursing home Medicare certified? Is the nursing ...
... up like a hospital. The staff provides medical care, as well as physical, speech and occupational therapy. ... relationships with residents. Some nursing homes have special care units for people with serious memory problems such ...
... this website may not be available. Alternatives to nursing homes Before you make any decisions about long ... live and what help you may need. A nursing home may not be your only choice. Discharge ...
The National Nursing Home Survey provides includes characteristics such as size of nursing home facilities, ownership, Medicare/Medicaid certification, occupancy rate, number of days of care provided, and expenses.
... for health care providers. Learn More Falls in Nursing Homes Recommend on Facebook Tweet Share Compartir On ... 5 Why do falls occur more often in nursing homes? Falling can be a sign of other ...
Automatic home medical product recommendation.
Luo, Gang; Thomas, Selena B; Tang, Chunqiang
Web-based personal health records (PHRs) are being widely deployed. To improve PHR's capability and usability, we proposed the concept of intelligent PHR (iPHR). In this paper, we use automatic home medical product recommendation as a concrete application to demonstrate the benefits of introducing intelligence into PHRs. In this new application domain, we develop several techniques to address the emerging challenges. Our approach uses treatment knowledge and nursing knowledge, and extends the language modeling method to (1) construct a topic-selection input interface for recommending home medical products, (2) produce a global ranking of Web pages retrieved by multiple queries, and (3) provide diverse search results. We demonstrate the effectiveness of our techniques using USMLE medical exam cases. PMID:20703712
Chu, Leung-Wing; Chi, Iris
China will face a dramatic transition from a young to an aged society in the coming 30 to 40 years. In 2000, there were 88,110,000 persons aged 65 years and older, which represented 7% of the population. This percentage is projected to increase to 23% in 2050. Regarding health and long-term care for older adults, the current challenge is to build a comprehensive system of care for older adults. Nursing home care is an inevitable care model for frail older adults in China, which is largely sponsored by the government of China with contributions from some nongovernment organizations and private investors. China is a large country. Within the country, long-term care varies greatly between rural and urban areas, and among the different economic developing areas. In urban and better-developed areas, the range of services exists; however, in rural and less-developed areas, the range of services is limited. The "Star Light Program" and "Beloved Care Engineering" were recent government initiatives to improve aged care. They were launched in 2001 and have dramatically increased the number of both senior centers and nursing homes for older adults. While the quantity of nursing homes is still inadequate with an additional mismatch problem between the supply and demand, the quality of care in most nursing homes is suboptimal. At present, most administrative and frontline workers in nursing homes have received little training in elder care. There is a need for good-quality structured training in long-term care for all types of staff. Moreover, quality standard for care, including standard setting, assessment, and monitoring, is an important issue and needs substantial improvement for nursing homes in China. Currently, 1.5% of older people live in nursing homes and apartments for older people. Because of the peculiar 4-2-1 family structure in China, we expect the prevalence of nursing home placement of older adults will increase in the coming years. The government of China has
Quality Assurance in Nursing Homes.
ERIC Educational Resources Information Center
Balgopal, Pallassana R.; And Others
This manual, developed for the nursing home employee, examines the concept of quality assurance in nursing homes, describes the benefits of an effective quality assurance program, and provides guidelines to aid nursing homes in developing an appropriate quality assurance program. After a brief introduction, a working definition of quality…
Legal Issues in Nursing Homes.
ERIC Educational Resources Information Center
Kapp, Marshall B.
This paper examines the variety of legal rules and processes which have been established to assess and ensure that the quality of care provided in nursing homes satisfies an acceptable level. It begins with a general overview of nursing home law. Areas discussed in this section include: (1) sources of nursing home law; (2) theories of liability;…
Mediås, I B; Fiskerud, R
169 "injury situations" involving 61 patients were registered in a nursing home during one year. Four patients were sent to hospital. A few patients had several falls. Men were more prone to injury than women. Age itself seemed to be of no importance. Patients on shortterm admittance were at high risk. In general patients with dementia were not at higher risk but suffered the more serious injuries and were also involved in various episodes of patient violence. The risk of injuries is generally high in nursing homes. A certain risk must be accepted, but it is important to introduce prophylactic measures. A larger nursing staff might have prevented some of the situations. PMID:1926073
[Aromatherapy in nursing homes].
Barré, Lucile
Pierre Delaroche de Clisson hospital uses essential oils as part of its daily organisation for the treatment of pain and the development of palliative care. The setting up of this project, in nursing homes and long-term care units, is the fruit of a complex mission carried out by a multidisciplinary team, which had to take into account the risks involved and overcome a certain amount of reluctance. PMID:26154352
Nursing Home Work Practices and Nursing Assistants' Job Satisfaction
ERIC Educational Resources Information Center
Bishop, Christine E.; Squillace, Marie R.; Meagher, Jennifer; Anderson, Wayne L.; Wiener, Joshua M.
Purpose: To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Design and Methods: Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey,…
The National Nursing Home Survey (NNHS) is a continuing series of national sample surveys of nursing homes, their residents, and their staff.The survey was conducted in 1973-74, 1977, 1985, 1995, 1997, and 1999. Although each of these surveys emphasized different topics, they all...
An international definition for "nursing home".
Sanford, Angela M; Orrell, Martin; Tolson, Debbie; Abbatecola, Angela Marie; Arai, Hidenori; Bauer, Juergen M; Cruz-Jentoft, Alfonso J; Dong, Birong; Ga, Hyuk; Goel, Ashish; Hajjar, Ramzi; Holmerova, Iva; Katz, Paul R; Koopmans, Raymond T C M; Rolland, Yves; Visvanathan, Renuka; Woo, Jean; Morley, John E; Vellas, Bruno
There is much ambiguity regarding the term "nursing home" in the international literature. The definition of a nursing home and the type of assistance provided in a nursing home is quite varied by country. The International Association of Gerontology and Geriatrics and AMDA foundation developed a survey to assist with an international consensus on the definition of "nursing home." PMID:25704126
Gaps in nurse staffng and nursing home resident needs.
Zhang, Ning Jackie; Unruh, Lynn; Wan, Thomas T H
Trends in nurse staffing levels in nursing homes from 1997 to 2011 varied across the category of nurse and the type of nursing home. The gaps found in this study are important to consider because nurses may become overworked and this may negatively affect the quality of services and jeopardize resident safety. Nursing home administrators should consider improving staffing strategically. Staffing should be based not only on the number of resident days, but also allocated according to particular resident needs. As the demand for nursing home care grows, bridging the gap between nurse staffing and resident nursing care needs will be especially important in light of the evidence linking nurse staffing to the quality of nursing home care. Until more efficient nursing care delivery exits, there may be no other way to safeguard quality except to increase nurse staffing in nursing homes. PMID:24592533
[Teledermatology within Dutch nursing homes].
Lubeek, Satish F K; Mommers, Roland J M; van der Geer, Eric R; van de Kerkhof, Peter C M; Gerritsen, Marie-Jeanne Rianne P
Skin problems are common within the nursing home population and could have a significant impact on quality of life. As a form of long-distance consultation teledermatology offers several potential benefits within this frail population. In this review we discuss several aspects of teledermatology, especially in relation to the nursing home population. Several studies demonstrated that teledermatology is a cost-effective and easy-to-use consultation method, which could significantly reduce the amount of hospital visits. However, teledermatology is only used in a limited number of Dutch nursing homes in daily practice due to several factors. For the optimal implementation of teledermatological consultation there are some important logistical, legal and financial framework conditions. In conclusion, teledermatology has a lot to offer within the nursing home population and therefore teledermatology will hopefully be increasingly used in daily practice within the near future. PMID:27098424
ERIC Educational Resources Information Center
Torpey, Elka Maria
The need for practical nurses who focus on caring for older people is growing. According to the U.S. Census Bureau, the number of people ages 65 and older is expected to increase from 40 million to 72 million between 2010 and 2030. And the U.S. Bureau of Labor Statistics (BLS) projects that this increasing population will result in job growth for…
Does quality influence consumer choice of nursing homes? Evidence from nursing home to nursing home transfers.
Hirth, Richard A; Banaszak-Holl, Jane C; Fries, Brant E; Turenne, Marc N
We estimated Cox proportional hazards models using assessment data from the Minimum Data Set to test whether nursing home residents and their proxies respond to quality of care by changing providers. Various indicators of poor quality increased the likelihood of transfer. Residents of for-profit homes or homes with excess capacity also were more likely to transfer. Inability to participate in care decisions and factors indicating frailty limited residents' ability to transfer. The apparent responsiveness to quality is encouraging. Nonetheless, because the absolute transfer rate is low, significant barriers to movement among nursing homes still may exist. PMID:15055834
Going Home: Analysis of Nursing Home Discharges.
ERIC Educational Resources Information Center
Retsinas, Joan; Garrity, Patricia
Previous research has shown that only nursing home "short stayers" will return to the community. Analyzed data to predict factors important both to discharge and tenure. Independent variables included age, sex, past residence, prognosis, and family ties. Results point to prognosis as a key predictor both of discharge and of tenure. (Author/ABB)
The Natural History of Nursing Home Patients.
ERIC Educational Resources Information Center
Lewis, Mary Ann; And Others
Former nursing home residents (N=197) were followed for 2 years after discharge. Four subgroups of patients were identified on the basis of different patterns of survival and use of health care resources: those who returned home, died in nursing homes, transferred to hospitals, or transferred to other nursing homes. (NRB)
Clashes At Nursing Homes Not Uncommon
... medlineplus.gov/news/fullstory_159335.html Clashes at Nursing Homes Not Uncommon 20 percent of residents affected ... 13, 2016 (HealthDay News) -- Many elderly adults in nursing homes face aggressive or disturbing behavior from their ...
Medical specialist attendance in nursing homes
Balzer, Katrin; Butz, Stefanie; Bentzel, Jenny; Boulkhemair, Dalila; Lühmann, Dagmar
The care in nursing homes was examined based on scientific studies. The analysis focuses on dementia and type II diabetes. There is evidence for deficits in the supply of medical specialist attendance to nursing home residents with these diseases in Germany. Compared with corresponding guidelines the medical care for nursing home residents may be too low or inadequate. PMID:23755088
Future Development of Nursing Home Quality Indicators
ERIC Educational Resources Information Center
Arling, Greg; Kane, Robert L.; Lewis, Teresa; Mueller, Christine
Nursing home quality indicators have been developed over the past 10 years to quantify nursing home quality and to draw systematic comparisons between facilities. Although these indicators have been applied widely for nursing home regulation, quality improvement, and public reporting, researchers and stakeholders have raised concerns about their…
Report Cards and Nursing Homes
ERIC Educational Resources Information Center
Castle, Nicholas G.; Lowe, Timothy J.
Purpose: We first describe which states have produced nursing home report cards; second, we compare what information is provided in these report cards; third, we identify data sources used to produce the report cards; and, finally, we examine seven factors previously shown to be associated with the usefulness of report-card information and provide…
Nursing homes: The new frontier.
Davis, Jane; Zuber, Kim
As the population continues to age, we will see a larger percentage of end-stage CKD patients in nursing homes, both skilled and long-term facilities. This is a fragile population and will take buy-in from all practitioners to care for them. Even with the dietitian to manage a complicated and detailed menu, the social worker to manage the transportation and multiple issues with equipment, the therapy staff to protect against loss of ADLs, the recreational therapist to protect against loss of cognitive function and the medical staff (APs, nursing, physicians), this population will continue to present both challenges and opportunities. PMID:26521633
Estimating patient-level nursing home costs.
Schlenker, R E; Shaughnessy, P W; Yslas, I
This article presents a methodology developed to estimate patient-level nursing home costs. Such estimates are difficult to obtain because most cost data for nursing homes are available from Medicare or Medicaid cost reports, which provide only average values per patient-day across all patients (or all of a particular payer's patients). The methodology presented in this article yields "resource consumption" (RC) measures of the variable cost of nursing staff care incurred in treating individual nursing home patients. Results from the application of the methodology are presented, using data collected in 1980 on a sample of 961 nursing home patients in 74 Colorado nursing homes. This type of approach could be used to link nursing home payments to the care needs of individual patients, thus improving the overall equity of the payment system and possibly reducing the access barriers facing especially Medicaid patients with high-cost care needs. PMID:3921494
Nursing Homes as Teaching Institutions: Legal Issues.
ERIC Educational Resources Information Center
Kapp, Marshall B.
Discusses the trend toward affiliation of nursing homes with educational programs as clinical teaching institutions for medical, nursing, and allied health students. Reviews potential ethical and legal issues for the nursing home administrator, professional staff member, educator, and student, including informed consent, supervisory…
Infections and antibiotic resistance in nursing homes.
Nicolle, L E; Strausbaugh, L J; Garibaldi, R A
Infections occur frequently in nursing home residents. The most common infections are pneumonia, urinary tract infection, and skin and soft tissue infection. Aging-associated physiologic and pathologic changes, functional disability, institutionalization, and invasive devices all contribute to the high occurrence of infection. Antimicrobial agent use in nursing homes is intense and usually empiric. All of these factors contribute to the increasing frequency of antimicrobial agent-resistant organisms in nursing homes. Programs that will limit the emergence and impact of antimicrobial resistance and infections in nursing homes need to be developed. PMID:8665472
Nursing Home Staff Turnover: Impact on Nursing Home Compare Quality Measures
ERIC Educational Resources Information Center
Castle, Nicholas G.; Engberg, John; Men, Aiju
Purpose: We used data from a large sample of nursing homes to examine the association between staff turnover and quality. Design and Methods: The staff turnover measures came from primary data collected from 2,840 nursing homes in 2004 (representing a 71% response rate). Data collection included measures for nurse aides, licensed practical nurses,…
Nursing Home Staffing and Quality under the Nursing Home Reform Act
ERIC Educational Resources Information Center
Zhang, Xinzhi; Grabowski, David C.
Purpose: We examine whether the Nursing Home Reform Act (NHRA) improved nursing home staffing and quality. Design and Methods: Data from 5,092 nursing homes were linked across the 1987 Medicare/Medicaid Automated Certification System and the 1993 Online Survey, Certification and Reporting system. A dummy-year model was used to examine the effects…
Nursing Home Length of Stay Patterns: Results from the 1985 National Nursing Home Survey.
ERIC Educational Resources Information Center
Spence, Denise A.; Wiener, Joshua M.
Estimated length of stay (LOS) for elderly nursing home patients. Converted discharges from 1985 National Nursing Home Survey into admission cohort and adding reported immediate previous nursing home LOS to surveyed LOS. Ultimate length of aggregated stay was longer than unaggregated estimates for elderly discharged residents. Mean aggregated stay…
Rurality and Nursing Home Quality: Evidence from the 2004 National Nursing Home Survey
ERIC Educational Resources Information Center
Kang, Yu; Meng, Hongdao; Miller, Nancy A.
Purpose of the Study: To evaluate the impact of rural geographic location on nursing home quality of care in the United States. Design and Methods: The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used…
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
2. VIEW NORTH SHOWING SOUTH (FRONT) ELEVATION OF NURSES HOME NO. 2 ON LEFT AND SOUTH ELEVATION OF NURSES HOME NO. 1 ON RIGHT - Jersey City Hospital, Nurses Homes, 112-114 Clifton Place, Jersey City, Hudson County, NJ
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2011 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2013 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2012 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2014 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2010 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...
Moral Hazard in Nursing Home Use
Grabowski, David C.; Gruber, Jonathan
Nursing home expenditures are a rapidly growing share of national health care spending with the government functioning as the dominant payer of services. Public insurance for nursing home care is tightly targeted on income and assets, which imposes a major tax on savings; moreover, low state reimbursement for Medicaid patients has been shown to lower treatment quality, and bed supply constraints may deny access to needy individuals. However, expanding eligibility, increasing Medicaid reimbursement, or allowing more nursing home bed slots has the potential to induce more nursing home use, increasing the social costs of long term care. A problem in evaluating this tradeoff is that we know remarkably little about the effects of government policy on nursing home utilization. We attempt to address this shortcoming using multiple waves of the National Long-Term Care Survey, matched to changing state Medicaid rules for nursing home care. We find consistent evidence of no effect of Medicaid policies on nursing home utilization, suggesting that demand for nursing home care is relatively inelastic with respect to public program generosity. From a policy perspective, this finding indicates that changes in overall Medicaid generosity will not have large effects on utilization. PMID:17095111
Nursing Practice Environment and Registered Nurses' Job Satisfaction in Nursing Homes
ERIC Educational Resources Information Center
Choi, JiSun; Flynn, Linda; Aiken, Linda H.
Purpose: Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs…
Assessing Resident Safety Culture in Nursing Homes: Using the Nursing Home Survey on Resident Safety
Castle, Nicholas G.; Wagner, Laura M.; Perera, Subashan; Ferguson, Jamie C.; Handler, Steven M.
Objectives To examine the overall responses of nursing home staff to a newly developed nursing home specific survey instrument to assess patient safety culture (PSC) and to examine whether nursing home staff (including Administrator / Manager, Licensed Nurse, Nurse Aide, Direct Care Staff, and Support Staff) differ in their PSC ratings. Methods Data were collected in late 2007 through early 2008 using a survey administered to staff in each of 40 nursing homes. In four of these nursing homes the responses of different staff were identified. The Nursing Home Survey on Patient Safety Culture (NHSPSC) was used to assess 12 domains of the PSC and identify differences in PSC perceptions between staff. Results For the 40 nursing homes in the sample, the overall facility response rate was 72%. For the four nursing homes of interest, the overall facility response rate was 68.9%. The aggregate NHSPSC scores, using all staff types for all survey items, show that most respondents report a poor PSC. However, Administrators / Managers had more positive scores than the other staff types (p<0.05) across most domains. Conclusions Staff in nursing homes generally agree that PSC is poor. This may have a significant impact on quality of care and quality of life for residents. PMID:22130345
Nursing Home Registered Nurses' and Licensed Practical Nurses' Knowledge of Causes of Falls.
Gray-Miceli, Deanna; de Cordova, Pamela B; Crane, Giles L; Quigley, Patricia; Ratcliffe, Sarah J
Reducing falls in nursing homes requires a knowledgeable nursing workforce. To test knowledge, 8 validated vignettes representing multifactorial fall causes were administered to 47 nurses from 3 nursing homes. Although licensed practical nurses scored higher than registered nurses in individual categories of falls, when we computed the average score of all 8 categories between groups of registered nurses and licensed practical nurses, registered nurses scored higher (F = 4.106; P < .05) in identifying 8 causal reasons for older adults to fall. PMID:26421775
Levine, Murray
The current article discusses the case of Henry Rahons. A nearly 80 year old man who was accused by the local district attorney of having unlawful sexual contact with Donna, his second wife of some seven years who had developed Alzheimer's disease in her later years. Under Iowa law, he was accused of having sexually abused her because she had "a mental defect or incapacity which precludes giving consent" to sex acts. A jury acquitted Henry of the charge of sexually abusing his wife. The evidence was equivocal that a sex act occurred on May 23, 2014, the date specified in the indictment. This article addresses the ability to assessed competence to consent to sex in similar situations. The current rules and attitudes about senior sex in nursing homes needs to be reevaluated. (PsycINFO Database Record PMID:27196391
Ownership Conversions and Nursing Home Performance
Grabowski, David C; Stevenson, David G
Objective To examine the effects of ownership conversions on nursing home performance. Data Source Online Survey, Certification, and Reporting system data from 1993 to 2004, and the Minimum Data Set (MDS) facility reports from 1998 to 2004. Study Design Regression specification incorporating facility fixed effects, with terms to identify trends in the pre- and postconversion periods. Principal Findings The annual rate of nursing home conversions almost tripled between 1994 and 2004. Our regression results indicate converting facilities are generally different throughout the pre/postconversion years, suggesting little causal effect of ownership conversions on nursing home performance. Before and after conversion, nursing homes converting from nonprofit to for-profit status generally exhibit deterioration in their performance, while nursing homes converting from for-profit to nonprofit status generally exhibit improvement. Conclusions Policy makers have expressed concern regarding the implications of ownership conversions for nursing home performance. Our results imply that regulators and policy makers should not only monitor the outcomes of nursing home conversions, but also the targets of these conversions. PMID:18355255
Cops, Consultants, and Goldfish: Variations in Nursing Home Regulation.
ERIC Educational Resources Information Center
Gardiner, John A.
Nursing home regulatory agencies are subjected to a variety of pressures. Nursing home residents' families and friends want the agencies to "get tough" while the nursing home industry wants agencies to act as consultants rather than cops. The task of regulating nursing homes in the United States is primarily carried out by units of state…
Reducing energy costs in nursing homes
Not Available
The handbook presents ideas and techniques for energy conservation in nursing homes. Case studies were developed of nursing homes located in different parts of the US. The typical nursing home assessed was proprietary, of intermediate-care level, medicaid-certified, and had less than 200 beds. Specific energy conservation measures were analyzed to determine the energy and dollar savings that could be realized. These include reducing heat loss through the building shell; reducing hot water costs; recovering the heat generated by dryers; reducing lighting costs; reducing heating and cooling costs, and analyzing fuels and fuel rates. A case for converting electric clothes dryers to gas was analyzed. (MCW)
Home Care Nursing Improves Cancer Symptom Management
Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.
International survey of nursing home research priorities.
Morley, John E; Caplan, Gideon; Cesari, Matteo; Dong, Birong; Flaherty, Joseph H; Grossberg, George T; Holmerova, Iva; Katz, Paul R; Koopmans, Raymond; Little, Milta O; Martin, Finbarr; Orrell, Martin; Ouslander, Joseph; Rantz, Marilyn; Resnick, Barbara; Rolland, Yves; Tolson, Debbie; Woo, Jean; Vellas, Bruno
This article reports the findings of a policy survey designed to establish research priorities to inform future research strategy and advance nursing home practice. The survey was administered in 2 rounds during 2013, and involved a combination of open questions and ranking exercises to move toward consensus on the research priorities. A key finding was the prioritization of research to underpin the care of people with cognitive impairment/dementia and of the management of the behavioral and psychological symptoms of dementia within the nursing home. Other important areas were end-of-life care, nutrition, polypharmacy, and developing new approaches to putting evidence-based practices into routine practice in nursing homes. It explores possible innovative educational approaches, reasons why best practices are difficult to implement, and challenges faced in developing high-quality nursing home research. PMID:24703926
Independence Training in Nursing-Home Residents
ERIC Educational Resources Information Center
Baltes, Margret M.; Zerbe, Melissa B.
Single-subject reversal designs were used in teaching elderly nursing-home residents to change dependency behavior and to reacquire and maintain self-feeding skills. Fast control of self-feeding was obtained. Results are discussed. (Author)
Participatory ergonomic improvement in nursing home.
Udo, Hiroshi; Kobayashi, Mikio; Udo, Akihiro; Branlund, Ben
The number of nursing home has increased largely in Japan since 1990. The Long-term Care Insurance in 2000 has accelerated the increase of nursing homes. The care giving and cooking in nursing homes have high risk factors of muscle-skeletal diseases (MSDs). However, the working conditions have not yet been improved. Thus, the incidence of low back pain and cervico-brachial disorder is very high among the care workers and cooks. Therefore, it is important to prevent the MSDs among the care workers and cooks. This study has been conducted to make a model of the participatory improvement focusing on low back pain in a nursing home for three years. As a result of the study, many improvements have been implemented and the incidence of low back pain has been reduced. PMID:16610548
Nursing Homes: Making the Right Choice
... visiting. For example, look for: Medicare and Medicaid certification Handicap access Residents who look well cared for ... Ask to see the current inspection report and certification of any nursing home you are considering. Visit ...
Pay-for-Performance in Nursing Homes
Briesacher, Becky A.; Field, Terry S.; Baril, Joann; Gurwitz, Jerry H.
Information on the impact of pay-for-performance programs is lacking in the nursing home setting. This literature review (1980-2007) identified 13 prior examples of pay-for-performance programs in the nursing home setting: 7 programs were active as of 2007, while 6 had been terminated. The programs were mostly short-lived, varied considerably in the choice of performance measures and pay incentives, and evaluations of the impact were rare. PMID:19544931
[Nursing care at home and secularism].
Lecointre, Brigitte
The question of secularism, long-time confined to schools and the relationships between the Church and State, is today being raised in the field of public health. Nurses are directly affected and are integrating this dimension of secularism into their care practices. A private practice nurse describes the effect these changes are having on her practice in patients' homes. PMID:26654502
38 CFR 51.31 - Automatic recognition.
Code of Federal Regulations, 2012 CFR
...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will...
38 CFR 51.31 - Automatic recognition.
Code of Federal Regulations, 2014 CFR
...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will...
38 CFR 51.31 - Automatic recognition.
Code of Federal Regulations, 2011 CFR
...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will...
38 CFR 51.31 - Automatic recognition.
Code of Federal Regulations, 2013 CFR
...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will...
38 CFR 51.31 - Automatic recognition.
Code of Federal Regulations, 2010 CFR
...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will...
Reassessing nurse aide job satisfaction in a Texas nursing home.
Thompson, Mark A; Horne, Kathleen K; Huerta, Timothy R
This article reports a study that replicates and extends Castle's 2007 study by examining factors related to satisfaction of nurse aides at Carillon House, a 120-bed nonprofit skilled nursing facility in Lubbock, Texas. The Nursing Home Nurse Aide Job Satisfaction Questionnaire was adapted to allow for the collection of qualitative responses and administered to the nursing staff. The results suggest that satisfaction among nurse aides is related to rewards, workload, and the team environment created among coworkers. These findings differ from what is generally found in the literature and may be related to the higher-than-average satisfaction rating of nurse aides at this facility. The study provides evidence that large-scale surveys may have ignored a stratified effect where higher satisfaction organizations have different driving forces than what has been demonstrated in the literature to date. PMID:21634313
Nursing home culture change: what does it mean to nurses?
Bellot, Jennifer
The purpose of this study was to explore, from the perspectives of licensed nurses, the organizational culture, work environment, and factors influencing culture change in two nursing homes participating in the Wellspring Program. All licensed nurses ≥ 0.25 full-time equivalent from two nursing homes were invited to complete the Organizational Culture Inventory and the Work Environment Scale. A subset of respondents was invited to participate in subsequent interviews. Data indicated unresolved conflict, low employee satisfaction, high work demands, and managerial control in the workplace. Qualitatively, three categories emerged: Confusion over culture change, role, and documentation; Conflict over the integration of traditional care with a resident-centered model; and Commitment to providing quality nursing care to the resident. To ensure the successful implementation of culture change, consideration must be given to clarity of communication, anticipation of role conflict, and building on the underlying strength of job commitment. PMID:22998657
Nursing Home Administrators' Opinions of the Nursing Home Compare Web Site
ERIC Educational Resources Information Center
Castle, Nicholas G.
Purpose: In November of 2002 the Centers for Medicare and Medicaid Services publicly reported on a national basis the quality of nursing homes on the Nursing Home Compare (NHC) Web site. This study examines administrators' opinions of this initiative and whether it has fostered quality improvement. Design and Methods: Data used in this…
Eldercare at Home: Choosing a Nursing Home
... at home. Problems such as frequent incontinence, dangerous wandering, inability to sleep at night (a disrupted sleep - ... a security system to prevent confused residents from wandering out of the building? Are there accessible outdoor ...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2010 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2012 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2014 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2011 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2013 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
Nursing priorities for the 1980's: hospitals and nursing homes.
Aiken, L H
It is clear that the two institutions where nurses play a critical role--hospitals and nursing homes--are experiencing major problems. Patients in these institutions are not receiving the full benefits of the best health care America has to offer. Organized nursing has the opportunity and capacity to resolve these difficulties and in the process improve both patient care and the importance of our profession. The time is right for change. To date, nursing has not taken on this difficult leadership task. I believe we will remain dependent on other professions unless we take on significant responsibilities for resolving the problems facing these two institutions. The GMENAC report on health manpower suggests that out profession should not rely on others for public policy recommendations which will affect our future. Nursing has greater respect and national visibility than ever before. Within this decade, nursing has the potential ability to help resolve the crisis affecting these two institutions. The future of the nation's hospitals, nursing homes, those for whom we care, and of the nursing profession may depend upon how we respond to these two challenges in the years ahead. PMID:6906951
[Ways to make cooperation between hospital nurse and home visiting nurse in treating a final stage cancer patient at home].
Nagai, Hamae; Ohori, Yoko; Shino, Satoko; Marutani, Harumi; Numata, Kumiko; Sato, Yasutomo
Due to a payment system based on Comprehensive Medical Evaluation has been adopted, both a shorter hospitalization and the use of home nursing care have been increasing. A good cooperation between hospital and home visiting nurses is desired in order to transfer continued nursing. Regarding a home nursing care service for the most terminal cancer patients, we conducted a survey of 459 home visiting nurses with twelve questions in five categories: (1) Before transferring to home care, (2) Right after the transfer to home care, (3) Patient in a stable period, (4) Time of near death and (5) Other (Requests to hospital nurses). The following issues became clearer in terms of how hospital and home visiting nurses should be cooperating with the handling of last stage terminal cancer patients: (1) A home visiting nurse should have a coordinating role with a hospital nurse when the patient is discharged from the hospital. (2) A participation of home visiting nurses on the coordination guidance at the time of a patient discharge is influenced by a manpower of the nursing station. (3) Even though home visiting nurses found a discrepancy between the hospital information and what patients and their families were getting from the hospital, home visiting nurses have learned through the job to clarify what patient and family needs were, and they responded accordingly. (4) A coordination between hospital and home visiting nurses was needed quite often when the patient's time has come to die at home. PMID:16422484
Nursing Homes for Student Learning
ERIC Educational Resources Information Center
Mueller, Alma L.; Mutzebaugh, Carole A.
Describes a community college's development and implementation of a second-year nursing curriculum which involved clinical experience in an extended care facility in which learning took place in the following areas: the normal physical and developmental aging process; rehabilitation for chronic illness; and specific psychiatric nursing principles…
Nursing home administrators' level of job satisfaction.
Murphy, Barbara
Job satisfaction has been shown to have a direct relationship to the quality of work. Are nursing home administrators satisfied with their work? How do they compare with their counterparts in other industries? The results of this survey, using the Job Description Index (JDI) and the Job in General (JIG) scale as published by Bowling Green State University, indicate that nursing home administrators have a more compressed rate of job satisfaction than their counterparts in other industries. They focus their dissatisfaction on their coworkers and pay. They demonstrate dissatisfaction by rotating their positions at a rate of every 31 months. This suggests some significant problems in the development and maintenance of quality care and some areas that could be addressed to raise the level of satisfaction among nursing home administrators. PMID:15499807
[Nursing diagnoses of the elderly at home].
Figueiredo, Maria do Livramento Fortes; Luz, Maria Helena Barros Araújo; de Brito, Cleidiane Maria Sales; Sousa, Suéli Nolêto Silva; da Silva, Dâmaris Rebeca Soares
The descriptive study, with quantitative approach, that has had as objective to do the characterization of ill elderly at home attended by the ESF teams of the Satellite's District in Teresina - PI and to collect Nursing Diagnoses and it respective interventions. This descriptive study was constituted by 50 seniors interviewed at home, the results showed that most of the women in age between of 60 and 79 years were ill at home for one or five years at least. There were eight Nursing Diagnoses (ND) prevalent, in which 98% of the seniors were identified with the ND - Inadequate Control of Therapeutic Regime, and in 72% the deambulation was prejudiced with mobility's limitation and, for all diagnoses were proposed nursing interventions objectifying the conquest of autonomy and independence of these seniors. PMID:18797782
Dangerous Urinary Tract Infections Common in Nursing Homes
... 159308.html Dangerous Urinary Tract Infections Common in Nursing Homes Study found 1 in 20 residents developed ... 2016 (HealthDay News) -- Urinary tract infections (UTIs) in nursing home residents can often have serious effects, including ...
Registered Nurse Staffing Mix and Quality of Care in Nursing Homes: A Longitudinal Analysis
ERIC Educational Resources Information Center
Kim, Hongsoo; Harrington, Charlene; Greene, William H.
Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…
Nurses in independent care homes: issues, challenges and potential.
Morris-Thompson, Trish; Marks-Maran, Diane
Many registered nurses in the UK work in the social care sector in independent care homes and nursing homes. This article explores the challenges related to providing nursing care for adults in care homes, issues arising for nurses and nursing in the social care sector, and providing a career pathway for nurses in the social care sector. Steps need to be taken to ensure that cooperation, collaboration and leadership in nursing in the social care sector is recognised and that appropriate representation of nurses in social care takes place at national level. PMID:26203504
Leisure-Time Activities in Selected Nursing Homes.
ERIC Educational Resources Information Center
Tague, Jean Ruth
This study sought to identify leisure interests and participation patterns of residents over 65 in selected nursing homes in Los Angeles County, California, together with general and professional beliefs of nursing home administrators and authorities on aging as to leisure activities for aged nursing home patients. Interviews were held with 107…
38 CFR 17.58 - Evacuation of community nursing homes.
Code of Federal Regulations, 2012 CFR
... to another facility that meets certain minimum standards, as set forth in 38 CFR 51.59(c)(1... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes....
38 CFR 17.58 - Evacuation of community nursing homes.
Code of Federal Regulations, 2013 CFR
... to another facility that meets certain minimum standards, as set forth in 38 CFR 51.59(c)(1... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes....
38 CFR 17.58 - Evacuation of community nursing homes.
Code of Federal Regulations, 2014 CFR
... to another facility that meets certain minimum standards, as set forth in 38 CFR 51.59(c)(1... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes....
Geropsychology Training in a VA Nursing Home Setting
ERIC Educational Resources Information Center
Karel, Michele J.; Moye, Jennifer
There is a growing need for professional psychology training in nursing home settings, and nursing homes provide a rich environment for teaching geropsychology competencies. We describe the nursing home training component of our Department of Veterans Affairs (VA) Predoctoral Internship and Geropsychology Postdoctoral Fellowship programs. Our…
Medicaid Nursing Home Pay for Performance: Where Do We Stand?
ERIC Educational Resources Information Center
Arling, Greg; Job, Carol; Cooke, Valerie
Purpose: Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make…
What Is Nursing Home Quality and How Is It Measured?
ERIC Educational Resources Information Center
Castle, Nicholas G.; Ferguson, Jamie C.
Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO)…
Measuring Staff Turnover in Nursing Homes
ERIC Educational Resources Information Center
Castle, Nicholas G.
Purpose: In this study the levels of staff turnover reported in the nursing home literature (1990-2003) are reviewed, as well as the definitions of turnover used in these prior studies. With the use of primary data collected from 354 facilities, the study addresses the various degrees of bias that result, depending on how staff turnover is defined…
Health Information Technology and Nursing Homes
ERIC Educational Resources Information Center
Liu, Darren
Nursing homes are considered lagging behind in adopting health information technology (HIT). Many studies have highlighted the use of HIT as a means of improving health care quality. However, these studies overwhelmingly do not provide empirical information proving that HIT can actually achieve these improvements. The main research goal of this…
Factors Associated with Increasing Nursing Home Closures
Castle, Nicholas G; Engberg, John; Lave, Judith; Fisher, Andrew
Purpose We determine the rate of nursing home closures for 7 years (1999–2005) and examine internal (e.g., quality), organizational (e.g., chain membership), and external (e.g., competition) factors associated with these closures. Design and Method The names of the closed facilities and dates of closure from state regulators in all 50 states were obtained. This information was linked to the Online Survey, Certification, and Reporting data, which contains information on internal, organizational, and market factors for almost all nursing homes in the United States. Results One thousand seven hundred and eighty-nine facilities closed over this time period (1999–2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing. Nursing homes with higher rates of deficiency citations, hospital-based facilities, chain members, small bed size, and facilities located in markets with high levels of competition were more likely to close. High Medicaid occupancy rates were associated with a high likelihood of closure, especially for facilities with low Medicaid reimbursement rates. Implications As states actively debate about how to redistribute long-term care services/dollars, our findings show that they should be cognizant of the potential these decisions have for facilitating nursing home closures. PMID:19674434
Kansas Nursing Home Medication Aide Curriculum. Revised.
ERIC Educational Resources Information Center
Bartel, Myrna J.; Fornelli, Linda K.
This curriculum guide is designed to aid Kansas instructors in conducting a course for teaching nursing home medication aides. Covered first are various introductory topics such as the role and responsibilities of medication aides, pharmacodynamics, forms in which medication is now available, common medical abbreviations, mathematics and weights…
End-of-Life Decision Making for Nursing Home Residents with Dementia: A Survey of Nursing Home Social Services Staff
ERIC Educational Resources Information Center
Lacey, Debra
The purpose of this survey was to describe nursing home social services staff roles and perceptions related to end-of-life medical decision making for nursing home residents in endstage dementia. Using a self-designed questionnaire, 138 nursing home social services staff from across New York State answered questions about advance directives,…
Is There Evidence of Cream Skimming among Nursing Homes following the Publication of the Nursing Home Compare Report Card?
ERIC Educational Resources Information Center
Mukamel, Dana B.; Ladd, Heather; Weimer, David L.; Spector, William D.; Zinn, Jacqueline S.
Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream…
Father Attendance in Nurse Home Visitation
Holmberg, John R.; Olds, David L.
Our aim was to examine the rates and predictors of father attendance at nurse home visits in replication sites of the Nurse-Family Partnership (NFP). Early childhood programs can facilitate father involvement in the lives of their children, but program improvements require an understanding of factors that predict father involvement. The sample consisted of 29,109 low-income, first-time mothers who received services from 694 nurses from 80 sites. We conducted mixed-model multiple regression analyses to identify population, implementation, site, and nurse influences on father attendance. Predictors of father attendance included a count of maternal visits (B = 0.12, SE = 0.01, F = 3101.77), frequent contact between parents (B = 0.61, SE = 0.02, F = 708.02), cohabitation (B = 1.41, SE = 0.07, F = 631.51), White maternal race (B = 0.77, SE = 0.06, F = 190.12), and marriage (B = 0.42, SE = 0.08, F = 30.08). Random effects for sites and nurses predicted father-visit participation (2.7 & 6.7% of the variance, respectively), even after controlling for population sociodemographic characteristics. These findings suggest that factors operating at the levels of sites and nurses influence father attendance at home visits, even after controlling for differences in populations served. Further inquiry about these influences on father visit attendance is likely to inform program-improvement efforts. PMID:25521707
Father attendance in nurse home visitation.
Holmberg, John R; Olds, David L
Our aim was to examine the rates and predictors of father attendance at nurse home visits in replication sites of the Nurse-Family Partnership (NFP). Early childhood programs can facilitate father involvement in the lives of their children, but program improvements require an understanding of factors that predict father involvement. The sample consisted of 29,109 low-income, first-time mothers who received services from 694 nurses from 80 sites. We conducted mixed-model multiple regression analyses to identify population, implementation, site, and nurse influences on father attendance. Predictors of father attendance included a count of maternal visits (B = 0.12, SE = 0.01, F = 3101.77), frequent contact between parents (B = 0.61, SE = 0.02, F = 708.02), cohabitation (B = 1.41, SE = 0.07, F = 631.51), White maternal race (B = 0.77, SE = 0.06, F = 190.12), and marriage (B = 0.42, SE = 0.08, F = 30.08). Random effects for sites and nurses predicted father-visit participation (2.7 & 6.7% of the variance, respectively), even after controlling for population sociodemographic characteristics. These findings suggest that factors operating at the levels of sites and nurses influence father attendance at home visits, even after controlling for differences in populations served. Further inquiry about these influences on father visit attendance is likely to inform program-improvement efforts. PMID:25521707
Nursing home nurses' perceptions of emergency transfers from nursing homes to hospital: A review of qualitative studies using systematic methods.
O'Neill, Barbara; Parkinson, Lynne; Dwyer, Trudy; Reid-Searl, Kerry
The aim is to describe nursing home nurses' perceptions around emergency transfers to hospital. Transfers are costly and traumatic for residents, and efforts are underway to avoid hospitalization. Nurses play a key role in transfers, yet their views are underreported. A systematic review of qualitative studies was undertaken, guided by Joanna Briggs Institute methods. From seven reviewed studies, it was clear nursing home nurses are challenged by the complexity of the transfer process and understand their need for appropriate clinical knowledge, skills and resources. Communication is important, yet nurses often use persuasive and targeted communication. Ambiguity, strained relationships and negative perceptions of residents' experiences around hospitalization contribute to conflict and uncertainty. Nurses are more confident when there is a plan. Transferring a resident is a complex process and special skills, knowledge and resources are required, but may be lacking. Efforts to formalize the transfer process and improve communication and collaboration amongst all stakeholders is needed and would be well received. PMID:26163012
Private Investment Purchase and Nursing Home Financial Health
Cadigan, Rebecca Orfaly; Stevenson, David G; Caudry, Daryl J; Grabowski, David C
Objective To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Data Sources Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998–2010. Study Design Regression specification incorporating facility and time fixed effects. Principal Findings We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company's real estate holdings. Conclusions Private investment acquired facilities are an important feature of today's nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. PMID:25104476
Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents.
Park, Yeonhwan; Oh, Seieun; Chang, Heekyung; Bang, Hwal Lan
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents" found on pages 30-39, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Explain the development and testing of the Evidence-Based Nursing Care Algorithm of
Optimizing Antibiotic Use in Nursing Homes Through Antibiotic Stewardship.
Sloane, Philip D; Huslage, Kirk; Kistler, Christine E; Zimmerman, Sheryl
Antibiotic stewardship is becoming a requirement for nursing homes. Programs should be interdisciplinary and multifaceted; should have support from nursing home administrators; and should aim to promote antibiotics only when needed, not just in case. Recommended components include use of evidence-based guidelines; ongoing monitoring of antibiotic prescriptions, cultures, and study results; monitoring of health outcomes; use of nursing home-specific antibiograms; regular reporting and feedback to medical providers and nurses; and education of residents and families. PMID:27621341
The influence of registered nurse staffing on the quality of nursing home care.
Munroe, D J
The purpose of this study was to determine the extent to which registered nurse (RN) staffing patterns influenced nursing home quality. Based upon extensive literature review, a model for nursing home quality was developed. Using data from reports of 455 Medicare-certified skilled nursing facilities, structural, process, and outcome factors thought to influence quality were entered into the model and analyzed using ordinary least squares regression. A small, though statistically significant, proportion of the variance in quality nursing home care was explained by the equation. A positive, significant relationship existed between nursing home quality and the ratio of RN hours to licensed vocational nurse (LVN) hours per resident day. PMID:2374834
Evaluation of a Nurse-Led Fall Prevention Education Program in Turkish Nursing Home Residents
ERIC Educational Resources Information Center
Uymaz, Pelin E.; Nahcivan, Nursen O.
Falls are a major cause of morbidity and mortality among the elderly living in nursing homes. There is a need to implement and evaluate fall prevention programs in nursing homes to reduce the number of falls. The purpose of this research was to examine the effect of a nurse-led fall prevention education program in a sample of nursing home…
Job Satisfaction of Nurse Aides in Nursing Homes: Intent to Leave and Turnover
ERIC Educational Resources Information Center
Castle, Nicholas G.; Engberg, John; Anderson, Ruth; Men, Aiju
Purpose: The relationship between job satisfaction of nurse aides and intent to leave and actual turnover after 1 year is examined. Design and Methods: Data came from a random sample of 72 nursing homes from 5 states (Colorado, Florida, Michigan, New York, and Oregon). From these nursing homes, we collected 1,779 surveys from nurse aides (a…
Why Do They Stay? Job Tenure among Certified Nursing Assistants in Nursing Homes
ERIC Educational Resources Information Center
Wiener, Joshua M.; Squillace, Marie R.; Anderson, Wayne L.; Khatutsky, Galina
Purpose: This study identifies factors related to job tenure among certified nursing assistants (CNAs) working in nursing homes. Design and Methods: The study uses 2004 data from the National Nursing Home Survey, the National Nursing Assistant Survey, and the Area Resource File. Ordinary least squares regression analyses were conducted with length…
The Roles and Functions of Medical Directors in Nursing Homes.
Nanda, Aman
The medical director is an important member of the healthcare team in a nursing home, and is responsible for overall coordination of care and for implementation of policies related to care of the residents in a nursing home. The residents in nursing homes are frail, medically complex, and have multiple disabilities. The medical director has an important leadership role in assisting nursing home administration in providing quality care that is consistent with current standards of care. This article provides an overview of roles and functions of the medical director, and suggests ways the medical director can be instrumental in achieving excellent care in today's nursing facilities. PMID:26056830
The Influence of Consistent Assignment on Nursing Home Deficiency Citations
ERIC Educational Resources Information Center
Castle, Nicholas G.
Objective: The association of consistent assignment of nurse aides (NAs) with quality of care and quality of life of nursing home residents is examined (using 5 groups of deficiency citations). Methods: Data used came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The…
Measuring End-of-Life Care Processes in Nursing Homes
ERIC Educational Resources Information Center
Temkin-Greener, Helena; Zheng, Nan; Norton, Sally A.; Quill, Timothy; Ladwig, Susan; Veazie, Peter
Purpose: The objectives of this study were to develop measures of end-of-life (EOL) care processes in nursing homes and to validate the instrument for measuring them. Design and Methods: A survey of directors of nursing was conducted in 608 eligible nursing homes in New York State. Responses were obtained from 313 (51.5% response rate) facilities.…
The 24-h recall instrument for home nursing to measure the activity profile of home nurses: development and psychometric testing.
De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Gosset, Christiane; Heyden, Isabelle; Van Geert, Michel; Moons, Philip
Home health care today is challenged by a shift from an acute to a chronic health-care model, moving the focus of care from the hospital to home-care setting. This increased focus on care at home emphasizes the need for an efficient, effective, and transparent management of home health care. However, it is not precisely known what home-care nurses do; what kind of care is received by patients; what the performance of home nurses is; and what the impact of the increasing need for home nursing is on the current and future role of home nurses. In this respect, it is necessary to gain a clear insight into the activity profile of home nurses, but there is no gold standard to measure their activities. This study reports on the development and psychometric testing of the '24-hour recall instrument for home nursing' to measure the activity profile of home nurses. Five home nurses in Belgium, simultaneously with the researcher, registered the performed activities in a total of 69 patients, using the 24-h recall instrument for home nursing. The validity and the interrater reliability of this instrument were high: the proportions that observed agreement were very high; the strength of kappa agreement was substantial to almost perfect; the prevalence index showed great variety; and the bias index was low. The findings in this study support the validity evidence based on test content and the interrater reliability of the 24-h recall instrument. This instrument can help to shape practice and policy by making the home nursing profession more transparent: a clear insight into the kind of care that is provided by home nurses and is received by the patients in primary care contributes to the development of a clear definition of the role of home nurses in health care. PMID:24479985
Nursing home deficiency citations for safety
Castle, NG; Wagner, LM; Ferguson, JC; Handler, SM
Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational (i.e., characteristics of the facility itself) and external (i.e., characteristics outside of the influence of the organization) factors associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents. PMID:21207305
Nursing home deficiency citations for safety.
Castle, Nicholas G; Wagner, Laura M; Ferguson, Jamie C; Handler, Steven M
Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents. PMID:21207305
Prevention of unethical actions in nursing homes.
Solum, Eva Merethe; Slettebø, Ashild; Hauge, Solveig
Ethical problems regularly arise during daily care in nursing homes. These include violation of patients' right to autonomy and to be treated with respect. The aim of this study was to investigate how caregivers emphasize daily dialogue and mutual reflection to reach moral alternatives in daily care. The data were collected by participant observation and interviews with seven caregivers in a Norwegian nursing home. A number of ethical problems linked to 10 patients were disclosed. Moral problems were revealed as the caregivers acted in ways that they knew were against patients' interest. We used a theoretical interpretation according to Habermas' discourse ethics on the importance of dialogue when deciding moral courses of action for patients. This theory has four basic requirements: communicative competence, equality, self-determination, and openness about motives. PMID:18515442
Factors influencing the recommendation of nursing homes.
Becker, B W; Kaldenberg, D O
This article reviews and compares the perceptions of nursing homes by residents and their proxies (family, friends, etc.) and reports that residents tended to give higher ratings to services than do their proxies. The analysis attempts to determine why residents give higher marks, which group the facility should look to for feedback, and whether the ratings will help organize the strengths and weaknesses in the facility to produce positive word of mouth within the community. PMID:11209476
[Compassionate care and the nursing home's charter].
Poivet, Valérie
The creation of a nursing home for dependent elderly people, disabled people or those with dementia provided an opportunity to reflect on the institute's charter. The main objective was to create a place in which residents and professionals feel good. An inter-professional collaborative approach focusing on the needs and aptitudes of the residents favoured the creation of an ideal climate. Thanks to the commitment of all concerned, the objectives have been achieved. PMID:27173631
77 FR 72738 - Contracts and Provider Agreements for State Home Nursing Home Care
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS 38 CFR Part 51 RIN 2900-AO57 Contracts and Provider Agreements for State Home Nursing Home Care... agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking is required to implement a change in law that revises how VA will pay for care provided to these veterans...
Family Perceptions of Geriatric Foster Family and Nursing Home Care.
ERIC Educational Resources Information Center
Braun, Kathryn L.; Rose, Charles L.
Relatives (N=62) of matched pairs of patients in geriatric foster homes and nursing homes rated care provided to their relatives. Significantly more foster family patients had positive pre-placement attitudes than did nursing home patients. Upon follow-up, relatives of foster patients reported seeing more patient improvement, satisfaction,…
Organizational Characteristics Associated with Staff Turnover in Nursing Homes
ERIC Educational Resources Information Center
Castle, Nicholas G.; Engberg, John
Purpose: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Design and Methods: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality,…
Healing at Home: 100 Years of Public Health Nursing.
ERIC Educational Resources Information Center
Fahy, Ellen T.; And Others
Includes "Now More than Ever" (Fahy); "Healing at Home" (photo essay); "Amelia Greenwald: Pioneer in International Public Health Nursing" (Mayer); "Alaska's Watched Pot" (Nord); and "Gertrude Weld Peabody: Unsung Patron of Public Health Nursing Education" (Doona). (JOW)
Return to nursing home investment: Issues for public policy
Baldwin, Carliss Y.; Bishop, Christine E.
Because Government policy does much to determine the return available to nursing home investment, the profitability of the nursing home industry has been a subject of controversy since Government agencies began paying a large portion of the Nation's nursing home bill. Controversy appears at several levels. First is the rather narrow concern, often conceived in accounting terms, of the appropriate reimbursement of capital-related expense under Medicaid and Medicare. Second is the concern about how return to capital affects the flow of investment into nursing homes, leading either to inadequate access to care or to over-capacity. Third is the concern about how-sources of return to nursing home investment affect the pattern of nursing home ownership and the amount of equity held by owners since the pattern of ownership and amount of equity have been linked to quality of care. PMID:10310945
Nurses take center stage in private duty home care.
Brackett, Nicole
The Affordable Care Act gives America's largest group of health care providers--nurses--a unique chance to lead in improving outcomes, increasing patient satisfaction, and lowering costs. Nurses' roles continue to grow in settings from hospitals and long-term care facilities to home health and hospice agencies. Nurses are also key players in private duty home care, where they serve as care coordinators for clients. Working directly with doctors, therapists, in-home caregivers, and families, nurses are critical in delivering quality, seamless in-home care. PMID:24069792
A longitudinal analysis of nursing home outcomes.
Porell, F; Caro, F G; Silva, A; Monane, M
OBJECTIVE: To investigate resident and facility attributes associated with long-term care health outcomes in nursing homes. DATA SOURCES: Quarterly Management Minutes Questionnaire (MMQ) survey data for Medicaid case-mix reimbursement of nursing homes in Massachusetts from 1991 to 1994, for specification of outcomes and resident attributes. Facility attributes are specified from cost report data. STUDY DESIGN: Multivariate logistic and "state-dependence" regression models are estimated for survival, ADL functional status, incontinence status, and mental status outcomes from longitudinal residence histories of Medicaid residents spanning 3 to 36 months in length. Outcomes are specified to be a function of resident demographic and diagnostic attributes and facility-level operating and nurse staffing attributes. PRINCIPAL FINDINGS: The estimated parameters for resident demographic and diagnostic attributes showed a great deal of construct validity with respect to clinical expectations regarding risk factors for adverse outcomes. Few facility attributes were associated with outcomes generally, and none was significantly associated with all four outcomes. CONCLUSIONS: The absence of uniform associations between facility attributes and the various long-term care health outcomes studied suggests that strong facility performance on one health outcome may coexist with much weaker performance on other outcomes. This has implications for the aggregation of individual facility performance measures on multiple outcomes and the development of overall outcome performance measures. PMID:9776939
Management of agitation in nursing home patients.
Billig, N
Agitation in demented nursing home residents is a major clinical problem with which patients, families and staff are required to cope. Agitation may be secondary to a variety of psychiatric, environmental and medical problems, and thus attempts must be made to [correction of be] clarify aetiological issues before initiating a treatment plan. Treatments for agitation are imperfect, and clinicians should be prepared to work through several to find the best for a given patient and clinical situation. Cognitive/behavioural/environmental treatments have the advantage of few or no adverse effects and no drug-drug interactions. Some of these define rather basic nursing management techniques for coping with agitated older adults, while others attempt to diminish specific behaviours. The use of pharmacological interventions should be reserved for those patients in whom other measures have been unsuccessful. While the range of medications that have been used to treat various kinds of agitated behaviours is large, there are few double-blind, placebo-controlled trials in this area and fewer still in nursing home populations. No one class and no one medication has been identified as a treatment of choice. While we work to find the aetiological mechanisms of irreversible forms of dementia, and the possible treatments for the underlying disorders, the challenge to develop more effective medications with better adverse effect profiles is before us. PMID:8820795
Certified Nursing Assistants' Explanatory Models of Nursing Home Resident Depression
Piven, Mary Lynn; Anderson, Ruth A.; Colón-Emeric, Cathleen S.; Sandelowski, Margarete
In this study, we explored how Certified Nursing Assistants (CNAs) understood resident depression. Interviews with 18 CNAs, working in two nursing homes were guided by Kleinman's Explanatory Models of Illness framework. Interview data were content analyzed and CNAs' descriptions of depression were compared to the MDS 2.0 Mood Screen and to DSM-IV-TR Depression Criteria. CNAs identified causes, signs, and symptoms of depression, but they were unsure about the duration and normalcy of depression in residents. Although they had no formal training, CNAs felt responsible for detecting depression and described verbal and non-verbal approaches that they used for emotional care of depressed residents. CNAs hold potential to improve the detection of depression and contribute to the emotional care of residents. Attention to knowledge deficits and facility barriers may enhance this capacity. PMID:18390825
What pediatric home care offers the nurse.
Peirson, G S
Pammy had never been home in her 16 months of life. She'd never been in a car seat, seen her sister go off to school, or sat outside in her stroller. Today was the first day of a new life. While her Dad finished putting the crib together and the respiratory therapist arrived with the missing ventilator connector, her mother and her nurse Judy were accompanying her in the ambulance home. Soon her tube-feeding bag was hanging on a hook next to the "Welcome Home, Pammy" sign that a neighbor had made on his computer, and her four-year-old brother was building a runway under the nurse's feet. The back-up ventilator filled a quarter of the small living room, and the tubing, suction catheters, vent parts, formula, and water bottles filled the closet in Pammy's room--large enough because Mom and Dad had moved out of the master bedroom. Judy had helped Pam's mother set up the room a week ago and already had a sense of her concerns, the four-year-old's busyness, and the irregular schedule that the father worked. This would be an enjoyable, but challenging experience. PMID:8295516
Person-Environment Interactions Contributing to Nursing Home Resident Falls
Hill, Elizabeth E.; Nguyen, Tam H.; Shaha, Maya; Wenzel, Jennifer A.; DeForge, Bruce R.; Spellbring, Ann Marie
Although approximately 50% of nursing home residents fall annually, the surrounding circumstances remain inadequately understood. This study explored nursing staff perspectives of person, environment, and interactive circumstances surrounding nursing home falls. Focus groups were conducted at two nursing homes in the mid-Atlantic region with the highest and lowest fall rates among corporate facilities. Two focus groups were conducted per facility: one with licensed nurses and one with geriatric nursing assistants. Thematic and content analysis revealed three themes and 11 categories. Three categories under the Person theme were Change in Residents' Health Status, Decline in Residents' Abilities, and Residents' Behaviors and Personality Characteristics. There were five Nursing Home Environment categories: Design Safety, Limited Space, Obstacles, Equipment Misuse and Malfunction, and Staff and Organization of Care. Three Interactions Leading to Falls categories were identified: Reasons for Falls, Time of Falls, and High-Risk Activities. Findings highlight interactions between person and environment factors as significant contributors to resident falls. PMID:20077985
Are nursing homes adequately staffed? The silent epidemic of malnutrition and dehydration in nursing home residents. Until mandatory staffing standards are created and enforced, residents are at risk.
Shipman, Debra; Hooten, Jack
Providing care to produce positive resident outcomes is an ethical duty of nursing home staff. Research has shown that inadequate staffing levels present an increased health risk to nursing home residents. Nursing home residents may experience dehydration and malnutrition caused by inadequate staffing. Continued research in the area of nutrition and dehydration in nursing home residents may positively influence changes in staffing levels at nursing homes. Currently, residents living in understaffed nursing homes and not receiving proper care are the victims. It is time for nurses to forcefully lobby for national mandatory nurse staffing standards. PMID:17672164
Workplace Stress and Ethical Challenges Experienced by Nursing Staff in a Nursing Home
ERIC Educational Resources Information Center
Vondras, Dean D.; Flittner, Diane; Malcore, Sylvia A.; Pouliot, Gregory
This research explores the workplace stress and ethical challenges reported by healthcare staff in a nursing home. A brief self-report survey was administered to 44 members of the nursing staff in a not-for-profit nursing home. The survey included items that elicited identification of specific workplace stressors and ethical challenges and global…
Nursing Practice Environment and Registered Nurses' Job Satisfaction in Nursing Homes
Choi, JiSun; Flynn, Linda; Aiken, Linda H.
Purpose: Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs in nursing homes. Design and Methods: The sample included 863 RNs working as staff RNs in 282 skilled nursing facilities in New Jersey. Two-level hierarchical linear modeling was used to account for the RNs nested by nursing homes. Results: Controlling for individual and nursing home characteristics, staff RNs' participation in facility affairs, supportive manager, and resource adequacy were positively associated with RNs' job satisfaction. Ownership status was significantly related to job satisfaction; RNs working in for-profit nursing homes were less satisfied. Implications: A supportive practice environment is significantly associated with higher job satisfaction among RNs working in nursing homes. Unlike other nursing home characteristics, specific dimensions of the nursing practice environment can be modified through administrative actions to enhance RN job satisfaction. PMID:21908803
Patient safety culture assessment in the nursing home
Handler, S M; Castle, N G; Studenski, S A; Perera, S; Fridsma, D B; Nace, D A; Hanlon, J T
Objective To assess patient safety culture (PSC) in the nursing home setting, to determine whether nursing home professionals differ in their PSC ratings, and to compare PSC scores of nursing homes with those of hospitals. Methods The Hospital Survey on Patient Safety Culture was modified for use in nursing homes (PSC‐NH) and distributed to 151 professionals in four non‐profit nursing homes. Mean scores on each PSC‐NH dimension were compared across professions (doctors, pharmacists, advanced practitioners and nurses) and with published benchmark scores from 21 hospitals. Results Response rates were 68.9% overall and 52–100% for different professions. Most respondents (76%) were women and had worked in nursing homes for an average of 9.8 years, and at their current facility for 5.4 years. Professions agreed on 11 of 12 dimensions of the survey and differed significantly (p<0.05) only in ratings for one PSC dimension (attitudes about staffing issues), where nurses and pharmacists believed that they had enough employees to handle the workload. Nursing homes scored significantly lower (ie, worse) than hospitals (p<0.05) in five PSC dimensions (non‐punitive response to error, teamwork within units, communication openness, feedback and communication about error, and organisational learning). Conclusions Professionals in nursing homes generally agree about safety characteristics of their facilities, and the PSC in nursing homes is significantly lower than that in hospitals. PSC assessment may be helpful in fostering comparisons across nursing home settings and professions, and identifying targets for interventions to improve patient safety. PMID:17142586
Reorganizing the nursing home industry: a proposal.
Shulman, D; Galanter, R
This paper proposes a reorganization of the nursing home industry with capital facilities owned by government, but with management conducted through a system of competitive contracts with the private sector. The paper explicity demonstrates in real estate finance terms how the present system of private ownership of capital facilities inherently impedes providing a high quality of care. The authors believe that in the proposed industry reorganization, market forces, instead of working against quality care, would be supportive of quality care in a framework that would involve generally less regulation than exists today. PMID:1272543
Nursing staff knowledge and beliefs about pain in elderly nursing home residents with dementia
Zwakhalen, Sandra MG; Hamers, Jan PH; Peijnenburg, Rieneke HA; Berger, Martijn PF
BACKGROUND: Aging is known to be associated with a high prevalence (up to 80%) of persistent pain among residents of nursing homes. However, even with high pain prevalence rates, nursing home residents are at risk for undertreatment. Knowledge deficits and beliefs among nurses influence staff behaviour in pain assessment and management. OBJECTIVES: To develop a psychometrically sound questionnaire and to gather information about knowledge and beliefs of nursing staff regarding various aspects of pain in elderly patients with dementia. In addition, the differences among several categories of nurses (based on educational level and work experience) with respect to beliefs about pain were investigated. METHODS: Participants were 123 staff members of psychogeriatric wards in two nursing homes in the Netherlands (mean of 11.4 years of experience). Their results were compared with those of two groups of nurses, one consisting of 25 registered nurse PhD students in nursing science and the other consisting of 20 trainee pain nurse specialists. RESULTS: The main findings indicate that nursing home staff respondents showed knowledge deficits about several aspects of pain, even though they were satisfied about the way pain was assessed and treated at their wards. Specific knowledge deficits were found regarding pain treatment and medication in elderly nursing home residents. Staff educational level seemed to influence their beliefs and knowledge about pain in elderly nursing home patients. PMID:17717609
Why Won't Physicians Make Nursing Home Visits?
ERIC Educational Resources Information Center
Mitchell, Janet B.; Hewes, Helene T.
Michigan physicians (N=930) were asked whether they made nursing home visits and if not, why not. A typology was developed to differentiate among various physician types based on reasons given. Six physician types were found, each identified with a different policy lever that could be used to encourage them to treat nursing home patients. (Author)
Are ADNs Prepared to Be Home Health Nurses?
ERIC Educational Resources Information Center
Neighbors, Marianne; Monahan, Frances D.
Responses from 132 of 350 home health nurses identified techniques and skills associate degree nurses (ADNs) should acquire to work for home health agencies. Accredited ADN programs reported that only 24 of the techniques are taught in all programs and 55 of the skills are taught in 90% of the programs. (SK)
Medicare Part D and the Nursing Home Setting
ERIC Educational Resources Information Center
Stevenson, David G.; Huskamp, Haiden A.; Newhouse, Joseph P.
Purpose: The purpose of this article is to explore how the introduction of Medicare Part D is changing the operations of long-term-care pharmacies (LTCPs) and nursing homes, as well as implications of those changes for nursing home residents. Design and Methods: We reviewed existing sources of information and interviewed stakeholders across…
Organizational Climate Determinants of Resident Safety Culture in Nursing Homes
ERIC Educational Resources Information Center
Arnetz, Judith E.; Zhdanova, Ludmila S.; Elsouhag, Dalia; Lichtenberg, Peter; Luborsky, Mark R.; Arnetz, Bengt B.
Purpose of the Study: In recent years, there has been an increasing focus on the role of safety culture in preventing costly adverse events, such as medication errors and falls, among nursing home residents. However, little is known regarding critical organizational determinants of a positive safety culture in nursing homes. The aim of this study…
ERIC Educational Resources Information Center
Learning Opportunities for Nurses Working within Home Care
ERIC Educational Resources Information Center
Lundgren, Solveig
Purpose: The purpose of this study is to explore home care nurses' experience of learning in a multicultural environment. Design/methodology/approach: The study was based on qualitative research design. Data were collected through repeated interviews with registered home care nurses working in a multicultural area. The data were analyzed through a…
Establishing and Maintaining Intimate Relationships among Nursing Home Residents.
ERIC Educational Resources Information Center
Crose, Royda
Argues that nursing home mental health counselors should address nursing home residents' need for assistance in conflict resolution, having meaningful social interactions, and in developing and maintaining feelings of self-worth. Describes benefits of group therapy approach using life review format to help build basic trust and feelings of…
The Effects of Monthly Psychiatric Consultation in a Nursing Home.
ERIC Educational Resources Information Center
Tourigny-Rivard, Marie-France; Drury, Marilyn
Studied the effects of monthly psychiatric consultation in a nursing home. Suggested that consultation was primarily useful to staff providing direct care to referred residents. Cited benefits to residents as increased staff awareness and acceptance of emotional problems and increased frequency of therapeutic programs offered at the nursing home.…
Medicaid Spenddown among Nursing Home Residents in Wisconsin.
ERIC Educational Resources Information Center
Arling, Greg; And Others
Examined Medicaid spenddown among nursing home residents from 72 Wisconsin facilities. Found only small proportion of discharges had spent down to Medicaid eligibility, but this group's long stays contributed heavily to nursing home days. Estimated over 40 percent of those who spent down did so within six months, 58 percent within a year, and 76…
Patients' Anticipation of Stress in Nursing Home Care.
ERIC Educational Resources Information Center
Stein, Shayna; And Others
Examined anticipation of stresses in 223 patients recently admitted to nursing homes, who completed the stresses in Institutional Care Scale (SIC). Factor analysis revealed five factors significantly related to psychological and physical variables. Suggests using SIC for admission screening in nursing homes. Appendix contains the SIC. (NRB)
Observational Learning among Older Adults Living in Nursing Homes
ERIC Educational Resources Information Center
Story, Colleen D.
The purpose of this study was to evaluate learning by older adults living in nursing homes through observational learning based on Bandura's (1977) social learning theory. This quantitative study investigated if older adults could learn through observation. The nursing homes in the study were located in the midwestern United States. The…
Top Management Team Characteristics and Innovation in Nursing Homes.
ERIC Educational Resources Information Center
Castle, Nicholas G.; Banaszak-Holl, Jane
Examines how demographic characteristics of the top management team in 236 nursing homes can affect the adoption of innovations. Results indicate that managers of non-chain nursing homes showed a greater association between demographic factors and innovation. Job tenure, educational background, and professional involvement were important…
[Internal and external assessment of nursing home residents' satisfaction].
Sanchez, Stéphane; Cohen, Nadia; Bertin-Hugault, François; Sanchez, Marc Antoine; Dramé, Moustapha; Denormandie, Philippe
Quality improvement procedures and measuring the satisfaction of nursing home residents is a major priority. A study assessed the differences between the results of a survey conducted by internal staff and of one carried out by an external service provider to evaluate the satisfaction of the residents of a nursing home. PMID:27449308
Geriatric Training Needs of Nursing-Home Physicians
ERIC Educational Resources Information Center
Lubart, Emily; Segal, Refael; Rosenfeld, Vera; Madjar, Jack; Kakuriev, Michael; Leibovitz, Arthur
Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training…
Social Support in Elderly Nursing Home Populations: Manifestations and Influences
ERIC Educational Resources Information Center
Rash, Elizabeth M.
The purpose of this study was to describe the characteristics of social support and the influencing factors on social support in nursing home environments. Observations and staff questionnaires from two central Florida nursing homes were used in this grounded theory study to answer the following questions: (1) How is social support manifested? and…
Improving Nursing Home Staff Knowledge and Attitudes about Pain
ERIC Educational Resources Information Center
Jones, Katherine R.; Fink, Regina; Pepper, Ginny; Hutt, Eveyln; Vojir, Carol P.; Scott, Jill; Clark, Lauren; Mellis, Karen
Purpose: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. Design and Methods: Twelve nursing homes participated in this intervention study: six…
Nursing Home Litigation and Tort Reform: A Case for Exceptionalism
ERIC Educational Resources Information Center
Studdert, David M.; Stevenson, David G.
The medical malpractice crisis that is currently spreading across the United States bears many similarities to earlier crises. One novel aspect of the current crisis is the explicit inclusion of litigation against nursing homes as a target of reform. Encouraged by the nursing home industry, policymakers are considering the extension of…
The Teaching Nursing Home as an Academic Program.
ERIC Educational Resources Information Center
Weiler, Philip G.
Reviews the origins of the teaching nursing home concept, describes its goals and major components, and explores some of the problems in developing it as an academic program. Asserts that the teaching nursing home, if properly developed, can be a strong academic program that improves geriatric patient care, research, and teaching. (Author/ABB)
Preparing Tomorrow's Nursing Home Nurses: The Wisconsin-Long Term Care Clinical Scholars Program
Nolet, Kim; Roberts, Tonya; Gilmore-Bykovskyi, Andrea; Roiland, Rachel; Gullickson, Colleen; Ryther, Brenda; Bowers, Barbara J.
Preparing future nurses to care for the growing population of older adults has become a national priority. The demand for long term care services is expected to double between 2000 and 2040, yet the field remains stigmatized as an undesirable place for highly-skilled nurses to work. Recent efforts to increase student preparation in geriatrics have been shown to improve student attitudes toward working with older adults and increase knowledge, but long term care settings remain unattractive to students. This paper reports on development, implementation and evaluation of The Wisconsin Long Term Care Clinical Scholars Program, a nursing home internship for baccalaureate nursing students. The program couples a paid nursing home work experience with an evidence-based long term care nursing curriculum. The program increased student preparation and interest in working with older adults and in nursing homes, while concurrently increasing the capacity of nursing homes to provide a positive student experience. PMID:25162659
The Impact of Certificate-of-Need Laws on Nursing Home and Home Health Care Expenditures
Rahman, Momotazur; Galarraga, Omar; Zinn, Jacqueline S.; Grabowski, David C.; Mor, Vincent
Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes. PMID:26223431
The role of the clinical nurse specialist in home healthcare.
Adams, Jennifer H
Incorporating clinical nurse specialists (CNS) into home healthcare models is crucial for agencies that want to be on the leading edge of healthcare. As an advanced practice nurse, the CNS adds value by working with patients, home healthcare clinicians, and systems to improve patient outcomes. The CNS is a change agent who directly impacts the client during transitions in and out of home care, throughout the course of chronic disease management, and by assuring quality care is delivered by field clinicians. PMID:25654346
Nursing Home Resident Symptomatology Triggering Transfer: Avoiding Unnecessary Hospitalizations
Ashcraft, Alyce S.; Champion, Jane Dimmitt
The purpose of this study was to describe nursing home resident symptomatology and medical diagnoses associated with nursing home to hospital transfers. A retrospective chart review of documented transfers was conducted at a 120-bed, nonprofit urban Continuing Care Retirement Center nursing home facility located in the southwestern United States. The transferred residents (n = 101) had seventy different medical diagnoses prior to hospital transfer with hypertension, coronary artery disease, and congestive heart failure most frequently reported. Most frequently reported symptomatology included fatigue, lethargy or weakness, shortness of breath, and change in level of consciousness. Multiple symptomatology was indicative of a wide variety of medical diagnoses. The diagnoses and symptomatology recorded in this paper identify the importance of strategic planning concerning assessment and communication of common nursing home resident symptomatology and the importance of basic nursing and diagnostic procedures for prevention of potentially avoidable hospitalizations. PMID:23091714
Nursing home case mix in Wisconsin. Findings and policy implications.
Arling, G; Zimmerman, D; Updike, L
Along with many other states, Wisconsin is considering a case mix approach to Medicaid nursing home reimbursement. To support this effort, a nursing home case mix model was developed from a representative sample of 410 Medicaid nursing home residents from 56 facilities in Wisconsin. The model classified residents into mutually exclusive groups that were homogeneous in their use of direct care resources, i.e., minutes of direct care time (weighted for nurse skill level) over a 7-day period. Groups were defined initially by intense, Special, or Routine nursing requirements. Within these nursing requirement categories, subgroups were formed by the presence/absence of behavioral problems and dependency in activities of daily living (ADL). Wisconsin's current Skilled/Intermediate Care (SNF/ICF) classification system was analyzed in light of the case mix model and found to be less effective in distinguishing residents by resource use. The case mix model accounted for 48% of the variance in resource use, whereas the SNF/ICF classification system explained 22%. Comparisons were drawn with nursing home case mix models in New York State (RUG-II) and Minnesota. Despite progress in the study of nursing home case mix and its application to reimbursement reform, methodologic and policy issues remain. These include the differing operational definitions for nursing requirements and ADL dependency, the inconsistency in findings concerning psychobehavioral problems, and the problem of promoting positive health and functional outcomes based on models that may be insensitive to change in resident conditions over time. PMID:2493112
Sexual Abuse of Older Residents in Nursing Homes: A Focus Group Interview of Nursing Home Staff
Iversen, Maria Helen; Kilvik, Astrid; Malmedal, Wenche
The objective of this study was to increase knowledge of sexual abuse against older residents in nursing homes. A qualitative approach was used. Through a focus group interview with staff in nursing homes, the aim was to reveal employees' thoughts, experiences, and attitudes. Findings from the focus group interview show that sexual abuse of older residents is a taboo topic among health professionals. Acts of sexual abuse are difficult to imagine; it is hard to believe that it occurs. The fact that staff are not aware that it could happen, or have a hard time believing that it actually happens, can amplify the residents' vulnerable position as potential victims of abuse, and it makes it even more challenging to report or uncover such acts. The study highlights the need for education of all health care workers in Norway as well as more research on sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step towards addressing sexual abuse of the aged in a more appropriate way. Further research must aim to reveal more about this taboo area. PMID:26078879
Analysis of nursing home capital reimbursement systems
Boerstler, Heidi; Carlough, Tom; Schlenker, Robert E.
An increasing number of States are using a fair-rental approach for reimbursement of nursing home capital costs. In this study, two variants of the fair-rental capital-reimbursement approach are compared with the traditional cost-based approach in terms of after-tax cash flow to the investor, cost to the State, and rate of return to investor. Simulation models were developed to examine the effects of each capital-reimbursement approach both at specific points in time and over various periods of time. Results indicate that although long-term costs were similar for the three systems, both fair-rental approaches may be superior to the traditional cost-based approach in promoting and controlling industry stability and, at the same time, in providing an adequate return to investors. PMID:10110878
Terminal patients in Belgian nursing homes: a cost analysis.
Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Vanden Berghe, Paul; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan
Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 € per patient during the final month of life. Total mean nursing home costs per patient of 3,822 € for patients receiving usual care were higher than costs of 2,456 € for patients receiving palliative care (p = 0.068). Higher costs of usual care were driven by higher hospitalization costs (p < 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. PMID:22367732
Contextual determinants of US nursing home racial/ethnic diversity.
Davis, Jullet A; Weech-Maldonado, Robert; Lapane, Kate L; Laberge, Alex
We hypothesized that for-profit/chain affiliated nursing homes, those in states with higher Medicaid reimbursement, and those in more competitive markets would have greater resident racial/ethnic diversity than nursing homes not meeting these criteria. Using 2004 Online Survey, Certification and Reporting data, Minimum Data Set, Lewis Mumford Center for Comparative Urban and Regional Research data, and the Area Resource File, we included U.S. Medicare/Medicaid certified nursing homes (N = 8950) located in 310 Metropolitan Statistical Areas. The dependent variable quantified facility-level multiracial diversity. Ordinary least squares regression showed support for the hypothesized relationships: for-profit/chain affiliated nursing homes were more diverse than nursing homes in all other ownership/chain member categories, while higher Medicaid per-diem rates, greater residential diversity, and stronger market competition were also positively associated with nursing home racial/ethnic composition. Results suggest there is room for policy changes to achieve equitable access to all levels of nursing home services for minority elders. PMID:24581072
A Measure of Palliative Care in Nursing Homes
Thompson, Sarah; Bott, Marjorie; Boyle, Diane; Gajewski, Byron; Tilden, Virginia P.
Context Efforts to improve care for nursing home residents stand to be enhanced by measures to assess the degree to which staff provide palliative care. As the incidence of death in nursing homes increases with the aging population, the gap in measurement must be addressed. To that end, we report the development and psychometric testing of a nursing home palliative care survey. Objectives The purpose of this study was to evaluate the psychometric properties of the Palliative Care Survey for use in nursing homes. Methods Psychometric evaluation of the instrument was completed in two phases. Phase 1 focused on individual item analyses and subsequent revision or deletion of items, and Phase 2 evaluated evidence for reliability and validity. Phase 1 included 26 nursing homes and staff (n = 717) and Phase 2 included 85 nursing homes and staff (n = 2779). Data were analyzed using item-total correlations, Cronbach's alpha, confirmatory factor analysis, and analysis of variance (ANOVA). Results Support was obtained for a 51-item Palliative Care Survey (PCS) made up of two constructs Palliative Care Practice and Palliative Care Knowledge. Conclusion The PCS measures the extent to which nursing home staff engage in palliative care practices and have knowledge consistent with good end-of-life care. Both practice and knowledge are an essential foundation to providing good end-of-life care to nursing home residents. Efforts to improve care for the dying in nursing homes have been slowed by an absence of measurement tools that capture care processes; a gap, which the Palliative Care Survey reported here, helps fill. PMID:20797836
Delirium in the Nursing Home Emergency Department Patient
Han, Jin H.; Morandi, Alessandro; Ely, E. Wesley; Callison, Clay; Zhou, Chuan; Storrow, Alan B.; Dittus, Robert S.; Habermann, Ralf; Schnelle, John
Objectives Nursing home patients are an important segment of the aging population, but are often neglected in emergency department (ED) delirium studies. We sought to determine if nursing home patients are more likely to present to the ED with delirium compared to non-nursing home patients, and explore how variations in their delirium risk factor profiles contribute to this relationship. Design Prospective cross-sectional study. Setting Tertiary care, academic ED. Participants Three hundred forty one English speaking patients who were 65 years and older. Measurements Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Multivariable logistic regression was used to determine if nursing home residence was associated with delirium. Odds ratios (OR) with their 95% confidence intervals (95%CI) were reported. Results Of the 341 patients enrolled, 58 (17%) resided in a nursing home. A total of 38 (11.2%) patients were considered to have delirium in the ED. Twenty two (37.9%) and 16 (5.7%) of nursing home and non-nursing home patients, respectively, had delirium in the ED with an unadjusted OR (95%CI) of 10.2 (4.9 – 21.2). After adjusting for dementia, a Katz ADL < 5, hearing impairment, and the presence of systemic inflammatory response syndrome (SIRS), nursing home residence was independently associated with delirium in the ED (adjusted OR = 4.2, 95%CI: 1.8 – 9.7). Conclusion In the ED setting, nursing home patients were more likely to present with delirium, and this relationship persisted after adjusting for delirium risk factors. PMID:19484845
42 CFR 431.704 - Nursing homes designated by other terms.
Code of Federal Regulations, 2014 CFR
... 42 Public Health 4 2014-10-01 2014-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term "nursing home," the CMS Administrator will determine the...
42 CFR 431.704 - Nursing homes designated by other terms.
Code of Federal Regulations, 2011 CFR
... 42 Public Health 4 2011-10-01 2011-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term "nursing home," the CMS Administrator will determine the...
42 CFR 431.704 - Nursing homes designated by other terms.
Code of Federal Regulations, 2010 CFR
... 42 Public Health 4 2010-10-01 2010-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term "nursing home," the CMS Administrator will determine the...
42 CFR 431.704 - Nursing homes designated by other terms.
Code of Federal Regulations, 2013 CFR
... 42 Public Health 4 2013-10-01 2013-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term "nursing home," the CMS Administrator will determine the...
42 CFR 431.704 - Nursing homes designated by other terms.
Code of Federal Regulations, 2012 CFR
... 42 Public Health 4 2012-10-01 2012-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term "nursing home," the CMS Administrator will determine the...
Infections in Nursing Homes: Epidemiology and Prevention Programs.
Montoya, Ana; Cassone, Marco; Mody, Lona
This review summarizes current literature pertaining to infection prevention in nursing home population including post-acute care patients and long-term care residents. Approximately 2 million infections occur each year and more than one-third of older adults harbor multidrug-resistant organisms in this setting. Surveillance, hand hygiene, isolation precautions, resident and employee health programs, education, and antibiotic stewardship are essential elements of infection prevention and control programs in nursing homes. This article discusses emerging evidence suggesting the usefulness of interactive multimodal bundles in reducing infections and antimicrobial resistance, thereby enhancing safety and quality of care for older adults in nursing homes. PMID:27394025
Muslim nursing homes in the United States: barriers and prospects.
Alfarah, Ziad; Ramadan, Fadi H; Cury, Emily; Brandeis, Gary H
Historically, many nursing homes in the United States have been established by religious groups. This was done to provide care for the elderly when care could not be furnished in other venues. Despite several attempts reported in the literature, there are currently no Muslim nursing homes in the United States. In the Arab and Muslim world, the acceptance and success of such an institution has been somewhat variable. As the Arab Muslim population in the United States ages and becomes more frail, the Muslim community will have to evaluate the need to establish nursing homes to provide care for elderly. PMID:21889415
[Work related predictors for "satisfaction with dementia care" among nurses working in nursing homes].
Schmidt, Sascha G; Palm, Rebecca; Dichter, Martin; Hasselhorn, Hans Martin
In German nursing homes dementia care is gaining increasing relevance. Dementia care is known to bear the high risk of a substantial occupational burden among nursing staff. Within this context, the "nurses' satisfaction with the care for residents with dementia" is investigated. Secondary data of the German 3q-study is used to assess degrees of nurses' satisfaction with the care for residents with dementia and potential work related predictors. Data from 813 nurses and nursing aides working in 53 nursing homes were included. 42% of all nursing staff was dissatisfied with the care for residents with dementia in their institution, however, pronounced differences were found between the institutions. Registered nurses and nurses in leading positions were more dissatisfied. A multiple regression analysis indicates that high "quantitative demands", low "leadership quality" and "social interaction with other professions" are strong predictors for nurses' satisfaction with the care for residents with dementia. No association was found for "emotional demands" and "possibilities for development". The results indicate that the "nurses" satisfaction with the care for residents with dementia" may be a highly relevant work factor for nursing staff in nursing homes which deserves additional attention in practice and research. The high predictive power of several work organisational factors implies that preventive action should also include work organisational factors. PMID:21480173
The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes
ERIC Educational Resources Information Center
Intrator, Orna; Feng, Zhanlian; Mor, Vince; Gifford, David; Bourbonniere, Meg; Zinn, Jacqueline
Purpose: Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher…
The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes
ERIC Educational Resources Information Center
Hyer, Kathryn; Thomas, Kali S.; Branch, Laurence G.; Harman, Jeffrey S.; Johnson, Christopher E.; Weech-Maldonado, Robert
Objective: This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period. Methods: Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing…
Characteristics and Recruitment Paths of Certified Nursing Assistants in Rural and Urban Nursing Homes
ERIC Educational Resources Information Center
Probst, Janice C.; Baek, Jong-Deuk; Laditka, Sarah B.
Context: Most nursing home care is provided by certified nursing assistants (CNAs), but little is known about rural CNAs. Purpose: To develop a representative geographic profile of the CNA workforce, focusing on paths leading to present job. Methods: Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey (NNAS), a…
Articulation Matrix for Home Health Aide, Nursing Assistant, Patient Care Assistant, Practical Nursing.
ERIC Educational Resources Information Center
Florida State Univ., Tallahassee. Center for Instructional Development and Services.
This document demonstrates the relationships among four Florida nursing education programs (home health aide, nursing assistant, patient care assistant, and practical nursing) by listing student performance standards and indicating which ones are required in each program. The 268 student performance standards are arranged in 23 areas of…
Nurse Delegation in Home Care: Research Guiding Policy Change.
Young, Heather M; Farnham, Jennifer; Reinhard, Susan C
The current study evaluated nurse delegation in home care, a pilot program introduced in 2007 in New Jersey to promote home care options for consumers needing assistance with medical/nursing tasks. Findings on readiness for the program, barriers and facilitating factors, experience with the program, and recommendations are summarized and presented. Methods included surveys and interviews with participants in nurse delegation, observations of planning and implementation meetings, and review meeting minutes. Major findings were no negative outcomes for consumers, improvements in quality of life and quality of care for consumers, high readiness and increasing satisfaction with experience in delegation, perception of nurse delegation in home care as a valued option, and the challenges of ensuring adequate staffing. Subsequent changes in regulation in New Jersey are underway, translating this research into policy. [Journal of Gerontological Nursing, 42(9), 7-15.]. PMID:27571400
Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.
Heeke, Sheila; Wood, Felecia; Schuck, Jennifer
A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template. PMID:23938358
Assisted Living Expansion and the Market for Nursing Home Care
Grabowski, David C; Stevenson, David G; Cornell, Portia Y
Objective To analyze the effect of market-level changes in assisted living supply on nursing home utilization and resident acuity. Data Sources Primary data on the supply of assisted living over time were collected from 13 states from 1993 through 2007 and merged with nursing home-level data from the Online Survey Certification and Reporting System and market-level information from the Area Resource File. Study Design Least squares regression specification incorporating market and time-fixed effects. Principal Findings A 10 percent increase in assisted living capacity led to a 1.4 percent decline in private-pay nursing home occupancy and a 0.2–0.6 percent increase in patient acuity. Conclusions Assisted living serves as a potential substitute for nursing home care for some healthier individuals with greater financial resources, suggesting implications for policy makers, providers, and consumers. PMID:22578039
A State Profile of IT Sophistication in Nursing Homes
Alexander, Gregory L.
In healthcare, IT sophistication has been defined as the diversity and maturity of information system hardware and software that support clinical services. Clinical services relevant to this study include resident care management, clinical support and administrative activities in nursing homes. An IT sophistication survey previously validated in acute care settings and adapted for nursing homes was used to develop a state profile of Missouri nursing homes. The IT survey was disseminated via paper and electronic methods as chosen by a selected responder that had IT oversight and knowledge of IT stakeholders. A census of 199 respondents completed the survey, representing a 41% (199/491) response rate. Findings support recent literature indicating a higher percentage of nursing homes are still using technology for administrative purposes; however, there is growing recognition that technologies with greater functionality, is used more extensively for electronic and automated transfer of resident care information. PMID:18999316
[Supervising student nurses in the provision of home care].
Talon-Chrétien, Marie-Claire; Prigent, Alexane; Thirion, Lucille
The private practice nurse may be required to supervise a student during their provision of care to patients in their home. These situations can be mutually rewarding and open the way for discussion around the quality of care. PMID:27393989
Family Caregivers Define and Manage the Nursing Home Placement Process.
Koplow, Sarah M; Gallo, Agatha M; Knafl, Kathleen A; Vincent, Catherine; Paun, Olimpia; Gruss, Valerie
The nursing home placement process is complex and difficult for family caregivers. This qualitative descriptive study examines the experiences of caregivers involved in the management of care and placement of an older family member using the Family Management Style Framework. Ten caregivers were recruited from four nursing homes in the Midwest. The caregivers were interviewed shortly after placement and again 3 months post-placement. Results provide a unique understanding of care management and the nursing home placement process from the perspective of the primary family caregiver. Overall, there were similarities across the same types of caregiving dyads, for example, spousal and adult-children caregivers. Caregivers expressed the need to maintain the identity of their older family member, a familial responsibility for caregiving, and change in their family relationship over time. Appreciating caregivers' challenges and needs gives health care professionals a better understanding for how to provide assistance for a smoother nursing home transition. PMID:25691220
Nursing Home eTool: Occupational Hazards in Long Term Care
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Spiritual caring: end of life in a nursing home.
Touhy, Theris A; Brown, Cynthia; Smith, Carol J
The purpose of this qualitative study was to explore spiritual care for dying nursing home residents from the perspectives of registered nurses, practical nurses, certified nursing assistants, advanced practice nurses, and physicians. Five major themes emerged: honoring the person's dignity, intimate knowing in the nursing home environment, wishing we could do more, personal knowing of self as caregiver, and struggling with end-of-life treatment decisions. Spiritual caring was described within the context of deep personal relationships, holistic care, and support for residents. Spiritual care responses and similarities and differences in the experiences of participants are presented. Education and research about how to assist residents and families as they struggle with difficult end-of-life decisions, adequate time and staff to provide the kind of care they "wished they could," and development of models that honor the close connection and attachment of staff to residents could enhance end-of-life care in this setting. PMID:16190010
Alzheimer's treatment in nursing homes: room for improvement.
Bright-Long, Lory
Managing Alzheimer's disease (AD) continues to challenge long-term care physicians and administrators. Although pharmacologic treatment can substantially benefit AD patients in the nursing home setting, common misconceptions and skepticism about its value are barriers to treatment use. Aggressive treatment for AD maximizes patient function and independence and is cost-effective. Herein we discuss state-of-the-art treatment of AD with a view to providing nursing home physicians a framework from which to make treatment decisions. PMID:16461250
[Training and representation of dementia of workers in nursing homes].
Sanchez, Stéphane; Gallin, Aurélie; Stefanuto, Muriel; Treffel, Sylvie; Antoine, Marc; Denormandie, Philippe
Training could be a lever for improving the quality of care of residents with dementia in nursing homes by changing social representations. Beyond a simple assessment of acquired knowledge, a change of social representations could be indicative of a true appropriation of the content of the training. A study was carried out to assess the impact of training on nursing home caregivers' representations of dementia and Alzheimer's disease. PMID:26976314
Total parenteral nutrition (TPN) at home: prototype high-tech home care nursing.
Davis, J H
Current economic and demographic trends in the United States indicate the demand for complex treatments, such as infusion therapies at home, will continue to escalate. In light of the increasingly acute and autonomous nature of home health practice, examination of home care nursing process affecting patient care outcomes is crucial. This study explored the cognitive, technical, and interpersonal components included in total parenteral nutrition (TPN) home care nursing. The purpose of this study was to evaluate psychometrically the Schmele Instrument to Measure the Process of Nursing Practice in Home Health (SIMP-H) so that it may be used to examine high-tech home care nursing process. Home visits must be observed to identify the specific cognitive, technical, and interpersonal components included in high-tech home care nursing that are important for patient care outcomes. This study captured high-tech home care nursing process on videotape, which provided a medium for evaluating interobserver reliability for the SIMP-H. Results revealed an interobserver reliability coefficient of .72. PMID:9025400
Being a Nursing Home Resident: A Challenge to One's Identity
Riedl, Maria; Them, Christa
Going into a nursing home can turn out to be a critical life experience if elderly people are afraid of losing their independence and identity after having moved into a nursing home. In order to find out what nursing home residents need in their first year after having moved into a nursing home to maintain their identity and self-determination, 20 problem-orientated interviews with residents of three nursing homes in the Austrian province of Salzburg were conducted and analysed based on content analysis according to Mayring. The participants of this study resist against having decisions taken away from them and fight for their independence and identity. In order to be able to cope with these strains, they need the help of family members, professionals, and identity-forming conversations in new social networks in the nursing home. The study participants draw enough strength from their faith in order to fight for their independence. They develop a new identity close to their previous identity by maintaining autonomy and mobility with a clear focus on the future. PMID:23691302
Care on demand in nursing homes: a queueing theoretic approach.
van Eeden, Karin; Moeke, Dennis; Bekker, René
Nursing homes face ever-tightening healthcare budgets and are searching for ways to increase the efficiency of their healthcare processes without losing sight of the needs of their residents. Optimizing the allocation of care workers plays a key role in this search as care workers are responsible for the daily care of the residents and account for a significant proportion of the total labor expenses. In practice, the lack of reliable data makes it difficult for nursing home managers to make informed staffing decisions. The focus of this study lies on the 'care on demand' process in a Belgian nursing home. Based on the analysis of real-life 'call button' data, a queueing model is presented which can be used by nursing home managers to determine the number of care workers required to meet a specific service level. Based on numerical experiments an 80/10 service level is proposed for this nursing home, meaning that at least 80 percent of the clients should receive care within 10 minutes after a call button request. To the best of our knowledge, this is the first attempt to develop a quantitative model for the 'care on demand' process in a nursing home. PMID:25542224
Innovative leadership and management in a nursing home.
Jeong, Sarah Yeun-Sim; Keatinge, Diana
The Australian Aged Care Reform Package, implemented from October 1997, has led radical changes in nursing practice in residential aged care facilities. Apart from anecdotal evidence, however, little is known about the impact of the Reform Package on nursing staff and their practice in nursing home facilities. In an attempt to explore these issues a qualitative explorative research study was conducted in one nursing home during 2000-2001. The study found that the impact of policy change on nursing staff and their practice depended on the management's leadership in interpreted the new policy and implemented innovative strategies in order to meet its requirements. The findings of the study highlight management's 'no them vs. us' and 'holistic' approach that considered both nursing staff and residents as whole beings. Integral to this approach was management's recognition that in order to facilitate teamwork, appropriate standards of nursing practice and resident care, and staff job satisfaction four resource elements must be provided. These elements comprise material, environmental, psychosocial and psychological resources. Management's provision of each of these resources ensured that nurses considered this nursing home 'a nice place to work'. PMID:15509274
Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia.
Monroe, Todd B; Parish, Abby; Mion, Lorraine C
Nurses caring for older people with various psychiatric illnesses face many obstacles when treating pain. One setting with a high percentage of psychiatric conditions is long-term care where more than half of residents have some form of dementia, and behavioral symptoms of dementia (BSDs) may mimic behavioral displays of pain. Furthermore, two-thirds of nursing home residents have pain. Thus, many nursing home residents with dementia have pain that may be confounded by BSDs. Since many people with dementia are at risk for poor pain management, determining current methods in which nurses assess and manage pain in nursing home residents will aid in recognizing potential barriers to using current pain management guidelines and help develop strategies to enhance nurses' assessment and management of pain in this vulnerable population. The aim of this study was to explore nursing home nurses' cues and practices to identify and alleviate pain in nursing home residents with dementia. Nurses use the constructs of 'comfort' and 'quality of life' as key components in their overall pain assessment strategy in people with dementia. Indeed, the extensive process they use involving frequent reassessment and application of interventions is geared towards "appearance of comfort." Nurses reported difficulty in ascertaining whether a person with dementia was in pain, and they expressed further difficulty determining the intensity associated with resident pain. Nurses further reported that residents with dementia who are not well know by the staff were are greater risk of poor pain management. It was not unusual for nurses to discuss the importance of conflict resolution among family members as well as allowing for open expression of family's concerns. Nurses had to focus not only on the resident's comfort, but also the families' level of comfort with pain management, especially at the end-of-life. Findings support further use and development of discomfort behavior scales to help
Institutional loyalty and job satisfaction among nurse aides in nursing homes.
Grau, L; Chandler, B; Burton, B; Kolditz, D
The high rate of turnover among nurse aides employed in nursing homes has been associated with the low job status and the poor job benefits accorded workers. However, this is not always the case. Competitive benefit packages and limited labor market opportunities increase the likelihood that nurse aides in some nursing homes may stay on the job despite their dissatisfaction with it. The present study investigated "institutional loyalty," an attitudinal proxy for job turnover, among 219 nurse aides for its relationship to a number of job-related factors. Somewhat unexpectedly, the quality of the social environment of the nursing home was found to be as important as attitudes toward job benefits in accounting for institutional loyalty. PMID:10108823
Outcomes of polypharmacy in nursing home residents.
Tamura, Bruce K; Bell, Christina L; Inaba, Michiko; Masaki, Kamal H
This article provides a comprehensive review of the outcomes of polypharmacy in nursing homes. Our review had some limitations. First, we only included studies beginning in 1990, and significant earlier studies are not included. Only English language articles were included. We only researched studies from MEDLINE, and may have missed studies based on our search terms and search tools. There are many definitions of polypharmacy in the literature, including number of medications or inappropriate medications. In this review, we defined polypharmacy as a high number of medications, but not inappropriate medications. It was not surprising that polypharmacy was consistently associated with an increased number of potentially inappropriate drugs. The majority of studies were viewed showed that polypharmacy was associated with increased ADEs, increased DDIs, and increased hospitalizations. We were surprised that polypharmacy was not consistently linked with falls, fractures, and mortality. For the mortality studies, it has been postulated that perhaps some patients receiving 10 or more medications may have been moribund or receiving end-of-life or hospice care. It is possible that the number of medications is not as important as the number of potentially in appropriate drugs. There need to be more studies on these outcomes, using different definitions of polypharmacy. Polypharmacy was associated with increased costs. The drug-related morbidity and mortality, including those resulting from inappropriate medications and increased staff time, led to increased costs. Use of consultant pharmacists has been shown to decrease polypharmacy costs. PMID:22500540
Organizational determinants of service quality in nursing homes.
Steffen, T M; Nystrom, P C
This study analyzed four prominent organizational factors thought to influence service quality in nursing homes. Perceptions of service quality were collected from over 400 family members who regularly visited residents in 41 nursing homes. Service quality was measured along five dimensions identified by marketing research on customers in service industries. These five dimensions were responsiveness, reliability, assurance, empathy, and tangibles. Perceptions of service quality exhibited significant associations with each of the four organizational factors: ownership, funding mix, facility size, and nurse staffing. Implications for health services administration are discussed. PMID:10167453
Newly qualified Project 2000 staff nurses in Scottish nursing homes: issues for education.
Runciman, Phyllis; Dewar, Belinda; Goulbourne, Alison
The contribution of nursing homes to nurse education in the UK is growing. This article presents educational issues raised by nine senior Nurse Managers from nursing homes in one Scottish health board. The Managers were interviewed as part of a larger Scottish study of employers' views of the skills of newly qualified Project 2000 staff nurses. Perceptions of the adequacy of the skills of newly qualified diplomates in first staff nurse posts in nursing homes following registration were explored. Impressions were mixed but generally favourable. The perceived strengths - confidence, knowledge and a questioning approach, and perceived limitations - in practical and organisational skills, matched closely those of senior Nurse Managers in the NHS sector. Managers noted the significance for learning of the business and customer care ethos of nursing home care and of the exacting skill requirements of specialist and increasingly acute care demands within this sector. There was uncertainty about and concern to strengthen preceptorship support. Matters for debate include the adequacy of telephone support versus in person on-site support for newly qualified nurses, whether expectations of initial performance are realistic and whether skill requirements differ between independent and NHS sectors. The potential value of NHS and independent health care inter-sectoral dialogue and networking is suggested. PMID:12384041
Nursing Home Quality, Cost, Staffing, and Staff Mix
ERIC Educational Resources Information Center
Rantz, Marilyn J.; Hicks, Lanis; Grando, Victoria; Petroski, Gregory F.; Madsen, Richard W.; Mehr, David R.; Conn, Vicki; Zwygart-Staffacher, Mary; Scott, Jill; Flesner, Marcia; Bostick, Jane; Porter, Rose; Maas, Meridean
Purpose: The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. Design and Methods: A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing…
Nursing Home Life: A Guide for Residents and Families.
ERIC Educational Resources Information Center
American Association of Retired Persons, Washington, DC.
This guide represents part of AARP's comprehensive consumer education effort in the area of long-term care. The purpose of the guide is to provide information for consumers as they look for a nursing home, arrange for admission, and adjust to life in the home after admission. Section 1 introduces the guide. Section 2 describes how to assess needs,…
Job Turnover and Job Satisfaction among Nursing Home Aides.
ERIC Educational Resources Information Center
Waxman, Howard M.; And Others
Interviewed 234 aides in seven nursing homes concerning job turnover rate, job satisfaction, and perception of milieu. A positive association found between turnover rate and aides' perceptions of the homes' order, organization, and control suggested that job turnover would lessen with more involvement in the decision-making process. (JAC)
An Empirical Evaluation of a Model Geropsychiatric Nursing Home.
ERIC Educational Resources Information Center
Gurian, B.; Chanowitz, B.
Describes sub-acute diagnostic and treatment nursing home program for difficult to manage older adults with medical and psychiatric illness. Notes that assessment and discharge can be completed within seven months, and that among sample population studied, almost equal percentages were discharged to state institutions, remained in the study home,…
38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.
Code of Federal Regulations, 2014 CFR
... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...
38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.
Code of Federal Regulations, 2012 CFR
... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...
38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.
Code of Federal Regulations, 2013 CFR
... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...
38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.
Code of Federal Regulations, 2010 CFR
... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...
38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.
Code of Federal Regulations, 2011 CFR
... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...
Nursing home prices and market structure: the effect of assisted living industry expansion.
Bowblis, John R
Since the 1990s, there has been substantial expansion of facility-based alternatives to nursing home care, such as assisted living facilities. This paper analyzes the relationship between expansion of the assisted living industry, nursing home market structure and nursing home private pay prices using a two-year panel of nursing homes in the State of Ohio. Fixed effect regressions suggest that the expansion of assisted living facilities are associated with increased nursing home concentration, but find no effect on private pay nursing home prices. This would be consistent with assisted livings reducing demand for nursing homes by delaying entry into a nursing home, though assisted livings are not direct competitors of nursing homes. PMID:23889775
The meaning of receiving help from home nursing care.
Moe, Aud; Hellzen, Ove; Enmarker, Ingela
The aim of this study was to illuminate the meaning of receiving help from home nursing care for the chronically ill, elderly persons living in their homes. The study was carried out in Norway. Data were collected by narrative interviews and analysed by phenomenological hermeneutic interpretations. Receiving help from home nursing care sometimes meant 'Being ill and dependent on help'. Other times it meant 'Being at the mercy of help'. It could also mean 'Feeling inferior as a human being'. Sometimes help was given by nurses who were respectful and proficient at caring for an elderly person, while at other times nurses seemed to be incompetent and worked with a paternalistic attitude without respect for privacy. Receiving help also meant elderly persons wanted to be regarded and approached as equal human beings, supported in the courage to meet challenges in life. PMID:23625732
Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation.
Oktay, J S; Volland, P J
This paper describes a program (Community Care Program) in which some elderly hospital patients who were candidates for nursing home placement were placed in foster homes. Caregivers were carefully trained and supervised. A total of 112 elderly inpatients were randomly assigned to placement in a nursing home or a foster care home. Patients and caregivers were interviewed at 3, 6, 9, and 12 months after placement. Community Care Program patients were more likely to maintain or improve ADL (activities of daily living) and mental status scores. They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients. Nursing home patients had higher life satisfaction, and participated in more social and recreational activities. The Community Care Program was 17 per cent less costly than nursing home care. The results suggest that foster care may be a viable alternative for a segment of the nursing home population. PMID:3674248
Motivators for Physical Activity among Ambulatory Nursing Home Older Residents
Chen, Yuh-Min; Li, Yueh-Ping
The purpose of this study was to explore self-identified motivators for regular physical activity among ambulatory nursing home older residents. A qualitative exploratory design was adopted. Purposive sampling was performed to recruit 18 older residents from two nursing homes in Taiwan. The interview transcripts were analyzed by qualitative content analysis. Five motivators of physical activity emerged from the result of analysis: eagerness for returning home, fear of becoming totally dependent, improving mood state, filling empty time, and previously cultivated habit. Research on physical activity from the perspectives of nursing home older residents has been limited. An empirically grounded understanding from this study could provide clues for promoting and supporting lifelong engagement in physical activity among older residents. The motivators reported in this study should be considered when designing physical activity programs. These motivators can be used to encourage, guide, and provide feedback to support older residents in maintaining physical activity. PMID:25054175
Nursing Home Medical Staff Organization: Correlates with Quality Indicators
Katz, Paul R.; Karuza, Jurgis; Lima, Julie; Intrator, Orna
Objectives Little is known about the relationship between how medical care is organized and delivered in nursing homes. Taking a lead from the acute care arena, we hypothesize that nursing home medical staff organization (NHMSO) is an important predictor of clinical outcomes in the nursing home. Methods A total of 202 usable surveys from a two-wave survey process using the Dillman Method were returned from medical directors who were randomly selected from the AMDA membership and were asked to fill out a survey on the structure of medical organization in their primary nursing home practice. Quality measures that are likely to be affected by physician practice patterns were culled from NH Compare and OSCAR data sets and matched to the physician surveys, i.e., long stay residents' prevalence of pain, restraint use, catheter use, pressure ulcers, pneumococcal vaccination, influenza vaccination, presence of advanced directives, prescription of antibiotics, and prevalence of depression. Results Using a series of hierarchical multiple regressions, significant R2 changes were found when the medical staff organization dimensions were added in the regressions after controlling for nursing home structural characteristics for the following outcomes: pneumococcal vaccination and restraint use. Near significant findings were noted for pain prevalence among long stay residents, catheter use and prevalence of pressure ulcers. Conclusions This study is the first to demonstrate a relationship between medical staff organizational dimensions and clinical outcomes in the nursing home setting and as such represents an initial "proof of concept." NHMSO should be considered as a potentially important mediating or moderating variable in the quality of care equation for nursing homes. PMID:21450190
Ineffective Staff, Ineffective Supervision, or Ineffective Administration? Why Some Nursing Homes Fail to Provide Adequate Care.
ERIC Educational Resources Information Center
Sheridan, John E.; And Others
This study involved 530 nursing staff working in 25 for-profit and nonprofit nursing homes, 2 of which failed to meet residential care standards. Nursing home climate in failed homes was perceived as being significantly lower in human relations and higher in laissez-faire and status orientation dimensions that the climate in the successful homes.…
Nursing Staffs' Views on Physical and Psychosocial Care Provision in Slovenian Nursing Homes.
Habjanić, Ana; Elo, Satu; Micetić-Turk, Dusanka; Isola, Arja
The aim of this study was to explore nursing staffs' perceptions of the physical and psychological care needs of elderly residents, their views on the relative importance of these needs and their perceived ability to meet them. The literature reveals that the quality of elder care in nursing homes should comprise both physical and psychosocial care. Despite this, the nursing staffs' perceptions of the physical and psychosocial care provision have not often been researched. As a method cross-sectional research design was used, with structured questionnaires and unstructured interviews. Our sample consisted of members of the nursing staff from four nursing homes in Slovenia (survey: N = 148; interview: N = 16). The resulting data was processed by means of statistical analysis and conventional content analysis. The nursing staff reported more knowledge of, skills with and willingness to meet residents'physical needs than psychosocial needs. On the other hand, communication, conversation, self-care and a home-like environment were considered by nursing staff as marking quality elder care. Consequently, nursing home administrators should try to strengthen psychosocial care provision to improve the residents' quality of life. Conversation, as the most often recognised aspect of psychosocial care, should be promoted, since improvements in this area would not be costly, and each nursing staff member may decide individually how best to include more conversation in the daily routines of elder care provision. PMID:26987155
Integrating new graduate nurses in home health care.
Meadows, Carl A
In 2005, the home health nursing sector of a large Canadian health authority was on its way toward changing a hiring prerequisite of acute care (medical or surgical) experience for entry to practice into home care nursing. At that time, home healthcare services in Canada and the United States were generally requiring acute care experience as prerequisites for working in home health. However, much of the research beginning as early as early 2000 challenged this perspective and universities and colleges offering baccalaureate degrees in nursing began including home health content in their curricula. The findings from research add to the ongoing critique of this acute care requirement and support the concept that acute care and home care are different practice areas with distinct competencies. This article discusses the contextual background that influenced the undertaking of our research, the relevant research literature, our research findings, model for integration, and evaluation of our pilot and lessons learned. The successes seen as a result of New Graduate integration are now being utilized by other home care nursing offices as a result of this work. PMID:19820662
Racial segregation and quality of care disparity in US nursing homes.
Rahman, Momotazur; Foster, Andrew D
In this paper, we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality. PMID:25461895
Racial Segregation and Quality of Care Disparity in US Nursing Homes
Rahman, Momotazur; Foster, Andrew D.
In this paper we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality. PMID:25461895
Unintentional Discontinuation of Chronic Medications for Seniors in Nursing Homes
Stall, Nathan M.; Fischer, Hadas D.; Wu, C. Fangyun; Bierman, Arlene S.; Brener, Stacey; Bronskill, Susan; Etchells, Edward; Fernandes, Olavo; Lau, Davina; Mamdani, Muhammad M.; Rochon, Paula; Urbach, David R.; Bell, Chaim M.
Abstract Transitions of care leave patients vulnerable to the unintentional discontinuation of medications with proven efficacy for treating chronic diseases. Older adults residing in nursing homes may be especially susceptible to this preventable adverse event. The effect of large-scale policy changes on improving this practice is unknown. The objective of this study was to analyze the effect of a national medication reconciliation accreditation requirement for nursing homes on rates of unintentional medication discontinuation after hospital discharge. It was a population-based retrospective cohort study that used linked administrative records between 2003 and 2012 of all hospitalizations in Ontario, Canada. We identified nursing home residents aged ≥66 years who had continuous use of ≥1 of the 3 selected medications for chronic disease: levothyroxine, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). In 2008 medication reconciliation became a required practice for accreditation of Canadian nursing homes. The main outcome measures included the proportion of patients who restarted the medication of interest after hospital discharge at 7 days. We also performed a time series analysis to examine the impact of the accreditation requirement on rates of unintentional medication discontinuation. The study included 113,088 adults aged ≥66 years who were nursing home residents, had an acute hospitalization, and were discharged alive to the same nursing home. Overall rates of discontinuation at 7-days after hospital discharge were highest in 2003–2004 for all nursing homes: 23.9% for thyroxine, 26.4% for statins, and 23.9% for PPIs. In most of the cases, these overall rates decreased annually and were lowest in 2011–2012: 4.0% for thyroxine, 10.6% for statins, and 8.3% for PPIs. The time series analysis found that nursing home accreditation did not significantly lower medication discontinuation rates for any of the 3 drug groups. From 2003
Pandemic Influenza Planning in Nursing Homes: Are We Prepared?
Mody, Lona; Cinti, Sandro
Avian influenza or Influenza A (H5N1) is caused by a viral strain that occurs naturally in wild birds, but to which humans are immunologically naïve. If an influenza pandemic occurs, it is expected to have dire consequences, including millions of deaths, social disruption, and enormous economic consequences. The Department of Health and Human Resources plan, released in November 2005, clearly affirms the threat of a pandemic. Anticipating a disruption in many factions of society, every segment of the healthcare industry, including nursing homes, will be affected and will need to be self-sufficient. Disruption of vaccine distribution during the seasonal influenza vaccine shortage during the 2004/05 influenza season is but one example of erratic emergency planning. Nursing homes will have to make vital decisions and provide care to older adults who will not be on the initial priority list for vaccine. At the same time, nursing homes will face an anticipated shortage of antiviral medications and be expected to provide surge capacity for overwhelmed hospitals. This article provides an overview of current recommendations for pandemic preparedness and the potential effect of a pandemic on the nursing home industry. It highlights the need for collaborative planning and dialogue between nursing homes and various stakeholders already heavily invested in pandemic preparedness. PMID:17767687
Overworked RNs, social workers cause high nursing assistant turnover in nursing homes.
Using benchmarking to stanch the loss of employees. Many nursing homes and long-term care facilities have a burdensome employee turnover rate, in some cases approaching 400% annually. A benchmarking study conducted by Southern University and the Louisiana State Nursing Home Association revealed that the factors widely believed to cause the problem--wages, benefits, and workload--are not to blame. Take a look at the results. PMID:10557961
The pivotal role of the director of nursing in nursing homes.
Siegel, Elena O; Mueller, Christine; Anderson, Kathryn L; Dellefield, Mary Ellen
The impending wave of aging boomers heightens long-standing concerns for the quality and cost of nursing home care. As industry and policy leaders continue efforts to remedy substandard nursing home care delivery practices, development of a well-prepared and adequately supported workforce of directors of nursing (DONs) is essential to ensuring the industry's readiness for the aging wave population. Directors of nursing are in pivotal positions to influence nursing home quality and costs; however, research demonstrating the extent of this influence-actual and potential-is lacking, and industry leaders have collectively failed to address the current or future capacity of this workforce. A long history of inattention to the DON position, coupled with low expectations for the competencies and requisite educational preparation, has potentially compromised the capacity of DONs to promote and sustain high-quality, cost-effective nursing home care. The purpose of this article is to provide a comprehensive overview and discussion of the current and potential capacity of DONs to lead the delivery of high-quality, cost-effective nursing home care from industry, educational and professional development, healthcare policy, and organizational contexts. Proposed strategies and recommendations to enhance and promote the future capacity of DONs are also presented. PMID:20234245
Working Conditions and Mental Health of Nursing Staff in Nursing Homes.
Zhang, Yuan; Punnett, Laura; Mawn, Barbara; Gore, Rebecca
Nursing staff in nursing homes suffer from poor mental health, probably associated with stressful working conditions. Working conditions may distribute differently among nursing assistants, licensed practical nurses, and registered nurses due to their different levels in the organizational hierarchy. The objectives of this study were to evaluate the association between working conditions and mental health among different nursing groups, and examine the potential moderating effect of job group on this association. Self-administered questionnaires were collected with 1,129 nursing staff in 15 for-profit non-unionized nursing homes. Working conditions included both physical and psychosocial domains. Multivariate linear regression modeling found that mental health was associated with different working conditions in different nursing groups: physical safety (β = 2.37, p < 0.05) and work-family conflict (β = -2.44, p < 0.01) in NAs; work-family conflict (β = -4.17, p < 0.01) in LPNs; and physical demands (β = 10.54, p < 0.05) in RNs. Job group did not moderate the association between working conditions and mental health. Future workplace interventions to improve mental health should reach to nursing staff at different levels and consider tailored working condition interventions in different nursing groups. PMID:27104634
Decreased rehospitalization costs through intermittent nursing visits to nursing home patients.
Chappell, H; Dickey, C
This study determined if visits by a nurse to patients in contract nursing homes would reduce the cost of patient returns to the discharging medical center. The authors discuss an approach that reduced readmissions and emergency room visits, producing a net savings of $70,394.90. PMID:8473929
Prevalence of Nursing Assistant Training and Certification Programs within Nursing Homes, 1997-2007
ERIC Educational Resources Information Center
Tyler, Denise A.; Jung, Hye-Young; Feng, Zhanlian; Mor, Vincent
Purpose: The purpose of this study was to describe how the prevalence of nurse aide training and competency evaluation programs (NATCEPs) provided in the nursing home (NH) setting changed between 1997 and 2007, to explore the environmental factors that may be influencing the prevalence of these programs, and to examine how the changing prevalence…
Nurse Aide Empowerment Strategies and Staff Stability: Effects on Nursing Home Resident Outcomes
ERIC Educational Resources Information Center
Barry, Theresa; Brannon, Diane; Mor, Vincent
Purpose: This study examines the moderating effect of staff stability on the relationship between management practices used to empower nurse aides and resident outcomes in a multistate sample of nursing homes. An adaptation of Kanter's theory of structural power in organizations guided the framework for the model used in this study. Design and…
Nursing Assistant Perceptions of Their Role in Quality Improvement Processes in Nursing Homes.
Davila, Heather; Abrahamson, Kathleen; Mueller, Christine; Inui, Thomas S; Black, Aaron G; Arling, Greg
Nursing assistants provide the majority of direct resident care in nursing homes and are centrally involved in implementing quality improvement (QI), yet little is known about their experiences in QI. Interviews with nursing assistants found that respondents perceive themselves as having a unique and important role in QI. They described key outcomes of QI as positive gains in the daily lives of residents, improved work processes, and increased time between staff and residents. PMID:26796975
A motivational interviewing education intervention for home healthcare nurses.
Pyle, Joni J
The ability of registered nurses to communicate well with their patients is foundational to patient-centered care, the management of chronic illness, and general healthcare. It is also vital to the nurse-patient relationship. Nurses, however, tend to identify with their patients' physical needs and rely heavily on the technical skills with which they feel more comfortable. This lack of ability to communicate well with their patients can result in poor nurse-patient understanding, can lead to poor patient outcomes, and a lack of patient engagement and involvement in their care. Motivational interviewing (MI), a patient-centered manner of communication, is a means to direct the nurse-patient interaction in a way that is patient centered. Brief education of MI has shown to be effective in increasing the self-efficacy of nurses in their ability to communicate well with their patients. In 2 geographically diverse Pennsylvania home care settings, MI education was provided to 20 nurses. The educational intervention was designed to increase the self-efficacy of nurses regarding their ability to affect the negative behaviors of chronically ill patients. A pretest and posttest was administered to the nurse participants to determine the effectiveness of the educational intervention. This evidence-based education increased the nurses' overall communication self-efficacy by 25%. PMID:25654455
Family Members' Experience With Hospice in Nursing Homes.
Gage, L Ashley; Washington, Karla; Oliver, Debra Parker; Kruse, Robin; Lewis, Alexandra; Demiris, George
Research has documented numerous benefits and challenges associated with receipt of hospice care in nursing homes; however, study of this partnership from the perspective of residents' family members has been limited. The purpose of this qualitative investigation was to explore family members' experience with hospice services received in the nursing home setting. Researchers conducted a secondary data analysis of 175 family member interviews using a thematic analytic approach. Findings highlighted the critical role of communication in supporting residents and their family members. Care coordination, support and oversight, and role confusion also impacted family members' experience of hospice care in the nursing home. Efforts directed at enhancing communication and more clearly articulating the roles of members of the health care team are indicated. PMID:25422516
Staffing Subsidies and the Quality of Care in Nursing Homes
Foster, Andrew D.; Lee, Yong Suk
Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%. PMID:25814437
Doll therapy: an intervention for nursing home residents with dementia.
Shin, Juh Hyun
The use of dolls as a therapeutic intervention for nursing home residents with dementia is relatively new. The current article describes a research study implemented with nursing home residents in Korea to examine the effects of doll therapy on their mood, behavior, and social interactions. A one-group, pretest-posttest design was used to measure the impact of doll therapy on 51 residents with dementia. Linear regression demonstrated statistically significant differences in aggression, obsessive behaviors, wandering, negative verbalization, negative mood, and negative physical appearance after introduction of the doll therapy intervention. Interactions with other individuals also increased over time. Findings support the benefits of doll therapy for nursing home residents with dementia; however, further research is needed to provide more empirical evidence and explore ethical considerations in the use of doll therapy in this vulnerable population. PMID:25622273
The challenges of a home-based nursing consultation business.
Schulmeister, L
The transition from working in a traditional setting to working at home alone can be challenging for new nurse consultants. Home-based consultants can use a variety of strategies to stay focused and connected, such as having a designated work area, limiting distractions, and networking. Nurse consultants can obtain information about business management from community resources, and computer on-line services offer a means of contacting other small-business owners. Ongoing business evaluations, which include professional accomplishments as well as an examination of income and expenses, help in planning. Home-based nurse consultants can increase the likelihood of business success by setting objectives, working diligently, and networking with others in the business community. PMID:10382409
Why do nursing homes close? An analysis of newspaper articles.
Fisher, Andrew; Castle, Nicholas
Using Non-numerical Unstructured Data Indexing Searching and Theorizing (NUD'IST) software to extract and examine keywords from text, the authors explored the phenomenon of nursing home closure through an analysis of 30 major-market newspapers over a period of 66 months (January 1, 1999 to June 1, 2005). Newspaper articles typically represent a careful analysis of staff impressions via interviews, managerial perspectives, and financial records review. There is a current reliance on the synthesis of information from large regulatory databases such as the Online Survey Certification And Reporting database, the California Office of Statewide Healthcare Planning and Development database, and Area Resource Files. Although such databases permit the construction of studies capable of revealing some reasons for nursing home closure, they are hampered by the confines of the data entered. Using our analysis of newspaper articles, the authors are able to add further to their understanding of nursing home closures. PMID:22873933
Snoezelen activity: the Good Shepherd Nursing Home experience.
Minner, De; Hoffstetter, Patty; Casey, Linda; Jones, Delores
Care of the resident with dementia can be both challenging and unpredictable. Activities provided for nursing home residents often have rules and may be a source of frustration for residents with advancing dementia. Snoezelen, or multisensory therapy, offers a failure-free activity in an enabling environment that can both stimulate and relax the resident with dementia. Good Shepherd Nursing Home in Versailles, Mo, undertook a 1-year outcome-based quality improvement project to find if use of Snoezelen therapy could reduce the number of behavioral symptoms that residents were suffering from. While there are still barriers to the use Snoezelen therapy, employees at Good Shepherd Nursing Home believe that the use of Snoezelen therapy has been a successful and rewarding experience for both residents and staff members. PMID:15535540
Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes
ERIC Educational Resources Information Center
Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.
Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…
Leadership, staffing and quality of care in nursing homes
Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is
75 FR 45207 - Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...
Federal Register 2010, 2011, 2012, 2013, 2014
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...: Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring...
78 FR 55778 - Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...
Federal Register 2010, 2011, 2012, 2013, 2014
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...: Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring...
75 FR 62185 - Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...
Federal Register 2010, 2011, 2012, 2013, 2014
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...: Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring...
78 FR 75959 - Agency Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...
Federal Register 2010, 2011, 2012, 2013, 2014
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Regulation on Reduction of Nursing Shortages in State Homes....'' SUPPLEMENTARY INFORMATION: Title: Regulation on Reduction of Nursing Shortages in State Homes; Application...
Sexual Abuse of Older Nursing Home Residents: A Literature Review
Malmedal, Wenche; Iversen, Maria Helen; Kilvik, Astrid
Despite an increasing literature related to elder abuse, sexual abuse of older persons in general and of vulnerable adults living in nursing homes in particular is still sparsely described. The purpose of this study was to assess the state of knowledge on the subject of sexual abuse against older nursing home residents through a literature review. Systematic searches in reference databases including Cinahl, Medline, OVID Nursing Database, ISI Web of Science, PsycINFO, Cochrane Library, and SveMed + were conducted. Through several phases of selection of the articles, using strict inclusion and exclusion criteria, six articles were chosen for a deeper examination. Findings from the review show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women. Findings from the literature review show that there is a need for knowledge and further research on the topic of sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step in seriously addressing sexual abuse against older persons. PMID:25642347
Understanding Nurses Decisions to Treat Pain in Nursing Home Residents with Dementia
Gilmore-Bykovskyi, Andrea L.; Bowers, Barbara J.
Nursing home (NH) residents with dementia continue to receive inadequate pain treatment. The purpose of this qualitative study was to examine how nurses make decisions to pharmacologically treat pain in NH residents with dementia. Using Grounded Dimensional Analysis, 15 in-depth interviews were conducted with 13 nurses from 4 Skilled Nursing Facilities in Wisconsin. Nurses experienced varying levels of certainty regarding suspected pain in response to certain resident characteristics and whether pain was perceived as visible/obvious or non-visible/not obvious. Nurses felt highly uncertain about pain in residents with dementia. Suspected pain in residents with dementia was nearly always conceptualized as a change in behavior which nurses responded to by trialing multiple interventions in attempts to return the resident to baseline, which despite current recommendations, did not include pain relief trials. Residents with dementia were described as being at greatest risk for experiencing underassessment, undertreatment and delayed treatment for pain. PMID:23330944
Survey-based Indices for Nursing Home Quality Incentive Reimbursement
Willemain, Thomas R.
Incentive payments are a theoretically appealing complement to nursing home quality assurance systems that rely on regulatory enforcement. However, the practical aspects of incentive program design are not yet well understood. After reviewing the rationale for incentive approaches and recent State and. Federal initiatives, the article considers a basic program design issue: creating an index of nursing home quality. It focuses on indices constructed from routine licensure and certification survey results because State initiatives have relied heavily on these readily accessible data. It also suggests a procedure for creating a survey-based index and discusses a sampling of Implementation issues. PMID:10309858
[Handling of laundry and garbage in nursing homes. A survey in 22 homes].
Hansen, D; Ross, B; Hilgenhöner, M; Loss, R; Grandek, M; Blättler, T; Popp, W
Management of infectious diseases in nursing homes is as important as it is in hospitals. Therefore, a standardized questionnaire was used for the detailed assessment of the handling of laundry and garbage with a special focus on methicillin-resistant staphylococcus aureus (MRSA) in 22 nursing homes in Germany. The study focused on the prevention of occupational diseases in the nursing home staff. Despite a few isolated problems, the situation of MRSA-positive patients was not as alarming as expected: guidelines for MRSA as published by KRINKO were often followed by the healthcare workers. However, general problems with managing garbage and laundry were identified. Many nursing homes lacked protective clothing and a sufficient garbage management plan. In addition, the handling of laundry was a problem in that the clothing of the patients and the working clothes of the staff were often washed at home rather than in accredited laundries. Thus, the awareness for hygienic problems needs to be raised, e.g., by expanding hygienic control for the nursing homes. PMID:22015787
Overcoming challenges of conducting research in nursing homes.
Jenkins, Catharine; Smythe, Analisa; Galant-Miecznikowska, Magdalena; Bentham, Peter; Oyebode, Jan
In the UK, one third of the 850,000 people with dementia live in care homes. This article explores the process of carrying out research in nursing homes, identifying barriers and enabling factors, and making recommendations for researchers. The authors' experiences derive from an ongoing study investigating the effect of educational interventions to promote and embed person-centred care, designed for nurses caring for the people with dementia in nursing homes. Design issues arose from the need to use cluster randomisation which requires a large sample size, implementation fidelity, poor compliance and high numbers of participants lost to follow up. Further difficulties included gaining ethical approval, recruitment, raising concerns and the practicalities of participant retention. There are many benefits of conducting research in care homes, for the homes themselves, their staff and residents. These include training and education, networking and empowerment of staff and subsequent improved standards of care. For the research team, benefits include opportunities to contribute to an underserved setting, to advance care standards and improve nurses' working lives. PMID:27231082
[Scale development of job stress for home care nurses].
Hong, Jeong-Sook; Lee, Ga-Eon
The purpose of this study was to develop a job stress scale for hospital-based home care nurses in Korea. The process was construction of the conceptual framework, development of the preliminary items, verification of the content validity, item analysis and test of the reliability. The preliminary items were based on literature review and in-depth interviews with home care nurses. As a result, eight categories and sixty items were selected. These were reviewed by seven specialists for content validity and finally fifty one items were chosen. Data was collected from 180 home care nurses who were engaged in 87 hospitals from August to September 2003. The result of item analysis one was excepted. The final item count was 50. Categories were as follows: overload work (8 items), lack of specialized knowledge and technique (5 items), ethical dilemma (4 items), role conflict (5 items), interpersonal relationships (6 items), visiting home environment (9 items), driving conditions (4 items) and lack of administrative support (9 items), The reliability of the scale by Cronbach's alpha was .948 and the domain's reliability ranged from .649 to .841. The result of this study could be used to measure the job stress of home care nurses. However, for further validity and reliability, repeated studies will be necessary. PMID:15613845
Lynx: Automatic Elderly Behavior Prediction in Home Telecare.
Lopez-Guede, Jose Manuel; Moreno-Fernandez-de-Leceta, Aitor; Martinez-Garcia, Alexeiw; Graña, Manuel
This paper introduces Lynx, an intelligent system for personal safety at home environments, oriented to elderly people living independently, which encompasses a decision support machine for automatic home risk prevention, tested in real-life environments to respond to real time situations. The automatic system described in this paper prevents such risks by an advanced analytic methods supported by an expert knowledge system. It is minimally intrusive, using plug-and-play sensors and machine learning algorithms to learn the elder's daily activity taking into account even his health records. If the system detects that something unusual happens (in a wide sense) or if something is wrong relative to the user's health habits or medical recommendations, it sends at real-time alarm to the family, care center, or medical agents, without human intervention. The system feeds on information from sensors deployed in the home and knowledge of subject physical activities, which can be collected by mobile applications and enriched by personalized health information from clinical reports encoded in the system. The system usability and reliability have been tested in real-life conditions, with an accuracy larger than 81%. PMID:26783514
Lynx: Automatic Elderly Behavior Prediction in Home Telecare
Lopez-Guede, Jose Manuel; Moreno-Fernandez-de-Leceta, Aitor; Martinez-Garcia, Alexeiw; Graña, Manuel
This paper introduces Lynx, an intelligent system for personal safety at home environments, oriented to elderly people living independently, which encompasses a decision support machine for automatic home risk prevention, tested in real-life environments to respond to real time situations. The automatic system described in this paper prevents such risks by an advanced analytic methods supported by an expert knowledge system. It is minimally intrusive, using plug-and-play sensors and machine learning algorithms to learn the elder's daily activity taking into account even his health records. If the system detects that something unusual happens (in a wide sense) or if something is wrong relative to the user's health habits or medical recommendations, it sends at real-time alarm to the family, care center, or medical agents, without human intervention. The system feeds on information from sensors deployed in the home and knowledge of subject physical activities, which can be collected by mobile applications and enriched by personalized health information from clinical reports encoded in the system. The system usability and reliability have been tested in real-life conditions, with an accuracy larger than 81%. PMID:26783514
Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes
Hunt, Selina R.; Corazzini, Kirsten; Anderson, Ruth A.
Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided. PMID:24652943
A Survey of Nursing Home Staffing Patterns and General Needs in the State of Maine.
ERIC Educational Resources Information Center
Maine's Regional Medical Program Research and Evaluation Service, Augusta.
A study of nursing homes in Maine was conducted by student researchers during the summer, 1970, under Maine's Regional Medical Program (MRMP). The survey, focusing on staffing patterns and general needs in nursing homes in Maine, was conducted in order to determine ways in which MRMP might assist the nursing homes and the Maine Department of…
Nursing Home Staff Characteristics and Knowledge Gain from a Didactic Workshop on Depression and Behavior Management
ERIC Educational Resources Information Center
Meeks, Suzanne; Burton, Elizabeth G.
Depression is a prevalent and serious problem among nursing home residents. Nursing home staff members are gatekeepers for mental health treatment for residents, but may know little about depression and its management. We evaluated a didactic workshop for nursing home staff on depressive symptoms and management. Results for 58 staff participants…
75 FR 39622 - Proposed Information Collection (Request for Nursing Home Information in Connection with Claim...
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS Proposed Information Collection (Request for Nursing Home Information in Connection with Claim for... who are patients in nursing home. DATES: Written comments and recommendations on the proposed.... Title: Request for Nursing Home Information in Connection with Claim for Aid and Attendance, VA Form...
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2013 CFR
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...
75 FR 56662 - Agency Information Collection (Request for Nursing Home Information in Connection With Claim for...
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS Agency Information Collection (Request for Nursing Home Information in Connection With Claim for... . Please refer to ``OMB Control No. 2900-0652.'' SUPPLEMENTARY INFORMATION: Title: Request for Nursing Home... 21-0779 is used to determine veterans residing in nursing homes eligibility for pension and aid...
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2011 CFR
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2012 CFR
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2011 CFR
... 42 Public Health 3 2011-10-01 2011-10-01 false Return to home skilled nursing facility. 422.133....133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled nursing facility if...
78 FR 29439 - Proposed Information Collection (Request for Nursing Home Information in Connection With Claim...
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS Proposed Information Collection (Request for Nursing Home Information in Connection With Claim for... who are patients in nursing home. DATES: Written comments and recommendations on the proposed...: Request for Nursing Home Information in Connection with Claim for Aid and Attendance, VA Form 21-0779....
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2010 CFR
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2010 CFR
... 42 Public Health 3 2010-10-01 2010-10-01 false Return to home skilled nursing facility. 422.133....133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled nursing facility if...
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2014 CFR
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...
Differences between Newly Admitted Nursing Home Residents in Rural and Nonrural Areas in a National Sample
ERIC Educational Resources Information Center
Bolin, Jane Nelson; Phillips, Charles D.; Hawes, Catherine
Purpose: Previous research in specific locales indicates that individuals admitted to rural nursing homes have lower care needs than individuals admitted to nursing homes in urban areas, and that rural nursing homes differ in their mix of short-stay and chronic-care residents. This research investigates whether differences in acuity are a function…
Coming to Terms: African-Americans' Complex Ways of Coping with Life in a Nursing Home
ERIC Educational Resources Information Center
Groger, Lisa
Based on qualitative interviews with 14 nursing home residents and 13 caregivers, this article explores how elders adapted to life in a nursing home, and how their caregivers came to embrace nursing home placement as the optimal way to meet their elders' need for care. These processes were mediated by two mechanisms: the function the institution…
The Ethnic Elderly in Metro Toronto Hospitals, Nursing Homes, and Homes for the Aged: Communication and Health Care.
ERIC Educational Resources Information Center
Saldov, Morris; Chow, Peter
Developed database on ethnic elderly persons; examined extent of communication problems they face in hospitals, nursing homes, and homes for aged in Metro Toronto; and reported on institutional response. Nursing home supervisors (n=77) reported that communication was essential to health care needs of ethnic elderly individuals. Most health care…
77 FR 45719 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...
Federal Register 2010, 2011, 2012, 2013, 2014
... Diem for Adult Day Care of Veterans in State Homes): Comment Request AGENCY: Veterans Health... day health care facilities are providing high quality services to Veterans in State homes. DATES... nursing home and adult day health services care to Veterans. VA requires facilities providing nursing...
Urinary incontinence quality improvement in nursing homes: where have we been? Where are we going?
Palmer, Mary H
The Centers for Medicare and Medicaid Services (CMS) has made urinary incontinence (UI) a quality indicator as part of the Nursing Home Quality Initiative (NHQI). In addition, CMS issued revised guidance on UI and catheters (known as tag F315) for nursing homes regarding compliance in the evaluation and management of UI and catheters, and an investigative protocol for state nursing home surveyors to use during regulatory inspections. The prevalence of UI in nursing homes remains high despite many years of research and clinical efforts to cure or improve it. Nurses play a key role in assuring appropriate assessment of nursing home residents to prevent and treat UI. Changes at the organizational level and inpatient care are needed to make dignity of nursing home residents central to UI quality improvement efforts. This article reviews the epidemiology of UI, the evidence for behavioral interventions, and the types of quality improvement strategies used for UI in nursing homes. PMID:19241782
Psychological Correlates of Survival in Nursing Home Cancer Patients.
ERIC Educational Resources Information Center
Stein, Shayna; And Others
Analyzed demographic, cancer, physical functioning and psychological data for late-stage cancer, newly admitted nursing home patients (n=90). Concluded that, compared to survivors, those who died within a three-month period more often acknowledged their condition as terminal, anticipated greater environmental stress and adjustment problems and had…
Serum zinc and pneumonia in nursing home elderly
Technology Transfer Automated Retrieval System (TEKTRAN)
Zinc plays an important role in immune function. The association between serum zinc and pneumonia in the elderly has not been studied. The study aim is to determine if serum zinc concentrations in nursing home elderly are associated with incidence and duration of pneumonia, total and duration of ant...
Understanding nursing home worker conceptualizations about good care.
Chung, Gawon
This study explored how direct care workers in nursing homes conceptualize good care and how their conceptualizations are influenced by external factors surrounding their work environment and the relational dynamics between them and residents. Study participants were drawn from a local service employees' union, and in-depth interviews were conducted. Data were analyzed using a grounded theory approach, and the results revealed that direct care workers equated good care, such as resident cleanliness, comfort, and happiness as a desirable outcome of care activities. Good care also meant affectionate, respectful, and patient attitudes of direct care workers toward residents in care delivery processes. Nursing home workers internalized the perspectives of residents and other professionals about what constitutes good care, and then drew their own conclusions about how to balance, combine, and compromise those diverse demands. It is important to communicate accurate and consistent messages about what comprises good nursing home care to nursing home workers and build a working environment where workers' conceptualizations about good care can be executed without organizational barriers. PMID:22936538
Physical Restraint Initiation in Nursing Homes and Subsequent Resident Health
ERIC Educational Resources Information Center
Engberg, John; Castle, Nicholas G.; McCaffrey, Daniel
Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental…
[Maintaining the proper distance for nurses working in the home].
Estève, Sonia
Health professionals must be able to respond to many different situations which require technical knowledge and self-control. Particularly when working in the patient's home, nurses must know how to maintain a proper distance to protect themselves from burnout. In this respect, the practice analysis constitutes an adapted support tool. PMID:27393988
The Coach Is in: Improving Nutritional Care in Nursing Homes
ERIC Educational Resources Information Center
Rahman, Anna N.; Simmons, Sandra F.; Applebaum, Robert; Lindabury, Kate; Schnelle, John F.
Purpose: This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. Methods: In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff…
Serious Mental Illness in Florida Nursing Homes: Need for Training
ERIC Educational Resources Information Center
Molinari, Victor A.; Merritt, Stacy S.; Mills, Whitney L.; Chiriboga, David A.; Conboy, Ann; Hyer, Kathryn; Becker, Marion A.
This study examined how the mental health needs of nursing home (NH) residents with serious mental illness (SMI) are addressed. Data were collected from three sources: interviews with 84 SMI stakeholders; surveys of 206 NH staff members; and focus groups at two psychiatry specialty NHs. Four common themes emerged: placement of older adults with…
Water homeostasis, frailty and congnitive function in the nursing home
Technology Transfer Automated Retrieval System (TEKTRAN)
The goal of this study is to develop and test a practical clinical method to assess frailty in nursing homes and to investigate the relationship between cognitive status of the elderly and the balance between water compartments of their body composition. This is a cross-sectional study, conducted a...
[The benefits of foot reflexology in nursing homes].
Simonnet, Karine
Massages, following the foot reflexology method, were given to patients in a nursing home suffering from Alzheimer's disease or related disorders. A methodical assessment, on a small sample of patients, showed a significant reduction in neuropsychiatric manifestations, opening up new perspectives for non-medication based therapy for the care of elderly dependent people. PMID:23301302
Remote monitoring of nursing home residents using a humanoid robot.
Bäck, Iivari; Kallio, Jouko; Perälä, Sami; Mäkelä, Kari
We studied the feasibility of using a humanoid robot as an assistant in the monitoring of nursing home residents. The robot can receive alarms via its wireless Internet connection and navigate independently to the room where the alarm originated. Once it has entered the room, the robot can transmit near real time images to the staff and also open a voice connection between the resident and the remote caregivers. This way the remote caregiver is able to check the situation in the room, and take appropriate actions. We tested the prototype robot in three private nursing homes in the Finnish county of South Ostrobothnia. During the testing, 2-4 alarms were produced by each participant and there were 29 alarms in total. The robot was able to navigate correctly to the room from which the alarm was sent and open the speech connection, as well as transmit images via the wireless Internet connection. The experiments provided evidence of the feasibility of using autonomous robots as assistants to nursing home staff in remote monitoring. The response from the nursing home residents was uniformly positive. PMID:22912489
Quiet Times: Ninth Graders Teach Poetry Writing in Nursing Homes.
ERIC Educational Resources Information Center
Dickson, Randi
Describes a community project (based on Kenneth Koch's book "I Never Told Anybody") in which students in a ninth-grade English class paired up with nursing home residents, making regular visits to encourage them to write poetry. Discusses finding a place, getting ready, working together, and what students learned about writing poetry and about…
A dog and a "happy person" visit nursing home residents.
Kaiser, Lana; Spence, Linda J; McGavin, Lily; Struble, Laura; Keilman, Linda
Recent recognition of the importance of the human-animal bond has led to the proliferation of programs designed to improve the lives of nursing home residents through the use of animals. Because human-human interaction in the nursing home setting is often of an obligatory nature, we wondered if a visit from a nonjudgmental, outgoing, enthusiastic young adult ("a happy person") could elicit the same positive influence as a visit from a nonjudgmental dog. The purpose of this study was to determine if elderly residents of a midwestern nursing home had a preference for the type of visitor (dog vs. person) when both visits were nonobligatory and nonjudgmental. Behaviors were evaluated to determine if one visitor was more likely to influence prosocial behaviors (moving closer, patting, smiling). Six residents were visited by both the dog and the happy person: 5 of 6 completed the final interview. Residents were equally likely to smile at and move closer to both visitors. Residents were more likely to pat the dog. Three residents liked both visits equally: 1 preferred the dog, and 1 preferred the happy person. These data suggest that nonobligatory visits to nursing home residents from a happy person may be as beneficial to the resident as visits from a dog. PMID:12365767
Understanding Nursing Home Worker Conceptualizations about Good Care
ERIC Educational Resources Information Center
Chung, Gawon
This study explored how direct care workers in nursing homes conceptualize good care and how their conceptualizations are influenced by external factors surrounding their work environment and the relational dynamics between them and residents. Study participants were drawn from a local service employees' union, and in-depth interviews were…
Nursing Home Care Quality: Insights from a Bayesian Network Approach
ERIC Educational Resources Information Center
Goodson, Justin; Jang, Wooseung; Rantz, Marilyn
Purpose: The purpose of this research is twofold. The first purpose is to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes. The second is to provide new insight into the relationships that exist among various measures of quality and how such measures…
Nursing Home Aides Experience Increase in Serious Injuries.
ERIC Educational Resources Information Center
Personick, Martin E.
Bureau of Labor Statistics' data show that the incidence rate of 15 workplace injuries and illnesses per 100 full-time nursing home workers is well above that for private industry as a whole. Back injuries are most frequently reported. Short tenure and high turnover are correlated with health and safety problems. (SK)
Measuring Work Environment and Performance in Nursing Homes
Temkin-Greener, Helena; Zheng, Nan (Tracy); Katz, Paul; Zhao, Hongwei; Mukamel, Dana B.
Background Qualitative studies of the nursing home work environment have long suggested that such attributes as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. Objectives This study is designed to: develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability and validity of the instrument; and identify individual and facility-level factors associated with better facility performance. Research Design and Methods The analysis was based on survey responses provided by managers (N=308) and direct care workers (N=7,418) employed in 162 facilities throughout New York State. Exploratory factor analysis, Chronbach's alphas, analysis of variance, and regression models were used to assess instrument reliability and validity. Multivariate regression models, with fixed facility effects, were used to examine factors associated with work effectiveness. Results The reliability and the validity of the survey instrument for measuring work environment and perceived work effectiveness has been demonstrated. Several individual (e.g. occupation, race) and facility characteristics (e.g. management style, workplace conditions, staffing) that are significant predictors of perceived work effectiveness were identified. Conclusions The organizational performance model used in this study recognizes the multidimensionality of the work environment in nursing homes. Our findings suggest that efforts at improving work effectiveness must also be multifaceted. Empirical findings from such a line of research may provide insights for improving the quality of the work environment and ultimately the quality of residents' care. PMID:19330892
MDS Coordinator Relationships and Nursing Home Care Processes
Piven, Mary L.; Bailey, Donald; Ammarell, Natalie; Corazzini, Kirsten; Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Anderson, Ruth A.
The purpose of this study was to describe how Minimum Data Set (MDS) Coordinators' relationship patterns influence nursing home care processes. The MDS Coordinator potentially interacts with staff across the nursing home to coordinate care processes of resident assessment and care planning. We know little about how MDS Coordinators enact this role or to what extent they may influence particular care processes beyond paper compliance. Guided by complexity science and using two nursing home case studies as examples (pseudonyms Sweet Dell and Safe Harbor), we describe MDS Coordinators' relationship patterns by assessing the extent to which they used and fostered the relationship parameters of good connections, new information flow, and cognitive diversity in their work. Sweet Dell MDS Coordinators fostered new information flow, good connections, and cognitive diversity, which positively influenced assessment and care planning. In contrast, Safe Harbor MDS Coordinators did little to foster good connections, information flow, or cognitive diversity with little influence on care processes. This study revealed that MDS Coordinators are an important new source of capacity for the nursing home industry to improve quality of care. Findings suggest ways to enhance this capacity. PMID:16585806
Activity Engagement: Perspectives from Nursing Home Residents with Dementia
Tak, Sunghee H.; Kedia, Satish; Tongumpun, Tera Marie; Hong, Song Hee
Engagement in social and leisure activities is an indicator of quality of life and well-being in nursing homes. There are few studies in which nursing home residents with dementia self-reported their experiences in activity engagement. This qualitative study describes types of current activity involvement and barriers to activities as perceived by nursing home residents with dementia. Thirty-one residents participated in short, open-ended interviews and six in in-depth interviews. Thematic content analysis showed that participants primarily depended on activities organized by their nursing homes. Few participants engaged in self-directed activities such as walking, visiting other residents and family members, and attending in church services. Many residents felt they had limited opportunities and motivation for activities. They missed past hobbies greatly but could not continue them due to lack of accommodation and limitation in physical function. Environmental factors, along with fixed activity schedule, further prevented them from engaging in activities. Residents with dementia should be invited to participate in activity planning and have necessary assistance and accommodation in order to engage in activities that matter to them. Based on the findings, a checklist for individualizing and evaluating activities for persons with dementia is detailed. PMID:25489122
A Profile of the Newly-Admitted Nursing Home Resident.
ERIC Educational Resources Information Center
Erber, Joan T.; Dye, Carol J.
Recently admitted nursing home residents received a battery of psychological tests and were rated on a number of behavioral indices. Results revealed the morale/anxiety dimension was independent of cognitive competency, internally controlled residents were rated high by others in behavioral competency, and self-rating scales measure something…
Pottery as Art Therapy with Elderly Nursing Home Residents.
ERIC Educational Resources Information Center
Doric-Henry, Lee
Reports on an art therapy intervention which was implemented with 20 elderly nursing home residents so as to improve their psychological well-being. Program evaluation included self-evaluations, case progress notes, journal notes, and photography. Results indicate that participants showed significantly improved measures of self-esteem, and reduced…
Adjustment to the Nursing Home as a Social Interactional Accomplishment.
ERIC Educational Resources Information Center
Sigman, Stuart J.
Argues that adjustment to nursing homes is influenced by peer group and staff-patient interaction. Concludes that both staff and residents place demands and expectations on newcomers' conduct, and staff define successful and unsuccessful adjustment so that patients are constrained in the range of socially acceptable behavior they are permitted to…
Severity of Neuropsychiatric Symptoms in Nursing Home Residents
Helvik, Anne-Sofie; Engedal, Knut; Wu, Bei; Benth, Jūratė Šaltytė; Corazzini, Kirsten; Røen, Irene; Selbæk, Geir
We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS) in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163) and 2010/2011 (n = 1,858). Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR) sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia. PMID:26933438
Cultural Competence in Nursing Homes: Issues and Implications for Education
ERIC Educational Resources Information Center
Parker, Victoria A.; Geron, Scott Miyake
A research and intervention project to enhance cultural competence (CC) within nursing home staff is described, with particular emphasis on the qualitative findings generated during baseline assessments of 10 participating facilities. These findings, developed from an analysis of transcripts of 56 focus groups, suggest the importance of five CC…
The interprofessional clinical experience: interprofessional education in the nursing home.
Sheppard, Kendra D; Ford, Channing R; Sawyer, Patricia; Foley, Kathleen T; Harada, Caroline N; Brown, Cynthia J; Ritchie, Christine S
The interprofessional clinical experience (ICE) was designed to introduce trainees to the roles of different healthcare professionals, provide an opportunity to participate in an interprofessional team, and familiarize trainees with caring for older adults in the nursing home setting. Healthcare trainees from seven professions (dentistry, medicine, nursing, nutrition, occupational therapy, optometry and social work) participated in ICE. This program consisted of individual patient interviews followed by a team meeting to develop a comprehensive care plan. To evaluate the impact of ICE on attitudinal change, the UCLA Geriatric Attitudes Scale and a post-experience assessment were used. The post-experience assessment evaluated the trainees' perception of potential team members' roles and attitudes about interprofessional team care of the older adult. Attitudes toward interprofessional teamwork and the older adult were generally positive. ICE is a novel program that allows trainees across healthcare professions to experience interprofessional teamwork in the nursing home setting. PMID:25140581
Developing a fidelity assessment instrument for nurse home visitors.
Black, Kirsten J; Wenger, Mary Beth; O' Fallon, Molly
Fidelity monitoring is a core component for successful translation of evidence-based interventions, yet little guidance is available on developing tools to assess intervention fidelity that are valid and feasible for use in community settings. We partnered with nurses in the field to develop a fidelity monitoring instrument that would capture the essential elements of the nursing intervention that is the core of Nurse-Family Partnership, a prenatal and early childhood home visitation program. Using a grounded approach, we employed concept mapping to identify the salient behavioral characteristics associated with the program, and then, adapting Dreyfus' model of skill development, created a tool to assess nurse home visitors (NHVs) according to their stage of growth. In a pilot, the Nursing Practice Assessment (NPA) form was used to assess 188 NHVs. The average time to complete the tool was 1 hour, and skill development stage was concordant with years of NHV experience. According to surveys of supervisors and NHVs, the tool captured the essential elements of the program model. Articulating the essential elements of each skill development stage can provide a foundation for professional development for NHVs. In response to feedback, online training modules were developed prior to large-scale implementation in the field. The grounded methods used to develop the NPA enhanced its internal consistency and implementation feasibility and could be utilized by other public health nursing programs. PMID:25778796
Effects of a geriatric nurse practitioner on process and outcome of nursing home care.
Kane, R L; Garrard, J; Skay, C L; Radosevich, D M; Buchanan, J L; McDermott, S M; Arnold, S B; Kepferle, L
We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care. PMID:2504064
Nursing dependency in registered nursing homes and long term care geriatric wards in Edinburgh.
Capewell, A E; Primrose, W R; MacIntyre, C
There has been growing interest and public investment in registered nursing homes, apparently based on the assumption that these homes are the private equivalent of hospital long term care. We have tested this hypothesis in a survey comparing 400 patients in 18 registered nursing homes with 217 patients in 11 geriatric long term care wards in Edinburgh. The nursing home patients formed a distinct and separate group: 362 (92%) were women, 392 (98%) were single or widowed, and 358 (90%) were self financing, whereas in the geriatric long term care group 148 (68%) were women and 35 (16%) were still married. Patients in nursing homes were also far less dependent than those in geriatric long term care wards (p less than 0.005). This study suggests that there may be large differences between the patients in these two types of institution, particularly with regard to nursing dependency. This finding has important implications in the future planning of long term places for the dependent elderly. PMID:3089370
[Skin Care to Prevent Development of Pressure Ulcers in Bedridden Nursing Home Residents from Developing Pressure Ulcers in Nursing Home Residents].
Furukawa, Chie
The purpose of this study was to clarify whether skincare products are effective in preventing development of pressure ulcers in bedridden nursing home residents. The study sample consisted of 21 nursing home residents at a nursing home in Osaka, Japan who use diapers. Participants were assigned to 3 groups and compared to a control group. None of the subjects developed a pressure ulcer and had improved skin condition around the anus. PMID:26809416
Needlestick injuries and needle disposal in Minnesota nursing homes.
Crossley, K; Willenbring, K; Thurn, J
We examined needle use and disposal, needlestick injuries and their management, and employee education regarding the acquired immunodeficiency syndrome and needle use by means of a questionnaire sent to all long-term care facilities certified for skilled care in Minnesota. Responses were received from 297 of 349 (85.1%) homes. Nearly all homes (271 of 293; 92.5%) provided education for new nursing employees about use and disposal of needles. Disposal of needles and sharps was generally consistent with current recommendations for short-term care hospitals. Needlestick injuries were usually related to recapping and were most common in registered and licensed practical nurses but were infrequent (i.e., less than 1 injury per home per employee-year) probably because parenteral therapy is infrequently used in long-term care settings. Only slightly over half (166 of 286; 58%) of the homes had protocols for management of needlestick injuries. Although Minnesota nursing homes properly dispose of needles and sharps, many of these institutions need to develop policies for management of needlestick injuries that are consistent with current recommendations. PMID:2370398
Back disorders and lumbar load in nursing staff in geriatric care: a comparison of home-based care and nursing homes
Background Back pain is one of the most frequent complaints in the nursing profession. Thus, the 12-month prevalence of pain in the lumbar spine in nursing staff is as high as 76%. Only a few representative studies have assessed the prevalence rates of back pain and its risk factors among nursing staff in nursing homes in comparison to staff in home-based care facilities. The present study accordingly investigates the prevalence in the lumbar and cervical spine and determines the physical workload to lifting and caring in geriatric care. Methods 1390 health care workers in nursing homes and home care participated in this cross sectional survey. The nursing staff members were examined by occupational physicians according to the principals of the multistep diagnosis of musculoskeletal disorders. Occupational exposure to daily care activities with patient transfers was measured by a standardised questionnaire. The lumbar load was calculated with the Mainz-Dortmund dose model. Information on ergonomic conditions were recorded from the management of the nursing homes. Comparisons of all outcome variables were made between both care settings. Results Complete documentation, including the findings from the occupational physicians and the questionnaire, was available for 41%. Staff in nursing homes had more often positive orthopaedic findings than staff in home care. At the same time the values calculated for lumbar load were found to be significant higher in staff in nursing homes than in home-based care: 45% vs. 6% were above the reference value. Nursing homes were well equipped with technical lifting aids, though their provision with assistive advices is unsatisfactory. Situation in home care seems worse, especially as the staff often has to get by without assistance. Conclusions Future interventions should focus on counteracting work-related lumbar load among staff in nursing homes. Equipment and training in handling of assistive devices should be improved especially
Geothermal greenhouse heating facilities for the Klamath County Nursing Home, Klamath Falls, Oregon
NASA Astrophysics Data System (ADS)
The Klamath County Nursing Home, located in Klamath Falls, Oregon, was constructed in 1976. The building of 55,654 square feet currently houses care facilities for approximately 120 persons. During the initial planning for the nursing home, the present site was selected primarily on the basis of its geothermal resource. This resource currently provides space and domestic hot water heating for the nursing home, Merle West Medical Center and the Oregon Institute of Technology. The feasibility of installing a geothermal heating system in a planned greenhouse for the nursing home is explored. The greenhouse system would be tied directly to the existing hot water heating system for the nursing home.
Mental status testing in the elderly nursing home population.
Nadler, J D; Relkin, N R; Cohen, M S; Hodder, R A; Reingold, J; Plum, F
The clinical utility of selected brief cognitive screening instruments in detecting dementia in an elderly nursing home population was examined. One hundred twenty nursing home residents (mean age 87.9) were administered the Mini-Mental State Exam (MMSE) and the Modified Mini-Mental State Exam (3MS). The majority of the subjects (75%) were also administered the Dementia Rating Scale (DRS). Both clinically diagnosed demented (n = 57) and non-demented (n = 63) subjects participated in the study. Dementia was diagnosed in accordance with DSM-III-R criteria by physicians specializing in geriatric medicine. Using standard cutoffs for impairment, the 3MS, MMSE, and DRS achieved high sensitivity (82% to 100%) but low specificity (33% to 52%) in the detection of dementia among nursing home residents. Positive predictive values ranged from 52% to 61%, and negative predictive values from 77% to 100%. Higher age, lower education, and history of depression were significantly associated with misclassification of non-demented elderly subjects. Receiver Operating Characteristic (ROC) curve analyses revealed optimal classification of dementia with cutoff values of 74 for the 3MS, 22 for the MMSE, and 110 for the DRS. The results suggest that the 3MS, MMSE, and DRS do not differ significantly with respect to classification accuracy of dementia in a nursing home population. Elderly individuals of advanced age (i.e., the oldest-old) with lower education and a history of depression appear at particular risk for dementia misclassification with these instruments. Revised cutoff values for impairment should be employed when these instruments are applied to elderly residents of nursing homes and the oldest-old. PMID:7576043
Treatment of heart failure in nursing home residents
Daamen, Mariëlle AMJ; Hamers, Jan PH; Gorgels, Anton PM; Tan, Frans ES; Schols, Jos MGA; Rocca, Hans-Peter Brunner-la
Background For the treatment of chronic heart failure (HF), both pharmacological and non-pharmacological treatment should be employed in HF patients. Although HF is highly prevalent in nursing home residents, it is not clear whether the recommendations in the guidelines for pharmacological therapy also are followed in nursing home residents. The aim of this study is to investigate how HF is treated in nursing home residents and to determine to what extent the current treatment corresponds to the guidelines. Methods Nursing home residents of five large nursing home care organizations in the southern part of the Netherlands with a previous diagnosis of HF based on medical records irrespective of the left ventricle ejection fraction (LVEF) were included in this cross-sectional design study. Data were gathered on the (medical) records, which included clinical characteristics and pharmacological- and non-pharmacological treatment. Echocardiography was used as part of the study to determine the LVEF. Results Out of 501 residents, 112 had a diagnosis of HF at inclusion. One-third of them received an ACE-inhibitor and 40% used a β-blocker. In 66%, there was a prescription of diuretics with a preference of a loop diuretic. Focusing on the residents with a LVEF ≤ 40%, only 46% of the 22 residents used an ACE-inhibitor and 64% a β-blocker. The median daily doses of prescribed medication were lower than those that were recommended by the guidelines. Non-pharmacological interventions were recorded in almost none of the residents with HF. Conclusions The recommended medical therapy of HF was often not prescribed; if prescribed, the dosage was usually far below what was recommended. In addition, non-pharmacological interventions were mostly not used at all. PMID:26918012
Quality of Life Effects of Automatic External Defibrillators in the Home: Results from the Home Automatic External Defibrillator Trial (HAT)
Mark, Daniel B.; Anstrom, Kevin J.; McNulty, Steven E.; Flaker, Greg C.; Tonkin, Andrew M.; Smith, Warren M.; Toff, William D.; Dorian, Paul; Clapp-Channing, Nancy E.; Anderson, Jill; Johnson, George; Schron, Eleanor B.; Poole, Jeanne E.; Lee, Kerry L.; Bardy, Gust H.
Background Public access automatic external defibrillators (AEDs) can save lives, but most deaths from out-of-hospital sudden cardiac arrest occur at home. The Home Automatic External Defibrillator Trial (HAT) found no survival advantage for adding a home AED to cardiopulmonary resuscitation (CPR) training for 7001 patients with a prior anterior wall myocardial infarction. Quality of life (QOL) outcomes for both the patient and spouse/companion were secondary endpoints. Methods A subset of 1007 study patients and their spouse/companions was randomly selected for ascertainment of QOL by structured interview at baseline and 12 and 24 months following enrollment. The primary QOL measures were the Medical Outcomes Study 36-Item Short-Form (SF-36) psychological well-being (reflecting anxiety and depression) and vitality (reflecting energy and fatigue) subscales. Results For patients and spouse/companions, the psychological well-being and vitality scales did not differ significantly between those randomly assigned an AED plus CPR training and controls who received CPR training only. None of the other QOL measures collected showed a clinically and statistically significant difference between treatment groups. Patients in the AED group were more likely to report being extremely or quite a bit reassured by their treatment assignment. Spouse/companions in the AED group reported being less often nervous about the possibility of using AED/CPR treatment than those in the CPR group. Conclusions Adding access to a home AED to CPR training did not affect quality of life either for patients with a prior anterior myocardial infarction or their spouse/companion but did provide more reassurance to the patients without increasing anxiety for spouse/companions. PMID:20362722
Mennonite Nursing Home passive solar demonstration
Not Available
A long-term nursing care facility and retirement center was designed for passive solar heating. The system comprises thermal mass, thermal insulation, Trombe walls, and direct gain clerestories. Included here is a topical report, analysis of building performance, owner's perspective, designer's perspective, and summary of information dissemination activities. (MHR)
Low-Quality Nursing Homes Were More Likely Than Other Nursing Homes To Be Bought Or Sold By Chains In 1993-2010.
Grabowski, David C; Hirth, Richard A; Intrator, Orna; Li, Yue; Richardson, John; Stevenson, David G; Zheng, Qing; Banaszak-Holl, Jane
Two defining features of the nursing home industry are the tremendous churn in chain ownership and the perception of low-quality care at many facilities. We examined whether nursing homes that underwent chain-related transactions, such as mergers and acquisitions, experienced a larger number of health deficiency citations than nursing homes that maintained common ownership over the same period. Using facility-level data for the period 1993-2010, we found that those nursing homes that underwent chain-related transactions had more deficiency citations in the years preceding and following a transaction than those nursing homes that maintained common ownership. Thus, we did not find that these transactions led to a decline in quality. Instead, we found that chains targeted nursing homes that were already having quality problems and that these problems persisted after the transaction. Given the high frequency of nursing home chain transactions, policy makers will need to continue to invest in tracking, reporting, and overseeing these transactions. One important step would be to report more detailed data on chain ownership, transactions, and aggregate chain quality on the Nursing Home Compare website, the federal government's online report card for nursing homes. PMID:27140998
Making Difficult Decisions: The Role of Quality of Care in Choosing a Nursing Home
Phelps, Charles E.; Temkin-Greener, Helena; Spector, William D.; Veazie, Peter; Mukamel, Dana B.
Objectives. We investigated how quality of care affects choosing a nursing home. Methods. We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model. Results. In all states, consumers were more likely to choose nursing homes of high hotel services quality but not clinical care quality. Nursing home choice was also significantly associated with shorter distance from prior residence, not-for-profit status, and larger facility size. Conclusions. In the absence of quality report cards, consumers choose a nursing home on the basis of the quality dimensions that are easy for them to observe, evaluate, and apply to their situation. Future research should focus on identifying the quality information that offers the most value added to consumers. PMID:23488519
Use of resident-origin data to define nursing home market boundaries.
Zwanziger, Jack; Mukamel, Dana B; Indridason, Indridi
Previous studies of nursing home markets have assumed that a nursing home's market is coincident with the boundaries of the county in which it is located. We test this assumption by using the zip code of residence for Medicare beneficiaries admitted into a nursing home in New York state in the periods 1992-93 and 1996-97. We find that nursing homes located in urban areas have markets that are a fraction of the size of the county in which they are located. We calculate the Herfindahl-Hirschman Index (HHI) to measure the competitiveness of each nursing home's market. This shows that nursing home markets tend to be more concentrated than those that result from assuming countywide markets. These results suggest that studies of nursing home markets should not use counties as markets. PMID:12067076
48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.
Code of Federal Regulations, 2011 CFR
... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...
48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.
Code of Federal Regulations, 2013 CFR
... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...
48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.
Code of Federal Regulations, 2012 CFR
... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...
48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.
Code of Federal Regulations, 2010 CFR
... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...
48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.
Code of Federal Regulations, 2014 CFR
... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...
Nursing documentation in nursing homes--state-of-the-art and implications for quality improvement.
Voutilainen, Päivi; Isola, Arja; Muurinen, Seija
This study was designed to gain information on the quality of nursing care based on the comments in nursing records. The specific aims of the study were to find out if the patients' (i) individual needs are assessed, the goals for nursing care are set, and the nursing interventions are determined; (ii) if the patients' needs are met and (iii) if goal achievement is regularly evaluated by including comments in nursing documents. In addition, the study aimed to describe the up-to-dateness of nursing care plans as well as the frequency of making daily notes. The data were collected on 36 wards of four residential homes. A 30% sample of the nursing documents on each ward was collected (n=332) using the Senior Monitor instrument. The documents studied were mainly nursing care plans and daily note sheets. Seventy-three per cent of the nursing home residents had an up-to-date nursing care plan at the time of data collection. The main results demonstrated that a written statement on the patient's mental ability was lacking in every fourth document although 75% of the patients suffer from at least moderate dementia in Finnish long-term care institutions. Development activities should also be targeted to the documentation of clear and concrete means by which patients' independent functioning is supported. In addition, evaluation was the area that warranted attention and development activities since only every fourth record included information on changes in the patients' functional capability. Although a lot of in-service training has been focused on improving the documentation practices, there is still a need for development. The means by which knowledge is transferred to guide the practice should be carefully considered. Also forms should be developed to meet the special requirements for recording nursing care in long-term care settings. PMID:15005666
Picture Your Nursing Home: Exploring the Sense of Home of Older Residents through Photography
van Hoof, J.; Verhagen, M. M.; Wouters, E. J. M.; Marston, H. R.; Rijnaard, M. D.; Janssen, B. M.
The quality of the built environment can impact the quality of life and the sense of home of nursing home residents. This study investigated (1) which factors in the physical and social environment correlate with the sense of home of the residents and (2) which environmental factors are most meaningful. Twelve participants engaged in a qualitative study, in which photography was as a supportive tool for subsequent interviews. The data were analysed based on the six phases by Braun and Clarke. The four themes identified are (1) the physical view; (2) mobility and accessibility; (3) space, place, and personal belongings; and (4) the social environment and activities. A holistic understanding of which features of the built environment are appreciated by the residents can lead to the design and retrofitting of nursing homes that are more in line with personal wishes. PMID:26346975
Hospitals will send an integrated nurse home with each discharge.
Morrow, Thomas
Hospitals must adapt to the rapidly changing environment of risk by changing the health behavior of their population. There is only one way to do this efficiently and at scale; send a nurse home with every patient at the time of discharge. That nurse can ensure adherence to medication and slowly, over time, transform personal behavior to evidence based levels ... basically taking their medication as prescribed, changing eating habits, increasing exercise, getting people to throw away their cigarettes, teaching them how to cope, improving their sleep and reducing their stress. But, this approach will require a nurse to basically "live" with the patient for prolonged periods of time, as bad health behaviors are quick to start but slow to change or end. The rapid developments in artificial intelligence and natural language understanding paired with cloud based computing and integrated with a variety of data sources has led to a new marketplace comprised of cognitive technologies that can emulate even the most creative, knowledgeable and effective nurse. Termed the Virtual Health Assistant, your patients can literally talk to these agents using normal conversational language. The possibility to send a nurse home with each patient to maintain adherence and prevent readmissions has arrived. The technology is available. Who will step forward to reap the rewards first? PMID:26571636
Safety culture of nursing homes: opinions of top managers
Castle, Nicholas G.; Wagner, Laura M.; Ferguson, Jamie C.; Handler, Steven M.
Background Examining the perception of the patient safety culture (PSC) of top managers in healthcare settings is important because their orientation to PSC can have a large influence on the facility. Purposes In this research, the perception of the PSC of Nursing Home Administrators (NHAs) and Directors of Nursing (DONs) is examined. Methodology/Approach Primary data were collected to examine the opinions of the PSC from NHAs and DONs. Information was collected from a large nationally representative sample of 4,000 nursing homes. The Nursing Home Survey on Patient Safety Culture (NHSPSC) survey instrument was used as a measure of PSC. This has 12 domains and 38 items. Bias indexes, intraclass correlation coefficients, and Pearson's product-moment correlation coefficients of the differences between NHA and DON item scores were examined. Findings Using a 0–100 scale, most scores fell into the 55–80 range. Higher scores represent a higher (more favorable) PSC. Agreement between the NHA and DON was excellent for 10 items, good in 15 items, moderate in 4 items, and poor in 8 items. Of the 4 largest differences in scores, the NHA scores were higher than the DON scores for one item and DON scores were higher than the NHA scores for 3 items. Implications The overall perception from both NHAs and DONs, would appear to represent a somewhat "positive" outlook from these top managers on their institution's PSC. However, NHAs in general report higher scores than DONs. The areas of divergence between these top managers are further discussed, with a view towards directing future patient safety investigations and initiatives in nursing homes. PMID:21317661
Reducing hospital admissions from nursing homes: a systematic review
Background The geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. Methods A systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination. Results Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. Conclusions Overall, eleven
78 FR 46421 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes): Comment Request AGENCY: Veterans Health... day health care facilities are providing high quality services to Veterans in State homes....
Pressure sores in nursing home patients.
Weiler, P G; Franzi, C; Kecskes, D
One hundred and sixty-seven patients were part of a cross-sectional study examining pressure sores in patients in skilled nursing facilities. Every patient admitted to this study was physically examined for the presence or absence of pressure sores and evaluated according to a standardized procedure. Using logistic regression analysis, the variables most significantly associated with pressure sores included a history of hypertension, infection, unwelcome response to visitors, history of poor dietary intake and a pattern of slow or poor response to commands. Knowledge of these factors may lead to more intensive efforts to develop better methods of prevention and treatment of pressure sores. PMID:2094365
Assisting Cognitively Impaired Nursing Home Residents with Bathing: Effects of Two Bathing Interventions on Caregiving
ERIC Educational Resources Information Center
Hoeffer, Beverly; Talerico, Karen Amann; Rasin, Joyce; Mitchell, C. Madeline; Stewart, Babara J.; McKenzie, Darlene; Barrick, Ann Louise; Rader, Joanne; Sloane, Philip D.
Purpose: When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing, nursing home caregivers are in a unique position to improve residents' experience. This report addresses whether certified nursing assistants (CNAs) who received training in a person-centered approach with showering and with the…
Role for a Labor-Management Partnership in Nursing Home Person-Centered Care
ERIC Educational Resources Information Center
Leutz, Walter; Bishop, Christine E.; Dodson, Lisa
Purpose: To investigate how a partnership between labor and management works to change the organization and focus of nursing home frontline work, supporting a transition toward person-centered care (PCC) in participating nursing homes. Design and Methods: Using a participatory research approach, we conducted case studies of 2 nursing homes…
Quality of Life in the Nursing Home: Perspectives of Younger and Older Residents
ERIC Educational Resources Information Center
Watt, Ashli; Konnert, Candace
Adults aged 65 and younger make up a significant proportion of nursing-home residents. To date, however, there is no research examining their quality of life (QOL), including how their perceptions of QOL compare to those of older nursing-home residents. This study used a multidimensional approach to (a) assess the QOL of younger nursing-home…
Assessing contributors to cost of care in nursing homes.
Hicks, L L; Rantz, M J; Petroski, G F; Madsen, R W; Conn, V S; Mehr, D R; Porter, R
In 1994 12.7% of the population was 65 and over, while 10.6% were 85 and over. Expenditures for nursing homes reached $72.3 billion in 1994 (much of which is tax-supported) accounting for 8.7% of all personal health money spent. Data from the 1993 Missouri Medicaid cost reports for 403 nursing homes were reviewed to determine differences in costs per resident day (PRD) and discover which factors most influenced these differences. Mid-sized facilities with 60-120 beds reported the lowest resident-related PRD costs. PRD expenses for aides and orderlies were higher in tax-exempt facilities, which was thought to be related to their "more altruistic" mission. Investor-owned facilities showed significantly greater administrative costs PRD, which may relate to higher administrative salaries and fancier offices. The authors suggest further study that would incorporate location, occupancy rate, quality of care, case mix, and payer mix data. PMID:9282032
Estimating undersupply of nursing home beds in states.
Swan, J H; Harrington, C
This examination of nursing home bed supply estimates undersupply in each of the states for the purpose of identifying the states with the greatest undersupply of beds. New data on state nursing home bed supply for the period 1979-1982 are used. The study employs selected independent variables in two different types of analyses to estimate bed supply for each state. Where a state is found to have a bed shortage, state public policymakers may wish to employ policies that differ from those suitable for states with an adequate supply of beds. Because of limitations in the data, issues of oversupply and of the extent of undersupply could not be examined. PMID:3519534
Regulation and Mindful Resident Care in Nursing Homes
Colón-Emeric, Cathleen S.; Plowman, Donde; Bailey, Donald; Corazzini, Kirsten; Utley-Smith, Queen; Ammarell, Natalie; Toles, Mark; Anderson, Ruth
Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindful staff behavior as it relates to resident health outcomes, and offer a theoretical explanation of why regulations sometimes enhance mindfulness and other times inhibit it. We analyzed data from an in-depth, multiple case study including field notes, interviews, and documents collected in 8 nursing homes. We completed a conceptual/thematic description using the concept of mindfulness to reframe the observations. Shared facility mission strongly impacted staff perceptions of the purpose and utility of regulations. In facilities with a resident-centered culture, regulations increased mindful behavior, whereas in facilities with a cost-focused culture, regulations reduced mindful care practices. When managers emphasized the punitive aspects of regulation we observed a decrease in mindful practices in all facilities. PMID:20479137
Variations in levels of care between nursing home patients in a public health care system
Background Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. Methods The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. Results There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. Conclusion In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients' own needs, but also on the needs of all the other residents
The Effect of Hospice on Hospitalizations of Nursing Home Residents
Zheng, Nan Tracy; Mukamel, Dana B.; Friedman, Bruce; Caprio, Thomas V.; Temkin-Greener, Helena
Objectives Hospice enrollment is known to reduce risk of hospitalizations for nursing home residents who use it. We examined whether residing in facilities with a higher hospice penetration: 1) reduces hospitalization risk for non-hospice residents; and 2) decreases hospice-enrolled residents' hospitalization risk relative to hospice-enrolled residents in facilities with a lower hospice penetration. Method Medicare Beneficiary File, Inpatient and Hospice Claims, Minimum Data Set Version 2.0, Provider of Services File and Area Resource File. Retrospective analysis of long-stay nursing home residents who died during 2005-2007. Overall, 505,851 non-hospice (67.66%) and 241,790 hospice-enrolled (32.34%) residents in 14,030 facilities nationwide were included. We fit models predicting the probability of hospitalization conditional on hospice penetration and resident and facility characteristics. We used instrumental variable method to address the potential endogeneity between hospice penetration and hospitalization. Distance between each nursing home and the closest hospice was the instrumental variable. Main Findings In the last 30 days of life, 37.63% of non-hospice and 23.18% of hospice residents were hospitalized. Every 10% increase in hospice penetration leads to a reduction in hospitalization risk of 5.1% for non-hospice residents and 4.8% for hospice-enrolled residents. Principal Conclusions Higher facility-level hospice penetration reduces hospitalization risk for both non-hospice and hospice-enrolled residents. The findings shed light on nursing home end-of-life care delivery, collaboration among providers and cost benefit analysis of hospice care. PMID:25304181
Fracture Risk among Nursing Home Residents Initiating Antipsychotic Medications
Rigler, Sally K.; Shireman, Theresa I.; Cook-Wiens, Galen J.; Ellerbeck, Edward F.; Whittle, Jeffrey C.; Mehr, David R.; Mahnken, Jonathan D.
Objectives to determine whether antipsychotic medication initiation is associated with subsequent fracture in nursing home residents, whether fracture rates differ between first-generation versus second-generation antipsychotic use, and whether fracture rates differ among users of haloperidol, risperidone, olanzapine, and quetiapine. Design time-to-event analyses were conducted in a retrospective cohort using linked Medicaid, Medicare, Minimum Data Set and Online Survey, Certification and Reporting data sets. Setting and Participants nursing home residents aged ≥ 65 years in CA, FL, MO, NJ and PA. Measurements fracture outcomes (any fracture; hip fracture) in first-versus second-generation antipsychotic users, and specifically among users of haloperidol, risperidone, olanzapine and quetiapine. Comparisons incorporated propensity scores that included patient-level variables (demographics, comorbidity, diagnoses, weight, fall history, concomitant medications, cognitive performance, physical function, aggressivebehavior) and facility-level variables (nursing home size, ownership factors, staffing levels). Results Among 8,262 subjects (within 4,131 pairs), 4.3% suffered any fracture during observation with 1% having a hip fracture during an average follow up period of 93 ± 71 days; range 1 to 293 days). Antipsychotic initiation was associated with any fracture (hazard ratio (HR) 1.39, p=0.004) and with hip fracture (HR 1.76, p=0.024). The highest risk was found for hip fracture when antipsychotic use was adjusted for dose(HR=2.96; p=0.008). However, no differences in time-to-fracture were found in first-versus second-generation agents or across competing individual drugs. Conclusion Antipsychotic initiation is associated with fracture in nursing home residents, but risk does not differ across commonly used antipsychotics. PMID:23590366
[What happened after meprobamate's withdrawal? Survey in two nursing homes].
Lounis, Yacine; Bonnet-Zamponi, Dominique; Pautas, Éric; Gaubert-Dahan, Marie-Line
We have conducted in two nursing homes a survey to study the impact of meprobamate's withdrawal, at the beginning of 2012, in terms of extent of prescribing to others psychotropic drugs and occurrence of adverse events. After meprobamate's withdrawal, 65 % of residents did not receive alternative medication and within three months after meprobamate stopping, adverse events (drowsiness, falls and hospitalization) decreased while agitation did not increase. PMID:26976315
Impact of human resource management practices on nursing home performance.
Rondeau, K V; Wagar, T H
Management scholars and practitioners alike have become increasingly interested in learning more about the ability of certain 'progressive' or 'high-performance' human resource management (HRM) practices to enhance organizational effectiveness. There is growing evidence to suggest that the contribution of various HRM practices to impact firm performance may be synergistic in effect yet contingent on a number of contextual factors, including workplace climate. A contingency theory perspective suggests that in order to be effective, HMR policies and practices must be consistent with other aspects of the organization, including its environment. This paper reports on empirical findings from research that examines the relationship between HRM practices, workplace climate and perceptions of organizational performance, in a large sample of Canadian nursing homes. Data from 283 nursing homes were collected by means of a mail survey that included questions on HRM practices, programmes, and policies, on human resource aspects of workplace climate, as well as a variety of indicators that include employee, customer/resident and facility measures of organizational performance. Results derived from ordered probit analysis suggest that nursing homes in our sample which had implemented more 'progressive' HRM practices and which reported a workplace climate that strongly values employee participation, empowerment and accountability tended to be perceived to generally perform better on a number of valued organizational outcomes. Nursing homes in our sample that performed best overall were found to be more likely to not only have implemented more of these HRM practices, but also to report having a workplace climate that reflects the seminal value that it places on its human resources. This finding is consistent with the conclusion that simply introducing HRM practices or programmes, in the absence of an appropriately supportive workplace climate, will be insufficient to attain
Arbitration agreements in health care nursing home contracts.
Infante, Marie C; Lovitch, Karen S
Increasingly, long-term care facilities are adopting alternative dispute resolution measures, such as arbitration, in admission contracts. Whereas avoiding the onus of civil lawsuits is understandable, nursing homes must ensure that the arbitration wording in the contract is precise, enforceable, and most importantly, pursuant to state and federal laws, regulations, and guidelines. Otherwise, the contract itself may be the subject of a court action. PMID:14650372
[Interests of an olfactory stimulation activity in a nursing home].
Garnaud, Mahlia; Rexand, Franck
The comparison between the memories productions of residents in a nursing home through two reminiscence activities, one including olfaction and not the other one, can highlight an increasing occurrence of recent memories in the case of olfactory activity. A longer talk time is also observed and a better self-esteem can be assessed. This suggests the possibility of a specific relational and psychotherapeutic work. PMID:26976316
Intended and unintended consequences of minimum staffing standards for nursing homes.
Chen, Min M; Grabowski, David C
Staffing is the dominant input in the production of nursing home services. Because of concerns about understaffing in many US nursing homes, a number of states have adopted minimum staffing standards. Focusing on policy changes in California and Ohio, this paper examined the effects of minimum nursing hours per resident day regulations on nursing home staffing levels and care quality. Panel data analyses of facility-level nursing inputs and quality revealed that minimum staffing standards increased total nursing hours per resident day by 5% on average. However, because the minimum staffing standards treated all direct care staff uniformly and ignored indirect care staff, the regulation had the unintended consequences of both lowering the direct care nursing skill mix (i.e., fewer professional nurses relative to nurse aides) and reducing the absolute level of indirect care staff. Overall, the staffing regulations led to a reduction in severe deficiency citations and improvement in certain health conditions that required intensive nursing care. PMID:24850410
NIOSH research initiatives to prevent back injuries to nursing assistants, aides, and orderlies in nursing homes.
Collins, J W; Owen, B D
Over the past 100 years, advances in nutrition, modern medicine, public health, and a multitude of public health improvements have increased the life expectancy of U.S. residents. The fact that Americans are living longer has resulted in extensive growth in our elderly population and a rapid employment growth that delivered about 2 million new jobs between 1980 and 1989 in the health care workforce. The Bureau of Labor Statistics Injury and Illness Data for nursing homes rose from 10.7 to 18.6 injuries or illnesses per 100 full-time workers between 1980 and 1992. The injury and illness rates among nursing home workers are partly due to the physical stress of providing round-the-clock assistance with the basic activities of daily living, such as getting in and out of a bed or chair, as well as bathing and toileting. The National Institute for Occupational Safety and Health (NIOSH) is conducting a series of research studies to identify strategies to reduce the risk of musculoskeletal injuries to workers in nursing homes. NIOSH has funded two laboratory evaluations of resident transferring methods and one field study in an actual nursing home. The purpose of this paper is to describe the key findings from past NIOSH research initiatives and to present an overview of future research. PMID:8728153
The Effects of Evacuation on Nursing Home Residents With Dementia
Brown, Lisa M.; Dosa, David M.; Thomas, Kali; Hyer, Kathryn; Feng, Zhanlian; Mor, Vincent
Background In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired. Methods Nursing homes in counties located in the path of Hurricane Gustav were identified. The Minimum Data Set resident assessment files were merged with the Centers for Medicare enrollment file to determine date of death for residents in identified facilities. Difference-in-differences analyses were conducted adjusting for residents' demographic characteristics and acuity. Results The dataset included 21,255 residents living in 119 at risk nursing homes over three years of observation. Relative to the two years before the storm, there was a 2.8 percent increase in death at 30 days and a 3.9 percent increase in death at 90 days for residents with severe dementia who evacuated for Hurricane Gustav, controlling for resident demographics and acuity. Conclusions The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility. PMID:22930698
Factors associated with daytime sleep in nursing home residents.
Li, Junxin; Chang, Yu-Ping; Porock, Davina
A retrospective, cross-sectional study was conducted to describe the occurrence of daytime sleep (DS) and to examine factors associated with DS in nursing home residents. We used the Minimum Data Set 2.0 records of 300 residents in a nursing home from January 2005 to March 2010. Descriptive statistics, independent t-test, chi-square, Pearson correlations, and logistic regression were utilized in analysis. About 71.3% of the residents slept more than 2 hours during the day, and this was significantly associated with residents' comorbidity (t = 2.0, p = .04), cognitive performance (t = 7.3, p = .01), activities of daily living (t = 3.7, p = .01), and social involvement (t = -7.6, p = .01). Cognitive performance and social involvement significantly predicted the occurrence of DS with social involvement being the strongest predictor (odds ratio: .58; 95% confidence interval: [.45, .75]). The findings suggest that interventions to engage nursing home residents in more social activities during the day may be beneficial to minimize their DS, especially for those who have difficulties with engaging socially on their own. PMID:25651553
Care Instability in Nursing Homes; A Qualitative Study
Rahimi, Majid; Fadayevatan, Reza; Abedi, Heidar Ali
Background: The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Objectives: This study was performed to assess the caring conditions in nursing homes. Patients and Methods: This study was conducted with a qualitative approach using conventional qualitative content analysis. The study was conducted on 23 Iranian participants including 14 elders and 9 caregivers. Data was collected with unstructured interviews and continued to the point of data saturation. Analysis of data was performed continually and concurrently with data collection through a comparative method. Results: Three themes emerged from 595 open codes including care as unpleasant task, sustained care and insufficient resources. Ten subthemes indicated participants' experiences and understanding of caring conditions in a nursing home. Conclusions: The prevailing given care was the routine one with a focus on physical aspects, although there was some psychological care given to the older people. The findings of this research are guidelines for managers and care planners in nursing homes who should pay attention to physical and psychological care needs of older people. In addition, it is important to pay close attention to the needs of caregivers and provision of instructions for treatment, supervision and education of caregivers and medical students to provide a better care. PMID:27186382
Iowa Certified Nursing Assistants Study: Self-Reported Ratings of the Nursing Home Work Environment
Culp, Kennith; Ramey, Sandra; Karlman, Susan
Certified nursing assistants (CNAs) are the principal bedside caregivers in nursing homes, yet little is known about their perceptions of the work environment. This population-based, cross-sectional study used a mailed questionnaire to a random sample of Iowa CNAs (N = 584), representing 166 nursing homes. Of the respondents, 88.5% (n = 517) were currently employed in long-term care settings; however, 11.5% (n = 67) indicated they had left their jobs. When CNA responses were compared with those of other occupational groups, general workers reported higher scores on involvement, coworker cohesion, work pressure, and supervisor support. Those who left their CNA jobs rated their work environment as characteristic of excessive managerial control and task orientation. Results of this study emphasize the importance of the relationship between CNAs and their supervisors, CNAs' need for greater autonomy and innovation, and the need for the work environment to change dramatically in the area of human resource management. PMID:20078021
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2012 CFR
... 42 Public Health 3 2012-10-01 2012-10-01 false Return to home skilled nursing facility. 422.133... Protections § 422.133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled...
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2013 CFR
... 42 Public Health 3 2013-10-01 2013-10-01 false Return to home skilled nursing facility. 422.133... Protections § 422.133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled...
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2014 CFR
... 42 Public Health 3 2014-10-01 2014-10-01 false Return to home skilled nursing facility. 422.133... Protections § 422.133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled...
Intrinsic Job Satisfaction, Overall Satisfaction, and Intention to Leave the Job among Nursing Assistants in Nursing Homes
ERIC Educational Resources Information Center
Decker, Frederic H.; Harris-Kojetin, Lauren D.; Bercovitz, Anita
Purpose: We examined predictors of intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants (NAs). Design and Methods: The study focused on NAs who worked 30 or more hours per week in a nursing home. Data on 2,146 NAs meeting this criterion came from the 2004 National Nursing Assistant Survey, the…
An Instrument to Assess the Oral Health Status of Nursing Home Adults.
ERIC Educational Resources Information Center
Kayser-Jones, Jeanie; And Others
Presents data from the development and testing of an instrument created to evaluate the oral health of nursing home residents by nursing personnel. Examination of 100 residents by dentists and 3 categories of trained nurses established statistically significant interrater reliability, suggesting that nursing staff can be taught to evaluate the…
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2013 CFR
... 42 Public Health 3 2013-10-01 2013-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services...
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2012 CFR
... 42 Public Health 3 2012-10-01 2012-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services...
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2014 CFR
... 42 Public Health 3 2014-10-01 2014-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services...
Breastfeeding status and marketing practices of baby food manufactured in nursing homes.
Mathur, G P; Pandey, P K; Mathur, S; Mishra, V K; Singh, K; Bhatt, O P; Loomba, R K; Luthra, C; Taneja, S; Kapoor, R
In January 1993 in Kanpur, India, a survey of 7 private nursing homes revealed that infant formula was given to most newborns (52.4%). The most common brands included Lactogen-I, Milk Care, Raptakos, Dexolac Special Care, and Lactodex. Staff at 5 nursing homes gave prelacteal feeds (water, glucose water, and infant formula) to newborns when they were separated from their mothers. Staff at only 2 nursing homes gave the newborn to the mother immediately after delivery. The longest period between delivery and giving the newborn to the mother was 24 hours. All but one of the nursing homes did not know about the government policy and the recent bill that bars free or low-cost infant formula supplies to hospitals. The administration of the nursing homes did not inform the procurement department, in writing, of the government policy. 4 nursing homes bought low-cost supplies of infant formula from the companies. The companies sold the infant formula to the nursing homes at a price 48.3% to 86.7% lower than the market price. Medical stores inside or outside the nursing homes sold the infant formula to parents at the other 3 homes. The nursing homes used, on average, 2-50 kg/month. Nestle (Lactogen-I) and Dalmia Industries (Milk Care) had a monopoly in infant formula in 4 and 3 nursing homes, respectively. Infant formula was in stock in 5 nursing homes. None of the nursing homes gave mothers free or low-cost infant formula at discharge. Lower than market price and increased number of calls to the hospitals and physicians by company personnel were marketing techniques used by the manufacturers to maintain market share. These results show that, despite government policy and the bill, hospitals continue to use infant formula. The government should use the mass media to increase awareness about its policy on infant foods and the concept of the Baby Friendly Hospital. PMID:8039859
The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes.
Harrington, Charlene; Schnelle, John F; McGregor, Margaret; Simmons, Sandra F
Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819
The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes
Harrington, Charlene; Schnelle, John F.; McGregor, Margaret; Simmons, Sandra F.
Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819
From the hospital to the nursing home: the 75% rule and the transfer process.
Murphy, Patrick J; Miles, Toni P
This has been a commentary on the implications of policy changes for nursing homes and rehabilitation hospital admissions. Only time will show how greatly this will affect the nursing home. However, since the 2004 implementation of the 75% Rule, nursing homes have already seen a jump in patients who are more acutely ill and have multiple medical needs. To lessen the potential burden of these changes on patient safety and comfort and to increase family satisfaction with care, we propose the following steps be considered. 1. We need better integration between hospital and nursing homes. Indeed, a strategic alliance between hospitals and nursing homes would be something that we should consider sooner rather than later. 2. All providers should understand that this is a continued push by both private and government insurance to get the patient out of the hospital sooner. As a result, patients will be discharged either to the rehab hospital or to the nursing home "sicker and quicker." 3. The implementation of the 75% Rule will probably result in a decreased use of rehab hospitals and an increased use of the nursing home. 4. In looking even further into the future, the nursing homes themselves are likely to be under continued pressure to get patients out of the nursing home more quickly. This in turn will result in what we consider the next big thing-home care. PMID:17941422
The Nature of Staff - Family Interactions in Nursing Homes: Staff Perceptions
Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Ammarell, Natalie; Bailey, Donald; Corazzini, Kirsten; Piven, Mary L.; Anderson, Ruth A.
Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home staff members and family members of nursing home residents, as part of a larger multi-method comparative case study. Here, we report on 6- month case studies of two nursing homes where in-depth interviews, shadowing experiences, and direct observations were completed. Staff members from both nursing homes described staff-family interactions as difficult, problematic and time consuming, yet identified strategies that when implemented consistently, influenced the staff-family interaction positively. Findings suggest explanatory processes in staff-family interactions, while pointing toward promising interventions. PMID:19649311
The uniqueness of elderly care: registered nurses' experience as preceptors during clinical practice in nursing homes and home-based care.
Carlson, Elisabeth; Bengtsson, Mariette
The expected shortage of registered nurses with an advanced degree as specialists in geriatric care or gerontology is imminent. Previous studies report that clinical practice where student nurses are supervised by registered nurses has a direct impact on how students perceive nursing as a profession and future career choice. Considering the anticipated need for well-educated and specialised nurses it is therefore, relevant as well as necessary to describe clinical learning with a focus on preceptorship in geriatric nursing care. This paper is a report of a study describing registered nurses' experience of precepting undergraduate student nurses during clinical practice in nursing homes and home-based care. A qualitative design, based on seven focus group interviews, was employed with 30 registered nurses with preceptor experience from nursing homes and home-based care for the elderly. Our findings present three precepting strategies that are unique to elderly care: preparing students for end of life care, facilitating a respectful approach to the older person and promoting creativity and independent work. The findings are discussed using a socio-cultural perspective and illustrate how communities of elderly practice can be valuable learning environments. PMID:23954003
Knowledge and Attitudes of Nursing Home Staff and Surveyors about the Revised Federal Guidance for Incontinence Care
ERIC Educational Resources Information Center
DuBeau, Catherine E.; Ouslander, Joseph G.; Palmer, Mary H.
Purpose: We assessed nursing home staff and state nursing home surveyors regarding their knowledge and attitudes about urinary incontinence, its management, and the revised federal Tag F315 guidance for urinary incontinence. Design and Methods: We conducted a questionnaire survey of a convenience sample of nursing home staff and state nursing home…
Social exchange as a framework for client-nurse interaction during public health nursing maternal-child home visits.
Byrd, Mary E
The purpose of this paper was to develop a nursing-focused use of social exchange theory within the context of maternal-child home visiting. The nature of social exchange theory, its application to client-nurse interaction, and its fit with an existing data set from a field research investigation were examined. Resources exchanged between the nurse and clients were categorized and compared across the patterns of home visiting, nursing strategies based on exchange notions were identified, and variations in exchange were linked with client outcomes. The nurse provided resources within the categories of information, status, service, and goods. Clients provided time, access to the home, space within the home to conduct the visit, opportunities to observe maternal-child interaction, access to the infant, and information. The ease and breadth of resource exchange varied across the patterns of home visiting. The social exchange perspective was useful in categorizing resources, specifying and uncovering new resource categories, understanding nursing strategies to initiate and maintain the client-nurse relationship, and linking client-nurse interactive phenomena with client outcomes. Social exchange theory is potentially useful for understanding client-nurse interaction in the context of maternal-child home visits. PMID:16684206
38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.
Code of Federal Regulations, 2012 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...
38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.
Code of Federal Regulations, 2013 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...
38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.
Code of Federal Regulations, 2011 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...
38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.
Code of Federal Regulations, 2010 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...
38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.
Code of Federal Regulations, 2014 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...
Do characteristics associated with nursing home residents vary by race/ethnicity?
Davis, Jullet A; Lapane, Kate L
This study identifies differences in the predisposing, enabling, and need characteristics of racial/ethnic minorities and non-Hispanic white men and women upon nursing home admission. The data come from the 1999 National Nursing Home Survey of Current Residents and contain 3,798 women of color, 3,787 men of color, 18,719 non-Hispanic white men, and 36,900 non-Hispanic white women. We estimated prevalence differences and 95% confidence intervals for the absolute differences in prevalence. Women of color in nursing homes are more likely than non-Hispanic white women in nursing homes to be bedfast and require assistance with dressing and money management. Men of color in nursing homes are more likely than non-Hispanic white men in nursing homes to require assistance with eating, care of possessions, managing money, securing personal items, and using the telephone. The overall finding suggests that people of color in nursing homes have greater impairments than non-Hispanic whites in nursing homes, and that men of color in nursing homes have greater impairment than any other race or gender categories. PMID:15253377
Does Information Matter? Competition, Quality, and the Impact of Nursing Home Report Cards
Grabowski, David C; Town, Robert J
Objective We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. Data Sources The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. Study Design We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. Results The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. Conclusions The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. PMID:21790590
Cost and care quality between licensed nursing homes under different types of ownership.
Lee, Chun-Lan; Liu, Ta-Li; Wu, Ling-Jiuan; Chung, Ue-Lin; Lee, Li-Chuan
In Taiwan, there is some uncertainty and concern regarding the quality and safety of unlicensed nursing homes, as they are typically crowded and poorly equipped. There are data insufficient regarding the quality of care in licensed nursing homes for the government to reliably assist unlicensed facilities to become licensed. The purpose of this study was to examine the relationship between the different nursing home ownership types and the following dependent variables: (1) operating cost per resident day, (2) RN to resident ratio, (3) facility size, (4) occupancy rate, and (5) quality of care amongst licensed nursing homes nationwide. The descriptive study used a survey design. Data were obtained from 28 licensed nursing homes using self-administered questionnaires, on-site interviews and record reviews. Data were analyzed by Kruskal-Wallis test, Mann-Whitney U test and Spearman s correlation. A positive and significant relationship existed between nursing home quality and the RN ratio per resident day. Chain/For-profit and Chain/Non- profit nursing homes tended to have higher operating costs and a better quality of service. Secondary research is still needed to examine the results by detailed cost analysis or by research oriented toward outcomes of residents care. These findings provide basic reference for the government for planning the operation of nursing home facilities and also to assist the many unlicensed nursing homes to ultimately become licensed. The results also present important data for developing reimbursement policies. PMID:12119600
Prescription drugs in nursing homes: managing costs and quality in a complex environment.
Mendelson, Dan; Ramchand, Rajeev; Abramson, Richard; Tumlinson, Anne
This brief provides a description of prescription drug use in nursing homes and a summary of current policy issues in this area. The brief first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The brief then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives. PMID:12463231
Structure, environment and strategic outcome: a study of Pennsylvania nursing homes.
Aaronson, W E; Zinn, J S; Rosko, M D
This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic. PMID:10140596
Market competition and quality of care in the nursing home industry.
Starkey, Katie Baker; Weech-Maldonado, Robert; Mor, Vincent
Poor quality nursing home care is a problem in the United States, a problem that threatens the lives and well-being of one of our most vulnerable populations. The competitive structure of the nursing home market may influence the strategies and behaviors nursing homes pursue to capture the resources they need to operate. The goal of this study was to determine whether nursing home quality is related to the level and type of competition present in the market. This study specifically examined whether or not a relationship exists between structural, process, and outcome quality indicators, and (1) the availability of nursing home substitutes, (2) the threat of market entry, (3) the presence of rivalry in the market, and (4) the relationship between the nursing homes and their buyers and suppliers. This study examined secondary data from the Minimum Data Set Plus (MDS +), the On-line Survey Certification of Automated Records (OSCAR), the Area Resource File (ARF), and the Medicaid Reimbursement Survey. Weighted least squares regression analysis was utilized to estimate the relationships between the quality indicators and the different aspects of competition. This study found that some forms of competition are significantly related to nursing home quality performance. The availability of nursing home substitutes, the presence of active certificate of need laws, and the level of excess demand are associated with nursing home quality. PMID:18972979
Quality of death: a dimensional analysis of palliative care in the nursing home.
Trotta, Rebecca L
Palliative care in nursing homes is increasingly discussed, investigated, and implemented, yet the term lacks conceptual clarity and definition. Furthermore, the components, process, and outcomes of palliative care as it is delivered in the nursing home have not been clearly articulated. This paper provides a dimensional analysis of palliative care in the nursing home to elucidate the concept and its context and consequences, as portrayed through available literature. As a method, dimensional analysis is rooted in symbolic interaction and grounded theory. As such, it provides a useful tool with which to analyze existing literature on palliative care in the nursing home. In this dimensional analysis, communication is the dominant perspective of palliative care in the nursing home. This analysis demonstrates that the consequences of palliative care in the nursing home are personhood and identity, and quality of death rather than quality of life. These consequences suggest that the focus of palliative care should be on the nursing home resident and the dying experience, rather than quality of life and issues around living that exclude the dying experience and do not acknowledge the personhood and identity of the resident. These elements represent a shift in focus away from one that does not include death, toward the dying experience, and that such a change in focus is necessary to achieve palliative care in the nursing home. Finally, the analysis elucidates potential outcome measures for the study of palliative care in nursing homes and outlines possibilities for further research. PMID:17985968
Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework
Corazzini, Kirsten; Twersky, Jack; White, Heidi K.; Buhr, Gwendolen T.; McConnell, Eleanor S.; Weiner, Madeline; Colón-Emeric, Cathleen S.
Purpose of the Study: To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. Design and Methods: The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. Results: Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. Implications: Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges. PMID:24451896
Weathering the storm: challenges to nurses providing care to nursing home residents during hurricanes.
Hyer, Kathryn; Brown, Lisa M; Christensen, Janelle J; Thomas, Kali S
This article documents the experience of 291 Florida nursing homes during the 2004 hurricane season. Using quantitative and qualitative methods, the authors described and compared the challenges nurses encountered when evacuating residents with their experiences assisting residents of facilities that sheltered in place. The primary concerns for evacuating facilities were accessing appropriate evacuation sites for residents and having ambulance transportation contracts honored. The main issue for facilities that sheltered in place was the length of time it took for power to be restored. Barriers to maintaining resident health during disasters for those who evacuated or sheltered in place are identified. PMID:19875034
Assuring professional pastoral care for every nursing home resident.
Knight, B
Ministry to persons in nursing homes is built on two mandates: "... He has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim liberty to the captives, and release to the prisoners; ... to comfort all who mourn ..." (Isaiah 61:1-3). The federal government provides the second: "Quality of Life. A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life" (OBRA '87, Guidance to Surveyors in Long Term Care Facilities, Code of Federal Regulations, Health Care Financing Administration, 1995, section 483.15, F240). This article discusses both the religious and the U.S. political history of caring for the old and frail. It concludes by describing political efforts in one state to increase the quality of that care and pastoral efforts to support the nursing assistants in long-term care facilities. PMID:10387595
The Role of Education and Health Care Delivery Structure in Quality of Nursing Care for Mentally Ill Patients in Nursing Homes.
ERIC Educational Resources Information Center
Caston, Richard J.
Surveyed 35 nursing home staff members and found that nurses generally are not knowledgeable about psychiatric symptoms and do not seek out psychiatric intervention for their patients. Suggests that the organizational character of health care delivery in nursing homes makes adequate nursing response to mental illnesses impossible. (JAC)
Nursing Home Staffing Requirements and Input Substitution: Effects on Housekeeping, Food Service, and Activities Staff
Bowblis, John R; Hyer, Kathryn
Objective To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Data Sources Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Study Design Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. Data Extraction Method OSCAR surveys from 1999 to 2004. Principal Findings Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Conclusions Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. PMID:23445455
[Palliative Care in Nursing Homes: Characteristics and Specificities].
Gremaud, Grégoire; Mazzocato, Claudia
Elderly patients in palliative situations residing in a nursing home present characteristics and specificities that clearly distinguish them from patients with advanced cancer. Besides the difficulty to define a precise prognosis, their many comorbidities, their communication difficulties because of cognitive disorders, their high sensitivity to primary and secondary effects of drugs render their management a real challenge for physician and caregivers. Accompanying these patients at the end of their life also raises many ethical problems, especially when they are no longer able to express their wishes and have not previously expressed advance directives. PMID:25711788
Anderson, Ruth A.; Ammarell, Natalie; Bailey, Donald; Colóon-Emeric, Cathleen; Corazzini, Kirsten N.; Lillie, Melissa; Scotton Piven, Mary Lynn; Utley-Smith, Queen; McDaniel, Reuben R.
In a nursing home case study using observation and interview data, we described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule guided CNAs to respond to residents as they would want someone to do for them. Mother wit guided CNAs to treat residents as they would treat their own children. These mental models engendered self-control and affection. We found limits to the models in that they led to actions such as infantalization and misinterpretations about potentially undiagnosed conditions such as depression or pain. Further, we found that CNAs were isolated from clinicians; little resident information was exchanged. We suggest ways to alter CNA mental models to give them a better basis for action and strategies for connecting CNAs and clinical professionals to improve information flow about residents. Study results highlight a critical need for registered nurses (RNs) to be involved in frontline care. PMID:16221876
Engaging undergraduate nursing students in the care of elderly residents in Australian nursing homes.
Rogan, Frances; Wyllie, Aileen
This paper presents an analysis of a qualitative descriptive study exploring the effect of a structured educational program for beginning undergraduate nursing students undertaking clinical placements in Australian nursing homes. The study focuses on the students' perceptions of their knowledge, skills and attitudes towards the elderly. The analysis shows how the program with its supportive structure was able to engage the students in caring for the elderly person. Data gathered through questionnaires and focus groups demonstrate that negative attitudes toward the elderly had been modified or changed and that a surprising number of students were showing an interest in what traditionally has been an unpopular area of clinical practice. The results support some previous studies demonstrating that with the right educational support and structures beginning nursing students can engage in positive learning experiences with the elderly. PMID:19036324
Patterns of Medical and Nursing Staff Communication in Nursing Homes: Implications and Insights From Complexity Science
Colón-Emeric, Cathleen S.; Ammarell, Natalie; Bailey, Donald; Corazzini, Kirsten; Utley-Smith, Queen; Lekan-Rutledge, Deborah; Anderson, Ruth A.; Piven, Mary L.
Complexity science teaches that relationships among health care providers are key to our understanding of how quality care emerges. The authors sought to compare the effects of differing patterns of medicine-nursing communication on the quality of information flow, cognitive diversity, self-organization, and innovation in nursing homes. Two facilities participated in 6-month case studies using field observations, shadowing, and depth interviews. In one facility, the dominant pattern of communication was a vertical "chain of command" between care providers, characterized by thin connections and limited information exchange. This pattern limited cognitive diversity and innovation in clinical problem solving. The second facility used an open communication pattern between medical and frontline staff. The authors saw higher levels of information flow, cognitive diversity, innovation, and self-organization, although tempered by staff turnover. The patterns of communication between care providers in nursing facilities have an important impact on their ability to provide quality, innovative care. PMID:16394208
Training Nursing Staff to Recognize Depression in Home Healthcare
Brown, Ellen L.; Raue, Patrick J.; Roos, Bernard A.; Sheeran, Thomas; Bruce, Martha L.
OBJECTIVES To describe the implementation and acceptability of the TRaining In the Assessment of Depression (TRIAD) intervention, which has been tested in a randomized trial. The primary aim of TRIAD is to improve the ability of homecare nurses to detect depression in medically ill, older adult homecare patients. DESIGN Description of the important components of TRIAD, its implementation, and evaluation results from nurse surveys. SETTING Three certified home healthcare agencies in Westchester County, New York. PARTICIPANTS Thirty-six homecare nurses. INTERVENTION Participants randomly assigned to TRIAD (n = 17) were provided with the opportunity to observe and practice patient interviewing. The approach focused on clinically meaningful identification of the two "gateway" symptoms of depression and is consistent with the newly revised Medicare mandatory Outcome and Assessment Information Set (OASIS-C). Control group participants (n = 19) received no training beyond that which agencies may have provided routinely. MEASUREMENTS Baseline and 1-year nurse confidence in depression detection, and postintervention acceptability ratings of the TRIAD intervention. RESULTS Participants randomized to the TRIAD intervention reported a statistically significant increase in confidence in assessing for depression mood (P<.001), whereas the usual care group's confidence remained unchanged (P = .34) 1 year later. CONCLUSION An educational program designed to improve depression detection by giving nurses the skills and confidence to integrate depression assessment into the context of routine care can be successfully implemented with homecare agency support. The authors discuss the intervention in terms of OASIS-C and the "real world" realities of intervention implementation. PMID:20002507
Pre-Service Education for Nurses' Aides in Hospitals, Nursing Homes, Home Health Agencies.
ERIC Educational Resources Information Center
Colorado State Dept. of Public Health, Denver. Public Health Nursing Section.
The guide was developed on the basis of advice from a widely representative committee appointed by the Colorado State Department of Public Health. The materials were tested in a course in an urban center and a course in a rural center. The initial portion of the manual presents: (1) guidelines for organizing preparatory nurse aide courses, (2)…
Effectiveness of Advanced Illness Care Teams for Nursing Home Residents with Dementia
ERIC Educational Resources Information Center
Chapman, Dennis G.; Toseland, Ronald W.
This study evaluated the effectiveness of advanced illness care teams (AICTs) for nursing home residents with advanced dementia. The AICTs used a holistic approach that focused on four domains: (1) medical, (2) meaningful activities, (3) psychological, and (4) behavioral. The authors recruited 118 residents in two nursing homes for this study and…
Outcomes in a Nursing Home Transition Case-Management Program Targeting New Admissions
ERIC Educational Resources Information Center
Newcomber, Robert; Kang, Taewoon; Graham, Carrie
Purpose: The Providing Assistance to Caregivers in Transition (PACT) program offers nursing home discharge planning and case management for individuals in the transitional period following a return to the community. The PACT program targeted individuals newly admitted to nursing homes and worked with a family caregiver to develop and implement a…
The Association between Changes in Health Status and Nursing Home Resident Quality of Life
ERIC Educational Resources Information Center
Degenholtz, Howard B.; Rosen, Jules; Castle, Nicholas; Mittal, Vikas; Liu, Darren
Purpose: Previous research on nursing home resident quality of life (QOL) has mainly been cross-sectional. This study examined the association between changes in QOL and changes in resident clinical factors. Design and Methods: A longitudinal study of resident QOL was conducted in two nursing homes. Self-report interviews using a multidimensional…
English as a Second Language: Helping Employees To Learn. An Informational Manual for Nursing Homes.
ERIC Educational Resources Information Center
Centrella, Nancy; And Others
The need for and development of a program in English as a Second Language (ESL) and functional English literacy for nursing home workers are outlined, and suggestions are offered for others desiring to start such a program. Anecdotal information and a needs assessment, in combination with Massachusetts state standards for nursing home workers, led…
Importance of Quality Recreation Activities for Older Adults Residing in Nursing Homes: Considerations for Gerontologists.
ERIC Educational Resources Information Center
Haberkost, Michael; And Others
Based on a needs assessment survey (66 responses from 101 nursing home activity coordinators), a recreation manual and training program was developed and tested with 25 coordinators/recreation staff. The 14 who completed evaluations increased their understanding of such topics as depression; goals of nursing home recreation programs; motivation of…
Management Seminar Series I and II for Nursing Home Administrators, March-July 1969.
ERIC Educational Resources Information Center
Peck, Janice R.
Developed by the University of Maryland for the Maryland-D.C. Nursing Home Association, these two series, each containing 84 hours of instruction in four three-day seminars, were designed to meet nursing home administrators' need for managerial skills and to prepare them for licensing. (Based on experiences with the first series, course materials…
Factors Predicting Lawsuits against Nursing Homes in Florida 1997-2001
ERIC Educational Resources Information Center
Johnson, Christopher E.; Dobalian, Aram; Burkhard, Janet; Hedgecock, Deborah K.; Harman, Jeffrey
Purpose: We explore how nursing home characteristics affect the number of lawsuits filed against the facilities in Florida during the period from 1997 to 2001. Design and Methods: We examined data from 478 nursing homes in 30 Florida counties from 1997 to 2001. We obtained the data from Westlaw's Adverse Filings: Lawsuits database, the Online…
Teaching a Course in Abnormal Psychology and Behavior Intervention Skills for Nursing Home Aides.
ERIC Educational Resources Information Center
Glenwick, David S.; Slutzsky, Mitchel R.; Garfinkel, Eric
Describes an 11-week course given at a nursing home to nursing home aides that focused on abnormal psychology and behavior intervention skills. Discusses the course goals, class composition, and course description. Addresses the problems and issues encountered with teaching this course to a nontraditional population in an unconventional setting.…
Daily Practice Teams in Nursing Homes: Evidence From New York State
ERIC Educational Resources Information Center
Temkin-Greener, Helena; Cai, Shubing; Katz, Paul; Zhao, Hongwei; Mukamel, Dana B.
Purpose: Most health care organizations, including nursing homes, report having teams. However, little is known about everyday practice teams among staff providing direct resident care. We assess the prevalence of such teams in nursing homes as reported by direct care staff and administrators, and examine characteristics of facilities that foster…
Training of Home Health Aides and Nurse Aides: Findings from National Data
ERIC Educational Resources Information Center
Sengupta, Manisha; Ejaz, Farida K.; Harris-Kojetin, Lauren D.
Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 home health aides (HHAs) from the National Home Health Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the…
Organizational and Individual Conditions Associated with Depressive Symptoms among Nursing Home Residents over Time
ERIC Educational Resources Information Center
Cassie, Kimberly M.; Cassie, William E.
Purpose: To examine the effect of organizational culture and climate on depressive symptoms among nursing home residents. Design and Methods: Using a pooled cross-sectional design, this study examines a sample of 23 nursing homes, 1,114 employees, and 5,497 residents. Depressive symptoms were measured using the Minimum Data Set, Depression Rating…
A Quality-Based Payment Strategy for Nursing Home Care in Minnesota
ERIC Educational Resources Information Center
Kane, Robert L.; Arling, Greg; Mueller, Christine; Held, Robert; Cooke, Valerie
This article describes a pay-for-performance system developed for Minnesota nursing homes. In effect, nursing homes can retain a greater proportion of the difference between their costs and the average costs on the basis of their quality scores. The quality score is a derived and weighted composite measure currently composed of five elements:…
Coming Together for Change: Workshops for Women in the Nursing Home.
ERIC Educational Resources Information Center
Lee, Janet; Carr, Marylea Benware
Describes series of therapeutic and educational workshops conducted with women nursing home residents with twin goals of improving self-esteem and self-reliance and facilitating community building and networking. Also notes that nursing home staff trainings were conducted whereby staff were encouraged to articulate their needs and those of…
Evidence-Based Health Promotion in Nursing Homes: A Pilot Intervention to Improve Oral Health
ERIC Educational Resources Information Center
Cadet, Tamara J.; Berrett-Abebe, Julie; Burke, Shanna L.; Bakk, Louanne; Kalenderian, Elsbeth; Maramaldi, Peter
Nursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts' nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an…
Increasing Physical Activity in Nursing Home Residents Using Student Power, Not Dollars
ERIC Educational Resources Information Center
Romack, Jennifer L.
Nursing home programs committed to providing quality care need to investigate innovative ways to meet today's budget challenges. The purpose of this article is to describe a creative collaboration between a nonprofit nursing home facility and a suburban university. Through service-learning, undergraduate students planned and implemented…
The Characteristics and Utilization Pattern of an Admission Cohort of Nursing Home Patients (II).
ERIC Educational Resources Information Center
Liu, Korbin; Manton, Kenneth G.
Projects utilization history of a synthetic cohort of nursing home admissions in 1976 by normalizing length of stay (LOS) specific discharge rates derived from life tables to an estimated 1.1 million persons. Results focus on the LOS distribution, discharge status, and total days of nursing home care used. (Author/JAC)
Prevention of urinary tract infections in nursing homes: lack of evidence-based prescription?
Background Urinary tract infections (UTIs, including upper and lower symptomatic) are the most common infections in nursing homes and prevention may reduce patient suffering, antibiotic use and resistance. The spectre of agents used in preventing UTIs in nursing homes is scarcely documented and the aim of this study was to explore which agents are prescribed for this purpose. Methods We conducted a one-day, point-prevalence study in 44 Norwegian nursing homes during April-May 2006. Nursing home residents prescribed any agent for UTI prophylaxis were included. Information recorded was type of agent and dose, patient age and gender, together with nursing home characteristics. Appropriateness of prophylactic prescribing was evaluated with references to evidence in the literature and current national guidelines. Results The study included 1473 residents. 18% (n = 269) of the residents had at least one agent recorded as prophylaxis of UTI, varying between 0-50% among the nursing homes. Methenamine was used by 48% of residents prescribed prophylaxis, vitamin C by 32%, and cranberry products by 10%. Estrogens were used by 30% but only one third was for vaginal administration. Trimethoprim and nitrofurantoin were used as prophylaxis by 5% and 4%, respectively. Conclusions The agents frequently prescribed to prevent UTIs in Norwegian nursing homes lack documented efficacy including methenamine and vitamin C. Recommended agents like trimethoprim, nitrofurantoin and vaginal estrogens are infrequently used. We conclude that prescribing of prophylactic agents for UTIs in nursing homes is not evidence-based. PMID:22040144
Resident-to-Resident Aggression in Nursing Homes: Results from a Qualitative Event Reconstruction Study
ERIC Educational Resources Information Center
Pillemer, Karl; Chen, Emily K.; Van Haitsma, Kimberly S.; Teresi, Jeanne; Ramirez, Mildred; Silver, Stephanie; Sukha, Gail; Lachs, Mark S.
Purpose: Despite its prevalence and negative consequences, research on elder abuse has rarely considered resident-to-resident aggression (RRA) in nursing homes. This study employed a qualitative event reconstruction methodology to identify the major forms of RRA that occur in nursing homes. Design and methods: Events of RRA were identified within…
Consequences of Empowered CNA Teams in Nursing Home Settings: A Longitudinal Assessment
ERIC Educational Resources Information Center
Yeatts, Dale E.; Cready, Cynthia M.
Purpose: Recent studies have concluded that there is a lack of "patient-centered" care in nursing homes and subsequently a need for nursing home culture change. As a result, a variety of new, promising initiatives have been introduced, with most of these incorporating the use of "empowered" employees. The purpose of this study was to evaluate the…
78 FR 53013 - Agency Information Collection (Request for Nursing Home Information in Connection With Claim for...
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS Agency Information Collection (Request for Nursing Home Information in Connection With Claim for... INFORMATION: Title: Request for Nursing Home Information in Connection with Claim for Aid and Attendance, VA... collection. Abstract: The data collected on VA Form 21-0779 is used to determine Veterans residing in...
Relationships of Assertiveness, Depression, and Social Support Among Older Nursing Home Residents
ERIC Educational Resources Information Center
Segal, Daniel
This study assessed the relationships of assertiveness, depression, and social support among nursing home residents. The sample included 50 older nursing home residents (mean age=75 years; 75% female; 92% Caucasian). There was a significant correlation between assertiveness and depression (r=-.33), but the correlations between social support and…
Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives
ERIC Educational Resources Information Center
Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.
Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…
Rethinking Teaching Nursing Homes: Potential for Improving Long-Term Care
ERIC Educational Resources Information Center
Mezey, Mathy D.; Mitty, Ethel L.; Burger, Sarah Green
To meet the special needs of and provide quality health care to nursing home residents, the health care workforce must be knowledgeable about the aging process. Health professionals are minimally prepared in their academic programs to care for older adults, and few programs have required rotations in geriatrics. Teaching nursing homes (TNHs) have…
BE-ACTIV: A Staff-Assisted Behavioral Intervention for Depression in Nursing Homes
ERIC Educational Resources Information Center
Meeks, Suzanne; Looney, Stephen W.; Van Haitsma, Kimberly; Teri, Linda
Purpose: This article (a) describes a 10-week, behavioral, activities-based intervention for depression that can be implemented in nursing homes collaboratively with nursing home activities staff and (b) presents data related to its development, feasibility, and preliminary outcomes. Design and Methods: We developed BE-ACTIV, which stands for…
Nursing Homes for the Birds: A Control-Relevant Intervention with Bird Feeders.
ERIC Educational Resources Information Center
Banziger, George; Roush, Sharon
Many gerontologists have noted the tendency of nursing homes to nurture dependency and learned helplessness in residents. To test the effectiveness of a control-relevant intervention strategy, nursing home residents (N=40) were given the opportunity to care for wild birds by tending individually placed bird feeders. Residents were assigned to one…
Creating a Child Care Center in a Nursing Home and Implementing an Intergenerational Program.
ERIC Educational Resources Information Center
Foster, Karen B.
The success of the Champaign County Nursing Home Child Care Center (CCNHCCC) in Illinois provides a model for the establishment of child care centers in nursing homes. Needs assessment, financial support, licensing, staff hiring and training are all important factors that need to addressed in the start up and running of such a program. The…
The Nursing Home Culture-Change Movement: Recent Past, Present, and Future Directions for Research
ERIC Educational Resources Information Center
Rahman, Anna N.; Schnelle, John F.
This article uses a retrospective approach to critique the research base underlying the nursing home culture-change movement--an effort to radically transform the nation's nursing homes by delivering resident-directed care and empowering staff. The article traces the development of the movement from its inception 10 years ago to 2005, when the…
Family Support in Nursing Homes Serving Residents with a Mental Health History
ERIC Educational Resources Information Center
Frahm, Kathryn; Gammonley, Denise; Zhang, Ning Jackie; Paek, Seung Chun
Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were…
Characteristics Predicting Nursing Home Admission in the Program of All-Inclusive Care for Elderly People
ERIC Educational Resources Information Center
Friedman, Susan M.; Steinwachs, Donald M.; Rathouz, Paul J.; Burton, Lynda C.; Mukamel, Dana B.
Long term care in a nursing home prior to enrollment in PACE remain at high risk of readmission, despite the availability of comprehensive services. This study determined overall risk and predictors of long-term nursing home admission within the Program of All-Inclusive Care for the Elderly (PACE). Design and Methods: Data PACE records for 4,646…
Psychometric Properties of a Korean Measure of Person-Directed Care in Nursing Homes
ERIC Educational Resources Information Center
Choi, Jae-Sung; Lee, Minhong
Objective: This study examined the validity and reliability of a person-directed care (PDC) measure for nursing homes in Korea. Method: Managerial personnel from 223 nursing homes in 2010 and 239 in 2012 were surveyed. Results: Item analysis and exploratory factor analysis for the first sample generated a 33-item PDC measure with eight factors.…
Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey
ERIC Educational Resources Information Center
Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi
Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…
Hospitalization of Nursing Home Residents with Cognitive Impairments: The Influence of Organizational Features and State Policies
ERIC Educational Resources Information Center
Gruneir, Andrea; Miller, Susan C.; Intrator, Orna; Mor, Vincent
Purpose: The purpose of this study was to quantify the effect of specific nursing home features and state Medicaid policies on the risk of hospitalization among cognitively impaired nursing home residents. Design and Methods: We used multilevel logistic regression to estimate the odds of hospitalization among long-stay (greater than 90 days)…
Medicare Cost Differences between Nursing Home Patients Admitted with and without Dementia
ERIC Educational Resources Information Center
Stuart, Bruce; Gruber-Baldini, Ann L.; Fahlman, Cheryl; Quinn, Charlene C.; Burton, Lynda; Zuckerman, Illene H.; Hebel, J. Rich; Zimmerman, Sheryl; Singhal, Puneet K.; Magaziner, Jay
Purpose: Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings. Design and Methods: An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures…
The Physical and Social Environments of Small Rural Nursing Homes: Assessing Supportiveness for Residents with Dementia
ERIC Educational Resources Information Center
Morgan, Debra G.; Semchuk, Karen M.; Stewart, Norma J.; D'Arcy, Carl
The physical and social environments are recognized as important therapeutic tools in the care of nursing home residents with dementia, yet little is known about the environments of rural nursing homes. This study was conducted in one rural health authority (16,000 km[superscript 2]) in the province of Saskatchewan. Long-term institutional care…
Pontiac fever among retirement home nurses associated with airborne legionella.
Remen, T; Mathieu, L; Hautemaniere, A; Deloge-Abarkan, M; Hartemann, P; Zmirou-Navier, D
The aim of this study was to ascertain incidence of symptoms compatible with Pontiac fever (PF) and to assess their association with exposure to legionella bacteria among retirement home nurses who help residents take their shower. Within a non-epidemic framework, 104 nurses of 19 retirement homes were followed up during an average period of four months. Data on symptoms, number and location of showers they attended were recorded daily by each participant. Water and aerosol bacterial quality was characterised at the end of follow-up using the culturable and the in-situ hybridisation techniques. Among 11 Pontiac-like episodes, eight cases complied with the study definition of PF. Water concentrations >10(3) cfu legionella per litre were associated with an increased risk of PF, with dose-response patterns. No association was established between the aerosol legionella concentrations and PF events. A threshold value of 103 cfu legionella per litre of water might be used with a view to protection from legionella-associated occupational conditions. PMID:21752493
Taste detection ability of elderly nursing home residents.
Ogawa, T; Uota, M; Ikebe, K; Notomi, Y; Iwamoto, Y; Shirobayashi, I; Kibi, M; Masayasu, S; Sasaki, S; Maeda, Y
Due to the rapid rise of aged populations throughout the world, it is essential to elucidate the cause of taste dysfunction, because it may reduce appetite, leading to inadequate dietary intake. We aimed to compare taste detection ability between dependently and independently living geriatric individuals of nearly the same age with oral status. Forty-three elderly individuals considered to be cognitively eligible and residing in nursing homes in Japan were enrolled (n = 43, 82·3 ± 8·5 years) and were compared with an independently living elderly group (n = 949, 79·9 ± 0·8 years), aiming to compare taste detection ability between dependently and independently living elders of nearly the same age. Information regarding comorbidity and medication was obtained as general health status, and oral status including number of present teeth, denture usage and maximal occlusal force was also noted. In the dependently living group, 69·4%, 14·3%, 16·3% and 8·2% of participants could detect sweet, sour, salty and bitter tastes, respectively, which was significantly lower than the independently living group for each taste (97·9%, 70·8%, 89·6% and 43·8% for sweet, sour, salty and bitter tastes, respectively). The multivariate logistic regression analysis revealed that residing in nursing homes was associated with reduced sensitivity for four different tastes. The diseases and the situation of dependent elders were more likely the cause of the decreased taste sensitivity. PMID:27027615
Effect of micronutrient supplementation on mood in nursing home residents.
Gosney, M A; Hammond, M F; Shenkin, A; Allsup, S
One third of older people in nursing and/or residential homes have significant symptoms of depression. In younger people, deficiencies in selenium, vitamin C and folate are associated with depression. This study examines the association between micronutrient status and mood before and after supplementation. The objective was to determine whether the administration of selenium, vitamin C and folate improved mood in frail elderly nursing home residents. Mood was assessed using the Hospital Anxiety and Depression rating scale (HAD), and Montgomery-Asberg Depression Rating Scale (MADRS). Micronutrient supplementation was provided for 8 weeks in a double-blinded randomised controlled trial. Significant symptoms of depression (29%) and anxiety (24%) were found at baseline. 67% of patients had low serum concentrations of vitamin C, but no-one was below the reference range for selenium. Depression was significantly associated with selenium levels, but not with folate or vitamin C levels. No individual with a HAD depression score of >or=8, had selenium levels >1.2 microM. In those patients with higher HAD depression scores, there was a significant reduction in the score and a significant increase in serum selenium levels after 8 weeks of micronutrient supplementation. Placebo group scores were unchanged. This small study concluded that depression was associated with low levels of selenium in frail older individuals. Following 8 weeks of micronutrient supplementation, there was a significant increase in selenium levels and improved symptoms of depression occurred in a subgroup. PMID:18463429
An ergonomic evaluation of nursing assistants' job in a nursing home.
Garg, A; Owen, B D; Carlson, B
Thirty-eight nursing assistants (NAs) in a nursing home ranked and rated 16 different patient handling tasks for perceived stresses to the low back. The nursing assistants were observed for 79 4 h shifts and were videotaped for 14 4 h shifts to describe a typical workday and to determine the number of patient-handling tasks performed per shift, the use of assistive devices, and biomechanical stresses to the low back. In addition, data were collected on nursing assistants' and patients' characteristics. The top eight ranked tasks included transferring patient from toilet to wheelchair (WC), WC to toilet, WC to bed, bed to WC, bathtub to WC, chairlift to WC, weighing patients and lifting patients up in bed. The mean ratings of perceived exertion for these tasks were between 'somewhat hard' and 'hard'. The estimated compressive force on L5/S1 disc for the 50th percentile patient weight ranged from 3.7 to 4.9 KN. Nursing assistants worked in teams of two and performed 24 patient transfers per 8 h shift by manually lifting and carrying patients. Assistive devices (a hydraulic lift and gait belt) were used less than 2% of the time. Patient safety and comfort, lack of accessibility, physical stresses associated with the devices, lack of skill, increased transfer time, and lack of staffing were some of the reasons for not using these assistive devices. Environmental barriers (such as confined workplaces, an uneven floor surface, lack of adjustability of beds, stationary railings around the toilet, etc.) made the job more difficult. Nursing assistants had a high prevalence of low-back pain and 51% of nursing assistants visited a health care provider in the last three years for work related low-back pain. PMID:1387079
Hospice family members' perceptions and experiences with end-of-life care in the nursing home
Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George
Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members' perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for
Prenatal and infancy home visitation by nurses: recent findings.
Olds, D L; Henderson, C R; Kitzman, H J; Eckenrode, J J; Cole, R E; Tatelbaum, R C
This article describes a 20-year program of research on the Nurse Home Visitation Program, a model in which nurses visit mothers beginning during pregnancy and continuing through their children's second birthdays to improve pregnancy outcomes, to promote children's health and development, and to strengthen families' economic self-sufficiency. The results of two randomized trials (one in Elmira, New York, and the second in Memphis, Tennessee) are summarized, and an ongoing trial in Denver, Colorado, is briefly described. Results of the Elmira and Memphis trials suggest the following: The program benefits the neediest families (low-income unmarried women) but provides little benefit for the broader population. Among low-income unmarried women, the program helps reduce rates of childhood injuries and ingestions that may be associated with child abuse and neglect, and helps mothers defer subsequent pregnancies and move into the workforce. Long-term follow-up of families in Elmira indicates that nurse-visited mothers were less likely to abuse or neglect their children or to have rapid successive pregnancies. Having fewer children enabled women to find work, become economically self-sufficient, and eventually avoid substance abuse and criminal behavior. Their children benefitted too. By the time the children were 15 years of age, they had had fewer arrests and convictions, smoked and drank less, and had had fewer sexual partners. The program produced few effects on children's development or on birth outcomes, except for children born to women who smoked cigarettes when they registered during pregnancy. The positive effects of the program on child abuse and injuries to children were most pronounced among mothers who, at registration, had the lowest psychological resources (defined as high levels of mental health symptoms, limited intellectual functioning, and little belief in their control of their lives). Generally, effects in Elmira were of greater magnitude and covered
77 FR 60128 - Noncompetitive Supplements to Nursing Assistant and Home Health Aide Program Grantees
Federal Register 2010, 2011, 2012, 2013, 2014
... HUMAN SERVICES Health Resources and Services Administration Noncompetitive Supplements to Nursing... Nursing Assistant and Home Health Aide (NAHHA) Program grantees to develop, implement, and evaluate... Sciences Center (TTUHSC) School of Nursing, 302 Pine Street, Abilene, TX 79601, T51HP20702...
Pragmatic diabetes management in nursing homes: individual care plan.
Benetos, Athanase; Novella, Jean-Luc; Guerci, Bruno; Blickle, Jean-Frederic; Boivin, Jean-Marc; Cuny, Pierre; Delemer, Brigitte; Gabreau, Thierry; Jan, Philippe; Louis, Jacques; Passadori, Yves; Petit, Jean-Michel; Weryha, Georges
Although the management of diabetes as a simple entity has been extensively developed, there is a dearth of evidence in elderly, frail patients with multiple comorbidities and polymedication. This population represents a large proportion of the residents of nursing homes (NHs). As a multidisciplinary group of French experts (geriatricians, endocrinologists, diabetologists, and general practitioners) with practical experience in this area, which is growing in magnitude throughout the world, we convened to compile pragmatic, simple advice on the management of elderly, frail diabetic patients. Given demands on NH personnel (manager, medical coordinator, nurses, and, at the front line of care provision, the undertrained and overworked carers), coupled with the quasiconstant of high staff turnover, the foundation stone of a patient's diabetes management is an Individual Care Plan (ICP) expressed in layman's language. This document that is opened on the patient's admission aims to make sure that the prescriptions established at admission are followed, notably to ensure correct treatment and adapted, regular monitoring with dates and times when examinations and tests are due. This includes monitoring of the diabetes control (HbA1c and, if necessary, blood and urine glucose) and its complications (cardiovascular disease, hypoglycemia, ocular problems, foot disorders, malnutrition, peripheral neuropathy, kidney failure). A necessary corollary is the training of staff to understand the specificities of caring for a frail patient with diabetes, on what to do in a potential emergency, and how to keep the ICP up to date for consultation by doctors and nurses. PMID:24113629
The influence of intergenerational exchange on nursing home admission in Taiwan.
Wu, S C; Li, C Y; Chang, A L
This study examines the effect of intergenerational exchange on nursing home admissions among functionally disabled older adults in Taiwan. A group of 317 nursing home residents were randomly selected from all nursing homes in Taipei, the capital of Taiwan. In addition, two community groups were randomly selected as multiple controls in the study. The results showed that intergenerational exchange has a statistically significant effect on nursing home admission after controlling for sociodemographic characteristics and health status. The odds of being admitted into a nursing home was lower for those elderly who provided instrumental assistance to their families before they were disabled. The adjusted relative risk estimate was 0.2 (95% CI = 0.1 - 0.6). It shows that the instrumental assistance the elderly provided to the family before they became disabled was reciprocated when they needed ADL assistance. This finding provides strong support for the social exchange theory. PMID:14617934
Geothermal greenhouse-heating facilities for the Klamath County Nursing Home, Klamath Falls, Oregon
Not Available
The Klamath County Nursing Home, located in Klamath Falls, Oregon, was constructed in 1976. The building of 55,654 square feet currently houses care facilities for approximately 120 persons. During the initial planning for the Nursing Home, the present site was selected primarily on the basis of its geothermal resource. This resource (approx. 190/sup 0/F) currently provides space and domestic hot water heating for the Nursing Home, Merle West Medical Center and the Oregon Institute of Technology. The feasibility of installing a geothermal heating system in a planned greenhouse for the Nursing Home is explored. The greenhouse system would be tied directly to the existing hot water heating system for the Nursing Home.
Social Supports as Enabling Factors in Nursing Home Admissions: Rural, Suburban, and Urban Differences.
Cohen, Adrienne; Bulanda, Jennifer Roebuck
This study investigates differences in social support and nursing home admission by rurality of residence. We use discrete-time event history models with longitudinal data from seven waves (1998-2010) of the Health and Retirement Study to prospectively examine the risk of spending 30 or more days in a nursing home (n = 5,913). Results show that elders with a health problem who live in rural areas of the South or Midwest have approximately 2 times higher odds of nursing home entry than elders living in urban areas in the Northeast. Rural elders report somewhat higher social support than non-rural elders, and controlling for these forms of social support does not explain the higher risk of a nursing home stay for Southerners and Midwesterners living in rural areas. Results suggest that social support has a similar association with nursing home entry for rural, suburban, and urban elders. PMID:25582118
Overcoming Resistance to Culture Change: Nursing Home Administrators' Use of Education, Training and Communication
Tyler, Denise A.; Lepore, Michael; Shield, Renee R.; Looze, Jessica; Miller, Susan C.
Nursing home culture change is becoming more prevalent and research has demonstrated its benefits for nursing home residents and staff, but little is known about the role of nursing home administrators in culture change implementation. The purpose of this study was to determine what barriers nursing home administrators faced in implementing culture change practices and to identify the strategies used to overcome these. We conducted in-depth individual interviews with 64 administrators identified through a nationally representative survey. Results showed that a key barrier to culture change implementation reported by administrators was staff, resident and family member resistance to change. Most nursing home administrators stressed the importance of using communication, education and training to overcome this resistance. Themes emerging around the concepts of communication and education indicate that these efforts should be ongoing, communication should be reciprocal, and that all stakeholders should be included. PMID:24266678
A longitudinal study of Medicaid payment, private-pay price and nursing home quality.
Grabowski, David C
Quality of care problems have persisted for decades within U.S. nursing homes. A potential state-level policy towards addressing this concern is the level of Medicaid payment. However, a number of studies have found that an increase in Medicaid payment is associated with lower quality in the presence of certificate-of-need (CON) laws and bed construction moratorium regulations, which serve as barriers to entry within the nursing home industry. Instead of relying on potentially confounded cross-sectional comparisons, this study presents novel, panel-based evidence that incorporates aggregate private-pay price data. These estimates almost uniformly indicate that an increase in the Medicaid payment rate raises nursing home quality. When compared to the earlier literature, these new findings are attributed to changes over time in the market for nursing home care related to the growth in nursing home substitutes. PMID:15170962
Use of Atypical Antipsychotics in Nursing Homes and Pharmaceutical Marketing
Pimentel, Camilla B.; Donovan, Jennifer L.; Field, Terry S.; Gurwitz, Jerry H.; Harrold, Leslie R.; Kanaan, Abir O.; Lemay, Celeste A.; Mazor, Kathleen M.; Tjia, Jennifer; Briesacher, Becky A.
BACKGROUND Many nursing home (NH) residents are prescribed atypical antipsychotics despite US Food and Drug Administration warnings of increased risk of death in older adults with dementia. Aggressive pharmaceutical marketing has been cited as a potential cause, although data are scarce. The objectives of this study were to describe the current extent and type of pharmaceutical marketing in NHs in one state, and to provide preliminary evidence for the potential influence of pharmaceutical marketing on the use of atypical antipsychotics in NHs. DESIGN Nested mixed-methods, cross-sectional study of NHs in a cluster randomized trial. SETTING 41 NHs in Connecticut. PARTICIPANTS NH administrators, directors of nursing and medical directors (n = 93, response rate 75.6%). MEASUREMENTS Quantitative data, including prescription drug dispensing data (September 2009–August 2010) linked with Nursing Home Compare data (April 2011), were used to determine facility-level prevalence of atypical antipsychotic use, facility-level characteristics, NH staffing and NH quality. Qualitative data, including semi-structured interviews and surveys of NH leaders conducted in the first quarter of 2011, were used to determine encounters with pharmaceutical marketing. RESULTS Leadership at 46.3% of NHs (19/41) reported pharmaceutical marketing encounters, consisting of educational training, written/Internet-based materials and/or sponsored training. No association was detected between the level of atypical antipsychotic prescribing and reports of any pharmaceutical marketing by at least one NH leader. CONCLUSION NH leaders frequently encounter pharmaceutical marketing through a variety of ways, although the impact on atypical antipsychotic prescribing is unclear. PMID:25688605
Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study.
Abrahamson, Kathleen; DeCrane, Susan; Mueller, Christine; Davila, Heather Wood; Arling, Greg
This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Interviews were conducted with 24 nursing home employees from within 8 facilities participating in the quality improvement project. Findings were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges. PMID:25407787
Private nursing homes: contribution to long stay care of the elderly in the Brighton Health District.
Bennett, J
Two surveys of private nursing homes, designated geriatric wards, and a sample of social service part III homes were carried out in the Brighton Health District using questionnaires supplemented (in the second survey) by some interviews. The dependency of old people in the private nursing homes was more like that of long stay hospital patients rather than that of residents in social services homes. In the private nursing homes, however, a smaller proportion of patients were in the medium to heavy nursing category (178 (31%) compared with 158 (63%) in the hospital long stay wards) and a larger proportion in the heavy nursing category (170 (30%) compared with 44 (17%) in the long stay wards). Of the patients in private nursing homes, 401 (82%) were local residents, 488 (86%) were long stay, and 459 (88%) were women; their mean age was 88 years. Two thirds of the patients were over 80. There were no significant differences between the private nursing homes and the wards in nursing workloads or staffing, except for a slightly higher provision of state registered nurses in the private sector. In the private nursing homes 348 (63%) of the patients had fees paid by private funds, 26 (5%) were in contract beds paid for by the National Health Service, and 176 (32%) were subsidized by the Department of Health and Social Security. Private nursing homes make a substantial contribution to the care of the elderly in the Brighton Health District, and the health authority should develop a more active partnership with this sector. PMID:3094690
Changes in the Personal Dignity of Nursing Home Residents: A Longitudinal Qualitative Interview Study
Oosterveld-Vlug, Mariska G.; Pasman, H. Roeline W.; van Gennip, Isis E.; Willems, Dick L.; Onwuteaka-Philipsen, Bregje D.
Background Most nursing home residents spend the remainder of their life, until death, within a nursing home. As preserving dignity is an important aim of the care given here, insight into the way residents experience their dignity throughout their entire admission period is valuable. Aim To investigate if and how nursing home residents' personal dignity changes over the course of time, and what contributes to this. Design A longitudinal qualitative study. Methods Multiple in-depth interviews, with an interval of six months, were carried out with 22 purposively sampled nursing home residents of the general medical wards of four nursing homes in The Netherlands. Transcripts were analyzed following the principles of thematic analysis. Results From admission onwards, some residents experienced an improved sense of dignity, while others experienced a downward trend, a fluctuating one or no change at all. Two mechanisms were especially important for a nursing home resident to maintain or regain personal dignity: the feeling that one is in control of his life and the feeling that one is regarded as a worthwhile person. The acquirement of both feelings could be supported by 1) finding a way to cope with one's situation; 2) getting acquainted with the new living structures in the nursing home and therefore feeling more at ease; 3) physical improvement (with or without an electric wheelchair); 4) being socially involved with nursing home staff, other residents and relatives; and 5) being amongst disabled others and therefore less prone to exposures of disrespect from the outer world. Conclusion Although the direction in which a resident's personal dignity develops is also dependent on one's character and coping capacities, nursing home staff can contribute to dignity by creating optimal conditions to help a nursing home resident recover feelings of control and of being regarded as a worthwhile person. PMID:24069235
The Effects of Listening Training on Nursing Home Assistants: Residents' Satisfaction with and Perceptions of Assistants' Listening Behavior.
ERIC Educational Resources Information Center
Trahan, Brenda Comeaux; Rockwell, Patricia
Reports on a study of the level of satisfaction of elderly nursing home residents with the listening behaviors of nursing home assistants, and examines the residents' perceptions regarding the listening behaviors of the assistants. Determines if a listening skills training course for nursing home assistants would prove beneficial in increasing…
The Potential of Wash-and-Dry Toilets to Improve the Toileting Experience for Nursing Home Residents
ERIC Educational Resources Information Center
Cohen-Mansfield, Jiska; Biddison, James R.
Purpose: We investigated the feasibility of using a "wash-and-dry" toilet in the nursing home. Design and Methods: We used a controlled comparison baseline-versus-treatment design with 22 female nursing home residents aged 75 and older living in a 562-bed, not-for-profit nursing home facility in Maryland. The Luscence Luxury Lavage wash-and-dry…
Nurse Preparation and Organizational Support for Supervision of Unlicensed Assistive Personnel in Nursing Homes: A Qualitative Exploration
ERIC Educational Resources Information Center
Siegel, Elena O.; Young, Heather M.; Mitchell, Pamela H.; Shannon, Sarah E.
Purpose: 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…
Nursing Assistants' Job Commitment: Effect of Nursing Home Organizational Factors and Impact on Resident Well-Being
ERIC Educational Resources Information Center
Bishop, Christine E.; Weinberg, Dana Beth; Leutz, Walter; Dossa, Almas; Pfefferle, Susan G.; Zincavage, Rebekah M.
Purpose: The purpose of this study was to investigate (a) whether certified nursing assistants (CNAs) are more committed to nursing home jobs when they perceive their jobs as enhanced (greater autonomy, use of knowledge, teamwork), and (b) whether CNA job commitment affects resident satisfaction. Design and Methods: A qualitative exploration of…
Distance Coursework and Coaching to Improve Nursing Home Incontinence Care: Lessons Learned
Rahman, Anna N.; Schnelle, John F.; Applebaum, Robert; Lindabury, Kate; Simmons, Sandra
Objectives To determine whether a distance coaching course on improving nursing home incontinence care could be replicated and brought to scale with a larger group of nursing homes without sacrificing outcomes. Design The study collected descriptive and comparative data. Setting The setting was comprised of 14 nursing homes in the original course and 34 homes in the replication course. Participants Participants in the study were supervisors and staff from enrolled nursing homes who completed the distance coaching courses on incontinence management. Measures Data for both courses were collected using a resident assessment form to evaluate implementation of new practices, pre- and post-training quizzes, a course evaluation survey, and a supervisor's report. Results There were few significant differences between the course groups with respect to course participation, knowledge transfer, and training program preferences. Although course 1 nursing homes reported assessing more residents on average than course 2 homes (22 residents vs. 12 residents, respectively), this difference is likely an artifact of differences in the reporting methodologies for the two courses. Conclusion This study found qualified support for using a distance coaching course to facilitate adoption of evidence-based incontinence care practices in nursing homes. The findings also underscore the challenges associated with designing dissemination/implementation programs that are both effective and feasible to implement with nursing homes. We recommend that nursing home educators consider this study's findings when designing new training programs. Outcomes may improve if some dissemination resources are diverted to distance coaching activities that support nursing home improvement efforts over extended periods. PMID:22642640
Ethnomethodology. II: A study of the Community Psychiatric Nurse in the patient's home.
Bowers, L
The former paper delineated the main points of ethnomethodology and its implications for nursing research. This paper describes a research study into the home visits of Community Psychiatric Nurses using the framework of ethnomethodology. Relevant sociological, psychological, medical and nursing literature is briefly reviewed. Home visits are found to be socially constructed events in which the sense of the talk is dependent upon the setting and context. The context of being in the home is shown to exert pressure upon how the developing events of the visit are construed by the participants. In particular, it is discovered that being a visitor in the patient's home tends to define the occasion of a Community Psychiatric Nurse visit as that of a meeting of friends. This is oriented to by the participants who draw upon their stock of typified knowledge of conduct of guests and hosts to make visible their desired definitions of the situation. The dynamics of power and control by the nurse are also altered by the location of the visit in the patient's home. Being in the home puts the patient firmly in charge, allowing him to take the lead at every turn. The nurse uses the strategies of persuasion and negotiation which can be enacted in the patient's home without fracturing the intersubjective understandings of the visit. Only in matters seen by both participants as clearly medico-psychiatric will the nurse become more assertive. Attention is drawn to some implications of these findings for the practice of Community Psychiatric Nursing. PMID:1551756
Predictors of quality in rural nursing homes using standard and novel methods.
Towsley, Gail L; Beck, Susan L; Pepper, Ginette A
We examined the effect of market and organizational characteristics on nursing home quality as measured by deficiencies (number and weighted) on states in a rural region of the United States. Rural nursing homes in five Mountain West states (N = 161) were sampled from the Online Survey Certification and Reporting system between January 1, 2004 and June 15, 2005. State comparisons indicated that rural nursing homes in Nevada had a higher number of deficiencies and weighted deficiency score as compared with Utah, Colorado, Wyoming, and Idaho. Using regression analyses, we found that a higher percentage of licensed practical nurses in the staffing mix were predictive of a greater number of deficiencies. Nursing homes with more beds or higher Medicaid occupancy had higher weighted deficiency scores. Although rural Mountain West nursing homes average a similar number of deficiencies as nursing homes nationwide, these nursing homes had a greater number of serious deficiencies and higher weighted deficiency scores, suggesting greater actual harm to resident health and safety. PMID:23330834
Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits.
Mattke, Soeren; Han, Dan; Wilks, Asa; Sloss, Elizabeth
Clinical home visit programs for Medicare beneficiaries are a promising approach to supporting aging in place and avoiding high-cost institutional care. Such programs combine a comprehensive geriatric assessment by a clinician during a home visit with referrals to community providers and health plan resources to address uncovered issues. We evaluated UnitedHealth Group's HouseCalls program, which has been offered to Medicare Advantage plan members in Arkansas, Georgia, Missouri, South Carolina, and Texas since January 2008. We found that, compared to non-HouseCalls Medicare Advantage plan members and fee-for-service beneficiaries, HouseCalls participants had reductions in admissions to hospitals (1 percent and 14 percent, respectively) and lower risk of nursing home admission (0.67 percent and 1.3 percent, respectively). In addition, participants' numbers of office visits--chiefly to specialists--increased 2-6 percent (depending on the comparison group). The program's effects on emergency department use were mixed. These results indicate that a thorough home-based clinical assessment of a member's health and home environment combined with referral services can support aging in place, promote physician office visits, and preempt costly institutional care. PMID:26643635
Quality of Life for Elderly Residents in Nursing Homes
Farzianpour, Fereshteh; Foroushani, Abbas Rahimi; Badakhshan, Abbas; Gholipour, Mahin; Roknabadi, Esmaeil Hosseinzadeh
Background and Objectives: More than 8% of Iran's populations are elderly. The greatest challenge in this generation is improvement of health and QoL. The main goal of this study was QoL for elderly residents in nursing homes over 65 years in Golestan Province - Iran. Methods: This research was an analytical cross study. The population society includes the elderly over 65 years in Golestan Province - Iran. The sample size was calculated based on the correlation of 193 elderly men and women. Therefore, if the correlation is 2.0 or greater is statistically significant at 80% and 0.95 confidence. The needed data collected from two questionnaires Consumer product Safety Commission (CPSC) to assess the QOL of nursing homes and the SF-36 for health QOL the elderly indicators through interviews and observation. The reliability of the CPSC questionnaire was estimated using Cronbach's alpha with a coefficient of 0.838. The SF-36 questionnaire was validated with Cronbach's alpha with a coefficient of 0.95. To analyze data, ANOVA one-way test was used that after investigating homogenization of variances with Levin statistic, if homogenization reported P is rejected, the independent T-test was used to interpret it. Results: Among QOL dimensions only General Health (GH) status showed a significant association with supporting organizations covering status (P = 0.01). The relationship between QOL with marital status in both genders was observed that the General Health (GH) (P = 0.001), Physical Functioning (PF) P = (0.007) Mobility Restricts (MR) P = (0.002), Emotional Problems (EP) (P = 0.001), vitality (V) (P = 0.001), Mental Health (MH) (P = 0.001) were significantly related. Conclusions: There was a significant relationship between the Physical Functioning (PF) mean and the mean of other QOL indicators in two groups of male and female (P = 0.007), also the safety of nursing homes just related respectively with residence variable (P = 0.01) and their employment (P = 0
[Equipment at the special nursing homes for the elderly: a workplace survey of new nursing homes in Osaka Prefecture].
Tomioka, Kimiko; Kumagai, Shinji; Kosaka, Hiroshi; Yoshida, Jin; Tabuchi, Takeo; Kosaka, Junko; Arai, Yasutomo
The number of those who need nursing care and the workers who provide it have been increasing year after year. In April 2000, the public nursing care insurance system was enacted by the Japanese government. After its enaction, care equipment came under scrutiny, but the situation regarding the installation of equipment is not fully understood. In order to understand the present state of care equipment in nursing facilities for the elderly, we conducted a workplace and interview survey. The surveyed facilities were 10 special nursing homes for the elderly in Osaka Prefecture which were established after April 2002. The average number of elderly residents was 79.0, the average value of degree of care was 3.52, and the average number of caregivers was 28.3 per facility. We found all facilities had installed some kinds of bathing equipment: stretcher type, 9 facilities; bath-chair type, 8 facilities. In the facilities with bath-chairs, 6 facilities had special bathtubs, and 6 facilities had general bathtubs. However, all facilities had the working principle that transfer should be done manually, and the equipment for transfer such as a lifts, a transfer and roller board were not be installed. In changing diapers, bed height adjustment was not possible. And the Japanese standard type of wheelchair has a non-detachable armrest, creating a structural barrier when transferring elderly people from a wheelchair to a toilet seat. At all facilities the basis of care was that caregivers should do it manually. In particular, all facilities had only a weak recognition of the risks of transfer. This investigation shows that facilities for the elderly should rethink elderly care based on a reduction of care load and most importantly protection of caregivers' health. PMID:16717403
Barooah, Adrita; Boerner, Kathrin; van Riesenbeck, Isabelle; Burack, Orah R.
This study examined certified nursing assistants' (CNAs) experiences of nursing home practices following resident death. Participants were 140 CNAs who had experienced recent resident death. In semi-structured, in-person interviews, CNAs were asked about their experiences with the removal of the resident's body, filling the bed with a new resident, and how they were notified about the death. The facilities' practice of filling the bed quickly was most often experienced as negative. Responses to body removal and staff notification varied, but negative experiences were reported by a substantial minority. Being notified prior to returning to work was associated with a more positive experience. Learning about the death by walking into a room to find the bed empty or already filled was the most negative experience. Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience. PMID:25554351
Quality of Mental Health Care for Nursing Home Residents: A Literature Review
Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.
Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors. PMID:20223943
77 FR 64386 - Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State...
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes) Under OMB Review AGENCY: Veterans Health... day health services care to Veterans. VA requires facilities providing nursing home and adult...
Nursing Home Quality and Financial Performance: Does the Racial Composition of Residents Matter?
Chisholm, Latarsha; Weech-Maldonado, Robert; Laberge, Alex; Lin, Feng-Chang; Hyer, Kathryn
Objective. To examine the effects of the racial composition of residents on nursing homes' financial and quality performance. The study examined Medicare and Medicaid-certified nursing homes across the United States that submitted Medicare cost reports between the years 1999 and 2004 (11,472 average per year). Data Source. Data were obtained from the Minimum Data Set, the On-Line Survey Certification and Reporting, Medicare Cost Reports, and the Area Resource File. Study Design. Panel data regression with random intercepts and negative binomial regression were conducted with state and year fixed effects. Principal Findings. Financial and quality performance differed between nursing homes with high proportions of black residents and nursing homes with no or medium proportions of black residents. Nursing homes with no black residents had higher revenues and higher operating margins and total profit margins and they exhibited better processes and outcomes than nursing homes with high proportions of black residents. Conclusion. Nursing homes' financial viability and quality of care are influenced by the racial composition of residents. Policy makers should consider initiatives to improve both the financial and quality performance of nursing homes serving predominantly black residents. PMID:23800123
Applying the Advancing Excellence in America's Nursing Homes Circle of Success to improving and sustaining quality.
Bakerjian, Debra; Zisberg, Anna
Looking forward to the Quality Assurance Performance Improvement (QAPI) program to be implemented and required in 2014, and as nursing home staff provide care for residents with increasingly complex health issues, knowledge of how to implement quality improvement (QI) is imperative. The nursing home administrator and director of nursing (DON) provide overall leadership, but it is the primary responsibility of the DON and other registered nurse staff to implement and manage the day to day QI process. This article describes potential roles of nursing leaders and key components of a QI project using a pressure ulcer case study exemplar to illustrate a quality improvement process. The authors suggest specific methods that RN leaders can employ using the Advancing Excellence Campaign Circle of Success as an organizing framework along with evidence-based resources. Nursing home leaders could use this article as a guideline for implementing any clinical quality improvement process. PMID:23870372
Indicators of Job Satisfaction of Home Healthcare Nurses in the San Francisco Bay Area of California.
Li, Xia; Canham, Daryl; Wahl, Sharon
The purpose of this study was to identify the factors that provide job satisfaction for home healthcare nurses and to determine if the nurses' educational level makes a difference in job satisfaction. Data were collected using Ellenbecker's (2004) 21-item Home Healthcare Nurses Job Satisfaction Scale. The study results indicated the majority of this population of home healthcare nurses was satisfied on all items, except in having the power to change agency policy. Educational level made no significant difference in job satisfaction. Recommendations include encouraging agencies to include clinicians in policy decision-making and management of patient care. Nursing education programs should ensure nurses graduate with the skills necessary for policy development and to make decisions that positively impact patient care. PMID:27243430
An investigation of the role nurses play in Norwegian home care.
Johansen, Edda; Fagerström, Lisbeth
Registered nurses' (RNs') role in Norwegian home care services exists in a state of flux owing to the early discharge of patients from hospitals, more time-consuming and complex care for young patients, and a growing number of older care recipients. The aim of this study was to investigate the RN role through an integrative research review, with a focus on nursing activities and competence. This study found that RNs and assistant nurses often perform the same tasks, providing assistance with personal hygiene, medication and wound management. The change towards more medicalized and complex home care entails that requirements pertaining to RNs' competence, the allocation of RNs' time and skills to those in most need of nursing care, and the assignment of assistant nurses to lower care levels activities must be delineated. Norwegian home care must examine how care activities can be better allocated between RNs, social educators, assistant nurses, and informal care-givers. PMID:20966846
Day-to-day care: the interplay of CNAs' views of residents & nursing home environments.
Fisher, Lucy Takesue; Wallhagen, Margaret I
This qualitative study identified certified nursing assistants' (CNAs') perspectives of nursing home residents and how these perspectives translate into care practices. Data included observations of and interviews with 27 CNAs in three dissimilar nursing homes. All participants were people of color, and all but 3 were immigrants. CNAs constructed three views of residents: as fictive kin, as a commodity, and as an autonomous person. Although individual CNAs held one primary view of residents in general, select residents were viewed from an alternative perspective, resulting in variations in care practices. These findings suggest that such distinctions, in tandem with structural, organizational, and cultural differences in nursing homes, present opportunities for nursing leadership to affect the visible, everyday practice of nursing CNAs. To target interventions, further research is needed on how CNAs come to differentially view residents and how these differences influence CNAs' care relationships with residents. PMID:19024427
A survey of attitudes and perceptions toward oral hygiene among staff at a geriatric nursing home.
Forsell, Marianne; Kullberg, Erika; Hoogstraate, Janet; Herbst, Bertil; Johansson, Olle; Sjögren, Petteri
The aim of this survey was to test the impact of an oral hygiene educational model on attitudes and perceptions toward oral hygiene among nursing home staff members. A pilot questionnaire was distributed to the nursing staff before and after a course on oral hygiene at a geriatric nursing home in Stockholm in 2008. The nursing staff was of the opinion that they had sufficient time to carry out oral hygiene tasks but considered such tasks unpleasant, mainly because of unwillingness and resistance from the residents. These attitudes and perceptions among the nursing staff did not change significantly after oral hygiene education. Future oral hygiene educational models need to be developed with an aim to alter the perceptions and behavior of the nursing home staff. PMID:21035232
Organizational commitment and turnover of nursing home administrators.
Castle, Nicholas G
In this investigation, the associations between organizational commitment (OC), intent-to-turnover, and actual turnover of a large sample of nursing home administrators (NHAs) are examined. Data used come from a mail survey, from which 632 responses were received from the NHAs (response rate = 63%). The one-year turnover rate of NHAs was 39 percent, and in almost all cases (87%) these NHAs had also exhibited low OC scores. The intent-to-turnover results show thinking about quitting comes before searching for a new position, which in turn both comes before the intention to quit. Multivariate analyses show work overload has a strong and robust association with both intent-to-turnover and turnover of NHAs, and may indicate that NHAs are leaving their positions because they are understaffed. PMID:16648695
Appendix adenocarcinoma in an elderly patient from a nursing home
Sönmez, Yalçın; Bayhan, Zülfü; Yaylak, Faik; Ekici, Mehmet Fatih; Değer, Ayşe Nur
Appendiceal malignancies are rare clinic entities. The clinical presentation of appendiceal malignancies is often atypical. Acute abdominal pain and acute appendicitis, which requires early surgical intervention, are the most common clinical presentations of appendiceal malignancies. In this case report, an adenocarcinoma of the appendix in a 64-year-old male from a nursing home has been presented. He had right lower quadrant pain for the last 5 days. On physical examination, he had significant guarding. Intravenous contrast-enhanced abdominopelvic tomography revealed no pathological features. Laparotomy under general anesthesia was scheduled. During exploration, a perforated appendicitis was observed. Formal appendectomy was performed. The patient was lost due to pneumonia and septic shock 5 days after surgical intervention. In addition, the natural history of the disease and its basic diagnostic and therapeutic aspects are discussed. Preoperative or intraoperative diagnosis may not be available for some patients. Thus, routine histopathological examination is essential for adequate diagnosis and treatment. PMID:27436927
[Conceptualizations on care for persons with dementia in nursing homes].
Rodríguez-Martín, Beatriz; Martínez-Andrés, María; Notario-Pacheco, Blanca; Martínez-Vizcaíno, Vicente
Despite the importance of family perceptions when analyzing care for the elderly in nursing homes, little is said about this aspect. This study aims to identify preferences and areas for improvement in care for persons with dementia, as perceived by families. A qualitative study was performed, based on Grounded Theory, combining two data collection techniques (participant observation and in-depth interviews) in a theoretical sample of institutionalized persons with dementia. The ideal model of care for persons with dementia, as perceived by participants, was based on specialized and individualized care and family participation in the care provided. Areas for improvement included aspects pertaining to specialized training in geriatrics, human relations, and the culture of institutional work. Faced with the current trend towards technification of care, families are now demanding personalized, small-scale care in which they form an active part of the team. PMID:27074217
Prosthetic rehabilitation of edentulism prevents malnutrition in nursing home residents.
Andreas Zenthöfer, Andreas; Rammelsberg, Peter; Cabrera, Tomas; Hassel, Alexander
To investigate the association between prosthetic rehabilitation and malnutrition in institutionalized elders, 255 nursing home residents were recruited for this study and underwent a comprehensive dental examination. The body mass index (BMI) was administered to estimate the nutritional condition. Participants with BMI < 20 kg/mc were categorized as malnourished (n = 33), whereas all others were categorized as adequately nourished (n = 222). The number of teeth present and the prevalence of prosthetic rehabilitation were significantly lower in malnourished participants (P < .05). Malnutrition risk was 4.6 times higher for participants who were edentulous and did not wear dentures. Adequate replacement of teeth is important to prevent malnutrition in institutionalized older people. PMID:25822309
Psychosexual needs and sexual behaviors of nursing care home residents.
Mroczek, Bożena; Kurpas, Donata; Gronowska, Małgorzata; Kotwas, Artur; Karakiewicz, Beata
The purpose of this study was to analyze psychosexual needs of nursing care home residents in Poland. The authors attempted to answer the question 'how do residents satisfy their psychosexual needs?' This survey-based study was performed with respect to the residents' right to privacy and intimacy. The residents were also informed that they could withdraw from the study at any stage. The history was taken from 85 subjects (60% women, 40% men). The mean age was 74.2±11.2. The most important psychosexual needs included: conversation, tenderness, emotional closeness (empathy, understanding), sexual contacts and physical closeness. As the most important elements of the relationship, respondents mentioned mutual respect and conviction that they can rely on their partners. Most respondents felt sexual tension occasionally, others once a week or less frequently. They relieved sexual tension through intimate contacts with their long-term partners, watching erotic films, masturbation, walking and diverting attention to other activities. Every fourth respondent was satisfied with his/her sexual life. The majority of seniors repeated stereotypes about sexuality of the elderly. Almost 71% claimed that sex in elderly people was taboo, 64% said that sex was for young people only, and 51% thought that sex was not important in life. Old age makes little difference to psychosexual needs. Most seniors need closeness manifesting as tenderness and conversations. Many old people are sexually active. Thus, it is worth considering whether people living in cohabitation should not have the possibility of staying together in nursing care home. PMID:23478162
"It's a Dignity Thing": Nursing Home Care Workers' Use of Emotions1
Rodriquez, Jason
This article examines how nursing home care workers use emotions to construct dignity at work. Previous scholarship has shown how the financial and organizational characteristics of nursing homes shape and constrain emotion work among staff. Using evidence gathered during 18 months of participant observation in two nursing homes and 65 interviews with staff, this article analyzes how, despite obstacles, nursing home care workers generated authentic emotional attachments to residents. Surprisingly, some staff members said they particularly appreciated working with residents difficult to control. They felt accomplished when such residents successfully transitioned from life at home to life in institutional care. Emotions created dignity for staff and induced compliance among residents. Emotions are not only generated by organizations and imposed on workers; staff themselves produced emotions—sometimes in ways consistent with organizational demands, and sometimes not—and they consistently found in their emotions a resource to manage the strains of their work lives. PMID:21743774
The Factors Influencing the Sense of Home in Nursing Homes: A Systematic Review from the Perspective of Residents
Rijnaard, M. D.; van Hoof, J.; Janssen, B. M.; Verbeek, H.; Pocornie, W.; Eijkelenboom, A.; Beerens, H. C.; Molony, S. L.; Wouters, E. J. M.
Purpose. To provide an overview of factors influencing the sense of home of older adults residing in the nursing home. Methods. A systematic review was conducted. Inclusion criteria were (1) original and peer-reviewed research, (2) qualitative, quantitative, or mixed methods research, (3) research about nursing home residents (or similar type of housing), and (4) research on the sense of home, meaning of home, at-homeness, or homelikeness. Results. Seventeen mainly qualitative articles were included. The sense of home of nursing home residents is influenced by 15 factors, divided into three themes: (1) psychological factors (sense of acknowledgement, preservation of one's habits and values, autonomy and control, and coping); (2) social factors (interaction and relationship with staff, residents, family and friends, and pets) and activities; and (3) the built environment (private space and (quasi-)public space, personal belongings, technology, look and feel, and the outdoors and location). Conclusions. The sense of home is influenced by numerous factors related to the psychology of the residents and the social and built environmental contexts. Further research is needed to determine if and how the identified factors are interrelated, if perspectives of various stakeholders involved differ, and how the factors can be improved in practice. PMID:27313892
Does Mandating Nursing Home Participation In Quality Reporting Make A Difference? Evidence from Massachusetts
Mukamel, Dana B.; Ye, Zhiqiu; Glance, Laurent G.; Li, Yue
Background Quality report cards have been shown to be effective in influencing patients' referrals and promoting quality improvement in some instances and not others. In this study we investigate one of the mechanisms that may detract from their effectiveness: voluntary versus mandatory participation of nursing homes in public quality reporting. Objectives To answer two questions: 1) Were the nursing homes choosing not to participate low quality performers relative to those who chose to participate? 2) Once participation became mandatory, did those that did not voluntarily participate initially, improve more than those that participated voluntarily? Research Design Massachusetts published the Massachusetts Satisfaction Survey report card for nursing homes for the years 2005, 2007, and 2009. Nursing homes' participation was voluntary in 2005 and mandatory in 2007 and 2009. We performed a retrospective statistical analysis of the relationship between nursing homes' decision to participate in quality reporting and 12 quality outcomes: deficiency citations, staffing, and 8 survey domains. Subjects 424 Massachusetts nursing homes. Results 67% of nursing homes participated in reporting voluntarily. Volunteer nursing homes had better quality for all measures (significant at the 0.05 level or trending towards significance at the 0.10 level for all but 2). Once reporting became mandatory, non-volunteers improved more than volunteers in all but 2 staffing measures (trending towards significance at the 0.10 level in 5). Conclusions Report cards are more effective if nursing homes' participation is mandated. Non-mandatory reporting systems, as those implemented by some states and professional associations, lead to missed opportunities for quality improvements. PMID:26125418
The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network.
van den Dool, Carline; Haenen, Anja; Leenstra, Tjalling; Wallinga, Jacco
OBJECTIVE Recerntly, the role of the healthcare network, defined as a set of hospitals linked by patient transfers, has been increasingly considered in the control of antimicrobial resistance. Here, we investigate the potential impact of nursing homes on the spread of antimicrobial-resistant pathogens across the healthcare network and its importance for control strategies. METHODS Based on patient transfer data, we designed a network model representing the Dutch healthcare system of hospitals and nursing homes. We simulated the spread of an antimicrobial-resistant pathogen across the healthcare network, and we modeled transmission within institutions using a stochastic susceptible-infected-susceptible (SIS) epidemic model. Transmission between institutions followed transfers. We identified the contribution of nursing homes to the dispersal of the pathogen by comparing simulations of the network with and without nursing homes. RESULTS Our results strongly suggest that nursing homes in the Netherlands have the potential to drive and sustain epidemics across the healthcare network. Even when the daily probability of transmission in nursing homes is much lower than in hospitals, transmission of resistance can be more effective because of the much longer length of stay of patients in nursing homes. CONCLUSIONS If an antimicrobial-resistant pathogen emerges that spreads easily within nursing homes, control efforts aimed at hospitals may no longer be effective in preventing nationwide outbreaks. It is important to consider nursing homes in planning regional and national infection control and in implementing surveillance systems that monitor the spread of antimicrobial resistance. Infect Control Hosp Epidemiol 2016;37:761-767. PMID:27052880
Advanced dementia research in the nursing home: the CASCADE study.
Mitchell, Susan L; Kiely, Dan K; Jones, Richard N; Prigerson, Holly; Volicer, Ladislav; Teno, Joan M
Despite the growing number of persons with advanced dementia, and the need to improve their end-of-life care, few studies have addressed this important topic. The objectives of this report are to present the methodology established in the CASCADE (Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life) study, and to describe how challenges specific to this research were met. The CASCADE study is an ongoing, federally funded, 5-year prospective cohort study of nursing [nursing home (NH)] residents with advanced dementia and their health care proxies (HCPs) initiated in February 2003. Subjects were recruited from 15 facilities around Boston. The recruitment and data collection protocols are described. The demographic features, ownership, staffing, and quality of care of participant facilities are presented and compared to NHs nationwide. To date, 189 resident/HCP dyads have been enrolled. Baseline data are presented, demonstrating the success of the protocol in recruiting and repeatedly assessing NH residents with advanced dementia and their HCPs. Factors challenging and enabling implementation of the protocol are described. The CASCADE experience establishes the feasibility of conducting rigorous, multisite dementia NH research, and the described methodology serves as a detailed reference for subsequent CASCADE publications as results from the study emerge. PMID:16917187
Nutritional Care in a Nursing Home in Italy
Donini, Lorenzo Maria; Neri, Barbara; De Chiara, Stefania; Poggiogalle, Eleonora; Muscaritoli, Maurizio
Introduction Malnutrition is a clinical condition due to the imbalance among needs, intake and use of nutrients, leading to the increase of morbidity and mortality, and to the impairment of quality of life. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects. A multicentric study called PIMAI (Project Iatrogenic MAlnutrition in Italy), was carried out in Italy over 2005. The aims of this study were to determine the prevalence of malnutrition in hospitals and in nursing care homes (NH), to assess the level of nutritional attention and to measure the perceived quality in food and nutritional care. This paper represents a preliminary analysis of data collected in a NH included in the PIMAI project. Materials and methods A total of 100 subjects (29 males and 71 females, aged 80.2±10 years), were recruited from January to June 2005 at the Clinical Rehabilitation Institute "Villa delle Querce" in Nemi (Rome), among patients in the NH facility. All the participants underwent a multidimensional geriatric evaluation (considering nutritional, clinical, functional and cognitive parameters), and a survey on "perceived quality" of nutritional care. Results and discussion According to nutritional status defined by the Mini Nutritional Assessment®, data analysis showed a high prevalence of malnutrition (36%) especially related to advanced age, chewing, cognitive and functional impairments. Patients seemed to consider nutrition to be important for their health; on the other hand, they were not thoroughly satisfied with the quality of food. Particularly, it was observed scarce attention to nutritional status from medical and nursing staff. Conclusions Our study confirms the need to pay greater attention to nutritional status in elderly institutionalized subjects. Medical and nursing teams need to be aware of the importance to perform an evaluation of nutritional status in these subset
[Consensus on nursing diagnoses, interventions and outcomes for home care of patients with heart failure].
Azzolin, Karina; de Souza, Emiliane Nogueira; Ruschel, Karen Brasil; Mussi, Cláudia Motta; de Lucena, Amália Fátima; Rabelo, Eneida Rejane
This was a consensus study with six cardiology nurses with the objective of selecting nursing diagnoses, outcomes and interventions described by NANDA International (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), for home care of patients with heart failure (HF). Eight nursing diagnoses (NDs) were pre-selected and a consensus was achieved in three stages, during which interventions/activities and outcomes/indicators of each NDs were validated and those considered valid obtained 70% to 100% consensus. From the eight pre-selected NDs, two were excluded due to the lack of consensus on appropriate interventions for the clinical home care scenario. Eleven interventions were selected from a total of 96 pre-selected ones and seven outcomes were validated out of 71. The practice of consensus among expert nurses provides assistance to the qualifications of the care process and deepens the knowledge about the use of tazonomies in nursing clinical practice. PMID:23596917
Low Vision Rehabilitation in a Nursing Home Population: The SEEING Study
Deremeik, James; Broman, Aimee T.; Friedman, David; West, Sheila K.; Massof, Robert; Park, William; Bandeen-Roche, Karen; Frick, Kevin; Muñoz, Beatriz
As part of a study of 198 residents with low vision in 28 nursing homes, 91 participated in a low vision rehabilitation intervention. Among the rehabilitation participants, 78% received simple environmental modifications, such as lighting; 75% received low vision instruction; 73% benefited from staff training; and 69% received simple nonoptical devices. Because of the cognitive and physical fragility of many nursing home residents, the authors recommend an approach that centers on training nursing home staff and improving the environment of the facilities, especially in the area of illumination. PMID:22942491
Elementary Rehabilitation Nursing Care; a Manual for Nurses and Ancillary Workers in Nursing Homes, Hospitals, Convalescent Facilities, and Public Health Agencies. Public Health Service Publication No. 1436.
ERIC Educational Resources Information Center
Colorado State Dept. of Public Health, Denver. Public Health Nursing Section.
This guide for teacher and student use presents a comprehensive program of physical rehabilitation for aged and physically disabled patients. Developed by the Public Health Nursing Section, the manual was tested by state health department personnel and persons doing inservice teaching in their respective nursing homes. The program is designed to…
Advance Care Planning in Norwegian nursing homes-Who is it for?
Thoresen, Lisbeth; Ahlzén, Rolf; Solbrække, Kari Nyheim
Advance care planning (ACP) is an international concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care. In a preparatory conversation, health care professionals facilitate one or more conversations where nursing home residents are invited to reflect on, and articulate wishes and preferences concerning future medical treatment and end-of-life care. Our aim with this study was to increase knowledge of existing ACP practices in Norwegian nursing homes. We wanted to know how nursing home residents, relatives and nursing home staff take part in the conversations, and to what extent these conversations can be regarded as promoting autonomy, legal rights and individual needs for the residents. We conducted participant observation of seven preparatory conversations, followed by interviews with health care staff (together) and resident and relative (together). In the result section, we present an informative case example of an ACP conversation where common and important characteristics running through our data are present. These are further elaborated under the following headings: Life critical questions, Residents' quiet participation in the conversations, the Dying phase - a clinical issue, Nurses and physicians; different domains and Timing. We find that nursing home staff in our study wants to contribute to open awareness, autonomy and a good death, but there are little reflections about the purpose and content of the conversations, how they should be carried out and when, and what frail nursing home residents are able to understand and express in ACP conversations. PMID:27531449
[Being a nursing home resident--a challenge for one's identity].
Riedl, Maria; Mantovan, Franco; Them, Christa
When entering the nursing home, elderly people are afraid of losing their independence and identity. That is why the entry into a nursing home turns out be a critical experience for the people affected. A systematic literature research on this topic illustrates that the impacts of a nursing home entry on the identity of these people have only scarcely been investigated so far. In the present study, 20 problem-centred interviews with residents of three different nursing homes were conducted and analysed according to the summarizing content analysis developed by Mayring (2007). The result shows that moving into a nursing home is accompanied by a strong emotional burden as these people have to leave behind their friends, families, pets, long-time neighbours and property. Moreover, other residents of the nursing home create fear through their need of care. The test persons participating in the present study do not want to have their decisions and actions imposed from outside because of their need of nursing care. They protest against it. They draw enough strength from the social network they maintain, from conversations and from their faith in order to fight for their independence. They develop a new identity close to their former identity by maintaining autonomy and mobility, and they stay future-oriented. PMID:22642199
Nurse's Aid And Housekeeping Mobile Robot For Use In The Nursing Home Workplace
NASA Astrophysics Data System (ADS)
Sines, John A.
The large nursing home market has several natural characteristics which make it a good applications area for robotics. The environment is already robot accessible and the work functions require large quantities of low skilled services on a daily basis. In the near future, a commercial opportunity for the practical application of robots is emerging in the delivery of housekeeping services in the nursing home environment. The robot systems will assist in food tray delivery, material handling, and security, and will perform activities such as changing a resident's table side drinking water twice a day, and taking out the trash. The housekeeping work functions will generate cost savings of approximately 22,000 per year, at a cost of 6,000 per year. Technical system challenges center around the artificial intelligence required for the robot to map its own location within the facility, to find objects, and to avoid obstacles, and the development of an energy efficient mechanical lifting system. The long engineering and licensing cycles (7 to 12 years) required to bring this type of product to market make it difficult to raise capital for such a venture.
Hospitalizations Among Nursing Home Residents in the Last Year of Life: Nursing Home Characteristics and Variation in Potentially Avoidable Hospitalizations
Xing, Jingping; Mukamel, Dana B.; Temkin-Greener, Helena
Objectives 1) To examine the incidence, variations, and costs in potentially avoidable hospitalizations (PAHs) among nursing home (NH) residents at the end-of-life. 2) To identify the association between NH characteristics and a facility-level quality measure (QM) for PAH. Design Retrospective study. Setting Hospitalizations originating from NHs. Participants Long-term care NH residents who died in 2007. Measurements We constructed a risk-adjusted QM for PAH. Poisson regression model was used to predict the count of PAH given residents' risk factors. For each facility, the QM was defined as the difference between the observed facility-specific rate (per 1,000 person-years) of PAH (O) and the expected risk-adjusted rate (E). We then fit a logistic regression model with state fixed-effects to examine the association between facility characteristics and the likelihood of having higher than expected rates of PAH (O-E>0). QM values higher than 0 indicate worse than average quality. Results Almost 50% of hospital admissions for NH residents in their last year of life were for potentially avoidable diagnoses, costing Medicare $1billion. Five conditions were responsible for over 80% of PAHs. PAH QM across facilities showed significant variation (mean=11.96; std dev=142.26; range: −399.48-398.09). Chain and hospital-based facilities were more likely to exhibit better performance (O-E<0). Facilities with higher nursing staffing were more likely to have better performance, as did facilities with higher skilled staff ratio, facilities with nurse practitioners/physician assistants, and those with on-site x-ray services. Conclusion Variations in facility-level PAHs suggest that a potential for reducing hospital admissions for these conditions may exist. Presence of modifiable facility characteristics associated with PAH performance provides insights into possible interventions for reducing PAHs at the end-of-life. PMID:24219191
Efficiency and quality of care in nursing homes: an Italian case study.
Garavaglia, Giulia; Lettieri, Emanuele; Agasisti, Tommaso; Lopez, Silvano
This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency. PMID:20922483
Determinants of financial performance of home-visit nursing agencies in Japan
Background Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. Methods We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). Results Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. Conclusions The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the
Nursing Home Price and Quality Responses to Publicly Reported Quality Information
Clement, Jan P; Bazzoli, Gloria J; Zhao, Mei
Objective To assess whether the release of Nursing Home Compare (NHC) data affected self-pay per diem prices and quality of care. Data Sources Primary data sources are the Annual Survey of Wisconsin Nursing Homes for 2001–2003, Online Survey and Certification Reporting System, NHC, and Area Resource File. Study Design We estimated fixed effects models with robust standard errors of per diem self-pay charge and quality before and after NHC. Principal Findings After NHC, low-quality nursing homes raised their prices by a small but significant amount and decreased their use of restraints but did not reduce pressure sores. Mid-level and high-quality nursing homes did not significantly increase self-pay prices after NHC nor consistently change quality. Conclusions Our findings suggest that the release of quality information affected nursing home behavior, especially pricing and quality decisions among low-quality facilities. Policy makers should continue to monitor quality and prices for self-pay residents and scrutinize low-quality homes over time to see whether they are on a pathway to improve quality. In addition, policy makers should not expect public reporting to result in quick fixes to nursing home quality problems. PMID:22092366
Excess demand, consumer rationality, and the quality of care in regulated nursing homes.
Nyman, J A
This article investigates whether an empirical basis exists for the hypothesis that nursing homes exploit the irrationality of some nursing home patients by providing inadequate quality care. Evidence from Wisconsin in 1983 shows that violations of the Medicaid certification code in nursing homes are not statistically related to two measures of consumer rationality. Violations are, however, related to a measure of the need to compete for patients, despite the presence of an effective program to enforce these certification standards through fines. Specifically, it is found that, where the bed supply is tight, an additional empty bed in every nursing home in a county is associated with between five and six fewer class C violations (or their equivalent) in every home. This evidence is consistent with the hypothesis that the quality problems that nursing homes have traditionally exhibited are linked to the absence of a need to complete for patients, created by the bed shortage conditions that continue to characterize a large portion of nursing home care markets in the United States. The implications for public policy are discussed. PMID:2654084
Designing and Validating Procedures for Insuring Quality Adult Education in Nursing Homes and Convalescent Centers. Toward a Theory of Practice for Insuring Quality Education in Nursing Homes: A Section 310 Final Report, May 15, 1980-June 12, 1981.
ERIC Educational Resources Information Center
McDermott, Bill P.
The Senior Adult Education Program (SAEP) for Monroe County, Michigan, conducted a documentation and analysis of the program component that provides high school completion classes in two local nursing homes. Three general research questions were (1) benefits to nursing home residents from the programs, (2) design of classes in nursing homes…
[The actual conditions and problems of terminal home nursing care at our hospital].
Hara, Tsuyoshi; Kawashiri, Hiroaki; Hirakata, Makoto; Yamasaki, Misaki; Sato, Mariko; Miura, Hiroshi; Murata, Tsuneari; Takagi, Hiroaki
In 2006, we reconfirmed Suwachuo hospital slogan as "When there is a need of community, we will do our best to meet it" and the department of home nursing care is officially established in our hospital next spring. A death rate at home is generally used to evaluate a home nursing care, and this rate at our department was 60.8% in 2008. However, community needs various options in addition to death at home. Keeping an eye on community opinions is of great importance. PMID:20443392
Medication management at home: enhancing nurse's skills and improving patient satisfaction--a longitudinal study.
Mager, Diana R; Morrissey Ross, Mary
The purpose of this longitudinal study was to improve nurse medication management skills during home care (HC) visits, and thus improve care quality and the related patient ratings of nurse performance. Nurses completed presurveys asking how often they asked to see, taught about, and explained side effects of patient medications. Two focus groups were held with HC nurses to determine barriers to provision of such medication interventions, followed by presentation of a series of 5 medication-related educational sessions. HC nurse's surveys 6 months later reveal an increased frequency of medication skill performance, and patient ratings in these same areas improved statistically significantly, nearing or surpassing national benchmarks. PMID:23659219
Staffing Ratios and Quality: An Analysis of Minimum Direct Care Staffing Requirements for Nursing Homes
Bowblis, John R
Objective To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. Data Sources U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. Study Design Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Data Extraction Method Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. Principle Findings The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. Conclusions MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care practices associated with lower quality. PMID:21609329
Assessing Children's Home Language Environments Using Automatic Speech Recognition Technology
ERIC Educational Resources Information Center
Greenwood, Charles R.; Thiemann-Bourque, Kathy; Walker, Dale; Buzhardt, Jay; Gilkerson, Jill
The purpose of this research was to replicate and extend some of the findings of Hart and Risley using automatic speech processing instead of human transcription of language samples. The long-term goal of this work is to make the current approach to speech processing possible by researchers and clinicians working on a daily basis with families and…
Knowledge, Attitude, and Practices Toward Blood Pressure Measurement at Home Among Japanese Nurses.
Ishikuro, Mami; Ubeda, Sergio Ramón Gutiérrez; Obara, Taku; Watanabe, Ikue; Metoki, Hirohito; Kikuya, Masahiro; Kuriyama, Shinichi; Maruyama, Ryoko; Ohkubo, Takayoshi; Imai, Yutaka
The self-measurement of blood pressure (BP) at home is useful in predicting the level of target organ damage and in managing hypertension. Nurses are essential practitioners for managing hypertension; however, it is unclear whether they have adequate knowledge of home BP management. This study assessed the knowledge, attitudes, and practices of home BP measurement among Japanese nurses. A questionnaire regarding home BP measurement was distributed among nurses and collected by mail. A total of 6,002 (61.8%) responses were eligible for the study. The proportion of participants who correctly recognized the reference values for clinic BP and home BP was 9.9% and 2.8%. Midwives and those working for the government had the highest proportion of correct responses of reference values among all nursing subgroups. Participants who thought that home BP gave the most important BP information were 62.7%. About 60% of the participants who recommended home BP measurement to hypertensive patients preferred to recommend an upper-arm cuff device. Our findings suggested that more knowledge of home BP measurement among nurses is warranted. PMID:27023297
Effects of Electronic Health Information Technology Implementation on Nursing Home Resident Outcomes
Pillemer, Karl; Meador, Rhoda H.; Teresi, Jeanne A.; Chen, Emily K.; Henderson, Charles R.; Lachs, Mark S.; Boratgis, Gabriel; Silver, Stephanie; Eimicke, Joseph P.
Objective To examine the effects of electronic health information technology (HIT) on nursing home residents. Methods The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators, as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. Results No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents' subjective assessment of the HIT intervention were generally positive. Discussion The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior. PMID:21646551
Alzheimer disease. Donepezil and nursing home placement--benefits and costs.
Jelic, Vesna; Winblad, Bengt
The recent DOMINO-AD trial suggests that continued treatment with donepezil delays nursing home placement for patients with severe Alzheimer disease, but more work is needed to support strong conclusions about whether the benefits outweigh the costs. PMID:26714658
Is the experience of meaningful activities understood in nursing homes? A qualitative study.
Palacios-Ceña, Domingo; Gómez-Calero, Cristina; Cachón-Pérez, José Miguel; Velarde-García, Juan Francisco; Martínez-Piedrola, Rosa; Pérez-De-Heredia, Marta
Lack of occupation can lead to boredom, apathy, social exclusion and solitude. Occupation should incorporate meaningful activities. The aim of this study is to describe how Spanish Nursing Home residents experienced and made sense of meaningful activities. A qualitative phenomenological approach was followed. Data were collected over an 18-month period between 2012 and 2014. Purposeful sampling was conducted with Spanish residents in nursing homes in Madrid. Data were collected using unstructured and semi-structured interviews. The data were analyzed using the Giorgi proposal. Thirty-eight residents (20 female and 18 male) participated. Three main themes describing the significance of meaningful activity in nursing homes emerged from the data: Feeling the passage of time, Seeking an occupation, and Living with restrictions. Nursing homes should strive to develop diverse and meaningful activity programs for residents in order to occupy their time and provide them with a greater sense of purpose. PMID:26626463
Job Demand and Job Satisfaction in Latent Groups of Turnover Intention Among Licensed Nurses in Taiwan Nursing Homes.
Chen, I-Hui; Brown, Roger; Bowers, Barbara J; Chang, Wen-Yin
Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession, intent to leave a type of facility, or intent to leave a specific workplace. In a latent class analysis (LCA) of data from 186 licensed nurses (RNs and LPNs) recruited from 25 nursing homes (NHs) in Taiwan, we classified nurses into turnover intention subgroups based on seven questionnaire items and used a multilevel contrast analysis to characterize the subgroups according to demographic and facility factors, job demand, and job satisfaction. A multilevel probit model was used to examine how job demand and job satisfaction influenced subgroup membership. Three turnover subgroups were identified: high turnover intention (12%), middle turnover intention (57%), and low turnover intention (31%). The high turnover intention subgroup comprised the youngest nurses and had the lowest percentage of registered nurses (RNs); nurses in this subgroup had worked the longest at the current NH and had the greatest likelihood of working at a for-profit facility. Nurses in the middle turnover intention subgroup had the lowest likelihood of working at a for-profit facility. Nurses in the low turnover intention subgroup were primarily RNs and had the shortest work experience in the current facility. Nurses in the high and middle turnover intention subgroups reported lower intrinsic job satisfaction than those with low turnover intention. Extrinsic job satisfaction mediated the relationship between job demand and turnover intention subgroup assignment. The results of this LCA can help target interventions to address heterogeneity of turnover intention and ultimately lessen turnover. PMID:26012950
38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.
Code of Federal Regulations, 2014 CFR
... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing...
38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.
Code of Federal Regulations, 2010 CFR
... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and on... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing...
38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...
Code of Federal Regulations, 2010 CFR
... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...
38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...
Code of Federal Regulations, 2012 CFR
... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...
38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.
Code of Federal Regulations, 2012 CFR
... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing...
38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...
Code of Federal Regulations, 2014 CFR
... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...
38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.
Code of Federal Regulations, 2013 CFR
... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing...
38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...
Code of Federal Regulations, 2013 CFR
... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...
38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...
Code of Federal Regulations, 2011 CFR
... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...
38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.
Code of Federal Regulations, 2011 CFR
... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing...
Does empowering resident families or nursing home employees in decision making improve service quality?
Hamann, Darla J
This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses. PMID:24652909
Advance care planning for nursing home residents with dementia: policy vs. practice.
Despite the potential benefits of ACP for nursing home residents with dementia, the authors of this study highlight that hardly any research has focused on the involvement of residents/families in ACP and that ACP is rarely realised for these people. Their research aimed to evaluate the ACP policy for people with dementia in nursing homes and to gain insight into the involvement of residents with dementia and their families in ACP. PMID:27231078
Experiences of home and institution in a secured nursing home ward in The Netherlands: A participatory intervention study.
Klaassens, Mirjam; Meijering, Louise
Nursing homes have been criticised for not providing a home for their residents. This article aims to provide insight into (1) the features of home and institution as experienced by residents and caregivers of a secured ward in a nursing home, and (2) how interventions implemented on the ward can contribute to a more home-like environment. For this purpose, a participatory intervention study, involving both caregivers and residents, was carried out. We collected data through qualitative research methods: observations, in-depth interviews and diaries to evaluate the interventions over time. We adopted an informed grounded theory approach, and used conceptualisations of total institutions and home as a theoretical lens. We found that the studied ward had strong characteristics of a total institution, such as batch living, block treatment and limited privacy. To increase the sense of home, interventions were formulated and implemented by the caregivers to increase the residents' autonomy, control and privacy. In this process, caregivers' perceptions and attitudes towards the provision of care shifted from task-oriented to person-centred care. We conclude that it is possible to increase the home-like character of a secured ward by introducing core values of home by means of interventions involving both caregivers and residents. PMID:26162729
Evaluation of a Behavior Management Training Program for Nursing Home Caregivers.
ERIC Educational Resources Information Center
Marsiske, Michael; And Others
This study examined the effectiveness of a new skills training program designed to increase nurse aides' knowledge of behavior management. The training program, designed as five 90-minute group learning modules, was implemented in two Western Pennsylvania nursing homes over a 5-month period. Topics covered within the training program included…
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2011 CFR
... 42 Public Health 3 2011-10-01 2011-10-01 false Services of residents in skilled nursing facilities... Services of Residents § 415.204 Services of residents in skilled nursing facilities and home health...' services furnished in the following settings that meet the specified requirements: (1) Skilled...
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2010 CFR
... 42 Public Health 3 2010-10-01 2010-10-01 false Services of residents in skilled nursing facilities... Services of Residents § 415.204 Services of residents in skilled nursing facilities and home health...' services furnished in the following settings that meet the specified requirements: (1) Skilled...
The Effect of a High-Fidelity Home Health Simulations on Nursing Students' Clinical Performance
ERIC Educational Resources Information Center
Crytzer, Michele Leigh
With an increasing number of patients receiving nursing care in outpatient settings, it is the responsibility of nursing education programs to provide students with adequate training to enable them to develop the skills necessary to provide safe, effective care in diverse environments, including the home. Providing care to patients in their own…
[Support at the end of life in care homes by nursing assistants].
Croyère, Nicole
In nursing homes, the nursing assistant supports patients at the end of life, notably as they move into palliative care. This involves team work to relieve pain, limit treatments considered disproportionate and improve comfort. Relations with the residents and their families are particularly important in this context. PMID:26567077
Recent Trends in Advance Directives at Nursing Home Admission and One Year after Admission
ERIC Educational Resources Information Center
McAuley, William J.; Buchanan, Robert J.; Travis, Shirley S.; Wang, Suojin; Kim, MyungSuk
Purpose: Advance directives are important planning and decision-making tools for individuals in nursing homes. Design and Methods: By using the nursing facility Minimum Data Set, we examined the prevalence of advance directives at admission and 12 months post-admission. Results: The prevalence of having any advance directive at admission declined…
Effect of an Incontinence Training Program on Nursing Home Staff's Knowledge, Attitudes, and Behavior.
ERIC Educational Resources Information Center
Campbell, Emily B; And Others
Nursing staff (n=166) in four nursing homes participated in quasi-experimental study to measure knowledge and attitudes about urinary incontinence and compliance with toileting protocols. Intervention group (n=96) showed slight increase in knowledge; their attitudes remained positive over four testing times. Compliance with protocol was only 72…
Top Management Leadership Style and Quality of Care in Nursing Homes
ERIC Educational Resources Information Center
Castle, Nicholas G.; Decker, Frederic H.
Purpose: The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Design and Methods: Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style…
The Effects of Resident and Nursing Home Characteristics on Activities of Daily Living
Wang, Jye; Kane, Robert L.; Eberly, Lynn E.; Virnig, Beth A.
Background Existing studies on the relationships between impairments and activities of daily living (ADLs) in nursing home residents have serious limitations. This study examines the relationships among admission impairments, including pain, depression, incontinence, balance, and falls, and follow-up ADLs, as well as the effect of the nursing home on follow-up ADLs of extended-stay nursing home residents. Methods This longitudinal cohort study consisted of 4,942 extended-stay residents who were admitted into 377 Minnesota nursing homes during 2004. General linear mixed models were used for all analyses, with 14 resident-level and 8 facility-level control variables. Results Incontinence and balance function at admission were significantly associated with increases in ADL dependence at follow-up. Individual nursing homes had independent effects on all three ADL models. Similar findings were found after facility-level control variables were added. Conclusions Incontinence predicts subsequent ADL functional levels. The relationship between balance dysfunction and subsequent ADL dependence could be causal. Future studies of the causal relationships between impairments and ADL should examine the effectiveness of impairment interventions on ADL as well as these relationships in different subgroups of nursing home residents. PMID:19201787
The relationship between quality of care and financial performance in nursing homes.
Weech-Maldonado, Robert; Neff, Gerald; Mor, Vince
Changes in the reimbursement structure of the Medicaid and Medicare programs have caused nursing homes to face severe revenue restraints. In the hopes of alleviating the effect of payment cutbacks on their financial performance, nursing homes have been instituting quality improvement initiatives. The goal of this study was to examine the relationships of quality of care with revenues, private-pay market share, and costs in the nursing home industry, and how these dynamics interplay to affect financial performance. This goal was achieved by using secondary data consisting of: (1) the Minimum Data Set Plus (MDS+); (2) the Health Care Information Analyst (HCIA) nursing home data set; and (3) the On-line Survey Certification of Automated Records (OSCAR) data set. Structural equation modeling (SEM) using maximum likelihood estimation was used to examine the total, direct, and indirect effects of the variables. Findings indicate that nursing homes that produce high quality care are able to achieve lower resident costs and in the process, report better financial performance than those facilities producing lower quality care. On the other hand, quality of care provided was not significantly associated with the revenues or private-pay market share of the nursing home. Overall, the total effects of quality to financial performance were positive (.055). PMID:12635994
Strategic groups, performance, and strategic response in the nursing home industry.
Zinn, J S; Aaronson, W E; Rosko, M D
OBJECTIVE. This study examines the effect of strategic group membership on nursing home performance and strategic behavior. DATA SOURCES AND STUDY SETTING. Data from the 1987 Medicare and Medicaid Automated Certification Survey were combined with data from the 1987 and 1989 Pennsylvania Long Term Care Facility Questionnaire. The sample consisted of 383 Pennsylvania nursing homes. STUDY DESIGN. Cluster analysis was used to place the 383 nursing homes into strategic groups on the basis of variables measuring scope and resource deployment. Performance was measured by indicators of the quality of nursing home care (rates of pressure ulcers, catheterization, and restraint usage) and efficiency in services provision. Changes in Medicare participation after passage of the 1988 Medicare Catastrophic Coverage Act (MCCA) measured strategic behavior. MANOVA and Turkey HSD post hoc means tests determined if significant differences were associated with strategic group membership. FINDINGS. Cluster analysis produced an optimal seven-group solution. Differences in group means were significant for the clustering, performance, and conduct variables (p < .0001). Strategic groups characterized by facilities providing a continuum of care services had the best patient care outcomes. The most efficient groups were characterized by facilities with high Medicare census. While all strategic groups increased Medicare census following passage of the MCCA, those dominated by for-profits had the greatest increases. CONCLUSIONS. Our analysis demonstrates that strategic orientation influences nursing home response to regulatory initiatives, a factor that should be recognized in policy formation directed at nursing home reform. PMID:8005789
When Patients Customize Nursing Home Ratings, Choices And Rankings Differ From The Government's Version.
Mukamel, Dana B; Amin, Alpesh; Weimer, David L; Sharit, Joseph; Ladd, Heather; Sorkin, Dara H
Report cards currently published by the Centers for Medicare and Medicaid Services (CMS) offer composite (summary) quality measures based on a five-star ratings system, such as the one featured on the Nursing Home Compare website. These ratings are "one size fits all patients" measures. Nursing Home Compare Plus is an alternative that allows patients and their families to create their own composite scores based on their own preferences and medical needs. We present data from 146 patients who were discharged from the hospital to nursing homes who used Nursing Home Compare Plus. We found that the individual patient-constructed composites differed from CMS's five-star ratings composite. Patients differed from each other and from CMS in the number of performance measures they chose to include in their composite and in their weighting of each performance measure. When comparing Nursing Home Compare Plus to Medicare's five-star ratings, we found only minimal agreement on ranking of nursing homes. We conclude that patients might benefit if current report cards are modified to include an option for personalized ranking. PMID:27044973
Second-hand smoke exposure: responses from home care and therapeutic group home nurses: a call to action.
L'Heureux, Juliana
Home care visiting nurses and those working in a therapeutic group home expressed concerns about their inadvertent exposure to secondhand smoke when caring for patients who live where cigarettes or tobacco products are used. The American Lung Association Fact Sheet on Secondhand Smoke Exposure cites the Environmental Protection Agency (EPA) classification of secondhand smoke as a cause of human cancer. Secondhand smoke causes approximately 3,400 lung cancer deaths and 22,700 to 69,600 heart disease deaths among adult nonsmokers in the United States each year (American Lung Association, 2009). For this study, home care nurses and those working in a therapeutic group home for the mentally ill in Augusta, Maine, were interviewed. This report describes their exposure and how secondhand smoke can be eliminated with minimal disruption to patient care. The interviewed nurses discussed the repeated exposures they experienced while caring for multiple smoking patients in residences that included apartment buildings and group homes and while transporting patients with private automobiles in which the use of cigarettes, cigarillos, cigars, pipes, and tobacco products can be common. Concerns about secondhand smoke exposures frequently focused on the unpleasant smoke odor retained on clothes and nursing equipment when people smoke during a patient visit. Protective actions also were reported. Strategies for action are discussed. PMID:19212225
77 FR 26183 - Technical Revisions To Update Reference to the Required Assessment Tool for State Nursing Homes...
Federal Register 2010, 2011, 2012, 2013, 2014
... (VA) regulations. On November 10, 2011, VA published in the Federal Register (76 FR 70076) a proposal... Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY: Department of Veterans Affairs... State homes that receive per diem from VA for providing nursing home care to veterans. It requires...
38 CFR 36.4226 - Withdrawal of authority to close manufactured home loans on the automatic basis.
Code of Federal Regulations, 2010 CFR
... also be withdrawn based on any of the causes for debarment set forth in 2 CFR parts 180 and 801. (b... to close manufactured home loans on the automatic basis. 36.4226 Section 36.4226 Pensions, Bonuses... Withdrawal of authority to close manufactured home loans on the automatic basis. (a)(1) As provided in 38...
Cross-mapping the ICNP with NANDA, HHCC, Omaha System and NIC for unified nursing language system development. International Classification for Nursing Practice. International Council of Nurses. North American Nursing Diagnosis Association. Home Health Care Classification. Nursing Interventions Classification.
Hyun, S; Park, H A
Nursing language plays an important role in describing and defining nursing phenomena and nursing actions. There are numerous vocabularies describing nursing diagnoses, interventions and outcomes in nursing. However, the lack of a standardized unified nursing language is considered a problem for further development of the discipline of nursing. In an effort to unify the nursing languages, the International Council of Nurses (ICN) has proposed the International Classification for Nursing Practice (ICNP) as a unified nursing language system. The purpose of this study was to evaluate the inclusiveness and expressiveness of the ICNP terms by cross-mapping them with the existing nursing terminologies, specifically the North American Nursing Diagnosis Association (NANDA) taxonomy I, the Omaha System, the Home Health Care Classification (HHCC) and the Nursing Interventions Classification (NIC). Nine hundred and seventy-four terms from these four classifications were cross-mapped with the ICNP terms. This was performed in accordance with the Guidelines for Composing a Nursing Diagnosis and Guidelines for Composing a Nursing Intervention, which were suggested by the ICNP development team. An expert group verified the results. The ICNP Phenomena Classification described 87.5% of the NANDA diagnoses, 89.7% of the HHCC diagnoses and 72.7% of the Omaha System problem classification scheme. The ICNP Action Classification described 79.4% of the NIC interventions, 80.6% of the HHCC interventions and 71.4% of the Omaha System intervention scheme. The results of this study suggest that the ICNP has a sound starting structure for a unified nursing language system and can be used to describe most of the existing terminologies. Recommendations for the addition of terms to the ICNP are provided. PMID:12094837
Adherence of pain assessment to the German national standard for pain management in 12 nursing homes
Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick
BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommended for practice. OBJECTIVES: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. METHODS: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. RESULTS: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. CONCLUSIONS: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain. PMID:24851238
Ethics policies on euthanasia in nursing homes: a survey in Flanders, Belgium.
Lemiengre, Joke; Dierckx de Casterlé, Bernadette; Verbeke, Geert; Van Craen, Katleen; Schotsmans, Paul; Gastmans, Chris
In many European countries there is a public debate about the acceptability and regulation of euthanasia. In 2002, Belgium became the second country after the Netherlands to enact a law on euthanasia. Although euthanasia rarely occurs, the complexity of the clinical-ethical decision making surrounding euthanasia requests and the need for adequate support reported by caregivers, means that healthcare institutions increasingly need to consider how to responsibly handle euthanasia requests. The development of written ethics policies on euthanasia may be important to guarantee and maintain the quality of care for patients requesting euthanasia. The aim of this study was to determine the prevalence, development, position, and communication of written ethics policies on euthanasia in Flemish nursing homes. Data were obtained through a cross-sectional mail survey of general directors of all Catholic nursing homes in Flanders, Belgium. Of the 737 nursing homes invited to participate, 612 (83%) completed the questionnaire. Of these, only 15% had a written ethics policy on euthanasia. Presence of an ethics committee and membership of an umbrella organization were independent predictors of whether a nursing home had such a written ethics policy. The Act on Euthanasia and euthanasia guidelines advanced by professional organizations were the most frequent reasons (76% and 56%, respectively) and reference sources (92% and 64%, respectively) for developing ethics policies on euthanasia. Development of ethics policies occurred within a multidisciplinary context. In general, Flemish nursing homes applied the Act on Euthanasia restrictively by introducing palliative procedures in addition to legal due care criteria. The policy was communicated to the consulting general practitioner and nurses in 74% and 89% of nursing homes, respectively. Although the overall prevalence of ethics policies on euthanasia was low in Flemish nursing homes, institution administrators displayed growing
Supporting SIDS Families: The Public Health Nurse SIDS Home Visit.
Stastny, Penny F; Keens, Thomas G; Alkon, Abbey
Sudden infant death syndrome (SIDS) death has a devastating effect on parents. There is no known cause, so parents experience guilt about what they might have done or not done to contribute to the death. Although some SIDS parents may receive support from family and friends, the public health nurse (PHN) has an important professional role in providing grief support, SIDS education, and offering SIDS resources and referrals. Based on years of clinical practice, we recommend the following: Perform the home visit as soon as possible. Show care and compassion. Personalize the baby by using his or her name and asking to see photographs. Reassure the parents that grief is a process which takes time. Educate about what SIDS is and what it is not. Increasingly, SIDS deaths occur in the presence of risk factors. Explain that risk factors are not causes of death. As an authority in health care, reassuring families that they did not cause their baby's death has a tremendous impact on relieving guilt. Putting newly bereaved SIDS parents in contact with other SIDS parents is one of the most helpful actions a PHN can take to help families. PMID:26822270
Determinants of performance failure in the nursing home industry☆
Zinn, Jacqueline; Mor, Vincent; Feng, Zhanlian; Intrator, Orna
This study investigates the determinants of performance failure in U.S. nursing homes. The sample consisted of 91,168 surveys from 10,901 facilities included in the Online Survey Certification and Reporting system from 1996 to 2005. Failed performance was defined as termination from the Medicare and Medicaid programs. Determinants of performance failure were identified as core structural change (ownership change), peripheral change (related diversification), prior financial and quality of care performance, size and environmental shock (Medicaid case mix reimbursement and prospective payment system introduction). Additional control variables that could contribute to the likelihood of performance failure were included in a cross-sectional time series generalized estimating equation logistic regression model. Our results support the contention, derived from structural inertia theory, that where in an organization's structure change occurs determines whether it is adaptive or disruptive. In addition, while poor prior financial and quality performance and the introduction of case mix reimbursement increases the risk of failure, larger size is protective, decreasing the likelihood of performance failure. PMID:19128865
The Effect of State Policies on Nursing Home Resident Outcomes
Mor, Vincent; Gruneir, Andrea; Feng, Zhanlian; Grabowski, David C.; Intrator, Orna; Zinn, Jacqueline
OBJECTIVES To test the effect of changes in Medicaid reimbursement on clinical outcomes of long-stay nursing home (NH) residents. DESIGN Longitudinal, retrospective study of NHs, merging aggregated resident-level quality measures with facility characteristics and state policy survey data. SETTING All free-standing NHs in urban counties with at least 20 long-stay residents per quarter (length of stay >90 days) in the continental United States between 1999 and 2005. PARTICIPANTS Long-stay NH residents INTERVENTIONS Annual state Medicaid average per diem reimbursement and the presence of case-mix reimbursement in each year. MEASUREMENTS Quarterly facility-aggregated, risk-adjusted quality-of-care measures surpassing a threshold for functional (activity of daily living) decline, physical restraint use, pressure ulcer incidence or worsening, and persistent pain. RESULTS All outcomes showed an improvement trend over the study period, particularly physical restraint use. Facility fixed-effect regressions revealed that a $10 increase in Medicaid payment increased the likelihood of a NH meeting quality thresholds by 9% for functional decline, 5% for pain control, and 2% for pressure ulcers but not reduced use of physical restraints. Facilities in states that increased Medicaid payment most showed the greatest improvement in outcomes. The introduction of case-mix reimbursement was unrelated to quality improvement. CONCLUSION Improvements in the clinical quality of NH care have been achieved, particularly where Medicaid payment has increased, generally from a lower baseline. Although this is a positive finding, challenges to implementing efficient reimbursement policies remain. PMID:21198463
Hospitals, nursing homes turn to 3rd-party financing
Slaff, J.
Experience is teaching the administrators of hospitals and nursing homes how to make better arrangements for third-party financing of energy-management systems. Accustomed to health-insurance reimbursement for health-care costs, hospitals have lacked incentives for conservation. Plans now used most by hospitals and health-care facilities involve third-party arrangements where: (1) an equipment vendor installs equipment and takes a share of the energy-cost savings; or (2) energy-services firms both install capital-intensive equipment and implement a variety of low-cost conservation measures, again for a percentage of the savings. Although most users think these arrangements are satisfactory, they advise a preliminary low-cost audit and participation in a basic energy-management seminar before employing an energy-services firm. Accurate baseline energy-consumption data should be developed in order to evaluate results, and assurance is needed that staff members understand the accounting formulas. Also recommended are independent audits after installation and attention to the legal clauses in contracts. (DCK)
Preparing Nursing Homes for the Future of Health Information Exchange
Rantz, M.; Galambos, C.; Vogelsmeier, A.; Flesner, M.; Popejoy, L.; Mueller, J.; Shumate, S.; Elvin, M.
Summary Objective Our purpose was to describe how we prepared 16 nursing homes (NHs) for health information exchange (HIE) implementation. Background NH HIE connecting internal and external stakeholders are in their infancy. U.S. initiatives are demonstrating HIE use to increase access and securely exchange personal health information to improve patient outcomes. Method To achieve our objectives we conducted readiness assessments, performed 32 hours of clinical observation and developed 6 use cases, and conducted semi-structured interviews with 230 participants during 68 site visits to validate use cases and explore HIE. Results All 16 NHs had technology available to support resident care. Resident care technologies were integrated much more with internal than external stakeholders. A wide range of technologies were accessible only during administrative office hours. Six non-emergent use cases most commonly communicated by NH staff were: 1) scheduling appointments, 2) Laboratory specimen drawing, 3) pharmacy orders and reconciliation, 4) social work discharge planning, 5) admissions and pre-admissions, and 6) pharmacy-medication reconciliation. Emerging themes from semi-structured interviews about use cases included: availability of information technology in clinical settings, accessibility of HIE at the point of care, and policies/procedures for sending/receiving secure personal health information. Conclusion We learned that every facility needed additional technological and human resources to build an HIE network. Also, use cases help clinical staff apply theoretical problems of HIE implementation and helps them think through the implications of using HIE to communicate about clinical care. PMID:26171073
Interventions to nurture excellence in the nursing home culture.
Deutschman, M
There is no one formula for culcure change. A joint steering committee of staff members can develop plans that will build trust, address each other as equals, and drive out fear as they move the process of change. Training and sharing information help staff recognize this is a process, not an event. New well-screened team members need training to integrate them into the culture. It is important to identify the knowledge and expertise of team members to maximize their energies and talents. Recruitment and retention of those who share the values of this culture are of paramount importance. It is worth the time and effort to secure commitment to these values. One example of this effort is a facility in Pennsylvania that, at its worst, had two thirds of its staff turnover in a year. The national average was 82% in 1995, an increase from 71.5% the year before. They were able to reduce their turnover rate to 27% by examining the hiring records and finding that workers with certain personality traits and attitudes were less likely to leave. They looked for compassion and communication skills, perceptions of older adults, ability to cope with death and dying, and ability to handle the unpleasant tasks of residene hygiene and bathroom visits. Current staff members determined and voted on best fit of candidates (Montague, 1997). Although training and evaluation are an important component of retention and commitment to values in any organization, training and evaluation of nursing home employees may be quite different from other employment. A nurse in a nursing home needs to be evaluated not only on clinical skills, but on communication skills, attitude, and leadership (Meyer, 1995). Then training and employee development programs can be targeted to specific areas for corrective action. What is taught in training and what occurs on the job should correspond, or role conflict occurs increasing the likelihood of turnover (Steffen, Nystrom, O'Connor, 1996). Although occasional