Health Professions › General Health Professions

Geriatric Care and Nursing Homes

Works Count: 78012

Wikipedia

Description

This cluster of papers focuses on the quality and practices in nursing home care, including topics such as person-centered care, staffing levels, long-term care, home-based primary care, the impact of COVID-19, resident assessment instruments, hospitalizations, and caregiver staffing.

Keywords

Nursing Home; Quality of Care; Person-Centered Care; Staffing Levels; Long-Term Care; Home-Based Primary Care; COVID-19 Impact; Resident Assessment Instrument; Hospitalizations; Caregiver Staffing

Improving the Quality of Transitional Care for Persons with Complex Care Needs

2003-03-26

Eric A. Coleman , Chad Boult

Standardizing Assessment of Elderly People in Acute Care: The interRAI Acute Care Instrument

2008-01-04

Len Gray , Roberto Bernabei , Katherine Berg +7 more

OBJECTIVES: To examine the frequency distributions and interrater reliability of individual items of the interRAI Acute Care instrument. DESIGN: Observational study of a representative sample of older inpatients; duplicate assessments … OBJECTIVES: To examine the frequency distributions and interrater reliability of individual items of the interRAI Acute Care instrument. DESIGN: Observational study of a representative sample of older inpatients; duplicate assessments conducted on a subsample by independent assessors to examine interrater reliability. SETTING: Acute medical, acute geriatric and orthopedic units in 13 hospitals in nine countries. PARTICIPANTS: Five hundred thirty‐three patients aged 70 and older (mean age 82.4, range 70–102) with an anticipated stay of 48 hours or longer of whom 161 received duplicate assessments. MEASUREMENTS: Sixty‐two clinical items across 11 domains. Premorbid (3‐day observation period before onset of the acute illness) and admission (the first 24 hours of hospital stay) assessments were conducted. RESULTS: The frequency of deficits exceeded 30% for most items, ranging from 1% for physically abusive behavior to 86% for the need for support in activities of daily living after discharge. Common deficits were in cognitive skills for daily decision‐making (38% premorbid, 54% at admission), personal hygiene (37%, 65%), and walking (39%, 71%). Interrater reliability was substantial in the premorbid period (average κ=0.61) and admission period (average κ=0.66). Of the 69 items tested, less than moderate agreement (κ<0.4) was recorded for six (9%), moderate agreement (κ=0.41–0.6) for 14 (20%), substantial agreement (κ=0.61–0.8) for 40 (58%), and almost perfect agreement (κ>0.8) for nine (13%). CONCLUSION: Initial assessment of the psychometric properties of the interRAI Acute Care instrument provided evidence that item selection and interrater reliability are appropriate for clinical application. Further studies are required to examine the validity of embedded scales, diagnostic algorithms, and clinical protocols.

View PDF Chat

Epidemiology of fecal incontinence: the silent affliction.

1996-01-01

John F. Johanson , Jerry Lafferty

Fecal incontinence represents an embarrassing social problem, the magnitude of which remains largely unknown. The present study prospectively examined the prevalence and demographic distributions of fecal incontinence.demographic data, in addition … Fecal incontinence represents an embarrassing social problem, the magnitude of which remains largely unknown. The present study prospectively examined the prevalence and demographic distributions of fecal incontinence.demographic data, in addition to information regarding the reason for visit, bowel habits, and the frequency, type, and severity of fecal incontinence, were collected from individuals at the time of visits to their primary care physician or gastroenterologist.Eight hundred and eighty-one individuals 18 yr or older were included in the analysis. The overall prevalence of fecal incontinence was 18.4%. When stratified by frequency, 2.7, 4.5, and 7.1% of participants admitted to incontinence daily, weekly, or once per month or less, respectively. Incontinence increased progressively with age and was 1.3 times more common in males than females. Only one-third of individuals with fecal incontinence had ever discussed the problem with a physician.The prevalence of fecal incontinence appears to be more common than previously appreciated. Moreover, only a minority with a physician. It would seem important to more actively pursue this "silent affliction" particularly in patients who do not readily volunteer this information.

MDS Cognitive Performance Scale(C)

1994-07-01

John N. Morris , Brant E. Fries , David R. Mehr +4 more

Journal Article MDS Cognitive Performance Scale© Get access John N. Morris, John N. Morris 1Hebrew Rehabilitation Center for AgedBoston Search for other works by this author on: Oxford Academic PubMed … Journal Article MDS Cognitive Performance Scale© Get access John N. Morris, John N. Morris 1Hebrew Rehabilitation Center for AgedBoston Search for other works by this author on: Oxford Academic PubMed Google Scholar Brant E. Fries, Brant E. Fries 2Institute of Gerontology and School of Public Health, University of Michigan, and Ann Arbor VA Medical Center Search for other works by this author on: Oxford Academic PubMed Google Scholar David R. Mehr, David R. Mehr 3Department of Family and Community Medicine, University of Missouri Health Sciences Center Search for other works by this author on: Oxford Academic PubMed Google Scholar Catherine Hawes, Catherine Hawes 4Research Triangle Institute, Research Triangle ParkNorth Carolina Search for other works by this author on: Oxford Academic PubMed Google Scholar Charles Phillips, Charles Phillips 4Research Triangle Institute, Research Triangle ParkNorth Carolina Search for other works by this author on: Oxford Academic PubMed Google Scholar Vincent Mor, Vincent Mor 5Center for Gerontology Health Care Research, Brown University, ProvidenceRhode Island Search for other works by this author on: Oxford Academic PubMed Google Scholar Lewis A. Lipsitz Lewis A. Lipsitz 6Hebrew Rehabilitation Center for Aged, Beth Israel Hospital and Harvard Medical SchoolBoston Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Gerontology, Volume 49, Issue 4, July 1994, Pages M174–M182, https://doi.org/10.1093/geronj/49.4.M174 Published: 01 July 1994 Article history Received: 29 July 1992 Accepted: 15 September 1993 Published: 01 July 1994

Differences in 4-Year Health Outcomes for Elderly and Poor, Chronically III Patients Treated in HMO and Fee-for-Service Systems

1996-10-02

John E. Ware

To compare physical and mental health outcomes of chronically ill adults, including elderly and poor subgroups, treated in health maintenance organization (HMO) and fee-for-service (FFS) systems.A 4-year observational study of … To compare physical and mental health outcomes of chronically ill adults, including elderly and poor subgroups, treated in health maintenance organization (HMO) and fee-for-service (FFS) systems.A 4-year observational study of 2235 patients (18 to 97 years of age) with hypertension, non-insulin-dependent diabetes mellitus (NIDDM), recent acute myocardial infarction, congestive heart failure, and depressive disorder sampled from HMO and FFS systems in 1986 and followed up through 1990. Those aged 65 years and older covered under Medicare and low-income patients (200% of poverty) were analyzed separately.Offices of physicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry, in HMO and FFS systems of care. Types of practices included both prepaid group (72% of patients) and independent practice association (28%) types of HMOs, large multispecialty groups, and solo or small, single-specialty practices in Boston, Mass, Chicago, Ill, and Los Angeles, Calif.Differences between initial and 4-year follow-up scores of summary physical and mental health scales from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) for all patients and practice settings.On average, physical health declined and mental health remained stable during the 4-year follow-up period, with physical declines larger for the elderly than for the nonelderly (P<.001). In comparisons between HMO and FFS systems, physical and mental health outcomes did not differ for the average patient; however, they did differ for subgroups of the population differing in age and poverty status. For elderly patients (those aged 65 years and older) treated under Medicare, declines in physical health were more common in HMOs than in FFS plans (54% vs 28%; P<.001). In 1 site, mental health outcomes were better (P<.05) for elderly patients in HMOs relative to FFS but not in 2 other sites. For patients differing in poverty status, opposite patterns of physical health (P<.05) and for mental health (P<.001) outcomes were observed across systems; outcomes favored FFS over HMOs for the poverty group and favored HMOs over FFS for the nonpoverty group.During the study period, elderly and poor chronically ill patients had worse physical health outcomes in HMOs than in FFS systems; mental health outcomes varied by study site and patient characteristics. Current health care plans should carefully monitor the health outcomes of these vulnerable subgroups.

Predictors of Nursing Home Admission for Persons with Dementia

2009-01-23

Joseph E. Gaugler , Fang Yu , Kathleen Krichbaum +1 more

Objective: The objective of this systematic review was to identify factors that consistently predict nursing home admission (NHA) in persons with dementia. Methods: Studies published in English were retrieved by … Objective: The objective of this systematic review was to identify factors that consistently predict nursing home admission (NHA) in persons with dementia. Methods: Studies published in English were retrieved by searching the MEDLINE (1966–2006), PSYCINFO (1950–2006), CINAHL (1982–2006), and Digital Dissertations (1950–2006) databases. Bibliographies of retrieved studies were also searched. Information on study characteristics and empirical results were extracted using a standardized protocol. Results: Of 782 relevant studies identified 80 were selected for review based upon eligibility criteria. The most consistent predictors of NHA in persons with dementia included severity of cognitive impairment, Alzheimer disease diagnosis, basic activity of daily living dependencies, behavioral symptoms, and depression. Caregivers who indicated greater emotional stress, a desire to institutionalize the care recipient, and feelings of being "trapped" in care responsibilities were more likely to admit persons with dementia to nursing homes. Demographic variables, incontinence, and service use did not consistently predict NHA. Conclusions: Several results seemed to challenge conventional assumptions of what precipitates NHA among persons with dementia. Caregiver stressors in conjunction with care recipient characteristics are important to consider when assessing NHA risk. The findings emphasize the need to construct more complex models of institutionalization when designing risk measures to target interventions.

Comprehensive Discharge Planning and Home Follow-up of Hospitalized Elders

1999-02-17

Mary D. Naylor , Dorothy Brooten , Roberta Campbell +4 more

Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients, but the benefits of more intensive follow-up of hospitalized elders at risk for poor … Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients, but the benefits of more intensive follow-up of hospitalized elders at risk for poor outcomes after discharge has not been studied.To examine the effectiveness of an advanced practice nurse-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions.Randomized clinical trial with follow-up at 2, 6, 12, and 24 weeks after index hospital discharge.Two urban, academically affiliated hospitals in Philadelphia, Pa.Eligible patients were 65 years or older, hospitalized between August 1992 and March 1996, and had 1 of several medical and surgical reasons for admission.Intervention group patients received a comprehensive discharge planning and home follow-up protocol designed specifically for elders at risk for poor outcomes after discharge and implemented by advanced practice nurses.Readmissions, time to first readmission, acute care visits after discharge, costs, functional status, depression, and patient satisfaction.A total of 363 patients (186 in the control group and 177 in the intervention group) were enrolled in the study; 70% of intervention and 74% of control subjects completed the trial. Mean age of sample was 75 years; 50% were men and 45% were black. By week 24 after the index hospital discharge, control group patients were more likely than intervention group patients to be readmitted at least once (37.1 % vs 20.3 %; P<.001). Fewer intervention group patients had multiple readmissions (6.2% vs 14.5%; P = .01) and the intervention group had fewer hospital days per patient (1.53 vs 4.09 days; P<.001). Time to first readmission was increased in the intervention group (P<.001). At 24 weeks after discharge, total Medicare reimbursements for health services were about $1.2 million in the control group vs about $0.6 million in the intervention group (P<.001). There were no significant group differences in post-discharge acute care visits, functional status, depression, or patient satisfaction.An advanced practice nurse-centered discharge planning and home care intervention for at-risk hospitalized elders reduced readmissions, lengthened the time between discharge and readmission, and decreased the costs of providing health care. Thus, the intervention demonstrated great potential in promoting positive outcomes for hospitalized elders at high risk for rehospitalization while reducing costs.

The Development, Validity, and Reliability of the Oars Multidimensional Functional Assessment Questionnaire

1981-07-01

Gerda G. Fillenbaum , Michael A. Smyer

This report outlines the development, validity, and reliability of part A of the OARS multidimensional Functional Assessment Questionnaire. Part A permits assessment of individuals' functioning on each of five dimensions … This report outlines the development, validity, and reliability of part A of the OARS multidimensional Functional Assessment Questionnaire. Part A permits assessment of individuals' functioning on each of five dimensions (social, economic, mental health, physical health and self-care capacity), the detailed information in each area being summarized on a 6-point rating scale by a rater. Content and consensual validity were ensured by the manner of construction. Information on criterion validity was obtained for all dimensions except social. The criterion used and their associated kendall's tau values were: an objective economic scale (.62); ratings based on personal interviews by geropsychiatrists (.60); physician's associates (.82); and physical therapists (.89). For 11 geographically dispersed raters from research and clinic settings, intraclass correlational coefficients, based on 30 subjects, ranged from .66 on physical health to .87 in self-care capacity; 74% of the ratings were in complete agreement, 24% differed by one point.

Designing the National Resident Assessment Instrument for Nursing Homes

1990-06-01

Jack Morris , C. Hawes , Brant E. Fries +6 more

In response to the Omnibus Reconciliation Act of 1987 mandate for the development of a national resident assessment system for nursing facilities, a consortium of professionals developed the first major … In response to the Omnibus Reconciliation Act of 1987 mandate for the development of a national resident assessment system for nursing facilities, a consortium of professionals developed the first major component of this system, the Minimum Data Set (MDS) for Resident Assessment and Care Screening. A two-state field trial tested the reliability of individual assessment items, the overall performance of the instrument, and the time involved in its application. The trial demonstrated reasonable reliability for 55% of the items and pinpointed redundancy of items and initial design of scales. On the basis of these analyses and clinical input, 40% of the original items were kept, 20% dropped, and 40% altered. The MDS provides a structure and language in which to understand long-term care, design care plans, evaluate quality, and describe the nursing facility population for planning and policy efforts.

Unending Work and Care: Managing Chronic Illness at Home.

1989-11-01

J. M. Kinney , Eva Kahana , Juliet Corbin +1 more

Measuring Organizational Traits of Hospitals: The Revised Nursing Work Index

2000-05-01

Linda H. Aiken , Patricia A. Patrician

Background: The organizational context in which nurses practice is important in explaining variation in patient outcomes, but research has been hampered by the absence of instruments to measure organizational attributes … Background: The organizational context in which nurses practice is important in explaining variation in patient outcomes, but research has been hampered by the absence of instruments to measure organizational attributes empirically. Objectives: To report on the development and utility of the Revised Nursing Work Index (NWI-R) in measuring characteristics of professional nursing practice environments. Methods: The NWI-R was used in a national acquired immunodeficiency syndrome (AIDS) care study. The sample consisted of 40 units in 20 hospitals. Of these 20 hospitals, 10 provided AIDS care in both dedicated AIDS units and general medical units, thus introducing to the design an element of internal control. The remaining 10 hospitals were selected through a matching procedure. Three of the matched control hospitals were magnet hospitals. Nurses were recruited into the study if they worked at least 16 hours per week on the study unit. The nurses completed the NWI-R in addition to other measures. Results: A response rate of 86% was attained. Response rates per unit ranged from 73% to 100%. Cronbach's alpha was 0.96 for the entire NWI-R, with aggregated subscale alphas of 0.84 to 0.91. Validity of the NWI-R was demonstrated by the origin of the instrument, its ability to differentiate nurses who worked within a professional practice environment from those who did not, and its ability to explain differences in nurse burnout. Conclusion: The NWI-R has been found to capture organizational attributes that characterize professional nursing practice environments.

Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments

2011-10-04

Linda H. Aiken , Jeannie P. Cimiotti , Douglas M. Sloane +3 more

Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what … Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes.

View PDF Chat

Home Visiting: Recent Program Evaluations: Analysis and Recommendations

1999-01-01

Deanna S. Gomby , Patti L. Culross , Richard E. Behrman

Assessing Self‐maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living

1983-12-01

Sidney Katz

The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures … The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.

Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes

2009-07-01

Linda H. Aiken , Sean P. Clarke , Douglas M. Sloane +2 more

The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education.Staffing and education have … The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education.Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited.Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients.Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments.Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.

View PDF Chat

Validation of the Cumulative Illness Rating Scale in a Geriatric Residential Population

1995-02-01

Patricia A. Parmelee , Paul Thuras , Ira R. Katz +1 more

To evaluate the validity of the Cumulative Illness Rating Scale (CIRS) in a geriatric institutional population by examining its associations with mortality, hospitalization, medication usage, laboratory findings and disability.A validation … To evaluate the validity of the Cumulative Illness Rating Scale (CIRS) in a geriatric institutional population by examining its associations with mortality, hospitalization, medication usage, laboratory findings and disability.A validation of the CIRS using self- and physician-report surveys, with archival data drawn from medical charts and facility records.Long-term care facility with skilled nursing and congregate apartments.Four hundred thirty-nine facility residents selected on the basis of completeness of self-report data and physician ratings.Composite measures of illness severity and comorbidity, based on physicians' CIRS ratings; time to death or acute hospitalization after assessment; medication use, drawn from pharmacy records; medical chart data on laboratory tests; self-reported functional disability.CIRS illness severity and comorbidity indices, as well as individual CIRS items, were significantly associated with mortality, acute hospitalization, medication usage, laboratory test results, and functional disability. The CIRS showed good divergent validity vis a vis functional disability in predicting mortality and hospitalization.The CIRS appears to be a valid indicator of health status among frail older institution residents. The illness severity and comorbidity composites performed equally well in predicting longitudinal outcomes. Item-level analyses suggest that the CIRS may be useful in developing differential illness profiles associated with mortality, hospitalization, and disability.

Comprehensive Clinical Assessment in Community Setting: Applicability of the MDS‐HC

1997-08-01

John N. Morris , Brant E. Fries , Knight Steel +6 more

OBJECTIVE : To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS‐HC), including reliability estimates, a comparison … OBJECTIVE : To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS‐HC), including reliability estimates, a comparison of MDS‐HC reliabilities with reliabilities of the same items in the MDS 2.0 nursing home assessment instrument, and an examination of the types of problems found in home care clients using the MDS‐HC. DESIGN : Independent, dual assessment of clients of home‐care agencies by trained clinicians using a draft of the MDS‐HC, with additional descriptive data regarding problem profiles for home care clients. SETTING AND PARTICIPANTS : Reliability data from dual assessments of 241 randomly selected clients of home care agencies in five countries, all of whom volunteered to test the MDS‐HC. Also included are an expanded sample of 780 home care assessments from these countries and 187 dually assessed residents from 21 nursing homes in the United States. MEASUREMENTS : The array of MDS‐HC assessment items included measures in the following areas: personal items, cognitive patterns, communication/hearing, vision, mood and behavior, social functioning, informal support services, physical functioning, continence, disease diagnoses, health conditions and preventive health measures, nutrition/hydration, dental status, skin condition, environmental assessment, service utilization, and medications. RESULTS : Forty‐seven percent of the functional, health status, social environment, and service items in the MDS‐HC were taken from the MDS 2.0 for nursing homes. For this item set, it is estimated that the average weighted Kappa is .74 for the MDS‐HC and .75 for the MDS 2.0. Similarly, high reliability values were found for items newly introduced in the MDS‐HC (weighted Kappa = .70). Descriptive findings also characterize the problems of home care clients, with subanalyses within cognitive performance levels. CONCLUSION : Findings indicate that the core set of items in the MDS 2.0 work equally well in community and nursing home settings. New items are highly reliable. In tandem, these instruments can be used within the international community, assisting and planning care for older adults within a broad spectrum of service settings, including nursing homes and home care programs. With this community‐based, second‐generation problem and care plan‐driven assessment instrument, disability assessment can be performed consistently across the world.

View PDF Chat

Predicting nursing home admission in the U.S: a meta-analysis

2007-06-19

Joseph E. Gaugler , Sue Duval , Keith A. Anderson +1 more

While existing reviews have identified significant predictors of nursing home admission, this meta-analysis attempted to provide more integrated empirical findings to identify predictors. The present study aimed to generate pooled … While existing reviews have identified significant predictors of nursing home admission, this meta-analysis attempted to provide more integrated empirical findings to identify predictors. The present study aimed to generate pooled empirical associations for sociodemographic, functional, cognitive, service use, and informal support indicators that predict nursing home admission among older adults in the U.S. Studies published in English were retrieved by searching the MEDLINE, PSYCINFO, CINAHL, and Digital Dissertations databases using the keywords: "nursing home placement," "nursing home entry," "nursing home admission," and "predictors/institutionalization." Any reports including these key words were retrieved. Bibliographies of retrieved articles were also searched. Selected studies included sampling frames that were nationally- or regionally-representative of the U.S. older population. Of 736 relevant reports identified, 77 reports across 12 data sources were included that used longitudinal designs and community-based samples. Information on number of nursing home admissions, length of follow-up, sample characteristics, analysis type, statistical adjustment, and potential risk factors were extracted with standardized protocols. Random effects models were used to separately pool the logistic and Cox regression model results from the individual data sources. Among the strongest predictors of nursing home admission were 3 or more activities of daily living dependencies (summary odds ratio [OR] = 3.25; 95% confidence interval [CI], 2.56–4.09), cognitive impairment (OR = 2.54; CI, 1.44–4.51), and prior nursing home use (OR = 3.47; CI, 1.89–6.37). The pooled associations provided detailed empirical information as to which variables emerged as the strongest predictors of NH admission (e.g., 3 or more ADL dependencies, cognitive impairment, prior NH use). These results could be utilized as weights in the construction and validation of prognostic tools to estimate risk for NH entry over a multi-year period.

View PDF Chat

MEASURING BEHAVIOURAL DISTURBANCE OF ELDERLY DEMENTED PATIENTS IN THE COMMUNITY AND ITS EFFECTS ON RELATIVES: A FACTOR ANALYTIC STUDY

1982-01-01

J. G. Greene , Robert L. Smith , MARIE GARDINER +1 more

In recent years increasing interest has centred on the elderly psychogeriatric patient living in the community and the part played by relatives in supporting these patients. There is a need, … In recent years increasing interest has centred on the elderly psychogeriatric patient living in the community and the part played by relatives in supporting these patients. There is a need, however, for ways of assessing the behavioural disturbance shown by such patients at home and the effect this behaviour has on relatives. Ratings by relatives of the behaviour at home of elderly dementing patients attending a geriatric psychiatry day hospital, together with the relatives' own ratings of the degree of stress and upset being experienced were obtained. Using the technique of factor analysis it was shown that the patient's behaviour and the relative's reaction could be analysed into a number of separate categories and that these were differentially related to each other. Thus, for example, personal distress in the relative was related mainly to the amount of apathetic and withdrawn behaviour shown by the patient, whereas negative feelings held by the relative towards the patient were related only to the degree of disturbance of the patient's mood. The construction of scales measuring these different aspects of patient's behaviour and relative's reaction is described.

Reliability Estimates for The Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS)

1995-04-01

C. Hawes , Jack Morris , Charles D. Phillips +3 more

The MDS is a core set of items, definitions, and response categories used to assess all of the nation's 1.5 million nursing home residents who reside in facilities participating in … The MDS is a core set of items, definitions, and response categories used to assess all of the nation's 1.5 million nursing home residents who reside in facilities participating in the Medicare or Medicaid programs. Further, the Health Care Financing Administration (HCFA) has proposed a rule that would require facilities to computerize MDS data and submit it to state and federal agencies, paving the way for a national database. This article describes the process of testing the reliability of the MDS items in 13 nursing homes in five states. The results demonstrate that MDS data gathered in a research effort attain reliabilities that make such data useful. MDS items met a standard for excellent reliability (i.e., intraclass correlation of .7 or higher) in key areas of functional status, such as cognition, ADLs, continence, and diagnoses. Sixty-three percent of the items achieved reliability coefficients of .6 or higher. Eighty-nine percent of the items in the MDS achieved .4 or higher.

Refining a Case-Mix Measure for Nursing Homes: Resource Utilization Groups (RUG-III)

1994-07-01

Brant E. Fries , D. P. Schneider , William J. Folley +3 more

A case-mix classification system for nursing home residents is developed, based on a sample of 7,658 residents in seven states. Data included a broad assessment of resident characteristics, corresponding to … A case-mix classification system for nursing home residents is developed, based on a sample of 7,658 residents in seven states. Data included a broad assessment of resident characteristics, corresponding to items of the Minimum Data Set, and detailed measurement of nursing staff care time over a 24-hour period and therapy staff time over a 1-week period. The Resource Utilization Groups, Version III (RUG-III) system, with 44 distinct groups, achieves 55.5% variance explanation of total (nursing and therapy) per diem cost and meets goals of clinical validity and payment incentives. The mean resource use (case-mix index) of groups spans a nine-fold range. The RUG-III system improves on an earlier version not only by increasing the variance explanation (from 43%), but, more importantly, by identifying residents with "high tech" procedures (e.g., ventilators, respirators, and parenteral feeding) and those with cognitive impairments; by using better multiple activities of daily living; and by providing explicit qualifications for the Medicare nursing home benefit. RUG-III is being implemented for nursing home payment in 11 states (six as part of a federal multistate demonstration) and can be used in management, staffing level determination, and quality assurance.

The Care Transitions Intervention

2006-09-25

Eric A. Coleman , Carla Parry , Sandra Chalmers +1 more

<h3>Background</h3> Patients with complex care needs who require care across different health care settings are vulnerable to experiencing serious quality problems. A care transitions intervention designed to encourage patients and … <h3>Background</h3> Patients with complex care needs who require care across different health care settings are vulnerable to experiencing serious quality problems. A care transitions intervention designed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates. <h3>Methods</h3> Randomized controlled trial. Between September 1, 2002, and August 31, 2003, patients were identified at the time of hospitalization and were randomized to receive the intervention or usual care. The setting was a large integrated delivery system located in Colorado. Subjects (N = 750) included community-dwelling adults 65 years or older admitted to the study hospital with 1 of 11 selected conditions. Intervention patients received (1) tools to promote cross-site communication, (2) encouragement to take a more active role in their care and to assert their pREFERENCES, and (3) continuity across settings and guidance from a “transition coach.” Rates of rehospitalization were measured at 30, 90, and 180 days. <h3>Results</h3> Intervention patients had lower rehospitalization rates at 30 days (8.3 vs 11.9,<i>P</i> = .048) and at 90 days (16.7 vs 22.5,<i>P</i> = .04) than control subjects. Intervention patients had lower rehospitalization rates for the same condition that precipitated the index hospitalization at 90 days (5.3 vs 9.8,<i>P</i> = .04) and at 180 days (8.6 vs 13.9,<i>P</i> = .046) than controls. The mean hospital costs were lower for intervention patients ($2058) vs controls ($2546) at 180 days (log-transformed<i>P</i> = .049). <h3>Conclusion</h3> Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rates of subsequent rehospitalization. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT00244491

Care‐Needs Certification in the Long‐Term Care Insurance System of Japan

2005-02-24

Takako Tsutsui , Naoko Muramatsu

The introduction of Japan's long‐term care insurance (LTCI) system in April 2000 has made long‐term care an explicit and universal entitlement for every Japanese person aged 65 and older based … The introduction of Japan's long‐term care insurance (LTCI) system in April 2000 has made long‐term care an explicit and universal entitlement for every Japanese person aged 65 and older based strictly on physical and mental status. At the start of the program, more than two million seniors were expected to apply for services to approximately 3,000 municipal governments, which are the LTCI insurers. The LTCI implementation required a nationally standardized needs‐certification system to determine service eligibility objectively, fairly, and efficiently. The current computer‐aided initial needs‐assessment instrument was developed based on data collected in a large‐scale time study of professional caregivers in long‐term care institutions. The instrument was subsequently tested and validated by assessing data of 175,129 seniors involved in the national model programs before the start of LTCI. The computer‐aided initial assessment (an 85‐item questionnaire) is used to assign each applicant to one of seven need levels. The Care Needs Certification Board, a committee of medical and other professionals, reviews the results. Three years after implementation, the LTCI system and its needs‐assessment/certification system have been well accepted in Japan. Despite the overall successes, there remain challenges, including area variations, growing demands for services, and the difficulty of keeping the needs certification free of politics. The LTCI computer network that links municipalities and the central government is instrumental in continuously improving the needs‐certification system. Future challenges include promoting evidence‐based system improvements and building incentives into the system for various constituencies to promote seniors' functional independence.

Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system

2008-12-01

John P. Hirdes , Gunnar Ljunggren , John N. Morris +5 more

A multi-domain suite of instruments has been developed by the interRAI research collaborative to support assessment and care planning in mental health, aged care and disability services. Each assessment instrument … A multi-domain suite of instruments has been developed by the interRAI research collaborative to support assessment and care planning in mental health, aged care and disability services. Each assessment instrument comprises items common to other instruments and specialized items exclusive to that instrument. This study examined the reliability of the items from five instruments supporting home care, long term care, mental health, palliative care and post-acute care. Paired assessments on 783 individuals across 12 nations were completed within 72 hours of each other by trained assessors who were blinded to the others' assessment. Reliability was tested using weighted kappa coefficients. The overall kappa mean value for 161 items which are common to 2 or more instruments was 0.75. The kappa mean value for specialized items varied among instruments from 0.63 to 0.73. Over 60% of items scored greater than 0.70. The vast majority of items exceeded standard cut-offs for acceptable reliability, with only modest variation among instruments. The overall performance of these instruments showed that the interRAI suite has substantial reliability according to conventional cut-offs for interpreting the kappa statistic. The results indicate that interRAI items retain reliability when used across care settings, paving the way for cross domain application of the instruments as part of an integrated health information system.

View PDF Chat

Scaling ADLs Within the MDS

1999-11-01

John N. Morris , Brant E. Fries , Shaine A. Morris

Background. Dependency in activities of daily living (ADLs) is a reality within nursing homes, and we describe ADL measurement strategies based on items in the Minimum Data Set (MDS) and … Background. Dependency in activities of daily living (ADLs) is a reality within nursing homes, and we describe ADL measurement strategies based on items in the Minimum Data Set (MDS) and the creation and distributional properties of three ADL self-performance scales and their relationship to other measures. Methods. Information drawn from four data sets for a multistep analysis was guided by four study objectives: (1) to identify the subcomponents of ADLs that are present in the MDS battery; (2) to demonstrate how these items could be aggregated within hierarchical and additive ADL summary scales; (3) to describe the baseline and longitudinal distributional properties of these scales in a large, seven-state MDS database; and (4) to evaluate how these scales relate to two external criteria. Results. Prevalence and factor structure findings for seven MDS ADL self-performance variables suggest that these items can be placed into early, middle, and late loss ADL components. Two types of summary ADL self-performance measures Were created: additive and hierarchical. Distributional properties of these scales are described, as is their relationship to two external ADL criteria that have been reported in prior studies: first as an independent variable predicting staff time involved in resident care; second as a dependent variable in a study of the efficacy of two programs to improve resident functioning. Conclusions. The new ADL summary scales, based on readily available MDS data, should prove useful to clinicians, program auditors, and researchers who use the MDS functional self-performance items to determine a resident's ADL status.

Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study

2013-11-10

Dietmar Ausserhofer , Britta Zander , Reinhard Busse +7 more

Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon.The aim of this study is to describe the prevalence and patterns of nursing … Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon.The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors.Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study.Across European hospitals, the most frequent nursing care activities left undone included 'Comfort/talk with patients' (53%), 'Developing or updating nursing care plans/care pathways' (42%) and 'Educating patients and families' (41%). In hospitals with more favourable work environments (B=-2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone.Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.

View PDF Chat

Prediction of institutionalization in the elderly. A systematic review

2009-11-23

Melanie Luppa , Tobias Luck , Siegfried Weyerer +3 more

in the past decades, many studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of predictors of NHP in the general … in the past decades, many studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of predictors of NHP in the general population of developed countries.relevant articles were identified by searching the databases MEDLINE, Web of Science, Cochrane Library and PSYNDEXplus. Studies based on population-based samples with prospective study design and identification of predictors by multivariate analyses were included. Quality of studies and evidence of predictors were determined.thirty-six studies were identified; one-third of the studies were of high quality. Predictors with strong evidence were increased age, low self-rated health status, functional and cognitive impairment, dementia, prior NHP and a high number of prescriptions. Predictors with inconsistent results were male gender, low education status, low income, stroke, hypertension, incontinence, depression and prior hospital use.findings suggested that predictors of NHP are mainly based on underlying cognitive and/or functional impairment, and associated lack of support and assistance in daily living. However, the methodical quality of studies needs improvement. More theoretical embedding of risk models of NHP would help to establish more clarity in complex relationships in using nursing homes.

View PDF Chat

Person-Centered Care For Nursing Home Residents: The Culture-Change Movement

2010-01-08

Mary Jane Koren

The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change … The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change principles and practices have been shaped by shared concerns among consumers, policy makers, and providers regarding the value and quality of care offered in traditional nursing homes. They have shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover. Policy makers can encourage culture change and capitalize on its transformational power through regulation, reimbursement, public reporting, and other mechanisms.

Implementing Supported Employmentas an Evidence-Based Practice

2001-03-01

Gary R. Bond , Deborah R. Becker , Robert E. Drake +5 more

Supported employment for people with severe mental illness is an evidence-based practice, based on converging findings from eight randomized controlled trials and three quasi-experimental studies. The critical ingredients of supported … Supported employment for people with severe mental illness is an evidence-based practice, based on converging findings from eight randomized controlled trials and three quasi-experimental studies. The critical ingredients of supported employment have been well described, and a fidelity scale differentiates supported employment programs from other types of vocational services. The effectiveness of supported employment appears to be generalizable across a broad range of client characteristics and community settings. More research is needed on long-term outcomes and on cost-effectiveness. Access to supported employment programs remains a problem, despite their increasing use throughout the United States. The authors discuss barriers to implementation and strategies for overcoming them based on successful experiences in several states.

A Research and Service Oriented Multilevel Assessment Instrument

1982-01-01

M. P. Lawton , Miriam S. Moss , Mark C. Fulcomer +1 more

Journal Article A Research and Service Oriented Multilevel Assessment Instrument Get access M. Powell Lawton, PhD, M. Powell Lawton, PhD Search for other works by this author on: Oxford Academic … Journal Article A Research and Service Oriented Multilevel Assessment Instrument Get access M. Powell Lawton, PhD, M. Powell Lawton, PhD Search for other works by this author on: Oxford Academic PubMed Google Scholar Miriam Moss, MA, Miriam Moss, MA Search for other works by this author on: Oxford Academic PubMed Google Scholar Mark Fulcomer, PhD, Mark Fulcomer, PhD Search for other works by this author on: Oxford Academic PubMed Google Scholar Morton H. Kleban, PhD Morton H. Kleban, PhD 2Philadelphia Geriatric Ctr.5301 Old York Road, Philadelphia, PA 19141. Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Gerontology, Volume 37, Issue 1, January 1982, Pages 91–99, https://doi.org/10.1093/geronj/37.1.91 Published: 01 January 1982

Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review

2013-10-05

Jeroen S. Kok , Ina J. Berg , Erik Scherder

Behavioral and psychological symptoms associated with dementia are common in nursing home residents. Quality indicators (QI) assessing quality of care for these residents are minimally risk adjusted and can provide … Behavioral and psychological symptoms associated with dementia are common in nursing home residents. Quality indicators (QI) assessing quality of care for these residents are minimally risk adjusted and can provide inaccurate information regarding the quality of care provided by the facility.Evaluate the performance of a new QI for the incidence of worsening behaviors in nursing home residents with behavioral and psychological symptoms association with dementia.Retrospective cohort study.A total of 381 Minnesota nursing homes with 26,165 residents.Minimum Data Set records for the first 2 calendar quarters of 2008.We calculated incidence of worsening behaviors QI by comparing items from the "behavior" section of the Minimum Data Set records from 2 consecutive quarters and reported the incidence rates by both the residents' level of cognitive impairment and the presence or absence of special care unit for dementia (SCU).The incidence rates of the worsening behavior QI in SCU ranged from 14% in residents with very severe cognitive impairment (a cognitive performance score = 6) to 30% in those with moderate cognitive impairment (a cognitive performance score = 3). The incidence QI rates among residents residing in conventional unit ranged from 15% among those with very severe cognitive impairment to 20% among those with moderate cognitive impairment. These differences in QI rates between the 2 units were statistically significant with a P value = .001. After risk adjustment for level of cognitive impairment, number of facilities with SCUs that flagged for problem behaviors dropped from 18.4% to 12.4% and the number of conventional units in the low-risk category from 16.8% to 4.7%.Resident cognitive function and the facility utility of SCU are associated with worsening behavior QI and should be adjusted for in any nursing home quality reporting measure.

View PDF Chat

Falling Through the Cracks: Challenges and Opportunities for Improving Transitional Care for Persons with Continuous Complex Care Needs

2003-03-26

Eric A. Coleman

Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care … Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care fragmentation. Despite how common these transitions have become, the challenges of improving care transitions have received little attention from policy makers, clinicians, and quality improvement entities. This article begins with a definition of transitional care and then discusses the nature of the problem, its prevalence, manifestations of poorly executed transitions, and potentially remediable barriers. Necessary elements for effective transitions are then presented, followed by promising new directions for quality improvement at the level of the delivery system, information technology, and national health policy. The article concludes with a proposed research agenda designed to advance the science of high-quality transitional care.

Caregiver Weil-Being: A Multidimensional Examination of Family Caregivers of Demented Adults

1986-06-01

L. K. George , Lisa P. Gwyther

The well-being of family caregivers of older memory-impaired adults was examined in four dimensions: physical health, mental health, financial resources, and social participation. Results indicated that, relative to random community … The well-being of family caregivers of older memory-impaired adults was examined in four dimensions: physical health, mental health, financial resources, and social participation. Results indicated that, relative to random community samples, caregivers are most likely to experience problems with mental health and social participation. In addition, characteristics of the caregiving situation were more closely associated with caregiver well-being than were illness characteristics of the patients.

Nurse Staffing and Inpatient Hospital Mortality

2011-03-16

Jack Needleman , Peter I. Buerhaus , V. Shane Pankratz +3 more

Cross-sectional studies of hospital-level administrative data have shown an association between lower levels of staffing of registered nurses (RNs) and increased patient mortality. However, such studies have been criticized because … Cross-sectional studies of hospital-level administrative data have shown an association between lower levels of staffing of registered nurses (RNs) and increased patient mortality. However, such studies have been criticized because they have not shown a direct link between the level of staffing and individual patient experiences and have not included sufficient statistical controls.We used data from a large tertiary academic medical center involving 197,961 admissions and 176,696 nursing shifts of 8 hours each in 43 hospital units to examine the association between mortality and patient exposure to nursing shifts during which staffing by RNs was 8 hours or more below the staffing target. We also examined the association between mortality and high patient turnover owing to admissions, transfers, and discharges. We used Cox proportional-hazards models in the analyses with adjustment for characteristics of patients and hospital units.Staffing by RNs was within 8 hours of the target level for 84% of shifts, and patient turnover was within 1 SD of the day-shift mean for 93% of shifts. Overall mortality was 61% of the expected rate for similar patients on the basis of modified diagnosis-related groups. There was a significant association between increased mortality and increased exposure to unit shifts during which staffing by RNs was 8 hours or more below the target level (hazard ratio per shift 8 hours or more below target, 1.02; 95% confidence interval [CI], 1.01 to 1.03; P<0.001). The association between increased mortality and high patient turnover was also significant (hazard ratio per high-turnover shift, 1.04; 95% CI, 1.02 to 1.06; P<0.001).In this retrospective observational study, staffing of RNs below target levels was associated with increased mortality, which reinforces the need to match staffing with patients' needs for nursing care. (Funded by the Agency for Healthcare Research and Quality.).

View PDF Chat

A Guttman Health Scale for the Aged

1966-10-01

Irving Rosow , Naomi Breslau

Journal Article A Guttman Health Scale for the Aged Get access Irving Rosow, Ph.D., Irving Rosow, Ph.D. Search for other works by this author on: Oxford Academic PubMed Google Scholar … Journal Article A Guttman Health Scale for the Aged Get access Irving Rosow, Ph.D., Irving Rosow, Ph.D. Search for other works by this author on: Oxford Academic PubMed Google Scholar Naomi Breslau, M.A. Naomi Breslau, M.A. 2Western Reserve UniversityCleveland, Ohio Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Gerontology, Volume 21, Issue 4, October 1966, Pages 556–559, https://doi.org/10.1093/geronj/21.4.556 Published: 01 October 1966

Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention

2004-10-26

Eric A. Coleman , Jodi D. Smith , Janet C. Frank +3 more

Objectives: To test whether an intervention designed to encourage older patients and their caregivers to assert a more active role during care transitions can reduce rehospitalization rates. Design: Quasi‐experimental design … Objectives: To test whether an intervention designed to encourage older patients and their caregivers to assert a more active role during care transitions can reduce rehospitalization rates. Design: Quasi‐experimental design whereby subjects receiving the intervention (n=158) were compared with control subjects derived from administrative data (n=1,235). Setting: A large integrated delivery system in Colorado. Participants: Community‐dwelling adults aged 65 and older admitted to the study hospital with one of nine selected conditions. Intervention: Intervention subjects received tools to promote cross‐site communication, encouragement to take a more active role in their care and assert their preferences, and continuity across settings and guidance from a transition coach. Measurements: Rates of postdischarge hospital use at 30, 60, and 90 days. Intervention subjects' care experience was assessed using the care transitions measure. Results: The adjusted odds ratio comparing rehospitalization of intervention subjects with that of controls was 0.52 (95% confidence interval (CI)=0.28–0.96) at 30 days, 0.43 (95% CI=0.25–0.72) at 90 days, and 0.57 (95% CI=0.36–0.92) at 180 days. Intervention patients reported high levels of confidence in obtaining essential information for managing their condition, communicating with members of the healthcare team, and understanding their medication regimen. Conclusion: Supporting patients and caregivers to take a more active role during care transitions appears promising for reducing rates of subsequent hospitalization. Further testing may include more diverse populations and patients at risk for transitions who are not acutely ill.

Readmissions, Observation, and the Hospital Readmissions Reduction Program

2016-02-25

Rachael B. Zuckerman , Steven H. Sheingold , E. John Orav +2 more

The Hospital Readmissions Reduction Program, which is included in the Affordable Care Act (ACA), applies financial penalties to hospitals that have higher-than-expected readmission rates for targeted conditions. Some policy analysts … The Hospital Readmissions Reduction Program, which is included in the Affordable Care Act (ACA), applies financial penalties to hospitals that have higher-than-expected readmission rates for targeted conditions. Some policy analysts worry that reductions in readmissions are being achieved by keeping returning patients in observation units instead of formally readmitting them to the hospital. We examined the changes in readmission rates and stays in observation units over time for targeted and nontargeted conditions and assessed whether hospitals that had greater increases in observation-service use had greater reductions in readmissions.We compared monthly, hospital-level rates of readmission and observation-service use within 30 days after hospital discharge among Medicare elderly beneficiaries from October 2007 through May 2015. We used an interrupted time-series model to determine when trends changed and whether changes differed between targeted and nontargeted conditions. We assessed the correlation between changes in readmission rates and use of observation services after adoption of the ACA in March 2010.We analyzed data from 3387 hospitals. From 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%, and rates for nontargeted conditions declined from 15.3% to 13.1%. Shortly after passage of the ACA, the readmission rate declined quickly, especially for targeted conditions, and then continued to fall at a slower rate after October 2012 for both targeted and nontargeted conditions. Stays in observation units for targeted conditions increased from 2.6% in 2007 to 4.7% in 2015, and rates for nontargeted conditions increased from 2.5% to 4.2%. Within hospitals, there was no significant association between changes in observation-unit stays and readmissions after implementation of the ACA.Readmission trends are consistent with hospitals' responding to incentives to reduce readmissions, including the financial penalties for readmissions under the ACA. We did not find evidence that changes in observation-unit stays accounted for the decrease in readmissions.

View PDF Chat

A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients

1995-05-18

C. Seth Landefeld , Robert M. Palmer , Denise Kresevic +2 more

Older persons who are hospitalized for acute illnesses often lose their independence and are discharged to institutions for long-term care. Older persons who are hospitalized for acute illnesses often lose their independence and are discharged to institutions for long-term care.

View PDF Chat

Practical statistics for medical research

1992-09-01

Michael King

Experiencing Transitions: An Emerging Middle-Range Theory

2000-09-01

Afaf Ibrahim Meleis , Linda M. Sawyer , Eun‐Ok Im +2 more

Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. … Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. Uncovering these risks may be enhanced by understanding the transition process. As a central concept of nursing, transition has been analyzed, its components identified, and a framework to articulate and to reflect the relationship between these components has been defined. In this article, the previous conceptual analysis of transitions is extended and refined by drawing on the results of five different research studies that have examined transitions using an integrative approach to theory development. The emerging middle-range theory of transitions consists of types and patterns of transitions, properties of transition experiences, facilitating and inhibiting conditions, process indicators, outcome indicators, and nursing therapeutics. The diversity, complexity, and multiple dimensionality of transition experiences need to be further explored and incorporated in future research and nursing practice related to transitions.

A Description of Agitation in a Nursing Home

1989-05-01

Jiska Cohen‐Mansfield , M S Marx , A. S. Rosenthal

Journal Article A Description of Agitation in a Nursing Home Get access Jiska Cohen-mansfield, Jiska Cohen-mansfield 1Research Institute of the Hebrew Home of Greater Washington, RockvilleMD2Georgetown University Center on Aging, … Journal Article A Description of Agitation in a Nursing Home Get access Jiska Cohen-mansfield, Jiska Cohen-mansfield 1Research Institute of the Hebrew Home of Greater Washington, RockvilleMD2Georgetown University Center on Aging, WashingtonDC Search for other works by this author on: Oxford Academic PubMed Google Scholar Marcia S. Marx, Marcia S. Marx 1Research Institute of the Hebrew Home of Greater Washington, RockvilleMD Search for other works by this author on: Oxford Academic PubMed Google Scholar Alvin S. Rosenthal Alvin S. Rosenthal 1Research Institute of the Hebrew Home of Greater Washington, RockvilleMD Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Gerontology, Volume 44, Issue 3, May 1989, Pages M77–M84, https://doi.org/10.1093/geronj/44.3.M77 Published: 01 May 1989 Article history Received: 12 April 1988 Accepted: 18 July 1988 Published: 01 May 1989

Long-Term Care Providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013-2014.

2016-02-01

Lauren Harris-Kojetin , Manisha Sengupta , Eunice Park‐Lee +4 more

Long-term care services provided by paid, regulated providers are an important component of personal health care spending in the United States. This report presents the most current national descriptive results … Long-term care services provided by paid, regulated providers are an important component of personal health care spending in the United States. This report presents the most current national descriptive results from the National Study of Long-Term Care Providers (NSLTCP), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Data presented are drawn from multiple sources, primarily NCHS surveys of adult day services centers and residential care communities (covers 2014 data year); and administrative records obtained from the Centers for Medicare and Medicare Services (CMS) on home health agencies, hospices, and nursing homes (covers 2013 and 2014 data years). This report provides information on the supply, organizational characteristics, staffing, and services offered by paid, regulated providers of long-term care services; and the demographic, health, and functional composition of users of these services. Services users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers. This report updates "Long-Term Care Services in the United States: 2013 Overview" (available from: http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf), which covered data years 2011 and 2012. In contrast, the title of this report and future reports will reflect the years of the data used rather than the publication year, in this case 2013 through 2014. A forthcoming companion product to this report, "Long-Term Care Providers and Services Users in the United States—State Estimates Supplement: National Study of Long-Term Care Providers, 2013–2014," contains tables and maps showing comparable state estimates for the national findings in this report, and will be available from: http://www.cdc.gov/nchs/ nsltcp/nsltcp_products.htm.

Assessment of Activities of Daily Living, Self-Care, and Independence

2016-07-29

Michelle E. Mlinac , Michelle C. Feng

Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review … Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care.

View PDF Chat

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

2016-11-15

Linda H. Aiken , Douglas M. Sloane , Peter Griffiths +7 more

To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care.Cross-sectional patient discharge data, hospital characteristics and nurse … To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care.Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models.Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland.Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals.Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction.Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80<OR<0.93), after adjusting for patient and hospital factors. Each 10 percentage point reduction in the proportion of professional nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying.A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.

View PDF Chat

The Fundamentals of Person-Centered Care for Individuals With Dementia

2017-09-12

Sam Fazio , Douglas Pace , Janice Flinner +1 more

Person-centered care is a philosophy of care built around the needs of the individual and contingent upon knowing the unique individual through an interpersonal relationship. This review article outlines the … Person-centered care is a philosophy of care built around the needs of the individual and contingent upon knowing the unique individual through an interpersonal relationship. This review article outlines the history, components, and impact of person-centered care practices. Through literature review, published articles on person-centered measures and outcomes were examined. The history of person-centered care was described, core principles of care for individuals with dementia outlined, current tools to measure person-centered care approaches reviewed, and outcomes of interventions discussed. Evidence-based practice recommendations for person-centered care for individuals with dementia are outlined. More research is needed to further assess the outcomes of person-centered care approaches and models.

View PDF Chat

A Good Life in Old Age?

2013-03-30

As ageing societies are pushing a growing number of frail old people into needing care, delivering quality long-term care services – care that is safe, effective, and responsive to needs … As ageing societies are pushing a growing number of frail old people into needing care, delivering quality long-term care services – care that is safe, effective, and responsive to needs – has become a priority for governments. Yet much still remains to be done to enhance evidence-based measurement and improvement of quality of long-term care services across EU and OECD countries. This book offers evidence and examples of useful experiences to help policy makers, providers and experts measure and improve the quality of long-term care services.

Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020

2020-03-27

Anne Kimball , Kelly M Hatfield , Melissa Arons +7 more

Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of a long-term care skilled nursing facility were tested for SARS-CoV-2; … Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of a long-term care skilled nursing facility were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.

View PDF Chat

Received and perceived social support in times of stress: A test of the social support deterioration deterrence model.

1996-01-01

Fran H. Norris , Krzysztof Kaniasty

Individual differences in need for cognitive closure.

1994-01-01

Donna M. Webster , Arie W. Kruglanski

Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes

2008-05-01

Linda H. Aiken , Sean P. Clarke , Douglas M. Sloane +2 more

Objective: The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Background: Staffing … Objective: The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Background: Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. Methods: Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. Results: Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. Conclusion: Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.

View PDF Chat

Neglecting nursing homes:

2025-06-24

Costanzo Ranci , Marco Arlotti , Stefania Cerea | Policy Press eBooks

Factors Influencing Foreign-Born Care Workers’ Acceptance in Residential Care Facilities in Japan: Work and Organizational Characteristics, Work Conditions, Job Stress, and Work Environment

2025-06-24

Maki Tei‐Tominaga , Miharu Nakanishi , M. Tanaka | Journal of Applied Gerontology

Japan, a super-aging society, faces a native care worker shortage and increased demand for foreign-born care workers (FBCWs) in geriatric care facilities. We investigated factors influencing native care workers' concerns … Japan, a super-aging society, faces a native care worker shortage and increased demand for foreign-born care workers (FBCWs) in geriatric care facilities. We investigated factors influencing native care workers' concerns and reluctance toward accepting FBCWs in Japan from four areas. Native care workers (N = 1060) in 10 geriatric care facilities (response rate = 71%), recruited using convenience sampling considering the regional job vacancies, responded to a self-report questionnaire survey. After excluding ineligible data (e.g., for day-care facilities) or missing data, the analysis included 589 participants (67.2% women, Mage = 42.63 ± 12.16 years). Results indicated that facilities not accepting FBCWs had significant concerns about managerial positions and job stress. Native care workers with concerns about accepting FBCWs and those working 50+ hours per week were three times more reluctant to accept FBCWs. However, ethical leadership reduced this reluctance. Therefore, facility employers in aging countries must address native care workers' concerns and ensure workplace improvement before hiring FBCWs.

The challenge of policy integration and the complexity of care home responses to the COVID-19 pandemic in Europe

2025-06-24

Eloísa del Pino Matute , Francisco Javier Moreno Fuentes | Policy Press eBooks

Swedish long-term care for older people in the shadow of the COVID-19 pandemic

2025-06-24

Lennarth Johansson , Pär Schön | Policy Press eBooks

A mixed methods study exploring delays amongst patients ready to be discharged home in an acute surgical unit in New Zealand

2025-06-23

Jolene Jones , Matthew Parsons , Jewel Barlow-Armstrong | Australian journal of advanced nursing

COVID-19 testing experiences and attitudes among young adults and socially isolated older adults living in public housing, New York City (2022)

2025-06-23

Emily Gill , Zora Hall , Lorna E. Thorpe +7 more | Frontiers in Public Health

Background As part of an initiative to increase COVID-19 testing uptake among underserved populations, we conducted focus groups to explore experiences and attitudes related to testing in two understudied groups—young … Background As part of an initiative to increase COVID-19 testing uptake among underserved populations, we conducted focus groups to explore experiences and attitudes related to testing in two understudied groups—young adults and socially-isolated older adults—recruited from residents living in New York City Housing Authority (NYCHA) public housing developments. Materials and methods In June through November 2022, we conducted eight virtual focus groups with 21 young adults and 11 older adults living in NYCHA ( n = 32 total). To identify themes, we conducted a rapid qualitative analysis approach. Results Residents discussed four overarching themes: (1) trusted COVID-19 information sources; (2) reasons for testing; (3) barriers to testing, and (4) strategies to increase testing uptake. Findings were similar across the two age groups; both cited multiple sources of information, including major media outlets, government or public health officials, and doctors. Young adults were more likely to access information from social media despite concerns about misinformation. Participants identified several barriers to testing, such as long lines, insurance coverage, and cost. Young adults reported that at-home COVID testing was more convenient, while older adults expressed concern about accuracy and administering the tests themselves. Recommendations for improving testing emphasized easier access via a central well-known location, in-home visits, free or low-cost tests, and increased outreach. Conclusion Mainstream media, doctors and public agencies remain the most trusted sources of information among younger and older residents alike. Many resident recommendations involved leveraging NYCHA infrastructure, highlighting the continuing role public housing authorities can play in COVID-19 and other health initiatives.

Influence of individuals’ attitudes and capabilities on implementation in aged care: a literature analysis

2025-06-23

Alice Windle , Gill Harvey , Carol Davy | JBI Evidence Implementation

The aged care sector is undergoing significant reform and innovation. The successful implementation of innovations requires effective strategies, tailored to address the particular barriers and enablers experienced by individuals in … The aged care sector is undergoing significant reform and innovation. The successful implementation of innovations requires effective strategies, tailored to address the particular barriers and enablers experienced by individuals in their own context. This study aimed to identify key factors relating to individuals' attitudes and capabilities that influence implementation in aged care. This study provides an in-depth, inductive qualitative content analysis of the literature included in a recent comprehensive scoping review on the implementation of innovations in aged care. Attitude and capability factors were frequently identified as influencing implementation in aged care, as either barriers or enablers. Attitudes held by staff were predominant, and were primarily related to the innovation as well as the change process. Attitudes included resistance, concern, and defensiveness as well as enthusiasm, motivation, and a growth mindset. The beliefs that underpinned attitudes primarily related to the benefits associated with the innovation as well as perceived fears and threats, need/relevance, difficulty, enjoyment, and conflict. Capability factors largely related to staff knowledge of the innovation, background knowledge, and relevant skills as well as clarity of role-related responsibilities. The generally low skill level of the aged care workforce was also a factor, as were the capabilities of older people/clients. Attitudes and capabilities are key factors that can influence implementation, particularly those held by staff as well as other stakeholders. Identifying and monitoring stakeholders' attitudes, underlying beliefs, and capabilities enables the selection of appropriate implementation strategies to optimize the successful introduction and sustainment of innovations to improve care for older people. http://links.lww.com/IJEBH/A373.

Psychosocial wellbeing of people with dementia: Systematic review and construct analysis

2025-06-23

Lena M. Hofbauer , Francisca S. Rodriguez | Acta Neuropsychiatrica

Abstract Objective: Psychosocial wellbeing is increasingly recognised as a key outcome in dementia research and care, reflecting a shift towards person-centred care and patient-reported outcome measures. However, progress is hindered … Abstract Objective: Psychosocial wellbeing is increasingly recognised as a key outcome in dementia research and care, reflecting a shift towards person-centred care and patient-reported outcome measures. However, progress is hindered by a lack of a clear and consistent definition. The present systematic review aimed to establish how previous dementia research has defined the term and how existing definitions may be unified. Methods: A systematic literature review was conducted in PubMed , Embase , and Web of Science using only the term ‘psychosocial’ as well as terms related to dementia in the search string. Two blinded reviewers independently conducted the abstracts screening, full-text screening. Definitions used in included records were extracted and their content grouped into categories and domains. For papers presenting empirical findings, quality screening was performed using Critical Appraisal Skills Programme (CASP) checklists and findings were narratively summarised. Results: A total of n=36 records were identified that provided a definition for psychosocial wellbeing. Conceptualizations most commonly (86 %) included emotional wellbeing, social health (64%), behavioural symptoms (44%), and subjective lived wellbeing (42%). A total of n=23 records also contained empirical data, which indicated that psychosocial wellbeing may be improved by several interventions such as tailored activities and validation group therapies, among others. Discussion: The construct of ‘psychosocial wellbeing’ as currently used in dementia research predominantly incorporates emotional and subjective lived wellbeing, social health, and behavioural symptoms. This indicates an emerging consensus. To progress dementia research and care practice, it is essential that future studies use a common operationalization.

FREE Online Self‐Assessment Exam: ORN StUD Performance in Practice (PIP)

2025-06-22

| American Journal on Addictions

Click on the PDF file for live links Click on the PDF file for live links

Recovery from disability after geriatric-home rehabilitation versus standard of care: protocol for a pilot study in older persons with disability at hospital discharge

2025-06-21

Bastiaan Van Grootven , Margreet van Dijk , Farah Islam +7 more | Pilot and Feasibility Studies

Currently, there is insufficient evidence supporting geriatric home rehabilitation after hospital discharge. Some studies demonstrate a positive effect, but meta-analytic evidence demonstrates uncertainty on the magnitude of the expected effect. … Currently, there is insufficient evidence supporting geriatric home rehabilitation after hospital discharge. Some studies demonstrate a positive effect, but meta-analytic evidence demonstrates uncertainty on the magnitude of the expected effect. Yet, evidence from other populations indicates that home rehabilitation could also be an effective strategy for older persons. Therefore, we aim to evaluate the effectiveness of geriatric home rehabilitation in older persons discharged from the hospital with disability. Given the potential challenges in recruiting participants delivering the intervention, and executing other study procedures in a multi-centre study, we will first carry out a pilot study. The pilot study will commence with an initial start-up phase at two centres: UZ Leuven and CHU UCL Namur, Belgium. Up to three participants per centre will be included to test the procedures and assessments, excluding randomisation and intervention delivery. The study then progresses to the full pilot phase to evaluate and confirm the feasibility of the proposed trial. This pilot study will take place at the same two centres. The pilot study aligns with the design of the envisioned full trial, i.e. a pragmatic, multicentre, individually randomised superiority trial. A 1 to 1 allocation ratio will be used for the pilot. A total of 24 participants from the two centres will be recruited to investigate the pilot study objectives. The pilot endpoints will be used to determine the feasibility of recruitment and study procedures including data collection, assessments and delivery of the intervention (a 6-week program consisting of exercise sessions 3 times per week, 45 min each). The results from the pilot study will be discussed within the pilot study steering group. Progression criteria will be reviewed to determine if the study progresses to a full trial, and which adaptations are needed. In case of a successful pilot, the study will progress to a full trial. The ambition of the full trial is to recruit 333 participants across 8 centres in Belgium, and to investigate the effectiveness of home rehabilitation for older persons discharged from the hospital with disability. Clinicaltrials.gov, NCT06404138 on 08 May 2024.

Development and psychometric testing of the Restorative Care Competence Assessment (ReCCA) instrument

2025-06-21

Sinikka Lotvonen , Kaisa‐Mari Saarela , Maria Korvola +4 more | Educational Gerontology

The Evolution of Long-Term Care and Health Policy in the United States

2025-06-20

Rachel M. Werner , Allison K. Hoffman , R. Tamara Konetzka | Journal of Health Politics Policy and Law

Abstract Long-term care policy has been neglected for decades in the U.S. due to high costs, leaving middle-class families struggling to afford care. Many rely on unpaid caregivers, who face … Abstract Long-term care policy has been neglected for decades in the U.S. due to high costs, leaving middle-class families struggling to afford care. Many rely on unpaid caregivers, who face significant financial and emotional burdens. Historically, long-term care was a family or community responsibility, but in 1965, with the creation of Medicare and Medicaid, Medicaid became the default payer of long-term care, but only supports low-income individuals and does so incompletely. Medicare pays for long-term care only incidentally and temporarily by providing post-acute care in nursing homes and at home. Private insurance is rare due to affordability and policy constraints. Unpaid caregivers fill in the gaps. While the system has evolved over time, most notably shifting from institutional settings to home-based settings, significant gaps remain. The result is a fragmented system that does not work well for most people. It is possible to reform long-term care through options including expanding Medicaid coverage, incorporating long-term care into Medicare, or creating a new social insurance program. Each option requires significant government funding and political commitment. Without action, the current system will continue to fail aging individuals and their families.

Development of a methodology for measuring the quality of statutory social workers’ complex decision-making

2025-06-20

Angela Lilly , Tim Rakow , Jill Manthorpe +1 more | PLoS ONE

Registered social workers in English Local Authorities are required to have an expertise in the complex decision-making needed to promote well-being when an adult’s own judgement about their well-being and … Registered social workers in English Local Authorities are required to have an expertise in the complex decision-making needed to promote well-being when an adult’s own judgement about their well-being and wishes about how to promote it might, in the circumstances, put their well-being at risk. Such circumstances are complex partly because core professional values – promoting autonomy and protecting from harm – can come into conflict. Given the consequential nature of social workers’ decisions, it is essential to be able to evaluate the quality of social workers’ decision-making. In this paper, we set out the systematic development, in collaboration with expert social workers, of a bespoke methodology to measure decision-making quality and investigate underpinning cognitive processes. Central to our methodology was social workers’ consideration of key legal principles. First, we reviewed the research literature to identify existing measurement schemes aspects of which might be suitable for incorporating into our methodology. No existing measurement schemes were found, but we identified a factorial survey vignette-based scheme which seemed promising as the basis for our own methodology. Second, by reviewing statute and case law, we identified 40 key legal principles which social workers should consider in their decision-making. Next, based on these principles, we developed four hypothetical case vignettes to activate decision-making. Finally, we developed four scoring templates, one for each vignette, setting out exemplar judgements and decisions against which practitioners’ judgements and decisions could be compared and scored. Our new methodology provides a means of assessing the quality of social workers’ decision-making and, as prior- and post-intervention quality can be measured, has the potential to generate evidence of the impact of policy and practice interventions on decision-making.

Joint Commission Home Care Standards—Part IV

2025-06-20

Arif Subhan | Journal of Clinical Engineering

Difference in long‐term care cost obtained with the short‐term intensive prevention service (day service type <scp>C</scp>): A 3‐year follow‐up study of <scp>Japanese</scp> older adults

2025-06-19

Ryota Watanabe , Masashige Saito , Kazushige Ide +1 more | Geriatrics and gerontology international/Geriatrics & gerontology international

Aim A short‐term intensive prevention service, known as day service type C, involves professional intervention for 3 to 6 months to enhance participants' social participation and roles within their communities. … Aim A short‐term intensive prevention service, known as day service type C, involves professional intervention for 3 to 6 months to enhance participants' social participation and roles within their communities. This study aimed to evaluate whether implementing short‐term intensive prevention services reduces cumulative long‐term care (LTC) costs over a 3‐year period, compared with the situation for non‐participants. Methods This study included older adults aged 65 years and older from Taketa City, Oita Prefecture. A total of 132 individuals participated in short‐term intensive prevention services from 2016 to 2019, and the non‐participant group comprised 116 individuals identified as eligible for services through a self‐administered postal survey in 2019 (both groups at baseline). The non‐participant group was selected as part of the Japan Gerontological Evaluation Study. Both groups were followed up for 3 years from baseline. The cumulative LTC costs derived from the public claims records served as the dependent variable. The covariates were sex, living situation, income, level of long‐term care need, and risk assessment scale. Linear regression analysis was performed. Results The participants incurred 241 398 JPY (± 681 335) per person, while the non‐participants incurred 1 147 858 JPY (± 1 244 750). The adjusted linear regression showed that the LTC cost for the participants was lower by 495 534 (−848 382 to −142 686) JPY per person than that for those in the non‐participation group. Conclusions Compared with non‐participants, the participants incurred approximately 500 000 JPY less in cumulative LTC costs per person over the subsequent 3 years. The widespread adoption of short‐term, intensive prevention services may contribute to the sustainability of LTC insurance systems. Geriatr Gerontol Int 2025; ••: ••–•• .

CASE STUDIES REGARDING THE RELATIONSHIP BETWEEN NURSES AND PATIENTS (NURSES ASSIGNED TO PATIENTS/ROOMS) IN EACH NURSING CARE DELIVERY SYSTEMS

2025-06-19

Kentaro SAKAINO , Wen-Jing CHIANG , Atsuo KAKEHI +1 more | AIJ Journal of Technology and Design

A Systematic Review of the Concepts of Efficacy, Effectiveness, and Efficiency as Applied and Measured for Virtual Health Care Delivery in Correctional Facilities

2025-06-18

Caroline Nyongesa , Tazeen Majeed , Marc Rémond +4 more | Telemedicine Journal and e-Health

Background: The use of virtual care interventions in correctional facilities has increased in recent years owing to the impacts of the COVID-19 pandemic. However, the literature shows variability in the … Background: The use of virtual care interventions in correctional facilities has increased in recent years owing to the impacts of the COVID-19 pandemic. However, the literature shows variability in the application and measurement of efficacy, effectiveness, and efficiency of virtual care interventions. This systematic review addresses this gap in evidence and provides an overview and appraisal of the methods and measures used to evaluate these aspects of virtual care interventions in correctional facilities, using a modified conceptual framework by the World Health Organization (WHO). Methods: We conducted a systematic review using a narrative synthesis approach. Comprehensive searches were performed in PubMed, Scopus, and Web of Science for peer-reviewed studies published in English between 2014 and 2024. The Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument was used to assess the methodological quality of included studies. Results: Twenty-one studies were included, and most were conducted in the United States and focused on synchronous modality for adult males. None of the studies explicitly defined the efficacy, effectiveness, and efficiency of virtual care interventions. The concept of effectiveness was the most frequently explored, and aligned best with WHO's conceptual framework, whereas efficiency was the least explored. The most common evaluation measures were clinical effectiveness, user satisfaction, and interexaminer agreement. Conclusions: This review highlights the need for adopting a unified framework for evaluating virtual care in correctional facilities that can standardize evaluation metrics and improve resource allocation, ultimately enhancing patient outcomes by ensuring that virtual care interventions are efficacious, effective, and efficient.

Unseen Strength: Dementia, the COVID-19 Pandemic, and the Resilient Hearts That Never Stopped Caring

2025-06-18

Alice Yip , Yuk‐Chiu Yip , Zoe Tsui +1 more | COVID

This qualitative study explored the motivations for, and resilience of, family caregivers visiting family members with dementia in residential care homes (RCHs) in Hong Kong during the COVID-19 pandemic. Data … This qualitative study explored the motivations for, and resilience of, family caregivers visiting family members with dementia in residential care homes (RCHs) in Hong Kong during the COVID-19 pandemic. Data for this qualitative descriptive study was obtained through audio-recorded, semi-structured, in-depth interviews with 25 family caregivers of individuals with dementia in RCHs. Following transcription, a thematic analysis was performed on the verbatim data. Three main themes emerged: (a) virtue of respect and filial piety; (b) family expectations and hopes; and (c) from red flags to resilience and rebuilding stronger relational bonds. The findings elucidate family caregiver motivations and resilience during RCH visits, offering crucial insights for healthcare policymakers. This can inform the design of care services and support to bolster the resilience of both caregivers and their relatives with dementia amidst ongoing global health-system pressures.

COVID-19 Bed Surge and Rationing of Rehabilitation Services in Japan: A Seasonal Autoregressive Integrated Moving Average (SARIMA) Analysis of Care Utilization with 10 years claims data

2025-06-18

Yuki Egashira , Ryo Watanabe | medRxiv (Cold Spring Harbor Laboratory)

Abstract Objective To explore the effect of COVID-19 and associated medical resource prioritization called “rationing” on the provision of rehabilitation services in Japan, focusing on cerebrovascular, musculoskeletal, and respiratory rehabilitation … Abstract Objective To explore the effect of COVID-19 and associated medical resource prioritization called “rationing” on the provision of rehabilitation services in Japan, focusing on cerebrovascular, musculoskeletal, and respiratory rehabilitation in the pre-COVID-19, during-COVID-19, and post-COVID-19 periods. Design Retrospective study using seasonal autoregressive integrated moving average model to predict expected values, which were compared with actual values to calculate observed-to-expected ratios. Setting Acute care hospitals in Kanagawa Prefecture, which has the second largest population in Japan after Tokyo, covering April 2014 to March 2024. Participants Patients aged 0–74 years who were enrolled in the National Health Insurance of Kanagawa Prefecture and underwent the studied types of rehabilitation. Exposure COVID-19 pandemic waves and associated bed utilization rates, with multiple distinct peaks. Outcome measures The difference between the predicted and actual values of the volume of rehabilitation services provided and the number of patients per insured person calculated as observed-to-expected ratios in response to the peak of bed utilization against COVID-19. Results The observed-to-expected ratio of inpatient rehabilitation services for cerebrovascular showed a significant decrease after five waves at −14.3%, and musculoskeletal conditions showed a similar decline during periods of high COVID-19 bed utilization. Outpatient services experienced sharp declines initially but showed differential recovery patterns. Respiratory rehabilitation displayed unique patterns, with inpatient services increasing up to 62.4% above expected levels until September 2021, before sharply declining. By March 2024, musculoskeletal rehabilitation demonstrated complete recovery, cerebrovascular rehabilitation showed partial recovery, while respiratory rehabilitation exhibited mixed patterns with persistent outpatient deficits. Conclusions The COVID-19 pandemic significantly impacted rehabilitation services in Japan, with inpatient services for cerebrovascular and musculoskeletal conditions being particularly vulnerable to disruptions during high COVID-19 bed utilization periods. The differential recovery patterns across rehabilitation types, with some structural changes persisting beyond the acute pandemic phase, indicate the need for flexible healthcare systems to deal with future healthcare crises. These findings underscore the importance of developing strategies to maintain essential rehabilitation services during public health emergencies, especially considering the aging global population and rising demand for rehabilitation. Article Summary Strengths and Limitations of this study This study is the first to use 10 years of large-scale claims data (Apr 2014–Mar 2024) to show how COVID-19 bed surges disrupted rehabilitation services across multiple waves, including the post-Category 5 period. The study findings indicate that service disruption varied by type: cerebrovascular and musculoskeletal rehab were more vulnerable, while respiratory rehab showed unique patterns of increase during the pandemic. A Seasonal Autoregressive Integrated Moving Average model using 72 months of pre-COVID data enabled accurate prediction of expected service levels across pre-, during-, and post-pandemic periods. The study design could not identify the causal relationship between healthcare resource constraints and changes in patient care-seeking behaviors as primary drivers of decreased service utilization. The study focused on a single prefecture, which may limit generalizability to other regions with different healthcare infrastructure.

Provider Perspectives Regarding Facility-Level Disparities in Access to Inpatient Psychiatric Occupational Therapy Services in the Veterans Health Administration

2025-06-17

Adam R. Kinney , Morgan Nance , Molly E. Penzenik +2 more | American Journal of Occupational Therapy

Importance: Veterans receiving inpatient psychiatric services with occupational performance limitations benefit from occupational therapy, yet facility-level disparities in access to such services have been previously reported in the Veterans Health … Importance: Veterans receiving inpatient psychiatric services with occupational performance limitations benefit from occupational therapy, yet facility-level disparities in access to such services have been previously reported in the Veterans Health Administration (VHA). There remains a need to understand explanatory mechanisms underlying the potentially inequitable distribution of such services. Objective: Elicit in-depth explanations of previously reported quantitative findings regarding facility-level disparities in access to inpatient psychiatric occupational therapy services in the VHA. Design: Explanatory–sequential mixed methods. Setting: VHA inpatient psychiatric settings nationally. Participants: VHA providers and administrators (N = 16) involved in delivering inpatient psychiatric occupational therapy. Intervention: None. Outcomes and Measures: Semistructured interviews eliciting explanations for quantitative findings regarding disparities in access to inpatient psychiatric occupational therapy. Results: Interviews elicited mechanisms explaining the relationship between access to inpatient psychiatric occupational therapy and an indicator of clinical need: activities of daily living limitations (e.g., artificial constraints on occupational therapy’s scope of practice). Interviews also shed light on facility-level disparities in access to inpatient psychiatric occupational therapy by offering explanations for the role of facility characteristics in shaping access, including facility complexity (e.g., staffing), psychiatric care quality (e.g., interdisciplinary care), and bed supply (e.g., staff:patient ratio). Conclusions and Relevance: This study revealed that facility resources (e.g., staffing levels) and aspects of facility culture (e.g., commitment to interdisciplinary care) may drive variable access to inpatient psychiatric occupational therapy across VHA facilities. The findings can inform the development and evaluation of evidence-based initiatives that improve care quality and Veteran outcomes in this setting. Plain-Language Summary: Previous research has revealed variable access to inpatient psychiatric occupational therapy services across Veterans Health Administration (VHA) facilities with differing levels of complexity, measured care quality, and bed supply. This study is the first to leverage the perspectives of clinical informants (providers and administrators within the VHA) to elicit explanations for such disparities. These explanations represent modifiable targets that can inform the development of corresponding strategies aimed at achieving equitable access to inpatient psychiatric occupational therapy services in the VHA.

Municipality politicians’ self-rated knowledge of work environments for key professions within Swedish elder care

2025-06-17

Susann Porter , Ulrika Flädjemark , Per Schubert | Journal of Health Organization and Management

Purpose Municipality politicians in Sweden represent their municipalities as employers, bearing overall legal responsibility for the work environment. This study examines the self-rated knowledge of politicians responsible for elder care … Purpose Municipality politicians in Sweden represent their municipalities as employers, bearing overall legal responsibility for the work environment. This study examines the self-rated knowledge of politicians responsible for elder care in the settings of home care and special housing in Sweden. The study focuses on two aspects of their role: their knowledge regarding the work of the key professionals who deliver elder care services (including care assistants, assistant nurses, registered nurses, physiotherapists, occupational therapists and first-line managers) and their knowledge of their accountability as employers for the work environments. Design/methodology/approach This quantitative study is based on self-reported responses to a questionnaire from 81 municipality politicians. All of Sweden’s 290 municipality political board chairs were invited to participate and asked to extend the invitation to other board members. The study is part of a larger study with a longitudinal single-group pre-post experimental research design that evaluated a digital educational programme regarding organisational and social work environments within elder care, targeting accountable municipality politicians in Sweden. Findings Politicians may lack knowledge regarding the work of elder care professions and their legal responsibilities as employers. The level of knowledge was higher among board chairs compared to board members. Regardless of political role, knowledge of the work of care assistants and assistant nurses was highest, whilst that of physiotherapists and occupational therapists was lowest. Research limitations/implications The results of this study are based on a questionnaire designed to assess the self-rated knowledge of municipality politicians regarding the work of key professions in elder care within special housing and home care contexts. Practical implications These results highlight the knowledge imbalance between board chairs and board members and are significant because all board members share equal responsibility for the decisions made. Given the limited time board members have to fulfil their political roles, it is essential to consider this constraint when addressing their knowledge needs. Social implications This study provides insights into the self-rated knowledge of municipality politicians responsible for elder care and focuses on two key aspects of their role. Examination of their knowledge of the work performed by key professionals who deliver elder care services indicate differences in knowledge levels based on political roles. Board chairs demonstrate a higher overall degree of knowledge compared to board members. Originality/value This research examines the knowledge of municipality politicians accountable for elder care regarding the work of different key professions within elder care, in both special housing and home care contexts as well as their knowledge of work environment legal responsibilities.

Families with low resources striving for resilience in the United Kingdom

2025-06-16

Mary E. Daly , Agathe Osinski | Edward Elgar Publishing eBooks

Successful Retention Strategies for Nurses in Home Visiting Nursing Services: A Scoping Review

2025-06-16

Vari Drennan , J. Mariano Ferrera , Claire Thurgate +3 more | Journal of Advanced Nursing

ABSTRACT Aim To identify successful strategies and underpinning mechanisms for retaining nurses in home visiting nursing services. Design Scoping review. Data Sources MEDLINE, CINAHL, Google Scholar, Theses Global Databases (1 … ABSTRACT Aim To identify successful strategies and underpinning mechanisms for retaining nurses in home visiting nursing services. Design Scoping review. Data Sources MEDLINE, CINAHL, Google Scholar, Theses Global Databases (1 January 2000 to 23 November 2023); international nursing organisations websites (January–April 2024). Review Methods The methods followed the Joanna Briggs Institute guidance. Two researchers independently screened and reviewed, with disagreements resolved through discussion. Included papers were analysed for underlying mechanisms. Results Of 1219 records identified, seven met the criteria. Four papers reported senior administrators' experience of successful multiple types of strategies (unspecified), but none reported retention outcomes. Three papers reported evaluations of initiatives providing clinical and peer support to nurses new to home visiting nursing. All three papers reported improved retention rates at 12 months in comparison to the year previous, although there was no consideration of other potentially influencing factors. We identified eight underlying mechanisms in the seven papers: (1) finance incentives; (2) work schedule flexibility for individuals; (3) team level management; (4) positive feedback on job performance; (5) team level interpersonal relationships; (6) the work organisation and resources; (7) support to individual's development in knowledge, clinical skill and confidence and (8) participation in organisation's decision making. Conclusion This review identified noticeable few papers over a time when all countries have been trying to address the growing health needs of the older populations. The gap in evidence as to the most effective combinations of retention strategies for home visiting nursing requires urgent attention. Clinical leaders and managers require evidence to inform their strategies for retaining home visiting nurses in order to provide high quality care as more health care systems increase the provision of acute, chronic, and palliative care in patients' own homes. Reporting Method This paper conforms to PRISMA reporting guidelines for scoping reviews. Patient or Public Contribution No patient or public contribution.

Positive and Negative Appraisals and Quality of Life Among Family Caregivers of Adults With Formal Long‐Term Care Needs: An Exploration of Model Using Structural Equation Modelling

2025-06-16

Mika Sakurai , Junko Hoshino | Journal of Clinical Nursing

ABSTRACT Aims To examine a model of the caregiving adaptation process among family caregivers supporting care recipients at home. Background Global demand for the support of adults with long‐term care … ABSTRACT Aims To examine a model of the caregiving adaptation process among family caregivers supporting care recipients at home. Background Global demand for the support of adults with long‐term care needs and family caregivers is increasing. Caregivers' quality of life is affected by positive and negative appraisals of care; however, few studies have simultaneously investigated these factors. Design A cross‐sectional study. Method The STROBE checklist for cross‐sectional studies was followed. Seventy‐four randomly selected home‐visit nursing stations in Japan participated in this study from June 2023 to June 2024. A self‐administered anonymous questionnaire was provided to family caregivers with care recipients at home. A total of 168 questionnaires were analysed. The variables included in the model were the European Quality of Life five‐dimension five‐level (EQ‐5D‐5L) instrument, positive and negative appraisals of care scale, four external resources and three internal resources, and six characteristics of caregivers and care recipients. Descriptive statistics and correlations between variables were analysed. The model was tested using structural equation modelling. Results Family caregivers' negative appraisal of care directly and negatively affected quality of life, and positive appraisal of care had no statistically significant association with quality of life. Positive appraisal of care had a direct negative association with negative appraisal of care. External resources such as support from nurses directly affected the positive appraisal of care. Internal resources such as caregivers' coping strategies had a significant negative effect on negative appraisal of care. Conclusion The findings suggest that improving caregivers' quality of life requires support to decrease negative appraisal of care by increasing internal resources and increase positive appraisal of care by providing external resources. Understanding the caregivers' adaptation process model is essential to prevent the deterioration of their quality of life. Reporting Method STROBE guidelines. Patient or Public Contribution Seventy‐four home visit nursing stations and participants who care for family members through home visit nursing were involved in the survey investigation and answering the questionnaires. Implications for the Profession and Patient Care For supporting family caregivers' QoL, a reduction in negative appraisals of care is essential, increasing internal resources such as caregivers' coping and positive appraisal of care directly reduces negative appraisal of care.

Healthcare workers' views on the response to COVID-19 in long-term care hospitals in Korea: a mixed-method study

2025-06-16

Eun Kyoung Yun , In Seo La , Sun-Mi Kim +2 more | Frontiers in Public Health

Introduction Long-term care hospitals (LTCHs) faced challenges beyond the scope of their previous practice in response to the pandemic. However, not much is known about LTCHs' responses and business continuity … Introduction Long-term care hospitals (LTCHs) faced challenges beyond the scope of their previous practice in response to the pandemic. However, not much is known about LTCHs' responses and business continuity plans (BCPs) during the pandemic. We investigated attempts by LTCHs to maintain continuity of operation during COVID-19 in order to gain insight on how to support them in future crises. Methods A mixed-method design was used, comprising a survey and individual interviews, to understand the responses and measures taken to address the pandemic. Results For LTCHs, inpatient ward operations were identified as an essential function. Following the government's recommendation, most (85.7%) confirmed having BCPs, but over half felt that the operational effectiveness of BCPs was inadequate. Only 9.5% formed teams dedicated to infectious disease emergency preparedness and response before COVID-19. Qualitative analysis identified six main themes that explained the efforts of the LTCHs: workplace culture and leadership, communication, human resources, safety, continuity of essential services, and financial and supply management. The themes explained the reasons for operational effectiveness and provided examples and context on how staff responded in small and medium-sized LTCHs during the pandemic, considering elements in health service continuity planning. Conclusion Management of significant changes forced by the pandemic necessitates preparing a response that considers key components beforehand, particularly for vulnerable healthcare facilities. To address unexpected crises, LTCHs should develop, implement, and practice well-thought-out plans to enhance organizational resiliency and ensure continued hospital functioning.

Employment Status, Decision-Making, and Sleep Among Hispanic and Latinx Dementia Family Caregivers: A Secondary Data Analysis

2025-06-16

Abigail Poe , Natashia Bibriescas , Chunhong Xiao +1 more | PubMed

Background: Hispanic and Latinx dementia family caregivers frequently face heightened stress, which can negatively impact their health and well-being. Balancing employment and caregiving responsibilities adds to this burden, potentially influencing … Background: Hispanic and Latinx dementia family caregivers frequently face heightened stress, which can negatively impact their health and well-being. Balancing employment and caregiving responsibilities adds to this burden, potentially influencing decision-making involvement and sleep. Objective: This study examined the relationship between employment status, caregiver involvement in everyday decision-making, and sleep duration among Hispanic and Latinx dementia caregivers. Methods: A sample of 138 Hispanic and Latinx dementia caregivers completed online surveys on their daily caregiving experiences. Cross-tabulations and linear regression were used to analyze associations between employment status (full-time, part-time, retired, stopped working due to caregiving), decision-making (eg, daily activities, meals, medical care), and total sleep time. Results: Participants had a mean age of 55.1 years (SD = 14), were predominantly female, and primarily cared for a parent. Caregivers who stopped working due to caregiving were more involved in planning activities (χ² = 20.21, P < .027). Retired caregivers were more involved in meal planning (χ² = 17.34, P < .01), and those who stopped working were more involved in medical decisions (χ² = 35.45, P < .001). Greater decision-making involvement predicted shorter total sleep time (β = −0.198, P < .01). However, the interaction between full-time employment and decision-making involvement was significant (β = 0.235, P = .05), suggesting that full-time employment buffered the negative impact of decision-making involvement on sleep duration. Conclusions: Findings highlight the complex relationship between employment status, decision-making involvement, and sleep among Hispanic and Latinx dementia caregivers. Culturally tailored interventions that consider both caregiving decision-making and employment-related demands may help support caregiver health and well-being.

What is the effectiveness and cost-effectiveness of at-home time-limited reablement service for improving an individuals independence and health outcomes and reducing the need for long term care: a rapid review

2025-06-14

Bethany F Anthony , Jacob Davies , Kalpa Pisavadia +7 more | medRxiv (Cold Spring Harbor Laboratory)

Local authorities and health services in Wales are tasked with reablement, aimed at helping individuals who are at risk of frailty maintain and improve independence. However, certain social care constraints … Local authorities and health services in Wales are tasked with reablement, aimed at helping individuals who are at risk of frailty maintain and improve independence. However, certain social care constraints reduce resources for reablement services. The review aimed to identify evidence on the effectiveness and cost-effectiveness of at-home time-limited reablement services for improving an individuals independence and health outcomes and reducing the need for long term care. The review included available evidence to December 2024. Eighteen studies were included: 15 primary studies of clinical effectiveness; two economic evaluations; and one study of both clinical and cost-effectiveness. There was a significant amount of evidence on the effectiveness of reablement interventions on person-related outcomes. The interventions were effective in improving outcomes associated with independent living and were effective in improving quality of life outcomes. Reablement interventions may be effective in improving falls outcomes, in reducing the risk of mortality, and improving clients coping in terms of sense of coherence. Strong international evidence indicates that reablement was effective in improving peoples ability to undertake mobility and daily living activities. The review also identified a significant amount of evidence on the effectiveness of reablement interventions on service-level outcomes. Reablement reduced the need for long term home care services and was effective in reducing residential care admissions. In terms of other service-level outcomes, there were some contradictory (and inconsistent findings on reablements effectiveness. One study found that reablement was effective in reducing the number of outpatient treatments compared with usual care. The economic evaluations found reablement services were cost-effective when compared to standard at-home care, although there were some methodological flaws that limited the certainty of findings. We identified the policy and practice implications, the need for further research and economic considerations.

From Nursing Homes to Home Care: Examining the Impact of the COVID-19 Pandemic on Direct Care Worker Transitions.

2025-06-13

Katherine Miller , Yang Yang , Jeromie Ballreich +1 more | PubMed

Task-shifting in dementia care: a comparative analysis of consultation models and proposed collaborative ecosystem in Japan

2025-06-13

Kae Ito , Tsuyoshi Okamura | Frontiers in Psychiatry

Introduction With an aging population, task-shifting in dementia care has been proposed to meet the needs of persons living with dementia (PLWD). In Japan, the Initial-phase Intensive Support Service (IPIS), … Introduction With an aging population, task-shifting in dementia care has been proposed to meet the needs of persons living with dementia (PLWD). In Japan, the Initial-phase Intensive Support Service (IPIS), led by primary care physicians, was introduced alongside traditional Psychogeriatric Services (PS), which are psychiatrist-led. However, the impact of this shift on care capacity remains unclear. Methods This study employed a convergent mixed-methods design to examine two dementia outreach services in Tokyo: PS and IPIS. This study aimed to: 1) compare the content of consultations between PS and IPIS; 2) identify tasks that could not be shifted; and 3) propose a collaborative care model to address identified service gaps. We analyzed 121 PS cases and 213 IPIS case records, and conducted interviews with team members to explore cases where IPIS was perceived as less equipped. Results The IPIS Service was generally suitable for early-stage dementia without severe behavioral symptoms but less equipped to manage: 1) mental health conditions beyond dementia; 2) long-standing psychosocial issues; and 3) acute crises—areas where PS traditionally intervened. Discussion The findings highlight the need for strengthened collaboration between primary care and psychiatric services. We propose a collaborative care ecosystem in which primary care physicians lead community-based dementia care, supported by psychogeriatric consultation.

Supporting Health Care Resilience Through “Reflexive Spaces” in Home Care Services: A Multiple Embedded Case Study

2025-06-13

Camilla Seljemo , Olav Røise , Eline Ree +1 more | Journal of Patient Safety

Objectives: The aim of this study was to explore where and how managers facilitate arenas for collective reflections and knowledge sharing (“reflexive spaces”) in homecare services during the COVID-19 pandemic. … Objectives: The aim of this study was to explore where and how managers facilitate arenas for collective reflections and knowledge sharing (“reflexive spaces”) in homecare services during the COVID-19 pandemic. Moreover, we sought to understand how these “reflexive spaces” contributed to adaptations to challenges induced by the pandemic. Finally, we aimed to discuss how these spaces might incorporate resilience into health care. Methods: This multiple embedded case study includes interviews with health care staff (n=16) and managers at different system levels (n=21) from 4 Norwegian municipalities. The data were analyzed in accordance with reflexive thematic analysis. Findings: The analysis identified 2 overarching themes: (1) arenas for reflection, communication, and dialogue, and (2) establishing new solutions through collective reflection facilitated by managers. Managers who initiated dialogue and established arenas for reflection and communication were highlighted as important for discussing and sharing knowledge about challenges created by the pandemic. In these spaces, both managers and staff reflected, collaborated, and learned from each other and then designed a tactical and resilient response to the ongoing challenges. Conclusions: Managers had a key role as facilitators for “reflexive spaces” within and across levels of responsibilities. Moreover, managers had a mediating role in bridging knowledge and understanding across levels within the health care system. Using “reflexive spaces” as part of daily practice appeared as an important measure to balance demands and capacity and respond both to crises and to everyday challenges.

The Epidemiology of the Long-Term Care Needs and Unmet Needs of Older Veterans in the United States

2025-06-13

Sandra Garcia‐Davis , WayWay M. Hlaing , Denise C. Vidot +7 more | Journal of Clinical Medicine

Background/Objectives: Veterans differ in sociodemographic composition and experience higher frequencies of disability than non-Veterans of the same age. Yet the epidemiology of the long-term care needs of Veterans, specifically activities … Background/Objectives: Veterans differ in sociodemographic composition and experience higher frequencies of disability than non-Veterans of the same age. Yet the epidemiology of the long-term care needs of Veterans, specifically activities of daily living (ADLs) and instrumental activities of daily living (IADLs), remains an important gap in the literature. The objectives of this study were to (1) characterize Veterans across levels of hierarchy of ADL and IADL support needs; (2) compare Veterans across the degree of need for help, from those who can still “self-manage” to those with an “unmet need”; and (3) identify the types and prevalence of ADL and IADL need combination patterns. Methods: This study used cross-sectional data from the 2021 administration of the HERO CARE survey. We included Veterans ages 65+ in our analyses (N = 7424). We calculated the overall weighted descriptive statistics across a hierarchy of ADL and IADL problems and the degree of need for help. One-way ANOVA for continuous variables and Rao–Scott chi-square tests for categorical variables were conducted to examine associations between groups, followed by post hoc pairwise comparisons, as appropriate. Results: Veteran respondents mean age was 82.3 (SD: 8.2 years), and most were male, non-Hispanic White, and married. In weighted analyses, more Veterans with both ADL and IADL problems compared to only ADL problems reported food insecurity, missed appointments, low health literacy, and depression. Among Veterans with ADL or IADL problems, 32.3% reported an unmet need for help. Almost a quarter of Veterans with ADL problems reported difficulties performing all eight ADLs (23.9%), and over a quarter of Veterans with IADL problems reported difficulties performing all seven IADLs (31.3%). Conclusions: Our findings show that Veterans are demographically and clinically different based on their hierarchy of impairment and degree of need for help. Identifying the patterns and prevalence of ADL and IADL needs among Veterans provides valuable information to align the Veterans Affairs (VA) programs and services with Veterans’ needs.

Needs assessment and eligibility criteria in long-term care

2025-06-12

Ana Llena‐Nozal , Satoshi Araki , Karolin Killmeier | OECD health working papers

Breaking the Cycle: Identifying Drivers of 30-Day Readmissions in Rural Medicare Populations

2025-06-12

Sheryll Go | Research Square (Research Square)

<title>Abstract</title> <bold>Reporting Method:</bold>This manuscript adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist from the EQUATOR Network. <bold>Background:</bold> Hospital readmissions within 30 days are key indicators … <title>Abstract</title> <bold>Reporting Method:</bold>This manuscript adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist from the EQUATOR Network. <bold>Background:</bold> Hospital readmissions within 30 days are key indicators of care quality and are penalized under CMS policy. Bandura’s self-efficacy theory and recent global research emphasize the role of modifiable behavioral and system-level factors in preventing readmissions, particularly in rural contexts. <bold>Objective:</bold> To identify common contributors to 30-day readmissions among Medicare patients with Acute Myocardial Infarction (AMI), Heart Failure (HF), and Pneumonia (PNA). <bold>Methods:</bold> This retrospective descriptive study reviewed electronic records of 30 Medicare patients aged 65 and older readmitted within 30 days between January and June 2023 at a rural Southern California hospital. Data were extracted from an Epic-based EHR using a structured audit tool capturing demographics, comorbidities, and readmission diagnoses. <bold>Results:</bold> Among AMI patients, all had hypertension, obesity, and smoking history; 40% were non-compliant with medications. HF patients had 100% medication non-compliance; 90% were obese or smokers. PNA patients showed high rates of swallowing dysfunction (100%), low ADL scores (90%), and smoking (60%). Overall, obesity (95%), smoking (83%), and hypertension (90%) were the most frequent contributors. <bold>Conclusion:</bold> Preventable lifestyle and management-related factors were prevalent in early readmissions. Findings support the role of nurse-led transitional care strategies such as tailored discharge education and follow-up. <bold>Relevance to Clinical Practice:</bold> Recognizing key readmission drivers enables nurses to enhance discharge planning, patient teaching, and care coordination for at-risk rural populations. <bold>No Patient or Public Contribution:</bold> This retrospective chart review did not include direct patient or public involvement.

Working to improve the cultural competency of supported living and residential care for adults with learning disabilities from minority ethnic communities

2025-06-12

Chris Hatton | http://isrctn.com/

Developing an intervention to maintain biweekly asymptomatic SARS-CoV-2 testing amongst English care home staff: An integrative approach

2025-06-11

Paul Flowers , Ruth Leiser , Maria Krutikov +7 more | medRxiv (Cold Spring Harbor Laboratory)

Purpose To describe the development of an intervention (‘ Test to Care’ ) maintaining biweekly asymptomatic SARS-CoV-2 testing amongst care home staff. Methods Diverse inputs were sequentially integrated: 1 ) … Purpose To describe the development of an intervention (‘ Test to Care’ ) maintaining biweekly asymptomatic SARS-CoV-2 testing amongst care home staff. Methods Diverse inputs were sequentially integrated: 1 ) A behaviour change wheel (BCW) analysis of the results from a systematic review of barriers and facilitators to staff testing for SARS-CoV-2 from 14 international studies to generate initial intervention content ideas; 2 ) A series of eight stakeholder events with UK care home staff and policy makers (N=∼70) to iteratively operationalise emerging intervention content; 3 ) Confirmatory thematic analysis of barriers and facilitators to biweekly asymptomatic SARS-CoV-2 testing from four focus groups (N=15) to check temporal relevance of the intervention; 4) Intervention specification via programme theory and a logic model. Results Narrative programme theory and a simple logic model described ‘ Test to Care ’. It showed the primary intervention function was ‘ incentivisation’, addressing agency backfill and sick pay. Secondary intervention functions included: ‘ education ’ and ‘ persuasion ’ to staff through communications and social marketing (i.e., posters and emails with embedded short videos); and ‘ environmental/social restructuring ’ and ‘ enablement ’ which invited managers to initiate and support implementation (i.e., the location of testing, management support and poster locations). Conclusions Our integrative approach to intervention development produced an evidence-based, theoretically-informed intervention tailored to its specific implementation context. The diversity of included inputs were essential to overcome the relative weaknesses and strengths of each input source (e.g., the historical timeframe of published studies in the review, and the sampling biases associated with focus group participation). What is already known on this subject? During the global COVID-19 pandemic, compliance with SARS-CoV-2 testing and other non-pharmaceutical interventions amongst care home staff was enforced through intervention functions such as ‘coercion’ and ‘restriction’ (e.g., mandatory routine testing). However, little is known about how to maintain testing when these intervention functions are removed. Intervention development guidance suggests optimal processes should combine the published literature, stakeholder engagement, and programme theory. However, few examples illustrate this process in detail. What does this study add? We present a worked example of using diverse inputs to systematically develop an intervention within a compressed time frame: a typical behaviour change wheel analysis of findings (i.e., barriers and facilitators) from international published studies, novel iterative stakeholder input to add/remove and operationalise intervention content, and sense-checking the emerging intervention’s relevance within the context in which the intervention will be used. Uniquely, the study also shows how narrative programme theory and logic models can be used to illustrate an intervention and its purported functions: numerous intervention functions are required (i.e., ‘incentivisation’, ‘education’, ‘persuasion’, ‘environmental/social restructuring’ and ‘enablement’), as are varied behaviour change techniques addressing a range of important mechanisms of action (i.e., ‘knowledge’, ‘beliefs about consequences’, ‘professional role and identity’, ‘social influence’, ‘environmental context and resource’, ‘behavioural regulation’ and ‘memory attention and decision-making’).

Dementia Care Navigation: The Role and Training of Dementia Care Specialists in Managed Care Organizations.

2025-06-11

Jarmin Yeh , Leslie Ross , Jennifer Schlesinger +4 more | PubMed

Recent policy shifts in the United States have created opportunities for managed care organizations (MCOs) to put in place care navigators, like Dementia Care Specialists (DCS), to coordinate care for … Recent policy shifts in the United States have created opportunities for managed care organizations (MCOs) to put in place care navigators, like Dementia Care Specialists (DCS), to coordinate care for older adults living with dementia and their families. This paper presents findings of the DCS training model developed primarily for nurse and social work care managers within ten MCOs that participated in California's pilot program serving Medicare-Medicaid dual-eligible members as part of a contracted collaboration with state agencies and the Centers for Medicare and Medicaid Services between 2013 and 2018, along with updated training model resources for replication.

Staff testing in care homes for older people: policy implications for early stages of future pandemic responses

2025-06-11

L O'Brien , Oliver Stirrup , Catherine Henderson +7 more | medRxiv (Cold Spring Harbor Laboratory)

Abstract Background Care home residents are at high risk of severe outcomes following respiratory infection due to age, co-morbidities, and close contact with staff and other residents. Frequent staff testing … Abstract Background Care home residents are at high risk of severe outcomes following respiratory infection due to age, co-morbidities, and close contact with staff and other residents. Frequent staff testing could potentially reduce respiratory infection cases in residents, but evidence is limited. This study uses historical COVID-19 data in England to assess the impact of varying staff testing rates under different transmission scenarios to inform response during future pandemics. Methods We developed a compartmental model of SARS-CoV-2 transmission in England, with three population strata: general population, care home staff, and residents. The model was calibrated using prevalence data from January 2021 to March 2022 and testing rates from the VIVALDI Study ( ISRCTN14447421 ). We conducted a scenario analysis projecting resident cases and deaths over 12 months under varying staff testing frequencies (monthly, twice-monthly, weekly, twice-weekly, daily) assuming a new dominant strain. We also explored the impact of testing when combined with a hypothetical low-cost highly-effective public health and social measures. Findings Staff testing alone has little impact on reducing cases and deaths in the resident population. Daily testing could avert only 3.8% (95%UI: 3.1-4.4%) cases and 3.5% (95%UI: 2.3-4.4%) deaths compared to a baseline testing of less than one test per month. When combined with public health and social measures, however, the effect is large. Daily staff testing, combined with public health and social measures, can reduce resident cases by 54% (95%UI: 50-58%) and deaths by 50% (95%UI: 26-59%). Additionally, if testing frequency is reduced but there is still a public health and social measure, the effect size decreases, however there are potential cost savings (£0.7 to £3.4 million). Interpretation Increasing staff testing alone is insufficient to significantly reduce SARS-CoV-2 cases and deaths in care home residents. However, combining testing with some form of a public health and social measure aimed at reducing transmission among residents, is epidemiologically effective and cost-effective in most scenarios and possibly cost saving.

Acceptability and Satisfaction of a Newly Developed Financial Preparedness Program for Caregivers of Older Adults with a Chronic Illness

2025-06-10

Katherine Judge , Lauren Stratton , C. K. Grant +2 more | The Gerontologist

Abstract Background and Objectives To address a gap in caregiver programming focused on financial literacy and preparedness, Managing Money: A Caregiver's Guide to Finances, a one-hour online program, was evaluated … Abstract Background and Objectives To address a gap in caregiver programming focused on financial literacy and preparedness, Managing Money: A Caregiver's Guide to Finances, a one-hour online program, was evaluated to determine program acceptability and participant satisfaction. Research Design and Methods Caregivers of individuals with chronic health conditions were recruited to attend a one-hour program focused on 1) understanding the financial impact of caregiving; 2) providing information on legal and financial documents; 3) how to prepare for discussions about finances and financial planning; 4) lowering risks of financial abuse and fraud; and 5) creating a backup plan for changes in care needs. Results were collected longitudinally, following participants to ninety days after attending the program. Results Overall, participants (n = 99) found the program highly acceptable, with the majority of caregivers agreeing or strongly agreeing the program: identified financial issues; provided important information; content was easy to read and understand; topics were clear and well-organized; activities were helpful; length was good; and caregivers would recommend the program. Program materials were rated helpful with up to 40% of participants reporting they used materials after attending the program. Discussion and Implications Providing care for individuals with chronic health conditions poses significant challenges for informal caregivers. The impact of finances, knowledge base and skills needed are often not included in an in-depth manner. The current program addresses this gap while also taking into consideration the need to develop pragmatic and scalable programs. The program may be useful in developing other targeted intervention protocols for caregivers.