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Sample records for danish nursing home

  1. Nursing Homes

    MedlinePlus

    ... our e-newsletter! Aging & Health A to Z Nursing Homes Basic Facts & Information Nursing homes have changed ... physical health and/or mental disabilities. Is a Nursing Home Right for You? Almost half of all ...

  2. Nursing Home Checklist

    MedlinePlus

    Nursing home checklist Name of nursing home: ____________________________________________________ Address: ________________________________________________________________ Phone number: __________________________________________________________ Date of visit: _____________________________________________________________ Basic information Yes No Notes Is the nursing home Medicare certified? Is the nursing ...

  3. Nursing Homes

    MedlinePlus

    ... up like a hospital. The staff provides medical care, as well as physical, speech and occupational therapy. ... relationships with residents. Some nursing homes have special care units for people with serious memory problems such ...

  4. Alternatives to Nursing Homes

    MedlinePlus

    ... this website may not be available. Alternatives to nursing homes Before you make any decisions about long ... live and what help you may need. A nursing home may not be your only choice. Discharge ...

  5. National Nursing Home Survey

    Cancer.gov

    The National Nursing Home Survey provides includes characteristics such as size of nursing home facilities, ownership, Medicare/Medicaid certification, occupancy rate, number of days of care provided, and expenses.

  6. Falls in Nursing Homes

    MedlinePlus

    ... for health care providers. Learn More Falls in Nursing Homes Recommend on Facebook Tweet Share Compartir On ... 5 Why do falls occur more often in nursing homes? Falling can be a sign of other ...

  7. Nursing homes in China.

    PubMed

    Chu, Leung-Wing; Chi, Iris

    2008-05-01

    China will face a dramatic transition from a young to an aged society in the coming 30 to 40 years. In 2000, there were 88,110,000 persons aged 65 years and older, which represented 7% of the population. This percentage is projected to increase to 23% in 2050. Regarding health and long-term care for older adults, the current challenge is to build a comprehensive system of care for older adults. Nursing home care is an inevitable care model for frail older adults in China, which is largely sponsored by the government of China with contributions from some nongovernment organizations and private investors. China is a large country. Within the country, long-term care varies greatly between rural and urban areas, and among the different economic developing areas. In urban and better-developed areas, the range of services exists; however, in rural and less-developed areas, the range of services is limited. The "Star Light Program" and "Beloved Care Engineering" were recent government initiatives to improve aged care. They were launched in 2001 and have dramatically increased the number of both senior centers and nursing homes for older adults. While the quantity of nursing homes is still inadequate with an additional mismatch problem between the supply and demand, the quality of care in most nursing homes is suboptimal. At present, most administrative and frontline workers in nursing homes have received little training in elder care. There is a need for good-quality structured training in long-term care for all types of staff. Moreover, quality standard for care, including standard setting, assessment, and monitoring, is an important issue and needs substantial improvement for nursing homes in China. Currently, 1.5% of older people live in nursing homes and apartments for older people. Because of the peculiar 4-2-1 family structure in China, we expect the prevalence of nursing home placement of older adults will increase in the coming years. The government of China has

  8. [Aromatherapy in nursing homes].

    PubMed

    Barré, Lucile

    2015-01-01

    Pierre Delaroche de Clisson hospital uses essential oils as part of its daily organisation for the treatment of pain and the development of palliative care. The setting up of this project, in nursing homes and long-term care units, is the fruit of a complex mission carried out by a multidisciplinary team, which had to take into account the risks involved and overcome a certain amount of reluctance. PMID:26154352

  9. Factor substitution in nursing homes.

    PubMed

    Cawley, John; Grabowski, David C; Hirth, Richard A

    2006-03-01

    This paper studies factor substitution in one important sector: the nursing home industry. Specifically, we measure the extent to which nursing homes substitute materials for labor when labor becomes relatively more expensive. From a policy perspective, factor substitution in this market is important because materials-intensive methods of care are associated with greater risks of morbidity and mortality among nursing home residents. Studying longitudinal data from 1991 to 2000 on nearly every nursing home in the United States, we use the method of instrumental variables (IV) to address measurement error in nursing home wages. The results from the IV models yield evidence of factor substitution: higher nursing home wages are associated with greater use of psychoactive drugs and lower quality.

  10. Nursing Home Work Practices and Nursing Assistants' Job Satisfaction

    ERIC Educational Resources Information Center

    Bishop, Christine E.; Squillace, Marie R.; Meagher, Jennifer; Anderson, Wayne L.; Wiener, Joshua M.

    2009-01-01

    Purpose: To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Design and Methods: Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey,…

  11. Nursing Home Nomads: A Study of Transfers.

    ERIC Educational Resources Information Center

    Retsinas, Joan

    Researchers have divided nursing home residents into long-stayers and short-stayers. While long-stayers rarely return home, they do not necessarily stay long in one institution. Instead, they may transfer from nursing home to nursing home. Although many studies have examined the impact of relocation on nursing home residents, few studies have…

  12. Rehabilitation in the nursing home.

    PubMed

    Joseph, C L; Wanlass, W

    1993-11-01

    Despite the considerable challenges to providing high-quality rehabilitation in a long-term care facility, growing demographic and fiscal pressures are likely to push the nursing home into the forefront of rehabilitation for the frail elderly. Model programs have been implemented in recent years that present alternative ways to increase access to skilled services and improve quality of care in nursing homes without a drastic increase in costs. The teaching nursing home program has supported projects to make longterm care facilities centers for education, innovative clinical care, and research, thus bringing nursing homes into the mainstream of the medical establishment. A majority of US medical schools have recognized the need for training in long-term care and have formed affiliations with nursing homes. The Department of Veterans Affairs has a large national system of nursing homes, which has made a significant contribution to the training of health professionals in many fields. Demonstration projects such as the Social Health Maintenance Organization and On Lok have sought to decrease the fragmentation of health care services for the elderly and bring nursing homes into a continuum of care. The adoption of the OBRA regulations is building a base for comprehensive assessment and improved provision of care in nursing homes nationwide. Nursing home rehabilitation has the potential to decrease institutionalization in the short-term resident, whereas maintenance therapy can improve quality of life and decrease the cost of caring for patients who must be institutionalized. But to achieve this potential, significant barriers must be overcome. Negative attitudes about aging and nursing homes percolate through all levels of health care from lack of reimbursement at the federal and state levels to the professional priorities that continue to favor "high-tech" medicine and stigmatize nursing homes and those who work in them, to low expectations of caregivers and the

  13. An international definition for "nursing home".

    PubMed

    Sanford, Angela M; Orrell, Martin; Tolson, Debbie; Abbatecola, Angela Marie; Arai, Hidenori; Bauer, Juergen M; Cruz-Jentoft, Alfonso J; Dong, Birong; Ga, Hyuk; Goel, Ashish; Hajjar, Ramzi; Holmerova, Iva; Katz, Paul R; Koopmans, Raymond T C M; Rolland, Yves; Visvanathan, Renuka; Woo, Jean; Morley, John E; Vellas, Bruno

    2015-03-01

    There is much ambiguity regarding the term "nursing home" in the international literature. The definition of a nursing home and the type of assistance provided in a nursing home is quite varied by country. The International Association of Gerontology and Geriatrics and AMDA foundation developed a survey to assist with an international consensus on the definition of "nursing home."

  14. An international definition for "nursing home".

    PubMed

    Sanford, Angela M; Orrell, Martin; Tolson, Debbie; Abbatecola, Angela Marie; Arai, Hidenori; Bauer, Juergen M; Cruz-Jentoft, Alfonso J; Dong, Birong; Ga, Hyuk; Goel, Ashish; Hajjar, Ramzi; Holmerova, Iva; Katz, Paul R; Koopmans, Raymond T C M; Rolland, Yves; Visvanathan, Renuka; Woo, Jean; Morley, John E; Vellas, Bruno

    2015-03-01

    There is much ambiguity regarding the term "nursing home" in the international literature. The definition of a nursing home and the type of assistance provided in a nursing home is quite varied by country. The International Association of Gerontology and Geriatrics and AMDA foundation developed a survey to assist with an international consensus on the definition of "nursing home." PMID:25704126

  15. Depression in nursing home residents.

    PubMed

    Abrams, R C; Teresi, J A; Butin, D N

    1992-05-01

    Although their extent remains unclear, major and minor depressions are widespread in the nursing home population. This statement appears intuitively to be correct when consideration is given to the inactivity, decline in functional competence, loss of personal autonomy, and unavoidable confrontation with the process of death and dying that are associated with nursing home placement. In addition, some nursing home residents have had previous episodes of depression or are admitted to the facility already dysthymic or with other chronic forms of the illness. Such circumstances provide a favorable culture for the development and persistence of depressive illness. When the high frequency of other psychiatric disorders among nursing home residents is factored in, it is not surprising that long-term health care facilities have come to be regarded as de facto psychiatric hospitals. Nursing homes largely lack the treatment resources of psychiatric hospitals, however. Nursing home physicians are often unprepared to make psychiatric diagnoses, and a perfunctory annual psychiatric evaluation is insufficient to manage the complex depression syndromes of nursing home residents. Because nursing home psychiatrists typically work on a consultation basis, recommendations are not necessarily acted upon by the primary physicians. The consequences of undiagnosed and untreated depression are substantial. From the psychiatric perspective, the possibility that depression increases the risk for eventual development of permanent dementia highlights the importance of early identification for cases of reversible dementia. From the rehabilitation point of view, persistent depression among individuals with physical dependency following a catastrophic illness is associated with failure to improve in physical functioning. Depression can probably be linked to increased medical morbidity in nursing home residents, a relationship that also has been suggested for elderly medical inpatients. If so

  16. [Teledermatology within Dutch nursing homes].

    PubMed

    Lubeek, Satish F K; Mommers, Roland J M; van der Geer, Eric R; van de Kerkhof, Peter C M; Gerritsen, Marie-Jeanne Rianne P

    2016-06-01

    Skin problems are common within the nursing home population and could have a significant impact on quality of life. As a form of long-distance consultation teledermatology offers several potential benefits within this frail population. In this review we discuss several aspects of teledermatology, especially in relation to the nursing home population. Several studies demonstrated that teledermatology is a cost-effective and easy-to-use consultation method, which could significantly reduce the amount of hospital visits. However, teledermatology is only used in a limited number of Dutch nursing homes in daily practice due to several factors. For the optimal implementation of teledermatological consultation there are some important logistical, legal and financial framework conditions. In conclusion, teledermatology has a lot to offer within the nursing home population and therefore teledermatology will hopefully be increasingly used in daily practice within the near future. PMID:27098424

  17. Does quality influence consumer choice of nursing homes? Evidence from nursing home to nursing home transfers.

    PubMed

    Hirth, Richard A; Banaszak-Holl, Jane C; Fries, Brant E; Turenne, Marc N

    2003-01-01

    We estimated Cox proportional hazards models using assessment data from the Minimum Data Set to test whether nursing home residents and their proxies respond to quality of care by changing providers. Various indicators of poor quality increased the likelihood of transfer. Residents of for-profit homes or homes with excess capacity also were more likely to transfer. Inability to participate in care decisions and factors indicating frailty limited residents' ability to transfer. The apparent responsiveness to quality is encouraging. Nonetheless, because the absolute transfer rate is low, significant barriers to movement among nursing homes still may exist. PMID:15055834

  18. Nursing Jobs in Nursing Homes

    ERIC Educational Resources Information Center

    Torpey, Elka Maria

    2011-01-01

    The need for practical nurses who focus on caring for older people is growing. According to the U.S. Census Bureau, the number of people ages 65 and older is expected to increase from 40 million to 72 million between 2010 and 2030. And the U.S. Bureau of Labor Statistics (BLS) projects that this increasing population will result in job growth for…

  19. Professional caregivers' work with the dying in nursing homes--a Foucault-inspired analysis of discourses in the last decade in a Danish context.

    PubMed

    Nielsen, Karen T; Glasdam, Stinne

    2013-12-01

    International studies on the death of elderly nursing home residents show the complexity in the understanding of the professionals who care for the dying. The aim of this study is to explore the discourses about professional caregivers caring for those dying in Denmark in the last decade. A discourse analysis inspired by Foucault was constructed. The material consists of different source documents: research articles, newspaper articles, theses, books, websites - 35 sources in total. There are constructed six positions of speech, five discourses and three themes: (1) 'the work of the professional caregivers - a complex low-status work'; (2) 'the education of the professionals - the way to ensure a good death or possessing the right qualifications' and (3) 'the vulnerable professionals'. The study concludes that an economical/political discourse is dominating and sets up the frames within which the professionals care for dying residents, although the medical, the social/critical and the religious discourses attempt to speak against it. All positions articulate that the professional caregivers' job has a low status and that it is not possible to provide an optimal care due to lack of time, resources and education. Psychical or mental demands make the professionals vulnerable. The meaning of optimal care varies according to the positions of speech.

  20. Clashes At Nursing Homes Not Uncommon

    MedlinePlus

    ... medlineplus.gov/news/fullstory_159335.html Clashes at Nursing Homes Not Uncommon 20 percent of residents affected ... 13, 2016 (HealthDay News) -- Many elderly adults in nursing homes face aggressive or disturbing behavior from their ...

  1. Medical specialist attendance in nursing homes.

    PubMed

    Balzer, Katrin; Butz, Stefanie; Bentzel, Jenny; Boulkhemair, Dalila; Lühmann, Dagmar

    2013-01-01

    The care in nursing homes was examined based on scientific studies. The analysis focuses on dementia and type II diabetes. There is evidence for deficits in the supply of medical specialist attendance to nursing home residents with these diseases in Germany. Compared with corresponding guidelines the medical care for nursing home residents may be too low or inadequate.

  2. Medical specialist attendance in nursing homes

    PubMed Central

    Balzer, Katrin; Butz, Stefanie; Bentzel, Jenny; Boulkhemair, Dalila; Lühmann, Dagmar

    2013-01-01

    The care in nursing homes was examined based on scientific studies. The analysis focuses on dementia and type II diabetes. There is evidence for deficits in the supply of medical specialist attendance to nursing home residents with these diseases in Germany. Compared with corresponding guidelines the medical care for nursing home residents may be too low or inadequate. PMID:23755088

  3. Future Development of Nursing Home Quality Indicators

    ERIC Educational Resources Information Center

    Arling, Greg; Kane, Robert L.; Lewis, Teresa; Mueller, Christine

    2005-01-01

    Nursing home quality indicators have been developed over the past 10 years to quantify nursing home quality and to draw systematic comparisons between facilities. Although these indicators have been applied widely for nursing home regulation, quality improvement, and public reporting, researchers and stakeholders have raised concerns about their…

  4. Report Cards and Nursing Homes

    ERIC Educational Resources Information Center

    Castle, Nicholas G.; Lowe, Timothy J.

    2005-01-01

    Purpose: We first describe which states have produced nursing home report cards; second, we compare what information is provided in these report cards; third, we identify data sources used to produce the report cards; and, finally, we examine seven factors previously shown to be associated with the usefulness of report-card information and provide…

  5. Nursing homes: The new frontier.

    PubMed

    Davis, Jane; Zuber, Kim

    2015-09-01

    As the population continues to age, we will see a larger percentage of end-stage CKD patients in nursing homes, both skilled and long-term facilities. This is a fragile population and will take buy-in from all practitioners to care for them. Even with the dietitian to manage a complicated and detailed menu, the social worker to manage the transportation and multiple issues with equipment, the therapy staff to protect against loss of ADLs, the recreational therapist to protect against loss of cognitive function and the medical staff (APs, nursing, physicians), this population will continue to present both challenges and opportunities. PMID:26521633

  6. Transforming home health nursing with telehealth technology.

    PubMed

    Farrar, Francisca Cisneros

    2015-06-01

    Telehealth technology is an evidence-based delivery model tool that can be integrated into the plan of care for mental health patients. Telehealth technology empowers access to health care, can help decrease or prevent hospital readmissions, assist home health nurses provide shared decision making, and focuses on collaborative care. Telehealth and the recovery model have transformed the role of the home health nurse. Nurses need to be proactive and respond to rapidly emerging technologies that are transforming their role in home care.

  7. Infections and antibiotic resistance in nursing homes.

    PubMed Central

    Nicolle, L E; Strausbaugh, L J; Garibaldi, R A

    1996-01-01

    Infections occur frequently in nursing home residents. The most common infections are pneumonia, urinary tract infection, and skin and soft tissue infection. Aging-associated physiologic and pathologic changes, functional disability, institutionalization, and invasive devices all contribute to the high occurrence of infection. Antimicrobial agent use in nursing homes is intense and usually empiric. All of these factors contribute to the increasing frequency of antimicrobial agent-resistant organisms in nursing homes. Programs that will limit the emergence and impact of antimicrobial resistance and infections in nursing homes need to be developed. PMID:8665472

  8. Nursing Home Staffing and Quality under the Nursing Home Reform Act

    ERIC Educational Resources Information Center

    Zhang, Xinzhi; Grabowski, David C.

    2004-01-01

    Purpose: We examine whether the Nursing Home Reform Act (NHRA) improved nursing home staffing and quality. Design and Methods: Data from 5,092 nursing homes were linked across the 1987 Medicare/Medicaid Automated Certification System and the 1993 Online Survey, Certification and Reporting system. A dummy-year model was used to examine the effects…

  9. Rurality and Nursing Home Quality: Evidence from the 2004 National Nursing Home Survey

    ERIC Educational Resources Information Center

    Kang, Yu; Meng, Hongdao; Miller, Nancy A.

    2011-01-01

    Purpose of the Study: To evaluate the impact of rural geographic location on nursing home quality of care in the United States. Design and Methods: The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used…

  10. Nursing Home Staff Turnover: Impact on Nursing Home Compare Quality Measures

    ERIC Educational Resources Information Center

    Castle, Nicholas G.; Engberg, John; Men, Aiju

    2007-01-01

    Purpose: We used data from a large sample of nursing homes to examine the association between staff turnover and quality. Design and Methods: The staff turnover measures came from primary data collected from 2,840 nursing homes in 2004 (representing a 71% response rate). Data collection included measures for nurse aides, licensed practical nurses,…

  11. 38 CFR 17.57 - Use of community nursing homes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...

  12. 38 CFR 17.57 - Use of community nursing homes.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...

  13. 38 CFR 17.57 - Use of community nursing homes.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...

  14. 38 CFR 17.57 - Use of community nursing homes.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...

  15. 38 CFR 17.57 - Use of community nursing homes.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the...

  16. Sex and the nursing home.

    PubMed

    Levine, Murray

    2016-01-01

    The current article discusses the case of Henry Rahons. A nearly 80 year old man who was accused by the local district attorney of having unlawful sexual contact with Donna, his second wife of some seven years who had developed Alzheimer's disease in her later years. Under Iowa law, he was accused of having sexually abused her because she had "a mental defect or incapacity which precludes giving consent" to sex acts. A jury acquitted Henry of the charge of sexually abusing his wife. The evidence was equivocal that a sex act occurred on May 23, 2014, the date specified in the indictment. This article addresses the ability to assessed competence to consent to sex in similar situations. The current rules and attitudes about senior sex in nursing homes needs to be reevaluated. (PsycINFO Database Record PMID:27196391

  17. Sex and the nursing home.

    PubMed

    Levine, Murray

    2016-01-01

    The current article discusses the case of Henry Rahons. A nearly 80 year old man who was accused by the local district attorney of having unlawful sexual contact with Donna, his second wife of some seven years who had developed Alzheimer's disease in her later years. Under Iowa law, he was accused of having sexually abused her because she had "a mental defect or incapacity which precludes giving consent" to sex acts. A jury acquitted Henry of the charge of sexually abusing his wife. The evidence was equivocal that a sex act occurred on May 23, 2014, the date specified in the indictment. This article addresses the ability to assessed competence to consent to sex in similar situations. The current rules and attitudes about senior sex in nursing homes needs to be reevaluated. (PsycINFO Database Record

  18. Nursing Practice Environment and Registered Nurses' Job Satisfaction in Nursing Homes

    ERIC Educational Resources Information Center

    Choi, JiSun; Flynn, Linda; Aiken, Linda H.

    2012-01-01

    Purpose: Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs…

  19. Cops, Consultants, and Goldfish: Variations in Nursing Home Regulation.

    ERIC Educational Resources Information Center

    Gardiner, John A.

    Nursing home regulatory agencies are subjected to a variety of pressures. Nursing home residents' families and friends want the agencies to "get tough" while the nursing home industry wants agencies to act as consultants rather than cops. The task of regulating nursing homes in the United States is primarily carried out by units of state…

  20. Reducing energy costs in nursing homes

    SciTech Connect

    Not Available

    1981-01-01

    The handbook presents ideas and techniques for energy conservation in nursing homes. Case studies were developed of nursing homes located in different parts of the US. The typical nursing home assessed was proprietary, of intermediate-care level, medicaid-certified, and had less than 200 beds. Specific energy conservation measures were analyzed to determine the energy and dollar savings that could be realized. These include reducing heat loss through the building shell; reducing hot water costs; recovering the heat generated by dryers; reducing lighting costs; reducing heating and cooling costs, and analyzing fuels and fuel rates. A case for converting electric clothes dryers to gas was analyzed. (MCW)

  1. Humanism in nursing homes: the impact of top management.

    PubMed

    Castle, Nicholas G; Ferguson, Jamie C; Hughes, Kevin

    2009-01-01

    We provide a review of ways in which top managers of nursing homes can provide or impact the humanistic component of care provided in their facilities. We describe the nursing home top management team; the role of top managers in nursing homes; the role of top managers as leaders in the nursing home; the literature examining the impact of top managers in nursing homes; and, examine developments in the nursing home industry that are influencing (or could potentially influence) the humanistic components of care. We conclude with suggestions for top managers, nursing home owners, and policy makers to create more caring humanistic environments. Suggestions include resident-directed care initiatives and culture change.

  2. Giving home care nurses a hand.

    PubMed

    Dannenfeldt, D

    1994-05-01

    Parkview Episcopal Medical Center in Pueblo, Colo., joined forces with Patient Care Technologies of Atlanta to automate the hospital's home care department--traditionally one of the least automated areas of health care. Home care nurses using hand-held computers now make more home visits in the time previously devoted to paperwork. These extra visits generate $876,000 in additional annual revenues. What's more, automation has improved the quality of the home care division's record-keeping and patient care.

  3. Trends in unionization of nursing homes.

    PubMed

    Sojourner, Aaron J; Grabowski, David C; Chen, Min; Town, Robert J

    Unionization may have important implications for the delivery of nursing home care, but little is known about this phenomenon. Since 1985, the proportion of nursing home workers covered by union contracts declined from 14.6% to 9.9%. The first national-scale data on facility-level unionization reveals that unions are more common in nursing homes with more residents, in hospital-based or chain-affiliated facilities, and in facilities serving a higher proportion of Medicaid patients. With new federal policy proposals aimed at substantially lowering the cost of organizing workers, policymakers will want to consider the potential impact of nursing home unionization on worker, patient, and market outcomes.

  4. Home Care Nursing Improves Cancer Symptom Management

    Cancer.gov

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  5. Mealtimes in nursing homes. The role of nursing staff.

    PubMed

    Pearson, Alan; Fitzgerald, Mary; Nay, Rhonda

    2003-06-01

    The literature suggests that food service largely has become identified as a non-nursing duty and as a task that should be completed as quickly as possible. This conflicts with the evidence that social interaction at mealtimes has the potential to promote well being. Using observational and interview techniques, the social and functional context of meal service in 10 nursing homes was examined in this study. The findings from the observation of and interviews with staff are reported in this article. Three broad themes describing the cultural practices of nursing home staff during mealtimes are identified as follows: maintaining personal identity, assisting individuals to eat, and maintaining interaction. Alongside residents' general outward acquiescence to the service, nurses did not see problems and deficiencies with the service observed by the researchers or reported by the residents. Recommendations to improve mealtime service in nursing homes have been put forward in an effort to enlighten staff. PMID:12830655

  6. [Nursing care at home and secularism].

    PubMed

    Lecointre, Brigitte

    2015-12-01

    The question of secularism, long-time confined to schools and the relationships between the Church and State, is today being raised in the field of public health. Nurses are directly affected and are integrating this dimension of secularism into their care practices. A private practice nurse describes the effect these changes are having on her practice in patients' homes. PMID:26654502

  7. Older nurses embrace hospice & home care.

    PubMed

    Macdonald, N Jean

    2004-05-01

    Older nurses who have "done their time" in hospital wards sometimes find home health or hospice nursing a welcome and rewarding change of pace. While their maturity often gives them the empathy and compassion that can bring comfort to their patients, their extensive experience supplies them with the knowledge they need to work confidently in an independent setting. PMID:15168577

  8. Eldercare at Home: Choosing a Nursing Home

    MedlinePlus

    ... at home. Problems such as frequent incontinence, dangerous wandering, inability to sleep at night (a disrupted sleep - ... a security system to prevent confused residents from wandering out of the building? Are there accessible outdoor ...

  9. Nursing home reform: its legislative history and economic impact upon nursing homes.

    PubMed

    Emerzian, A D; Stampp, T

    1993-01-01

    This article presents a legislative history of Subtitle C of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87). It articulates the philosophy behind the act and describes the economic and organizational impact on the nursing home industry. Additionally, data from Connecticut nursing homes are analyzed to determine the factors that affect the costs of complying with OBRA.

  10. Nursing assistant turnover in nursing homes and need satisfaction.

    PubMed

    Caudill, M; Patrick, M

    1989-06-01

    1. Level of Maslow's Hierarchy of Needs is basic physiological needs measured by salary, adequate housing, and food. Attainment of these needs increased the length of stay of nursing assistants in nursing homes. 2. Safety and security (level 2) influenced length of stay of nursing assistants. Those with benefits of retirement, vacation, and holiday pay tended to have less turnover. 3. Praise by the patient and family was most important to nursing assistants. Belonging to a peer group and praise by charge nurse also decreased turnover of nursing assistants (level 3). 4. Level 4, self-esteem measured by input into decisions and being able to criticize, increased length of stay of nursing assistants.

  11. Nursing home closures and quality of care.

    PubMed

    Castle, Nicholas G

    2005-02-01

    The purpose of this research is to examine the relationship between quality of care in nursing homes and their likelihood of closure. We hypothesize that lower-quality facilities will be more likely to close than higher-quality facilities. Using the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychotropic medication use as quality measures from approximately 12,000 facilities from 1992 to 1998, the author examine cross-sectional and change score relationships between these measures and a nursing home's likelihood of closure. The descriptive analysis shows that 621 nursing homes closed in this time period, and the results for physical restraint use were robust in their positive association with closures in most analyses lending some support for this study's hypothesis. However, overall, the author concludes that nursing facility closures are relatively rare events. And the likelihood of closure, even for poor-quality facilities, is low. PMID:15643031

  12. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  13. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  14. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  15. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  16. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  17. Hand Hygiene Practices Reported by Nurse Aides in Nursing Homes.

    PubMed

    Castle, Nicholas; Handler, Steven; Wagner, Laura

    2016-03-01

    Information from nurse aides describing their opinions of hand hygiene practices in nursing homes including perceived barriers to hand hygiene is presented. The information comes from a questionnaire developed for this investigation, with items addressing compliance, facility guidelines and protocols, training, hand washing facilities and materials, and hand washing barriers. Information from 4,211 nurse aides (response rate of 56%) working in a nationally representative sample of 767 nursing homes (participation rate = 51%) is used. We find that 57.4% of nurse aides comply with hand washing when caring for residents most of the time, while 21.7% always comply. With facilities, 43.3% sometimes check that hand washing is performed. In summary, self-reported compliance was poor, and facilities and materials were often lacking. These findings are useful in identifying issues and interventions, including the need for further initiatives to address hand hygiene practices.

  18. Prevalence of violence towards nursing staff in Slovenian nursing homes

    PubMed Central

    Eržen, Ivan

    2016-01-01

    Abstract Introduction The purpose of this research was to identify the prevalence of violence towards nursing staff in Slovenian nursing homes. Methods For the purpose of this study, a non-experimental sampling method was employed, using a structured questionnaire as a data collection instrument (n=527). The contents of the questionnaire proved valid and reliable, with a high enough degree of internal consistency (Cronbach Alpha minimum 0.82). Results The nursing staffs working in nursing homes for senior citizens are at high risk of violence. In the last year, the employees were most often faced with verbal violence (71.7%), physical violence (63.8%) and sexual violence (35.5%). 35.5% of employees suffered injuries at their working place. During aggressive outbursts of nursing home residents, employees particularly experience vulnerability, fear and insecurity. Conclusion There is a need for a comprehensive approach to tackle workplace violence. Some psychiatric health care facilities have already introduced certain measures in this field, and reduction of workplace violence proves that it is possible to reduce aggressive outbursts of patients. After conducting further quantitative research, which would expose detailed characteristics and the background of such violence, it would be sensible to develop similar measures in the field of health care in nursing homes. PMID:27703541

  19. Nursing home diversification requires caution by hospitals.

    PubMed

    Monroe, S M

    1988-12-01

    Hospital executives considering diversifying into long-term care for the elderly need to understand the ways the nursing home acquisition market and the long-term care industry have changed in the past two years and how to best respond to those changes. Diversification into the nursing home business must be carefully planned, taking into account such factors as state Medicaid reimbursement policies; the respective advantages of buying an existing facility or constructing a new one; the need for executives with expertise in long-term care; and the financial requirements of the proposal.

  20. 38 CFR 17.58 - Evacuation of community nursing homes.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... to another facility that meets certain minimum standards, as set forth in 38 CFR 51.59(c)(1... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes....

  1. 38 CFR 17.58 - Evacuation of community nursing homes.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... to another facility that meets certain minimum standards, as set forth in 38 CFR 51.59(c)(1... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes....

  2. 38 CFR 17.58 - Evacuation of community nursing homes.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... to another facility that meets certain minimum standards, as set forth in 38 CFR 51.59(c)(1... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes....

  3. What Is Nursing Home Quality and How Is It Measured?

    ERIC Educational Resources Information Center

    Castle, Nicholas G.; Ferguson, Jamie C.

    2010-01-01

    Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO)…

  4. Geropsychology Training in a VA Nursing Home Setting

    ERIC Educational Resources Information Center

    Karel, Michele J.; Moye, Jennifer

    2005-01-01

    There is a growing need for professional psychology training in nursing home settings, and nursing homes provide a rich environment for teaching geropsychology competencies. We describe the nursing home training component of our Department of Veterans Affairs (VA) Predoctoral Internship and Geropsychology Postdoctoral Fellowship programs. Our…

  5. Medicaid Nursing Home Pay for Performance: Where Do We Stand?

    ERIC Educational Resources Information Center

    Arling, Greg; Job, Carol; Cooke, Valerie

    2009-01-01

    Purpose: Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make…

  6. Registered Nurse Staffing Mix and Quality of Care in Nursing Homes: A Longitudinal Analysis

    ERIC Educational Resources Information Center

    Kim, Hongsoo; Harrington, Charlene; Greene, William H.

    2009-01-01

    Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…

  7. Cost-effectiveness implications based on a comparison of nursing home and home health case mix.

    PubMed

    Kramer, A M; Shaughnessy, P W; Pettigrew, M L

    1985-10-01

    Case-mix differences between 653 home health care patients and 650 nursing home patients, and between 455 Medicare home health patients and 447 Medicare nursing home patients were assessed using random samples selected from 20 home health agencies and 46 nursing homes in 12 states in 1982 and 1983. Home health patients were younger, had shorter lengths of stay, and were less functionally disabled than nursing home patients. Traditional long-term care problems requiring personal care were more common among nursing home patients, whereas problems requiring skilled nursing services were more prevalent among home health patients. Considering Medicare patients only, nursing home patients were much more likely to be dependent in activities of daily living (ADLs) than home health patients. Medicare nursing home and home health patients were relatively similar in terms of long-term care problems, and differences in medical problems were less pronounced than between all nursing home and all home health patients. From the standpoint of cost-effectiveness, it would appear that home health care might provide a substitute for acute care hospital use at the end of a hospital stay, and appears to be a more viable option in the care of patients who are not severely disabled and do not have profound functional problems. The Medicare skilled nursing facility, however, is likely to continue to have a crucial role in posthospital care as the treatment modality of choice for individuals who require both highly skilled care and functional assistance.

  8. Health Information Technology and Nursing Homes

    ERIC Educational Resources Information Center

    Liu, Darren

    2009-01-01

    Nursing homes are considered lagging behind in adopting health information technology (HIT). Many studies have highlighted the use of HIT as a means of improving health care quality. However, these studies overwhelmingly do not provide empirical information proving that HIT can actually achieve these improvements. The main research goal of this…

  9. [Nurse telephone support at home during chemotherapy].

    PubMed

    Despiau, Frédéric; Bombail, Marie; Leches, Céline; Montastruc, Marion; Gladieff, Laurence; Delord, Jean-Pierre

    2015-01-01

    An innovative scheme has been operational since 2013 at the Institut Claudius Regaud in Toulouse, aimed at patients undergoing chemotherapy. After an initial consultation, patients receive regular telephone support at home from expert nurses between treatments. The scheme helps to improve patient management and reinforce the community-hospital link. PMID:26365645

  10. Nursing home employee attitudes towards AIDS.

    PubMed

    Sarvela, P D; Moore, J R

    1989-01-01

    This article examines nursing home employee attitudes toward issues related to AIDS and is based on data collected from 343 employees from 13 nursing homes in rural, small towns in sourthern Illinois during the spring of 1988. Results suggested that a large majority of the employees had negative attitudes toward people with AIDS. For example, 67% of the sample indicated that it was more important to limit the spread of AIDS rather than to protect the rights of people with AIDS. Furthermore, 42% suggested that AIDS patients should be sent to sanitariums to protect others from AIDS. Greater than half of the sample (56%) responded that they would feel uncomfortable around people with AIDS. About one third (32%) felt that being around someone with AIDS would put their health in danger, and 21% would be afraid to even take care of a family member with AIDS. With regard to job-specific AIDS attitudes, 51% indicated that health-care workers should be able to refuse to work with AIDS patients, and another 46% felt that hospitals and nursing homes should be able to refuse to admit people with AIDS. In addition to these and other results, this article presents a brief discussion concerning possible educational strategies which might be implemented in this setting to reduce the negative attitudes of these employees. Considerations are also presented for nursing home administrators, who face the problem of developing effective policies for dealing with the rising number of AIDS patients who will be admitted to their facilities.

  11. Introducing Psychiatric Care into Nursing Homes.

    ERIC Educational Resources Information Center

    Sakauye, Kenneth M.; Camp, Cameron J.

    1992-01-01

    Consultation-liaison psychiatry program in teaching nursing home helped implement six guiding principles, including make patient human to the staff; assume no behavior is random; look for depression or psychosis as source of problems; reduce medications and medication doses; create more homelike environment; and use conditions in which learning…

  12. Measuring Staff Turnover in Nursing Homes

    ERIC Educational Resources Information Center

    Castle, Nicholas G.

    2006-01-01

    Purpose: In this study the levels of staff turnover reported in the nursing home literature (1990-2003) are reviewed, as well as the definitions of turnover used in these prior studies. With the use of primary data collected from 354 facilities, the study addresses the various degrees of bias that result, depending on how staff turnover is defined…

  13. Kansas Nursing Home Medication Aide Curriculum. Revised.

    ERIC Educational Resources Information Center

    Bartel, Myrna J.; Fornelli, Linda K.

    This curriculum guide is designed to aid Kansas instructors in conducting a course for teaching nursing home medication aides. Covered first are various introductory topics such as the role and responsibilities of medication aides, pharmacodynamics, forms in which medication is now available, common medical abbreviations, mathematics and weights…

  14. Peer Counselor Training for Nursing Home Residents.

    ERIC Educational Resources Information Center

    Scharlach, Andrew E.

    1988-01-01

    Designed model program designed to increase social support for newly admitted nursing home residents through a structured program of peer counseling. Found residents (N=15) receiving peer counseling improved somewhat on measures of social conditioning; peer counselors (N=15) improved with regard to appearance and grooming. (Author/ABL)

  15. Is There Evidence of Cream Skimming among Nursing Homes following the Publication of the Nursing Home Compare Report Card?

    ERIC Educational Resources Information Center

    Mukamel, Dana B.; Ladd, Heather; Weimer, David L.; Spector, William D.; Zinn, Jacqueline S.

    2009-01-01

    Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream…

  16. End-of-Life Decision Making for Nursing Home Residents with Dementia: A Survey of Nursing Home Social Services Staff

    ERIC Educational Resources Information Center

    Lacey, Debra

    2006-01-01

    The purpose of this survey was to describe nursing home social services staff roles and perceptions related to end-of-life medical decision making for nursing home residents in endstage dementia. Using a self-designed questionnaire, 138 nursing home social services staff from across New York State answered questions about advance directives,…

  17. Nursing home disaster planning and response: a policy perspective.

    PubMed

    Zork, Freya

    2014-12-01

    Nursing home residents are among the most vulnerable members of a community threatened by disaster. In the past, insufficient planning has resulted in preventable morbidity and mortality for nursing home residents during disasters. State and federal policies have evolved over the past decade to improve oversight of nursing home disaster planning. However, continued political advocacy is critically necessary to promote the safety of nursing home residents during potential emergencies and, especially, naturally occurring disasters. Opportunities exist to improve nursing home disaster response, including better preparation and training and dedicated resources for data management and oversight.

  18. Quality of service in nursing homes.

    PubMed

    Curry, A; Stark, S

    2000-11-01

    This paper illustrates the relevance of using the Servqual instrument as a service quality measurement tool in the healthcare context. The expectations and perceptions of nursing home residents and their relatives are compared and contrasted to determine the priorities and satisfaction levels of both groups with respect to the services provided. Some interesting differences emerged between the two respondent groups, which gave more accurate and relevant pointers as to potential areas of future improvement. Because a number of nursing homes were surveyed, it was also possible to ascertain which homes might serve as useful examples of the best practice and which were in need of improvement action. In frail, elderly respondent groups it is not especially easy to elicit views as to quality of service. Servqual, carefully and sympathetically designed and applied, proved appropriate for this task. PMID:11142067

  19. [Nursing home care on the move; a stock-taking overview of 5 substitution projects nursing home care].

    PubMed

    Schols, J M; Theunissen, N J; Borst, V; Sinnema, M E

    1995-02-01

    An inventory was made of 5 substitute care projects in old people's homes, performed by the nursing home in Geertruidenberg. Data were gathered by semi-structured interviews and enquiries. The general goal of substitution of nursing home care for outdoor patients is to provide complementary outreaching nursing home services, by which real nursing home admittance can be postponed or avoided. In fact, in many cases substitution care appears to avoid nursing home admittance. In 1991-1993 there were 144 participants in these projects, from which only 11 at least were admitted to the nursing home. In the near future however, the quality of these outreaching nursing home projects has to be improved, especially on aspects as: continuity and methodology of care and with respect to the multidisciplinary approach. At last the financial support of these projects appears to be complicated and uncertain. A structural solution for this problem is urgent too.

  20. Private Investment Purchase and Nursing Home Financial Health

    PubMed Central

    Cadigan, Rebecca Orfaly; Stevenson, David G; Caudry, Daryl J; Grabowski, David C

    2015-01-01

    Objective To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Data Sources Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998–2010. Study Design Regression specification incorporating facility and time fixed effects. Principal Findings We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company’s real estate holdings. Conclusions Private investment acquired facilities are an important feature of today’s nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. PMID:25104476

  1. Optimizing Antibiotic Use in Nursing Homes Through Antibiotic Stewardship.

    PubMed

    Sloane, Philip D; Huslage, Kirk; Kistler, Christine E; Zimmerman, Sheryl

    2016-01-01

    Antibiotic stewardship is becoming a requirement for nursing homes. Programs should be interdisciplinary and multifaceted; should have support from nursing home administrators; and should aim to promote antibiotics only when needed, not just in case. Recommended components include use of evidence-based guidelines; ongoing monitoring of antibiotic prescriptions, cultures, and study results; monitoring of health outcomes; use of nursing home-specific antibiograms; regular reporting and feedback to medical providers and nurses; and education of residents and families. PMID:27621341

  2. Nursing home nurses' perceptions of emergency transfers from nursing homes to hospital: A review of qualitative studies using systematic methods.

    PubMed

    O'Neill, Barbara; Parkinson, Lynne; Dwyer, Trudy; Reid-Searl, Kerry

    2015-01-01

    The aim is to describe nursing home nurses' perceptions around emergency transfers to hospital. Transfers are costly and traumatic for residents, and efforts are underway to avoid hospitalization. Nurses play a key role in transfers, yet their views are underreported. A systematic review of qualitative studies was undertaken, guided by Joanna Briggs Institute methods. From seven reviewed studies, it was clear nursing home nurses are challenged by the complexity of the transfer process and understand their need for appropriate clinical knowledge, skills and resources. Communication is important, yet nurses often use persuasive and targeted communication. Ambiguity, strained relationships and negative perceptions of residents' experiences around hospitalization contribute to conflict and uncertainty. Nurses are more confident when there is a plan. Transferring a resident is a complex process and special skills, knowledge and resources are required, but may be lacking. Efforts to formalize the transfer process and improve communication and collaboration amongst all stakeholders is needed and would be well received. PMID:26163012

  3. 25 die in nursing home.

    PubMed

    Demers, D P

    1981-01-01

    On July 14, 1980, at approximately 9:30 pm, a fire in the Extendicare Skilled Nursing Facility in Mississauga, Ontario, resulted in the deaths of 25 patients, most of them elderly. The area of origin of the accidental fire was a patient room on the top floor of the three-story, fire-resistive building. Significant factors that contributed to the fatalities in this fire were rapid fire development, the failure to extinguish the fire in its incipient stage, failure to keep the door to the room of origin closed, improper staff actions, and delayed alarm to the fire department.

  4. The economies of scale for nursing home care.

    PubMed

    Chen, Li-Wu; Shea, Dennis G

    2004-03-01

    Using a modified hybrid short-term operating cost function and a national sample of nursing homes in 1994, the authors examined the scale economies of nursing home care. The results show that scale economies exist for Medicare postacute care, with an elasticity of -0.15 and an optimal scale of around 4,000 patient days annually. However, more than 68 percent of nursing homes in the analytic sample produced Medicare days at a level below the optimal scale. The financial pressures resulting from the implementation of a prospective payment system for Medicare skilled nursing facilities may further reduce the quantity of Medicare days served by nursing homes. In addition, the results show that chain-owned nursing homes do not have lower short-term operating costs than do independent facilities. This indicates that the rationale behind recent increasing horizontal integration among nursing homes may not be seeking greater cost efficiency but some other consideration.

  5. The Roles and Functions of Medical Directors in Nursing Homes.

    PubMed

    Nanda, Aman

    2015-03-03

    The medical director is an important member of the healthcare team in a nursing home, and is responsible for overall coordination of care and for implementation of policies related to care of the residents in a nursing home. The residents in nursing homes are frail, medically complex, and have multiple disabilities. The medical director has an important leadership role in assisting nursing home administration in providing quality care that is consistent with current standards of care. This article provides an overview of roles and functions of the medical director, and suggests ways the medical director can be instrumental in achieving excellent care in today's nursing facilities.

  6. 77 FR 72738 - Contracts and Provider Agreements for State Home Nursing Home Care

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-06

    ... AFFAIRS 38 CFR Part 51 RIN 2900-AO57 Contracts and Provider Agreements for State Home Nursing Home Care... agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking is required to implement a change in law that revises how VA will pay for care provided to these veterans...

  7. The 24-h recall instrument for home nursing to measure the activity profile of home nurses: development and psychometric testing.

    PubMed

    De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Gosset, Christiane; Heyden, Isabelle; Van Geert, Michel; Moons, Philip

    2015-01-01

    Home health care today is challenged by a shift from an acute to a chronic health-care model, moving the focus of care from the hospital to home-care setting. This increased focus on care at home emphasizes the need for an efficient, effective, and transparent management of home health care. However, it is not precisely known what home-care nurses do; what kind of care is received by patients; what the performance of home nurses is; and what the impact of the increasing need for home nursing is on the current and future role of home nurses. In this respect, it is necessary to gain a clear insight into the activity profile of home nurses, but there is no gold standard to measure their activities. This study reports on the development and psychometric testing of the '24-hour recall instrument for home nursing' to measure the activity profile of home nurses. Five home nurses in Belgium, simultaneously with the researcher, registered the performed activities in a total of 69 patients, using the 24-h recall instrument for home nursing. The validity and the interrater reliability of this instrument were high: the proportions that observed agreement were very high; the strength of kappa agreement was substantial to almost perfect; the prevalence index showed great variety; and the bias index was low. The findings in this study support the validity evidence based on test content and the interrater reliability of the 24-h recall instrument. This instrument can help to shape practice and policy by making the home nursing profession more transparent: a clear insight into the kind of care that is provided by home nurses and is received by the patients in primary care contributes to the development of a clear definition of the role of home nurses in health care.

  8. The 24-h recall instrument for home nursing to measure the activity profile of home nurses: development and psychometric testing.

    PubMed

    De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Gosset, Christiane; Heyden, Isabelle; Van Geert, Michel; Moons, Philip

    2015-01-01

    Home health care today is challenged by a shift from an acute to a chronic health-care model, moving the focus of care from the hospital to home-care setting. This increased focus on care at home emphasizes the need for an efficient, effective, and transparent management of home health care. However, it is not precisely known what home-care nurses do; what kind of care is received by patients; what the performance of home nurses is; and what the impact of the increasing need for home nursing is on the current and future role of home nurses. In this respect, it is necessary to gain a clear insight into the activity profile of home nurses, but there is no gold standard to measure their activities. This study reports on the development and psychometric testing of the '24-hour recall instrument for home nursing' to measure the activity profile of home nurses. Five home nurses in Belgium, simultaneously with the researcher, registered the performed activities in a total of 69 patients, using the 24-h recall instrument for home nursing. The validity and the interrater reliability of this instrument were high: the proportions that observed agreement were very high; the strength of kappa agreement was substantial to almost perfect; the prevalence index showed great variety; and the bias index was low. The findings in this study support the validity evidence based on test content and the interrater reliability of the 24-h recall instrument. This instrument can help to shape practice and policy by making the home nursing profession more transparent: a clear insight into the kind of care that is provided by home nurses and is received by the patients in primary care contributes to the development of a clear definition of the role of home nurses in health care. PMID:24479985

  9. Measuring End-of-Life Care Processes in Nursing Homes

    ERIC Educational Resources Information Center

    Temkin-Greener, Helena; Zheng, Nan; Norton, Sally A.; Quill, Timothy; Ladwig, Susan; Veazie, Peter

    2009-01-01

    Purpose: The objectives of this study were to develop measures of end-of-life (EOL) care processes in nursing homes and to validate the instrument for measuring them. Design and Methods: A survey of directors of nursing was conducted in 608 eligible nursing homes in New York State. Responses were obtained from 313 (51.5% response rate) facilities.…

  10. The Influence of Consistent Assignment on Nursing Home Deficiency Citations

    ERIC Educational Resources Information Center

    Castle, Nicholas G.

    2011-01-01

    Objective: The association of consistent assignment of nurse aides (NAs) with quality of care and quality of life of nursing home residents is examined (using 5 groups of deficiency citations). Methods: Data used came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The…

  11. Job Satisfaction of Nurse Aides in Nursing Homes: Intent to Leave and Turnover

    ERIC Educational Resources Information Center

    Castle, Nicholas G.; Engberg, John; Anderson, Ruth; Men, Aiju

    2007-01-01

    Purpose: The relationship between job satisfaction of nurse aides and intent to leave and actual turnover after 1 year is examined. Design and Methods: Data came from a random sample of 72 nursing homes from 5 states (Colorado, Florida, Michigan, New York, and Oregon). From these nursing homes, we collected 1,779 surveys from nurse aides (a…

  12. Evaluation of a Nurse-Led Fall Prevention Education Program in Turkish Nursing Home Residents

    ERIC Educational Resources Information Center

    Uymaz, Pelin E.; Nahcivan, Nursen O.

    2016-01-01

    Falls are a major cause of morbidity and mortality among the elderly living in nursing homes. There is a need to implement and evaluate fall prevention programs in nursing homes to reduce the number of falls. The purpose of this research was to examine the effect of a nurse-led fall prevention education program in a sample of nursing home…

  13. Why Do They Stay? Job Tenure among Certified Nursing Assistants in Nursing Homes

    ERIC Educational Resources Information Center

    Wiener, Joshua M.; Squillace, Marie R.; Anderson, Wayne L.; Khatutsky, Galina

    2009-01-01

    Purpose: This study identifies factors related to job tenure among certified nursing assistants (CNAs) working in nursing homes. Design and Methods: The study uses 2004 data from the National Nursing Home Survey, the National Nursing Assistant Survey, and the Area Resource File. Ordinary least squares regression analyses were conducted with length…

  14. Nursing Home Quality as a Common Good

    PubMed Central

    Grabowski, David C.; Gruber, Jonathan; Angelelli, Joseph J.

    2009-01-01

    A long-standing assumption among economists is that nursing home quality is common across Medicaid and private-pay patients within a shared facility. However, there has been only limited empirical work addressing this issue. Using a unique individual level panel of residents of nursing homes from seven states, we exploit both within-facility and within-person variation in payer source and quality to examine this issue. We also test the robustness of these results across states with different Medicaid and private-pay rate differentials. Across various identification strategies, our results are consistent with the assumption of common quality across Medicaid and private-paying patients within facilities. PMID:20463859

  15. Family Perceptions of Geriatric Foster Family and Nursing Home Care.

    ERIC Educational Resources Information Center

    Braun, Kathryn L.; Rose, Charles L.

    1987-01-01

    Relatives (N=62) of matched pairs of patients in geriatric foster homes and nursing homes rated care provided to their relatives. Significantly more foster family patients had positive pre-placement attitudes than did nursing home patients. Upon follow-up, relatives of foster patients reported seeing more patient improvement, satisfaction,…

  16. Situating beyond the Social: Understanding the Role of Materiality in Danish Nursing Education

    ERIC Educational Resources Information Center

    Soffer, Ann Katrine B.

    2016-01-01

    Situated learning serves as an analytical framework for learning in a community of practice and has been widely used to understand the learning process that is entailed in becoming a nurse. Yet in this paper, the difficulties encountered with the original notion of situated learning once it is applied to contemporary Danish nursing education are…

  17. Organizational Characteristics Associated with Staff Turnover in Nursing Homes

    ERIC Educational Resources Information Center

    Castle, Nicholas G.; Engberg, John

    2006-01-01

    Purpose: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Design and Methods: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality,…

  18. Return to nursing home investment: Issues for public policy

    PubMed Central

    Baldwin, Carliss Y.; Bishop, Christine E.

    1984-01-01

    Because Government policy does much to determine the return available to nursing home investment, the profitability of the nursing home industry has been a subject of controversy since Government agencies began paying a large portion of the Nation's nursing home bill. Controversy appears at several levels. First is the rather narrow concern, often conceived in accounting terms, of the appropriate reimbursement of capital-related expense under Medicaid and Medicare. Second is the concern about how return to capital affects the flow of investment into nursing homes, leading either to inadequate access to care or to over-capacity. Third is the concern about how-sources of return to nursing home investment affect the pattern of nursing home ownership and the amount of equity held by owners since the pattern of ownership and amount of equity have been linked to quality of care. PMID:10310945

  19. OBRA 1987 and the quality of nursing home care.

    PubMed

    Kumar, Virender; Norton, Edward C; Encinosa, William E

    2006-03-01

    Because minimum government standards for quality regulate only part of the market failure, they may have unintended effects. We present a general theory of how government regulation of quality of care may affect different market segments, and test the hypotheses for the nursing home market. OBRA 1987 was a sweeping government reform to improve the quality of nursing home care. We study how the effect of OBRA on the quality of nursing home care, measured by resident outcomes, varied with nursing home profitability. Using a semi-parametric method to control for the endogenous effects of regulation, we found that this landmark legislation had a negative effect on the quality of care in less profitable nursing homes, but improved the quality in more profitable nursing homes during the initial period after OBRA. But, this legislation had no statistically significant effect in the later period when the regulation was weakly enforced.

  20. Preparing Nurses To Care for the Elderly: Clinical Placements in Nursing Homes.

    ERIC Educational Resources Information Center

    Portnoy, Frances L.; Tanner, Fredericka

    This paper offers documents from and descriptions of a collaborative project in clinical placements of student nurses in nursing homes as part of a nursing education program. The original project participants were the College of Nursing at the University of Massachusetts/Boston (UMass/Boston); the division of Nursing at the University of…

  1. Assessing nursing homes' capacity to create and sustain improvement.

    PubMed

    Scott, Jill; Vojir, Carol; Jones, Katherine; Moore, Laurie

    2005-01-01

    Nursing home leadership and staff in 32 nursing homes were surveyed using an adaptation of Shortell's Organization and Management Survey. An earlier psychometric assessment of Shortell's communication and leadership scales raised concerns about the reliability of these scales in the nursing home setting. Exploratory factor analysis was performed to determine if another scale structure should be considered. Using principal-axis extraction with a varimax rotation, a 5-factor solution that accounted for 47% of item variance was defined.

  2. The cumulative influence of conflict on nursing home staff.

    PubMed

    Abrahamson, Kathleen; Anderson, James G; Anderson, Marilyn M; Suitor, J Jill; Pillemer, Karl

    2010-01-01

    Nursing staff burnout is a significant challenge in the delivery of nursing home care. Using a representative sample of nursing staff working within the nursing home setting, our analysis addressed the influence of conflict with residents' families on the burnout experience of staff. Through the use of computer simulation modeling we were able to assess the cumulative effects of conflict between staff and families. Findings indicated that conflict with the residents' families increased both burnout and dissatisfaction among nursing staff. The burnout experience of nursing staff peaked with initial episodes of conflict, then leveled off as simulated conflict with family members continued. Because previous research has indicated that burnout tends to peak early in nurses' career cycle, the finding that initial episodes of conflict have a strong influence on nursing staff burnout highlights the importance of interpersonal conflict within nursing homes in both individual and institutional outcomes.

  3. Future distinguishing competencies of baccalaureate-educated registered nurses in nursing homes.

    PubMed

    Backhaus, Ramona; Verbeek, Hilde; van Rossum, Erik; Capezuti, Elizabeth; Hamers, Jan P H

    2015-01-01

    In view of the likelihood that the complexity of care required by those admitted to nursing homes will continue to increase, an expert consensus study was conducted to reach consensus on the competencies which distinguish baccalaureate-educated registered nurses from other nursing staff working in nursing homes. Thirty-one international experts, identified through literature and our professional network, participated in a two-round web-based survey and an expert meeting. Experts reached consensus on 16 desirable competencies, including some not traditionally associated with nursing expertise e.g. being a team leader, role model and coach within the nursing team. These findings suggest that revision of current nursing curricula, nurse training programs and nursing home job profiles might be needed to meet the medically and psychologically complex needs of nursing home residents. PMID:26283584

  4. The effect of chain ownership on nursing home costs.

    PubMed Central

    McKay, N L

    1991-01-01

    Although it is commonly assumed that chain ownership will result in lower costs due to economies of scale, the empirical evidence with respect to the effect of chain ownership on nursing home costs is mixed. Chain for-profit nursing homes will have a cost advantage over independent for-profit homes only if there are firm-level (multiple-home) economies of scale. For the study population of Texas nursing homes in 1983, cost structures differed sufficiently across ownership types to warrant estimating separate cost functions by ownership type. The results indicate that, when other factors affecting cost are held constant, chain homes have lower average costs than independent homes at intermediate and high levels of output, but higher average costs at low and very high levels of output. The results highlight the importance of considering whether or not to pool data across ownership categories when estimating nursing home cost functions. PMID:1826676

  5. Hand hygiene deficiency citations in nursing homes.

    PubMed

    Castle, Nicholas; Wagner, Laura; Ferguson, Jamie; Handler, Steven

    2014-02-01

    Hand hygiene (HH) is recognized as an effective way to decrease transmission of infections. Little research has been conducted surrounding HH in nursing homes (NHs). In this research, deficiency citations representing potential problems with HH practices by staff as identified in the certification process conducted at almost all US NHs were examined. The aims of the study were to identify potential relationships between these deficiency citations and characteristics of the NH and characteristics of the NH environment. We used a panel of 148,900 observations with information primarily coming from the 2000 through 2009 Online Survey, Certification, And Reporting data (OSCAR). An average of 9% of all NHs per year received a deficiency citation for HH. In the multivariate analyses, for all three caregivers examined (i.e., nurse aides, Licensed Practical Nurses, and Registered Nurses) low staffing levels were associated with receiving a deficiency citation for HH. Two measures of poor quality (i.e., [1] Quality of care deficiency citations and [2] J, K, or L deficiency citations, that is deficiency citations with a high extent of harm and/or more residents affected) were also associated with receiving a deficiency citation for HH. Given the percentage of NHs receiving deficiency citations for potential problems with HH identified in this research, more attention should be placed on this issue.

  6. Person-Environment Interactions Contributing to Nursing Home Resident Falls

    PubMed Central

    Hill, Elizabeth E.; Nguyen, Tam H.; Shaha, Maya; Wenzel, Jennifer A.; DeForge, Bruce R.; Spellbring, Ann Marie

    2011-01-01

    Although approximately 50% of nursing home residents fall annually, the surrounding circumstances remain inadequately understood. This study explored nursing staff perspectives of person, environment, and interactive circumstances surrounding nursing home falls. Focus groups were conducted at two nursing homes in the mid-Atlantic region with the highest and lowest fall rates among corporate facilities. Two focus groups were conducted per facility: one with licensed nurses and one with geriatric nursing assistants. Thematic and content analysis revealed three themes and 11 categories. Three categories under the Person theme were Change in Residents’ Health Status, Decline in Residents’ Abilities, and Residents’ Behaviors and Personality Characteristics. There were five Nursing Home Environment categories: Design Safety, Limited Space, Obstacles, Equipment Misuse and Malfunction, and Staff and Organization of Care. Three Interactions Leading to Falls categories were identified: Reasons for Falls, Time of Falls, and High-Risk Activities. Findings highlight interactions between person and environment factors as significant contributors to resident falls. PMID:20077985

  7. Are nursing homes adequately staffed? The silent epidemic of malnutrition and dehydration in nursing home residents. Until mandatory staffing standards are created and enforced, residents are at risk.

    PubMed

    Shipman, Debra; Hooten, Jack

    2007-07-01

    Providing care to produce positive resident outcomes is an ethical duty of nursing home staff. Research has shown that inadequate staffing levels present an increased health risk to nursing home residents. Nursing home residents may experience dehydration and malnutrition caused by inadequate staffing. Continued research in the area of nutrition and dehydration in nursing home residents may positively influence changes in staffing levels at nursing homes. Currently, residents living in understaffed nursing homes and not receiving proper care are the victims. It is time for nurses to forcefully lobby for national mandatory nurse staffing standards.

  8. Certified Nursing Assistants’ Explanatory Models of Nursing Home Resident Depression

    PubMed Central

    Piven, Mary Lynn; Anderson, Ruth A.; Colón-Emeric, Cathleen S.; Sandelowski, Margarete

    2008-01-01

    In this study, we explored how Certified Nursing Assistants (CNAs) understood resident depression. Interviews with 18 CNAs, working in two nursing homes were guided by Kleinman’s Explanatory Models of Illness framework. Interview data were content analyzed and CNAs’ descriptions of depression were compared to the MDS 2.0 Mood Screen and to DSM-IV-TR Depression Criteria. CNAs identified causes, signs, and symptoms of depression, but they were unsure about the duration and normalcy of depression in residents. Although they had no formal training, CNAs felt responsible for detecting depression and described verbal and non-verbal approaches that they used for emotional care of depressed residents. CNAs hold potential to improve the detection of depression and contribute to the emotional care of residents. Attention to knowledge deficits and facility barriers may enhance this capacity. PMID:18390825

  9. Effects of Nursing Practice Environments on Quality Outcomes in Nursing Homes

    PubMed Central

    Flynn, Linda; Liang, Yulan; Dickson, Geri L.; Aiken, Linda H.

    2012-01-01

    The objective of this study was to determine whether nurse staffing levels and modifiable characteristics of the nursing practice environment are associated with important quality indicators represented by the percentage of residents with pressure ulcers and numbers of deficiency citations in nursing homes. A cross-sectional design linked nurse survey data, aggregated to the facility level, with Nursing Home Compare, a publicly available federal database containing nursing home–level measures of quality. The facility sample consisted of 63 Medicare- and Medicaid-certified nursing homes in New Jersey, and the nurse survey sample comprised 340 registered nurses providing direct resident care. Characteristics of the practice environment were measured using the Practice Environment Scale of the Nursing Work Index, included in the nurse survey. The total number of deficiency citations, the percentage of residents with pressure ulcers, nurse staffing levels, and facility characteristics were extracted from the Nursing Home Compare database. Results indicated that a supportive practice environment was inversely associated with the percentage of residents with pressure ulcers and fully mediated the effect of profit status on this important outcome. The nursing practice environment and facility size explained 25% of the variance in quality deficiencies. There were no associations between staffing levels and quality indicators. Findings indicate that administrative initiatives to create environments that support nursing practice may hold promise for improving quality indicators in nursing homes. PMID:21054327

  10. Workplace Stress and Ethical Challenges Experienced by Nursing Staff in a Nursing Home

    ERIC Educational Resources Information Center

    Vondras, Dean D.; Flittner, Diane; Malcore, Sylvia A.; Pouliot, Gregory

    2009-01-01

    This research explores the workplace stress and ethical challenges reported by healthcare staff in a nursing home. A brief self-report survey was administered to 44 members of the nursing staff in a not-for-profit nursing home. The survey included items that elicited identification of specific workplace stressors and ethical challenges and global…

  11. The silent customers: measuring customer satisfaction in nursing homes.

    PubMed

    Kleinsorge, I K; Koenig, H F

    1991-12-01

    Nursing home administrators concerned with customer satisfaction and quality of care need a tool to assess and monitor ongoing satisfaction of nursing home residents and family members. The authors report a preliminary effort to develop such a survey using focus groups. PMID:10115898

  12. Learning Opportunities for Nurses Working within Home Care

    ERIC Educational Resources Information Center

    Lundgren, Solveig

    2011-01-01

    Purpose: The purpose of this study is to explore home care nurses' experience of learning in a multicultural environment. Design/methodology/approach: The study was based on qualitative research design. Data were collected through repeated interviews with registered home care nurses working in a multicultural area. The data were analyzed through a…

  13. Establishing and Maintaining Intimate Relationships among Nursing Home Residents.

    ERIC Educational Resources Information Center

    Crose, Royda

    1990-01-01

    Argues that nursing home mental health counselors should address nursing home residents' need for assistance in conflict resolution, having meaningful social interactions, and in developing and maintaining feelings of self-worth. Describes benefits of group therapy approach using life review format to help build basic trust and feelings of…

  14. Cherished Possessions and Adaptation of Older People to Nursing Homes.

    ERIC Educational Resources Information Center

    Wapner, Seymour; And Others

    1990-01-01

    Examined cherished possessions and adaptation to nursing home of 100 nursing home residents. Findings showed those with possessions were better adapted; possessions served functions of historical continuity, comfort, and belongingness; and more women than men had cherished possessions. (Author/PVV)

  15. Improving Nursing Home Staff Knowledge and Attitudes about Pain

    ERIC Educational Resources Information Center

    Jones, Katherine R.; Fink, Regina; Pepper, Ginny; Hutt, Eveyln; Vojir, Carol P.; Scott, Jill; Clark, Lauren; Mellis, Karen

    2004-01-01

    Purpose: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. Design and Methods: Twelve nursing homes participated in this intervention study: six…

  16. What home healthcare nurses should know about fraud and abuse.

    PubMed

    Michael, Janet E

    2003-08-01

    Home care nurses provide a critical link in all services provided by a home health agency. This article outlines basic information nurses can use to understand fraud and abuse regulations, see the importance of corporate compliance programs, and recognize the potential impact a focus on fraud and abuse has on their practice.

  17. What home healthcare nurses should know about fraud and abuse.

    PubMed

    Michael, J E

    1999-09-01

    Home care nurses provide a critical linh in all services provided by a home health agency. This article outlines basic information nurses can use to understand fraud and abuse regulations, see the importance of corporate compliance programs, and recognize the potential impact a focus on fraud and abuse has on their practice.

  18. Why Won't Physicians Make Nursing Home Visits?

    ERIC Educational Resources Information Center

    Mitchell, Janet B.; Hewes, Helene T.

    1986-01-01

    Michigan physicians (N=930) were asked whether they made nursing home visits and if not, why not. A typology was developed to differentiate among various physician types based on reasons given. Six physician types were found, each identified with a different policy lever that could be used to encourage them to treat nursing home patients. (Author)

  19. [Internal and external assessment of nursing home residents' satisfaction].

    PubMed

    Sanchez, Stéphane; Cohen, Nadia; Bertin-Hugault, François; Sanchez, Marc Antoine; Dramé, Moustapha; Denormandie, Philippe

    2016-01-01

    Quality improvement procedures and measuring the satisfaction of nursing home residents is a major priority. A study assessed the differences between the results of a survey conducted by internal staff and of one carried out by an external service provider to evaluate the satisfaction of the residents of a nursing home.

  20. The silent customers: measuring customer satisfaction in nursing homes.

    PubMed

    Kleinsorge, I K; Koenig, H F

    1991-12-01

    Nursing home administrators concerned with customer satisfaction and quality of care need a tool to assess and monitor ongoing satisfaction of nursing home residents and family members. The authors report a preliminary effort to develop such a survey using focus groups.

  1. Geriatric Training Needs of Nursing-Home Physicians

    ERIC Educational Resources Information Center

    Lubart, Emily; Segal, Refael; Rosenfeld, Vera; Madjar, Jack; Kakuriev, Michael; Leibovitz, Arthur

    2009-01-01

    Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training…

  2. Are ADNs Prepared to Be Home Health Nurses?

    ERIC Educational Resources Information Center

    Neighbors, Marianne; Monahan, Frances D.

    1997-01-01

    Responses from 132 of 350 home health nurses identified techniques and skills associate degree nurses (ADNs) should acquire to work for home health agencies. Accredited ADN programs reported that only 24 of the techniques are taught in all programs and 55 of the skills are taught in 90% of the programs. (SK)

  3. Patients' Anticipation of Stress in Nursing Home Care.

    ERIC Educational Resources Information Center

    Stein, Shayna; And Others

    1985-01-01

    Examined anticipation of stresses in 223 patients recently admitted to nursing homes, who completed the stresses in Institutional Care Scale (SIC). Factor analysis revealed five factors significantly related to psychological and physical variables. Suggests using SIC for admission screening in nursing homes. Appendix contains the SIC. (NRB)

  4. The emergence of Medicare hospice care in US nursing homes.

    PubMed

    Miller, S C; Mor, V

    2001-11-01

    Although Medicare-financed hospice care has been provided in nursing homes in the USA for over 10 years, very little is known regarding the use of this government health care benefit in nursing homes. Using resident assessment data and hospice and inpatient Medicare claim data from five US states, we were able to identify and describe nursing home residents receiving hospice care between 1992 and 1996, and their hospice utilization patterns. Six per cent of all dying nursing home residents received hospice care at some point in time and, in 1996, an estimated 24% of all Medicare hospice patients in the five study states received hospice while in a nursing home. Of those residents beginning hospice care after nursing home admission, 48% were 85 years or older, 70% were female, 94% were white, 76% were unmarried and 62% had a non-cancer principal diagnosis. The average length of stay in the hospice programme for residents receiving hospice care while in the nursing home was 90.6 days, the median 35 and the mode 2. Hospice care in US nursing homes is a prevalent model of care that appears further to extend the Medicare hospice benefit to older adults who are female and to those with non-cancer diagnoses. Lengths of stay in the programme are similar to those observed in the community and the average length of stay is substantially shorter than previously estimated by an influential government study.

  5. Organizational Climate Determinants of Resident Safety Culture in Nursing Homes

    ERIC Educational Resources Information Center

    Arnetz, Judith E.; Zhdanova, Ludmila S.; Elsouhag, Dalia; Lichtenberg, Peter; Luborsky, Mark R.; Arnetz, Bengt B.

    2011-01-01

    Purpose of the Study: In recent years, there has been an increasing focus on the role of safety culture in preventing costly adverse events, such as medication errors and falls, among nursing home residents. However, little is known regarding critical organizational determinants of a positive safety culture in nursing homes. The aim of this study…

  6. Social Support in Elderly Nursing Home Populations: Manifestations and Influences

    ERIC Educational Resources Information Center

    Rash, Elizabeth M.

    2007-01-01

    The purpose of this study was to describe the characteristics of social support and the influencing factors on social support in nursing home environments. Observations and staff questionnaires from two central Florida nursing homes were used in this grounded theory study to answer the following questions: (1) How is social support manifested? and…

  7. Nursing Home Litigation and Tort Reform: A Case for Exceptionalism

    ERIC Educational Resources Information Center

    Studdert, David M.; Stevenson, David G.

    2004-01-01

    The medical malpractice crisis that is currently spreading across the United States bears many similarities to earlier crises. One novel aspect of the current crisis is the explicit inclusion of litigation against nursing homes as a target of reform. Encouraged by the nursing home industry, policymakers are considering the extension of…

  8. Medicare Part D and the Nursing Home Setting

    ERIC Educational Resources Information Center

    Stevenson, David G.; Huskamp, Haiden A.; Newhouse, Joseph P.

    2008-01-01

    Purpose: The purpose of this article is to explore how the introduction of Medicare Part D is changing the operations of long-term-care pharmacies (LTCPs) and nursing homes, as well as implications of those changes for nursing home residents. Design and Methods: We reviewed existing sources of information and interviewed stakeholders across…

  9. Observational Learning among Older Adults Living in Nursing Homes

    ERIC Educational Resources Information Center

    Story, Colleen D.

    2010-01-01

    The purpose of this study was to evaluate learning by older adults living in nursing homes through observational learning based on Bandura's (1977) social learning theory. This quantitative study investigated if older adults could learn through observation. The nursing homes in the study were located in the midwestern United States. The…

  10. Caring relationships in home-based nursing care - registered nurses' experiences.

    PubMed

    Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin

    2013-01-01

    The caring relationship between the nurse and the person in need of nursing care has been described as a key concept in nursing and could facilitate health and healing by involving the person's genuine needs. The aim of this study was to explore registered nurses' experiences of their relationships with persons in need of home-based nursing care. Individual interviews with nurses (n=13 registered nurses and 11 district nurses) working in home-based nursing care were performed. A thematic content analysis was used to analyze the transcribed interviews and resulted in the main theme Good nursing care is built on trusting relationship and five sub-themes, Establishing the relationship in home-based nursing care, Conscious efforts maintains the relationship, Reciprocity is a requirement in the relationship, Working in different levels of relationships and Limitations and boundaries in the relationship. A trusting relationship between the nurse and the person in need of healthcare is a prerequisite for good home-based nursing care whether it is based on face-to-face encounters or remote encounters through distance-spanning technology. A trusting relationship could reduce the asymmetry of the caring relationship which could strengthen the person's position. The relationship requires conscious efforts from the nurse and a choice of level of the relationship. The trusting relationship was reciprocal and meant that the nurse had to communicate something about themself as the person needs to know who is entering the home and who is communicating through distance-spanning technology.

  11. Nursing home employee perceptions of culture change.

    PubMed

    Palmer, Jennifer A; Meterko, Mark; Zhao, Shibei; Berlowitz, Dan; Mobley, Esther; Hartmann, Christine W

    2013-07-01

    This study examined nursing home staff members' comfort levels with specific culture change scenarios and observed whether there were differences by occupation. We conducted a cross-sectional survey of 218 staff members in all occupational categories at four Veterans Health Administration Community Living Centers (i.e., nursing homes). Staff indicated their comfort level using a 9-point scale (1 = not at all comfortable to 9 = extremely comfortable). The culture change scenarios were divided into three subscales: Resident Safety (5 items), Resident Experience (5 items), and Staff Experience (2 items). Overall, respondents were slightly uncomfortable with the scenarios (overall mean = 4.57). Staff reported least comfort with the Resident Safety subscale (mean = 3.63) and most comfort with the Resident Experience subscale (mean = 5.65), with significant differences within these two subscales by occupational category. Existent power differentials among staff may influence comfort levels with culture change. Assessing staff comfort with culture change may help guide implementation efforts in a strategic manner. PMID:23777296

  12. Nursing home employee perceptions of culture change.

    PubMed

    Palmer, Jennifer A; Meterko, Mark; Zhao, Shibei; Berlowitz, Dan; Mobley, Esther; Hartmann, Christine W

    2013-07-01

    This study examined nursing home staff members' comfort levels with specific culture change scenarios and observed whether there were differences by occupation. We conducted a cross-sectional survey of 218 staff members in all occupational categories at four Veterans Health Administration Community Living Centers (i.e., nursing homes). Staff indicated their comfort level using a 9-point scale (1 = not at all comfortable to 9 = extremely comfortable). The culture change scenarios were divided into three subscales: Resident Safety (5 items), Resident Experience (5 items), and Staff Experience (2 items). Overall, respondents were slightly uncomfortable with the scenarios (overall mean = 4.57). Staff reported least comfort with the Resident Safety subscale (mean = 3.63) and most comfort with the Resident Experience subscale (mean = 5.65), with significant differences within these two subscales by occupational category. Existent power differentials among staff may influence comfort levels with culture change. Assessing staff comfort with culture change may help guide implementation efforts in a strategic manner.

  13. West Virginia nursing homes: are they up to the standard?

    PubMed

    Madero, Guillermo; Neitch, Shirley

    2014-01-01

    Quality measurement and performance monitoring are under continuous assessment in Nursing Homes (NH). Through this research project we assess the quality of care provided in the NH in the state of West Virginia by publicly accessible quality measurements. The methodology for this research study was through the retrieval of data from the Nursing Home Compare website in which a total of 80 NH were located and analyzed. The results demonstrate that more than 50% of NH in West Virginia are at or above the national average when compared using the Five Star Rating System by CMS, in overall rating (59%), health inspections (57%), nursing home staffing (63%) and quality measures (55%). Contrary to the prevailing reputation, the nursing homes of West Virginia are at or above the nation's average in overall rating, health inspections, nursing home staffing and quality measures.

  14. Experiences of Technology Integration in Home Care Nursing

    PubMed Central

    Johnson, KA; Valdez, RS; Casper, GR; Kossman, SP; Carayon, P; Or, CKL; Burke, LJ; Brennan, PF

    2008-01-01

    The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients. PMID:18999245

  15. Diversion, transition programs target nursing homes' status quo.

    PubMed

    Reinhard, Susan C

    2010-01-01

    As millions of Americans age and exercise their preference for long-term care in the least restrictive environment, policymakers search for ways to increase community-based services. A new federal program--Money Follows the Person--is off to a slow but promising start. The program's "downstream" approach moves residents out of nursing homes and into community care settings. For example, states with mature nursing home transition programs have managed to relocate 25-35 percent of their nursing home residents to assisted living. Other programs successfully using "upstream" strategies to keep people out of nursing homes have not been widely copied. The challenge for policymakers is to maintain funding and flexibility so that nursing homes are no longer the default option for older adults and people with disabilities.

  16. Situating beyond the social: understanding the role of materiality in Danish nursing education.

    PubMed

    Soffer, Ann Katrine B

    2016-10-01

    Situated learning serves as an analytical framework for learning in a community of practice and has been widely used to understand the learning process that is entailed in becoming a nurse. Yet in this paper, the difficulties encountered with the original notion of situated learning once it is applied to contemporary Danish nursing education are introduced. One issue that has arisen is the analytical requirement for an educational program to be a homogeneous, singular, and social phenomenon thereby discounting the varied and different sites and materialities found within nursing education. By using the materiality of the hospital bed as an empirical example of the way materiality also shapes practices, an alternative understanding of situated participation can emerge. This approach allows different sites and materialities to be conceptualized as equally genuine parts of the situated leaning framework. I suggest the notion of multi-configured learning, which captures the heterogeneity and materiality encountered during ethnographic fieldwork at a Danish nursing school.

  17. Improving nursing documentation for private-duty home health care.

    PubMed

    Borchers, E L

    1999-06-01

    Private-duty, home health care agencies have struggled in assuring compliance with accurate and complete nursing documentation. In this descriptive study, the author reports on an improvement and innovation project in a private-duty, home health care agency aimed at improving nursing documentation, as measured in chart review audits. Initial strategies were directed toward revising the documentation system, with implementation of a flow record, and conducting group nurse education. These efforts had a minimal effect on improving documentation compliance. A major, multifocus strategy was then implemented. The educational component stressed pre- and posttest. The chart audit tool was revised to track individual nurse behaviors. Nurses were mentored when documentation did not meet standards. Lastly, the nurse job description and corresponding performance appraisal document were revised to clarify nurse responsibility and strengthen nurse accountability; progressive discipline was initiated when warranted. Significant and sustained improvement was subsequently realized.

  18. Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001-11.

    PubMed

    Li, Yue; Harrington, Charlene; Mukamel, Dana B; Cen, Xi; Cai, Xueya; Temkin-Greener, Helena

    2015-12-01

    Recent increases in state Medicaid payments to nursing homes have the potential to reduce disparities in nurse staffing between facilities with high and low concentrations of racial/ethnic minority residents. Analyses of nursing home and state policy survey data for the period 2001-11 suggest that registered nurse and licensed practical nurse staffing levels increased slightly during this period, regardless of racial/ethnic minority resident concentration. Adjusted disparities in registered nurse hours per resident day between nursing homes with high and low concentrations of minority residents persisted, although they were reduced. Certified nursing assistant hours per patient day increased in nursing homes with low concentrations of minorities but decreased in homes with high concentrations, creating a new disparity. Overall, increases in state Medicaid payment rates to nursing homes were associated with improvements in staffing and reduced staffing disparities across facilities, but the adoption of case-mix payments had the opposite effect. Further reforms in health care delivery and payment are needed to address persistent disparities in care between nursing homes serving higher proportions of minority residents and those serving lower proportions, and to prevent unintended exacerbations of such disparities.

  19. Sexual Abuse of Older Residents in Nursing Homes: A Focus Group Interview of Nursing Home Staff

    PubMed Central

    Iversen, Maria Helen; Kilvik, Astrid; Malmedal, Wenche

    2015-01-01

    The objective of this study was to increase knowledge of sexual abuse against older residents in nursing homes. A qualitative approach was used. Through a focus group interview with staff in nursing homes, the aim was to reveal employees' thoughts, experiences, and attitudes. Findings from the focus group interview show that sexual abuse of older residents is a taboo topic among health professionals. Acts of sexual abuse are difficult to imagine; it is hard to believe that it occurs. The fact that staff are not aware that it could happen, or have a hard time believing that it actually happens, can amplify the residents' vulnerable position as potential victims of abuse, and it makes it even more challenging to report or uncover such acts. The study highlights the need for education of all health care workers in Norway as well as more research on sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step towards addressing sexual abuse of the aged in a more appropriate way. Further research must aim to reveal more about this taboo area. PMID:26078879

  20. Analysis of nursing home capital reimbursement systems

    PubMed Central

    Boerstler, Heidi; Carlough, Tom; Schlenker, Robert E.

    1991-01-01

    An increasing number of States are using a fair-rental approach for reimbursement of nursing home capital costs. In this study, two variants of the fair-rental capital-reimbursement approach are compared with the traditional cost-based approach in terms of after-tax cash flow to the investor, cost to the State, and rate of return to investor. Simulation models were developed to examine the effects of each capital-reimbursement approach both at specific points in time and over various periods of time. Results indicate that although long-term costs were similar for the three systems, both fair-rental approaches may be superior to the traditional cost-based approach in promoting and controlling industry stability and, at the same time, in providing an adequate return to investors. PMID:10110878

  1. Nursing home case mix in Wisconsin. Findings and policy implications.

    PubMed

    Arling, G; Zimmerman, D; Updike, L

    1989-02-01

    Along with many other states, Wisconsin is considering a case mix approach to Medicaid nursing home reimbursement. To support this effort, a nursing home case mix model was developed from a representative sample of 410 Medicaid nursing home residents from 56 facilities in Wisconsin. The model classified residents into mutually exclusive groups that were homogeneous in their use of direct care resources, i.e., minutes of direct care time (weighted for nurse skill level) over a 7-day period. Groups were defined initially by intense, Special, or Routine nursing requirements. Within these nursing requirement categories, subgroups were formed by the presence/absence of behavioral problems and dependency in activities of daily living (ADL). Wisconsin's current Skilled/Intermediate Care (SNF/ICF) classification system was analyzed in light of the case mix model and found to be less effective in distinguishing residents by resource use. The case mix model accounted for 48% of the variance in resource use, whereas the SNF/ICF classification system explained 22%. Comparisons were drawn with nursing home case mix models in New York State (RUG-II) and Minnesota. Despite progress in the study of nursing home case mix and its application to reimbursement reform, methodologic and policy issues remain. These include the differing operational definitions for nursing requirements and ADL dependency, the inconsistency in findings concerning psychobehavioral problems, and the problem of promoting positive health and functional outcomes based on models that may be insensitive to change in resident conditions over time. PMID:2493112

  2. Terminal patients in Belgian nursing homes: a cost analysis.

    PubMed

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Vanden Berghe, Paul; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2013-06-01

    Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 € per patient during the final month of life. Total mean nursing home costs per patient of 3,822 € for patients receiving usual care were higher than costs of 2,456 € for patients receiving palliative care (p = 0.068). Higher costs of usual care were driven by higher hospitalization costs (p < 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients.

  3. Contextual determinants of US nursing home racial/ethnic diversity.

    PubMed

    Davis, Jullet A; Weech-Maldonado, Robert; Lapane, Kate L; Laberge, Alex

    2014-03-01

    We hypothesized that for-profit/chain affiliated nursing homes, those in states with higher Medicaid reimbursement, and those in more competitive markets would have greater resident racial/ethnic diversity than nursing homes not meeting these criteria. Using 2004 Online Survey, Certification and Reporting data, Minimum Data Set, Lewis Mumford Center for Comparative Urban and Regional Research data, and the Area Resource File, we included U.S. Medicare/Medicaid certified nursing homes (N = 8950) located in 310 Metropolitan Statistical Areas. The dependent variable quantified facility-level multiracial diversity. Ordinary least squares regression showed support for the hypothesized relationships: for-profit/chain affiliated nursing homes were more diverse than nursing homes in all other ownership/chain member categories, while higher Medicaid per-diem rates, greater residential diversity, and stronger market competition were also positively associated with nursing home racial/ethnic composition. Results suggest there is room for policy changes to achieve equitable access to all levels of nursing home services for minority elders. PMID:24581072

  4. Explaining differences in remuneration rates of nursing homes in Germany.

    PubMed

    Mennicken, Roman; Augurzky, Boris; Rothgang, Heinz; Wasem, Jürgen

    2014-05-01

    Remuneration rates of German nursing homes are prospectively negotiated between long-term care insurance (LTCI) and social assistance on the one side and nursing homes on the other. They differ considerably across regions while there is no evidence for substantial differences in care provision. This article explains the differences in the remuneration rates by observable characteristics of the nursing home, its residents and its region with a special focus on the largest federal state of North Rhine Westphalia, in which the most expensive nursing homes are located. We use data from the German Federal Statistical Office for 2005 on all nursing homes that offer full-time residential care for the elderly. We find that differences in remuneration rates can partly be explained by exogenous factors. Controls for residents, nursing homes and district characteristics explain roughly 30 % of the price difference; 40 % can be ascribed to a regionally different kind of negotiation between nursing homes and LTCI. Thirty percent of the raw price difference remains unexplained by observable characteristics.

  5. Contextual determinants of US nursing home racial/ethnic diversity.

    PubMed

    Davis, Jullet A; Weech-Maldonado, Robert; Lapane, Kate L; Laberge, Alex

    2014-03-01

    We hypothesized that for-profit/chain affiliated nursing homes, those in states with higher Medicaid reimbursement, and those in more competitive markets would have greater resident racial/ethnic diversity than nursing homes not meeting these criteria. Using 2004 Online Survey, Certification and Reporting data, Minimum Data Set, Lewis Mumford Center for Comparative Urban and Regional Research data, and the Area Resource File, we included U.S. Medicare/Medicaid certified nursing homes (N = 8950) located in 310 Metropolitan Statistical Areas. The dependent variable quantified facility-level multiracial diversity. Ordinary least squares regression showed support for the hypothesized relationships: for-profit/chain affiliated nursing homes were more diverse than nursing homes in all other ownership/chain member categories, while higher Medicaid per-diem rates, greater residential diversity, and stronger market competition were also positively associated with nursing home racial/ethnic composition. Results suggest there is room for policy changes to achieve equitable access to all levels of nursing home services for minority elders.

  6. Growth of the teaching nursing home. The Veterans Administration experience.

    PubMed

    Rubenstein, L Z; Wieland, D; Pearlman, R A; Grover, P; Mabry, J

    1990-01-01

    Nursing homes are becoming increasingly involved with medical education, and the Veterans Administration (VA) has been particularly active in this movement. We conducted a system-wide survey of VA nursing home facilities to determine the degree to which they participate in medical and other professional training and the features associated with such training. Of the 116 VA nursing homes in 1987, 113 (97.4%) returned completed questionnaires. Compared to "standard" VA facilities (n = 85), "teaching" nursing homes (n = 28)--those in which physicians received at least 20 hours of training per capita annually--were significantly larger, admitted and discharged significantly more patients per occupied bed, and placed a significantly larger proportion of discharged patients in noninstitutional community settings. Care costs in the teaching nursing homes were slightly but not significantly higher, despite significant increases in levels of professional staffing and amounts of training activities in all disciplines. During the survey year, teaching nursing homes provided training experiences for 440 students, residents, and fellows in internal and rehabilitation medicine, as well as for 2,700 other health professionals. The growth of teaching nursing homes in the VA system appears to be associated with positive changes in the pattern of health-care delivery, and it is increasing the number of health-care professionals trained in long-term care.

  7. Terminal patients in Belgian nursing homes: a cost analysis.

    PubMed

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Vanden Berghe, Paul; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2013-06-01

    Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 € per patient during the final month of life. Total mean nursing home costs per patient of 3,822 € for patients receiving usual care were higher than costs of 2,456 € for patients receiving palliative care (p = 0.068). Higher costs of usual care were driven by higher hospitalization costs (p < 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. PMID:22367732

  8. The Relationship Between Registered Nurses and Nursing Home Quality: An Integrative Review (2008-2014).

    PubMed

    Dellefield, Mary Ellen; Castle, Nickolas G; McGilton, Katherine S; Spilsbury, Karen

    2015-01-01

    Nursing home care is expensive; second only to acute hospital care for inpatient Medicare costs. The increased focus on costs of care accrued by Medicare beneficiaries in nursing homes presents a valuable opportunity for registered nurses (RNs) to further demonstrate quantitatively the value they add to the capacity of the nursing home nursing skill mix to provide cost-effective and efficient quality care. Most of the studies included in this review consistently reported that higher RN staffing and higher ratios of RNs in the nursing skill mix are related to better NH quality. Concerns about the costs of employing more highly skilled RNs and directors of nursing that have the potential to positively influence members of the nursing skill mix will continue to influence nursing home industry hiring practices. For both the advancement of nursing as an applied science and the benefit of society at large, nursing researchers are challenged to better demonstrate how the increased presence of a RN on each shift has the potential to enhance the cost effectiveness, efficiency, and quality of nursing homes.

  9. 42 CFR 431.704 - Nursing homes designated by other terms.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the...

  10. 42 CFR 431.704 - Nursing homes designated by other terms.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the...

  11. 42 CFR 431.704 - Nursing homes designated by other terms.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the...

  12. 42 CFR 431.704 - Nursing homes designated by other terms.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the...

  13. 42 CFR 431.704 - Nursing homes designated by other terms.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the...

  14. Infections in Nursing Homes: Epidemiology and Prevention Programs.

    PubMed

    Montoya, Ana; Cassone, Marco; Mody, Lona

    2016-08-01

    This review summarizes current literature pertaining to infection prevention in nursing home population including post-acute care patients and long-term care residents. Approximately 2 million infections occur each year and more than one-third of older adults harbor multidrug-resistant organisms in this setting. Surveillance, hand hygiene, isolation precautions, resident and employee health programs, education, and antibiotic stewardship are essential elements of infection prevention and control programs in nursing homes. This article discusses emerging evidence suggesting the usefulness of interactive multimodal bundles in reducing infections and antimicrobial resistance, thereby enhancing safety and quality of care for older adults in nursing homes.

  15. Measuring healthcare disparities and racial segregation in Missouri nursing homes.

    PubMed

    Chang, Yishih J; Siegel, Bruce; Wilkerson, Gail

    2012-01-01

    Measuring and, ultimately, addressing disparities in long-term care quality continue to be a challenge. Although literature suggests that disparities in healthcare quality exist and nursing homes remain relatively segregated, healthcare professionals and policymakers stand to benefit from improvements in measuring both racial segregation and healthcare disparities. This paper quantifies the relationships between healthcare disparities and racial segregation using the disparities quality index and dissimilarity index. Results suggested that the more segregated the nursing homes, the greater the observed disparities. Multivariate regression analysis indicated that the proportion of Black residents in nursing homes is the variable that best predicts disparities.

  16. Hospitalizations of nursing homes residents: the role of reimbursement policies.

    PubMed

    Ashton, Toni

    2014-01-23

    Factors which contribute to hospitalization of nursing home residents are multiple and complex. They include dimensions of the policy setting as well as patient management practices. In seeking interventions to reduce such hospitalizations, most research has focussed on changing patient management. But provider reimbursement policies may also influence the decision to hospitalize nursing home residents. This includes payments to hospitals and general practitioners as well as to the nursing homes themselves. Differences in payment methods may mean that interventions that work well in one setting do not work well in another.This is a commentary on http://www.ijhpr.org/content/3/1/2/.

  17. Measuring healthcare disparities and racial segregation in Missouri nursing homes.

    PubMed

    Chang, Yishih J; Siegel, Bruce; Wilkerson, Gail

    2012-01-01

    Measuring and, ultimately, addressing disparities in long-term care quality continue to be a challenge. Although literature suggests that disparities in healthcare quality exist and nursing homes remain relatively segregated, healthcare professionals and policymakers stand to benefit from improvements in measuring both racial segregation and healthcare disparities. This paper quantifies the relationships between healthcare disparities and racial segregation using the disparities quality index and dissimilarity index. Results suggested that the more segregated the nursing homes, the greater the observed disparities. Multivariate regression analysis indicated that the proportion of Black residents in nursing homes is the variable that best predicts disparities. PMID:22059384

  18. Nursing home cost and ownership type: evidence of interaction effects.

    PubMed

    Arling, G; Nordquist, R H; Capitman, J A

    1987-06-01

    Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed. PMID:3301746

  19. Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.

    PubMed

    Heeke, Sheila; Wood, Felecia; Schuck, Jennifer

    2014-01-01

    A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template. PMID:23938358

  20. Encounters in Home-Based Nursing Care - Registered Nurses’ Experiences

    PubMed Central

    Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin

    2013-01-01

    The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses’ experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care. PMID:23847697

  1. Job satisfaction of rural public and home health nurses.

    PubMed

    Juhl, N; Dunkin, J W; Stratton, T; Geller, J; Ludtke, R

    1993-03-01

    Based on Vroom's expectancy theory, this study was conducted to identify differences in job satisfaction between nurses working in public health settings, and staff nurses and administrators working in both settings. Questionnaires containing an adaptation of a job satisfaction scale were mailed to all 258 registered nurses practicing in public health and home health settings (response rate 57%) in a rural midwestern state. Respondents were asked to rate their satisfaction with various dimensions of their jobs, as well as how important each aspect was to them. Although both groups of nurses reported low satisfaction with salary, public health nurses were significantly less satisfied with their salaries than were home health nurses (F = 32.96, P < or = 0.001); home health nurses, however, were significantly less satisfied with benefits/rewards (F = 11.85, P < or = 0.001), task requirements (F = 8.37, P < or = 0.05), and professional status (F = 5.30, P < or = 0.05). Although administrators did not differ significantly from staff nurses on job satisfaction, they did perceive organizational climate (F = 4.50, P < or = 0.05) to be an important feature of satisfaction. These differences may be partially explained by divergent salaries, roles, and responsibilities between public health and home health nurses. PMID:8516258

  2. Home Care Nursing via Computer Networks: Justification and Design Specifications

    PubMed Central

    Brennan, Patricia Flatley

    1988-01-01

    High-tech home care includes the use of information technologies, such as computer networks, to provide direct care to patients in the home. This paper presents the justification and design of a project using a free, public access computer network to deliver home care nursing. The intervention attempts to reduce isolation and improve problem solving among home care patients and their informal caregivers. Three modules comprise the intervention: a decision module, a communications module, and an information data base. This paper describes the experimental evaluation of the project, and discusses issues in the delivery of nursing care via computers.

  3. [Work related predictors for "satisfaction with dementia care" among nurses working in nursing homes].

    PubMed

    Schmidt, Sascha G; Palm, Rebecca; Dichter, Martin; Hasselhorn, Hans Martin

    2011-04-01

    In German nursing homes dementia care is gaining increasing relevance. Dementia care is known to bear the high risk of a substantial occupational burden among nursing staff. Within this context, the "nurses' satisfaction with the care for residents with dementia" is investigated. Secondary data of the German 3q-study is used to assess degrees of nurses' satisfaction with the care for residents with dementia and potential work related predictors. Data from 813 nurses and nursing aides working in 53 nursing homes were included. 42% of all nursing staff was dissatisfied with the care for residents with dementia in their institution, however, pronounced differences were found between the institutions. Registered nurses and nurses in leading positions were more dissatisfied. A multiple regression analysis indicates that high "quantitative demands", low "leadership quality" and "social interaction with other professions" are strong predictors for nurses' satisfaction with the care for residents with dementia. No association was found for "emotional demands" and "possibilities for development". The results indicate that the "nurses" satisfaction with the care for residents with dementia" may be a highly relevant work factor for nursing staff in nursing homes which deserves additional attention in practice and research. The high predictive power of several work organisational factors implies that preventive action should also include work organisational factors.

  4. The process of Danish nurses' professionalization and patterns of thought in the 20th century.

    PubMed

    Beedholm, Kirsten; Frederiksen, Kirsten

    2015-06-01

    In this article, we address how the professionalization process is reflected in the way Danish nursing textbooks present 'nursing' to new members of the profession during the 20th century. The discussion is based on a discourse analysis of seven Danish textbooks on basic nursing published between 1904 and 1996. The analysis was inspired by the work of Michel Foucault, in particular the concepts of rupture and rules of formation. First, we explain how the dominating role of the human body in nursing textbooks disappears in the mid-20th century. This transformation can of course be attributed to changes in tasks and responsibilities for nurses or to the implementation of increasing amounts of knowledge and theories from other disciplines than medicine into the nurses' knowledge base. However, inspired by Foucault, we consider these historical changes to be the conditions of possibilities and not causes. The second part of the analysis shows that along with 'the disappearance of the body', a second discursive change appears: the role of doctors and medicine changes fundamentally from about mid-20th century. Finally, we argue that this discursive reorganization enabling new patterns of thought to emerge was driven by a professional interest in describing nursing as an independent profession.

  5. Nurse Delegation in Home Care: Research Guiding Policy Change.

    PubMed

    Young, Heather M; Farnham, Jennifer; Reinhard, Susan C

    2016-09-01

    The current study evaluated nurse delegation in home care, a pilot program introduced in 2007 in New Jersey to promote home care options for consumers needing assistance with medical/nursing tasks. Findings on readiness for the program, barriers and facilitating factors, experience with the program, and recommendations are summarized and presented. Methods included surveys and interviews with participants in nurse delegation, observations of planning and implementation meetings, and review meeting minutes. Major findings were no negative outcomes for consumers, improvements in quality of life and quality of care for consumers, high readiness and increasing satisfaction with experience in delegation, perception of nurse delegation in home care as a valued option, and the challenges of ensuring adequate staffing. Subsequent changes in regulation in New Jersey are underway, translating this research into policy. [Journal of Gerontological Nursing, 42(9), 7-15.]. PMID:27571400

  6. Nursing Home eTool: Occupational Hazards in Long Term Care

    MedlinePlus

    ... Publications Newsroom Small Business Anti-Retaliation eTools Home : Nursing Home Scope | References | Site Map | Credits Nursing Home eTool Bloodborne Pathogens Ergonomics Dietary Laundry Maintenance ...

  7. Transforming nursing home culture: evidence for practice and policy.

    PubMed

    Zimmerman, Sheryl; Shier, Victoria; Saliba, Debra

    2014-02-01

    The nursing home culture change movement aims to improve resident quality of life and quality of care by emphasizing the deinstitutionalization of nursing home culture and focusing on person-centered care. This article briefly reviews the history of culture change, discusses some of the challenges related to culture change in nursing homes, and overviews the conceptualization and select models of culture change. Building from this background, it critiques current understanding, identifies critical research questions, and notes key issues arising during a workshop that addressed existing and emerging evidence in the field. This review and analysis provide a context for how 9 accompanying papers in this supplemental issue of The Gerontologist fill identified evidence gaps and provide evidence for future practice and policies that aim to transform nursing home culture. PMID:24443601

  8. Immunization roulette: influenza occurrence in five nursing homes.

    PubMed

    Christie, R W; Marquis, L L

    1985-08-01

    Immunization with A/Bangkok 1/79 (H3N2) vaccine appeared to be protective for immunized nursing home residents during an influenza outbreak in 1983. All thirteen deaths during the 4-month period of the study were among residents of two of five nursing homes where influenza immunization was low or nonexistent. Death certificates included a diagnosis of I-ILI for only six of the 13 decedents, showing that I-ILI may be greatly underreported as a cause of death, and skewing statistical evaluation of the impact of influenza in nursing home populations. The cost of protection is only a small fraction of the cost to society of caring for seriously ill nursing home residents with I-ILI who must be admitted to a hospital.

  9. [The threat of antibiotic resistance to nursing homes].

    PubMed

    Bonten, M J M

    2016-01-01

    Antibiotic resistance is considered a major threat to healthcare. The Dutch government recently announced additional measures to contain this threat, one of these being the creation of regional care networks dedicated to control antibiotic resistance. Among the anticipated activities of these networks is quantifying the prevalence of antibiotic resistance in nursing homes, through regular point-prevalence surveillance studies. There is a broadly felt belief that nursing homes might be a 'mer à boire' of antibiotic resistance. Although scientific data do not support that claim, it is nevertheless likely that the planned investigations will identify yet unknown clusters of ESBL-carriers, necessitating infection control measures. Given the absence of an acute problem and the consequences for nursing home management, staff and clients of point-prevalence surveillance studies, a staged approach for investigating antibiotic resistance in nursing homes should be considered. PMID:27650029

  10. Competition, information, and quality: Evidence from nursing homes.

    PubMed

    Zhao, Xin

    2016-09-01

    Economic theory suggests that competition and information can both be important for product quality, and yet evidence on how they may interact to affect quality is sparse. This paper estimates the impact of competition between nursing homes on their quality, and how this impact varies when consumers have better access to information. The effect of competition is identified using exogenous variation in the geographical proximity of nursing homes to their potential consumers. The change in information transparency is captured by the launch of the Five-Star Quality Rating System in 2009, which improved access to the quality information of nursing homes. We find that while the effect of competition on nursing home quality is generally rather limited, this effect becomes significantly stronger with increased information transparency. The results suggest that regulations on public quality reporting and on market structure are policy complements, and should be considered jointly to best improve quality.

  11. Can family caregiving substitute for nursing home care?

    PubMed

    Charles, Kerwin Kofi; Sevak, Purvi

    2005-11-01

    Informal care should be a substitute for nursing homes but empirical evidence often suggests the opposite. This may be because informal care receipt is positively correlated with unobserved negative health characteristics. We exploit variation in children's characteristics as instruments for informal care to provide Two-Stage Least Squares (TSLS) estimates of nursing home use among a sample of 6855 individuals from the 1993-2000 waves of the AHEAD survey. While OLS results suggest informal care is associated with greater future nursing home risk, TSLS estimates show that receipt of informal care statistically and substantially reduces the risk of nursing home entry. This finding has implications for Medicaid and private long-term care insurance markets.

  12. Assisted Living Expansion and the Market for Nursing Home Care

    PubMed Central

    Grabowski, David C; Stevenson, David G; Cornell, Portia Y

    2012-01-01

    Objective To analyze the effect of market-level changes in assisted living supply on nursing home utilization and resident acuity. Data Sources Primary data on the supply of assisted living over time were collected from 13 states from 1993 through 2007 and merged with nursing home-level data from the Online Survey Certification and Reporting System and market-level information from the Area Resource File. Study Design Least squares regression specification incorporating market and time-fixed effects. Principal Findings A 10 percent increase in assisted living capacity led to a 1.4 percent decline in private-pay nursing home occupancy and a 0.2–0.6 percent increase in patient acuity. Conclusions Assisted living serves as a potential substitute for nursing home care for some healthier individuals with greater financial resources, suggesting implications for policy makers, providers, and consumers. PMID:22578039

  13. The Quality Assessment Index (QAI) for measuring nursing home quality.

    PubMed Central

    Gustafson, D H; Sainfort, F C; Van Konigsveld, R; Zimmerman, D R

    1990-01-01

    There have been few detailed evaluations of measures of quality of care in nursing homes. This is unfortunate because it has meant that much research on factors affecting nursing home quality has used measures of questionable reliability and validity. Moreover, some measures currently in use have been developed using methodologies not based on solid conceptual grounds, offering little reason to expect them to have much internal or external validity. In this article we suggest characteristics that should be present in measures of nursing home quality, propose a methodology for the development of such measures, propose a specific nursing home quality measure (the Quality Assessment Index or QAI), and report the results of several tests of its validity and reliability. PMID:2184147

  14. [The threat of antibiotic resistance to nursing homes].

    PubMed

    Bonten, M J M

    2016-01-01

    Antibiotic resistance is considered a major threat to healthcare. The Dutch government recently announced additional measures to contain this threat, one of these being the creation of regional care networks dedicated to control antibiotic resistance. Among the anticipated activities of these networks is quantifying the prevalence of antibiotic resistance in nursing homes, through regular point-prevalence surveillance studies. There is a broadly felt belief that nursing homes might be a 'mer à boire' of antibiotic resistance. Although scientific data do not support that claim, it is nevertheless likely that the planned investigations will identify yet unknown clusters of ESBL-carriers, necessitating infection control measures. Given the absence of an acute problem and the consequences for nursing home management, staff and clients of point-prevalence surveillance studies, a staged approach for investigating antibiotic resistance in nursing homes should be considered.

  15. Incidence of Venous Thromboembolic Events Among Nursing Home Residents

    PubMed Central

    Gomes, Josephine P; Shaheen, Wassim H; Truong, Son V; Brown, Edward F; Beasley, Brent W; Gajewski, Byron J

    2003-01-01

    Chronic care facility stay has been shown to be an independent risk factor for venous thromboembolism. Review of the literature, however, reveals a paucity of data addressing the issue of venous thromboembolism in nursing home residents. The purpose of this study was to determine the incidence of venous thromboembolic events among nursing home residents. A retrospective cohort study was derived from data compiled in the State of Kansas Minimum Data Set (MDS) for nursing home residents from July 1, 1997 to July 1, 1998. A total of 18,661 residents (median age, 85 years, 74% female, 95% white) satisfied the study criteria. The outcome measures of the primary endpoint—development of a venous thromboembolic event (VTE)—were obtained from the MDS quarterly health assessments and the Medicare ICD-9 codes. We determined the incidence of VTE among nursing home residents as 1.30 events per 100 person-years of observation. PMID:14687280

  16. Transforming nursing home culture: evidence for practice and policy.

    PubMed

    Zimmerman, Sheryl; Shier, Victoria; Saliba, Debra

    2014-02-01

    The nursing home culture change movement aims to improve resident quality of life and quality of care by emphasizing the deinstitutionalization of nursing home culture and focusing on person-centered care. This article briefly reviews the history of culture change, discusses some of the challenges related to culture change in nursing homes, and overviews the conceptualization and select models of culture change. Building from this background, it critiques current understanding, identifies critical research questions, and notes key issues arising during a workshop that addressed existing and emerging evidence in the field. This review and analysis provide a context for how 9 accompanying papers in this supplemental issue of The Gerontologist fill identified evidence gaps and provide evidence for future practice and policies that aim to transform nursing home culture.

  17. The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

    ERIC Educational Resources Information Center

    Intrator, Orna; Feng, Zhanlian; Mor, Vince; Gifford, David; Bourbonniere, Meg; Zinn, Jacqueline

    2005-01-01

    Purpose: Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher…

  18. Self-Managed Work Teams in Nursing Homes: Implementing and Empowering Nurse Aide Teams

    ERIC Educational Resources Information Center

    Yeatts, Dale E.; Cready, Cynthia; Ray, Beth; DeWitt, Amy; Queen, Courtney

    2004-01-01

    Purpose: This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. Design and Methods: A quasi-experimental design is underway where certified nurse aide…

  19. Characteristics and Recruitment Paths of Certified Nursing Assistants in Rural and Urban Nursing Homes

    ERIC Educational Resources Information Center

    Probst, Janice C.; Baek, Jong-Deuk; Laditka, Sarah B.

    2009-01-01

    Context: Most nursing home care is provided by certified nursing assistants (CNAs), but little is known about rural CNAs. Purpose: To develop a representative geographic profile of the CNA workforce, focusing on paths leading to present job. Methods: Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey (NNAS), a…

  20. The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes

    ERIC Educational Resources Information Center

    Hyer, Kathryn; Thomas, Kali S.; Branch, Laurence G.; Harman, Jeffrey S.; Johnson, Christopher E.; Weech-Maldonado, Robert

    2011-01-01

    Objective: This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period. Methods: Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing…

  1. [Training and representation of dementia of workers in nursing homes].

    PubMed

    Sanchez, Stéphane; Gallin, Aurélie; Stefanuto, Muriel; Treffel, Sylvie; Antoine, Marc; Denormandie, Philippe

    2016-01-01

    Training could be a lever for improving the quality of care of residents with dementia in nursing homes by changing social representations. Beyond a simple assessment of acquired knowledge, a change of social representations could be indicative of a true appropriation of the content of the training. A study was carried out to assess the impact of training on nursing home caregivers' representations of dementia and Alzheimer's disease.

  2. [Training and representation of dementia of workers in nursing homes].

    PubMed

    Sanchez, Stéphane; Gallin, Aurélie; Stefanuto, Muriel; Treffel, Sylvie; Antoine, Marc; Denormandie, Philippe

    2016-01-01

    Training could be a lever for improving the quality of care of residents with dementia in nursing homes by changing social representations. Beyond a simple assessment of acquired knowledge, a change of social representations could be indicative of a true appropriation of the content of the training. A study was carried out to assess the impact of training on nursing home caregivers' representations of dementia and Alzheimer's disease. PMID:26976314

  3. What Is Nursing Home Quality and How Is It Measured?

    PubMed Central

    Castle, Nicholas G.; Ferguson, Jamie C.

    2010-01-01

    Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. Results: Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified throughout the review. Implications: We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed. PMID:20631035

  4. Lack of ear care knowledge in nursing homes

    PubMed Central

    Solheim, Jorunn; Shiryaeva, Olga; Kvaerner, Kari J

    2016-01-01

    Background Rising life expectancy means an increase in the number of elderly people with hearing loss in the population. Many elderly people live in nursing homes, with varying care needs. A substantial proportion of these people will need help with their hearing aids and other hearing devices. Objective The objective of the study has been to assess the knowledge, experience, skills, competence, and need for information of staff at nursing homes in relation to residents’ hearing loss and hearing aids. Materials and methods One hundred and ninety-five employees at seven nursing homes participated in the study. The main approach was a descriptive study, using questionnaires. Results The main findings are that 73% of informants found that many residents need help with their hearing aids. Only one-tenth report that they know enough about the residents’ hearing aids. Almost four out of five informants find that the residents become socially isolated as a result of hearing loss. Seventy-eight percent agree to some extent that more residents would benefit from hearing aids. Conclusion Staff at nursing homes have insufficient knowledge about hearing loss and hearing aids. Increased focus on the elderly with hearing impairment in nursing homes is needed. Contact between nursing homes and audiological specialists should be improved to best followup hearing loss and hearing aids. PMID:27757038

  5. Being a Nursing Home Resident: A Challenge to One's Identity

    PubMed Central

    Riedl, Maria; Them, Christa

    2013-01-01

    Going into a nursing home can turn out to be a critical life experience if elderly people are afraid of losing their independence and identity after having moved into a nursing home. In order to find out what nursing home residents need in their first year after having moved into a nursing home to maintain their identity and self-determination, 20 problem-orientated interviews with residents of three nursing homes in the Austrian province of Salzburg were conducted and analysed based on content analysis according to Mayring. The participants of this study resist against having decisions taken away from them and fight for their independence and identity. In order to be able to cope with these strains, they need the help of family members, professionals, and identity-forming conversations in new social networks in the nursing home. The study participants draw enough strength from their faith in order to fight for their independence. They develop a new identity close to their previous identity by maintaining autonomy and mobility with a clear focus on the future. PMID:23691302

  6. Workplace Literacy Partnership for Nursing Home Employees. Final Report.

    ERIC Educational Resources Information Center

    Continuing Education Inst., Needham, MA.

    The Continuing Education Institute (CEI) established a seven-member training collaborative to upgrade the literacy and English language skills of nursing assistants, dietary aides, and housekeeping workers employed in a chronic and acute care hospital and in five Massachusetts nursing homes. Three adult basic education (ABE) classes, five…

  7. Educating Home Healthcare Nurses About Heart Failure Self-Care.

    PubMed

    Ekong, Joyce; Radovich, Patti; Brown, Gina

    2016-10-01

    The ability of home healthcare nurses to effectively educate patients with heart failure (HF) on appropriate self-care is key to lowering the hospital readmission rates and other adverse outcomes. Evidence indicates, however, that nurses often lack current knowledge about HF self-care. Furthermore, patient education often fails to produce health literacy. Thus, this educational intervention for home healthcare nurses included content about key aspects of managing HF (e.g., diet, medications), as well as how to use the teach-back method during patient education. Pre- and posttesting (using the Nurses' Knowledge of HF Education Principles Questionnaire) and role-playing were used to evaluate the intervention delivered to 33 home care nurses. Findings exposed knowledge deficits regarding high-sodium foods, symptoms indicating deterioration, problematic weight gain, fluid management, as well as other topics related to HF. The education was partially effective in addressing these nurses' knowledge gaps. The evidence-based education for home healthcare nurses suggests that not only may nurses lack knowledge essential to teaching HF self-care; they may also lack effective patient education skills such as using the teach-back method. PMID:27677064

  8. A Comparative Analysis of the Relationship between Communication Apprehension and Loneliness for Elderly Nursing Home and Non-Nursing Home Residents.

    ERIC Educational Resources Information Center

    Downs, Valerie C.; And Others

    1988-01-01

    Utilizes the socio-environmental perspective to compare feelings of communication apprehension and perceived loneliness between nursing home and non-nursing home residents. Finds that communication apprehension consistently and significantly predicts perceived loneliness for non-nursing home residents, but fails to predict perceived loneliness for…

  9. Compliance with external hip protectors in nursing homes in Norway

    PubMed Central

    Forsen, L; Sandvig, S; Schuller, A; Sogaard, A

    2004-01-01

    Objectives: To investigate compliance with hip protector use. Design: Observational prospective study. Setting: 19 nursing homes (1040 beds). Subjects: All residents during an 18 month period were included in this study. Intervention: Hip protectors were introduced as a regular part of health care service for all residents. Residents at high risk were encouraged to use hip protectors regularly. Each nursing home had a contact person. Main outcome measures: The percentage of residents accepting the hip protector offer, probability of continued use, reasons for terminating use, and percentage of falls with hip protector were evaluated. Results: Fifty five percent of the residents accepted the hip protector offer. The percentage increased by age, but showed no significant dependence on gender, profession of the contact person, or size of nursing home. The probability of continued use showed no significant dependence on age and gender. Nursing homes with a nurse as contact person showed 51% higher risk of residents terminating regular hip protector use than nursing homes with a physiotherapist as contact person (relative risk (RR) 1.51, 95% confidence interval (CI) 1.11 to 2.05, p = 0.008). The corresponding result for large (75–92 beds) compared with small (24–68 beds) nursing homes was RR = 1.44 (95% CI 1.02 to 2.02, p = 0.036). Seventy six percent of 2323 falls occurred while using hip protectors. Conclusion: The contact person and size of the nursing home seemed to be important factors for continued use of hip protectors while age and gender seemed to be less important. PMID:15583255

  10. RN jurisdiction over nursing care systems in nursing homes: application of latent class analysis

    PubMed Central

    Corazzini, Kirsten N.; Anderson, Ruth A.; Mueller, Christine; Thorpe, Joshua M.; McConnell, Eleanor S.

    2015-01-01

    Background In the context of declining registered nurse (RN) staffing levels in nursing homes, professional nursing jurisdiction over nursing care systems may erode. Objectives The purpose of this study is to develop a typology of professional nursing jurisdiction in nursing homes in relation to characteristics of RN staffing, drawing upon Abbott's (1988) tasks and jurisdictions framework. Method The study was a cross-sectional, observational study using the 2004 National Nursing Home Survey (N=1,120 nursing homes). Latent class analysis tested whether RN staffing indicators differentiated facilities in a typology of RN jurisdiction, and compared classes on key organizational environment characteristics. Multiple logistic regression analysis related the emergent classes to presence or absence of specialty care programs in 8 clinical areas. Results Three classes of capacity for jurisdiction were identified, including ‘low capacity’ (41% of homes) with low probabilities of having any indicators of RN jurisdiction, ‘mixed capacity’ (26% of homes) with moderate to high probabilities of having higher RN education and staffing levels, and ‘high capacity’ (32% of homes) with moderate to high probabilities of having almost all indicators of RN jurisdiction. ‘High capacity’ homes were more likely to have specialty care programs relative to ‘low capacity’ homes; such homes were less likely to be chain-owned, and more likely to be larger, provide higher technical levels of patient care, have unionized nursing assistants, have a lower ratio of LPNs to RNs, and a higher education level of the administrator. Discussion Findings provide preliminary support for the theoretical framework as a starting point to move beyond extensive reliance on staffing levels and mix as indicators of quality. Further, findings indicate the importance of RN specialty certification. PMID:22166907

  11. Nursing Home Life: A Guide for Residents and Families.

    ERIC Educational Resources Information Center

    American Association of Retired Persons, Washington, DC.

    This guide represents part of AARP's comprehensive consumer education effort in the area of long-term care. The purpose of the guide is to provide information for consumers as they look for a nursing home, arrange for admission, and adjust to life in the home after admission. Section 1 introduces the guide. Section 2 describes how to assess needs,…

  12. Nursing Home Quality, Cost, Staffing, and Staff Mix

    ERIC Educational Resources Information Center

    Rantz, Marilyn J.; Hicks, Lanis; Grando, Victoria; Petroski, Gregory F.; Madsen, Richard W.; Mehr, David R.; Conn, Vicki; Zwygart-Staffacher, Mary; Scott, Jill; Flesner, Marcia; Bostick, Jane; Porter, Rose; Maas, Meridean

    2004-01-01

    Purpose: The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. Design and Methods: A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing…

  13. An Empirical Evaluation of a Model Geropsychiatric Nursing Home.

    ERIC Educational Resources Information Center

    Gurian, B.; Chanowitz, B.

    1987-01-01

    Describes sub-acute diagnostic and treatment nursing home program for difficult to manage older adults with medical and psychiatric illness. Notes that assessment and discharge can be completed within seven months, and that among sample population studied, almost equal percentages were discharged to state institutions, remained in the study home,…

  14. Organizational determinants of service quality in nursing homes.

    PubMed

    Steffen, T M; Nystrom, P C

    1997-01-01

    This study analyzed four prominent organizational factors thought to influence service quality in nursing homes. Perceptions of service quality were collected from over 400 family members who regularly visited residents in 41 nursing homes. Service quality was measured along five dimensions identified by marketing research on customers in service industries. These five dimensions were responsiveness, reliability, assurance, empathy, and tangibles. Perceptions of service quality exhibited significant associations with each of the four organizational factors: ownership, funding mix, facility size, and nurse staffing. Implications for health services administration are discussed. PMID:10167453

  15. Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia.

    PubMed

    Monroe, Todd B; Parish, Abby; Mion, Lorraine C

    2015-10-01

    Nurses caring for older people with various psychiatric illnesses face many obstacles when treating pain. One setting with a high percentage of psychiatric conditions is long-term care where more than half of residents have some form of dementia, and behavioral symptoms of dementia (BSDs) may mimic behavioral displays of pain. Furthermore, two-thirds of nursing home residents have pain. Thus, many nursing home residents with dementia have pain that may be confounded by BSDs. Since many people with dementia are at risk for poor pain management, determining current methods in which nurses assess and manage pain in nursing home residents will aid in recognizing potential barriers to using current pain management guidelines and help develop strategies to enhance nurses' assessment and management of pain in this vulnerable population. The aim of this study was to explore nursing home nurses' cues and practices to identify and alleviate pain in nursing home residents with dementia. Nurses use the constructs of 'comfort' and 'quality of life' as key components in their overall pain assessment strategy in people with dementia. Indeed, the extensive process they use involving frequent reassessment and application of interventions is geared towards "appearance of comfort." Nurses reported difficulty in ascertaining whether a person with dementia was in pain, and they expressed further difficulty determining the intensity associated with resident pain. Nurses further reported that residents with dementia who are not well know by the staff were are greater risk of poor pain management. It was not unusual for nurses to discuss the importance of conflict resolution among family members as well as allowing for open expression of family's concerns. Nurses had to focus not only on the resident's comfort, but also the families' level of comfort with pain management, especially at the end-of-life. Findings support further use and development of discomfort behavior scales to help

  16. Pain Assessment Strategies in Home Care and Nursing Homes in Mid-Norway: A Cross-sectional Survey.

    PubMed

    Torvik, Karin; Nordtug, Bente; Brenne, Inger Karin; Rognstad, May-Karin

    2015-08-01

    The prevalence of pain ranges from 27.8% to 86.5% in nursing homes and 42% to 50% in home care. Pain assessment is the first step toward effective pain management. The aim of this study was to explore the use of pain assessment strategies (verbal, numeric, and observation rating scales and standardized questions) in home care and nursing homes. The study was a descriptive cross-sectional survey. Health care providers who were responsible for the patients' medications replied to a questionnaire. In-home care and nursing homes in 11 randomly selected municipalities in Mid-Norway were included. Three hundred ninety-two individuals were included in this study (70% response rate): 271 (69%) from nursing homes and 121 (31%) from home care. The respondents working in home care had a higher educational level than those in working in nursing homes. Pain assessment instruments were not used frequently in nursing homes and home care. Verbal and numeric rating scales were used significantly more frequently in home care than in nursing homes. Registered nurses (RNs) in nursing homes used standardized questions significantly more often than did RNs in home care. RNs and social educators in home care self-reported less competence in treating the patients' total pain experience than did those in nursing homes. Workplace (working in home care) and regular training in the use of pain assessment tools explained more than 20% of the variation in the use of pain assessment tools. Regular training in the use of pain assessment tools is needed for health care workers in home care and nursing homes.

  17. Testing an intervention to reduce assaults on nursing assistants in nursing homes: a pilot study.

    PubMed

    Fitzwater, Evelyn L; Gates, Donna M

    2002-01-01

    Nursing home staffs frequently encounter physical and emotional violence directed toward them by residents. This article addresses the problem from an occupational health perspective and describes a pilot study focused an educational intervention to reduce resident assaults on certified nursing assistants (CNAs) in nursing homes. After a 4-hour education intervention, the study CNAs reported fewer physical assaults by residents and increased levels of knowledge and confidence in their ability to manage residents' aggressive behavior compared with a similar CNA group. Limitations include a small convenience sample who works only the day shift. Results support education and training as effective in reducing resident physical assaults and enhancing nursing home safety. Further research should investigate assaultive resident behavior and evaluate the effectiveness of interventions to prevent, reduce, and manage violence in nursing homes. PMID:11865253

  18. Hand hygiene compliance among the nursing staff in freestanding nursing homes in Taiwan: a preliminary study.

    PubMed

    Liu, Wen-I; Liang, Shu-Yuan; Wu, Shu-Fang Vivienne; Chuang, Yeu-Hui

    2014-02-01

    This study aimed to explore the hand hygiene compliance among the nursing staff in Taiwanese freestanding nursing homes. A descriptive observational research design was used. A total of 782 opportunities for hand hygiene were observed by one trained research assistant in two freestanding nursing homes. The hand-hygiene observation tool was used to assess hand hygiene practice. The overall hand hygiene compliance among nursing staff in nursing homes was only 11.3%. Results further showed that the compliance was greater after contact with body fluids (odds ratio = 6.9, confidence interval (CI) = 3.75-9.88, P = 0.000) and lower before the performance of aseptic procedures (odds ratio = 0.15, CI = 0.04-0.63, P = 0.003) when compared with other activities. Hand hygiene compliance was relatively low among the nursing staff in freestanding nursing homes in Taiwan. To comprehensively analyze this issue, further research involving a larger number of nursing homes and strategies to improve compliance with hand hygiene among the nursing staff at these institutions is needed.

  19. Working in and around the 'chain of command': power relations among nursing staff in an urban nursing home.

    PubMed

    Jervis, Lori L

    2002-03-01

    By most accounts, the discipline of nursing enjoys considerable hegemony in US nursing homes. Not surprisingly, the ethos of this setting is influenced, in large part, by nursing's value system. This ethos powerfully impacts both the residents who live in nursing homes and the staff who work there. Using ethnographic methods, this project explored power relations among nursing assistants and nurses in an urban nursing home in the United States. Factors contributing to tensions among nursing staff were the stigma attached to nursing homes and those who work in them, as well as the long history of class conflict and power struggles within the discipline of nursing. The latter struggles, in turn, reflected nursing's quest for professional status in the face of medicine's hegemony over health-care. Ultimately, these factors coalesced to produce a local work environment characterized by conflict--and by aides' resistance to nurses' domination.

  20. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...

  1. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...

  2. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...

  3. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...

  4. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... hospital or nursing home patients and domiciled members. 17.166 Section 17.166 Pensions, Bonuses, and... hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or... are professionally determined necessary to the patients' or members' overall hospital, nursing...

  5. Nursing home prices and market structure: the effect of assisted living industry expansion.

    PubMed

    Bowblis, John R

    2014-01-01

    Since the 1990s, there has been substantial expansion of facility-based alternatives to nursing home care, such as assisted living facilities. This paper analyzes the relationship between expansion of the assisted living industry, nursing home market structure and nursing home private pay prices using a two-year panel of nursing homes in the State of Ohio. Fixed effect regressions suggest that the expansion of assisted living facilities are associated with increased nursing home concentration, but find no effect on private pay nursing home prices. This would be consistent with assisted livings reducing demand for nursing homes by delaying entry into a nursing home, though assisted livings are not direct competitors of nursing homes.

  6. Analysis of nursing home use and bed supply: Wisconsin, 1983.

    PubMed Central

    Nyman, J A

    1989-01-01

    This article presents evidence that in 1983 excess demand was a prevailing characteristic of nursing home care markets in Wisconsin, a state with one of the highest bed to elderly population ratios. It further shows that excess demand is the source of at least three types of error in use-based estimates of the determinants of the need for nursing home care. First, if excess demand is present, estimates of the determinants of Medicaid use may simply represent a crowding out of Medicaid patients, driven by the determinants of private use. As a result, factors associated with greater overall need in an area will be correlated with fewer Medicaid patients in nursing homes, ceteris paribus. Second, estimates of the substitutability of home health care for nursing home care may be misleadingly insignificant if they are based on the bed supply-constrained behavior of Medicaid-eligible subjects. Third, because the determinants of bed supply become the determinants of overall use under excess-demand conditions, the determinants of use will reflect, to some extent, the nursing home's desire for profits. Because profitability considerations are reflected in use based estimates of need, these estimates are likely to be misleading. PMID:2681081

  7. 77 FR 45719 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... AFFAIRS Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per... the notice. This notice solicits comments on information needed to ensure that nursing home and adult day health care facilities are providing high quality services to Veterans in State homes....

  8. 78 FR 46421 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-31

    ... AFFAIRS Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per... the notice. This notice solicits comments on information needed to ensure that nursing home and adult day health care facilities are providing high quality services to Veterans in State homes....

  9. Concentrated poverty and nursing home bed supply in Chicago.

    PubMed

    Reed, S C; Andes, S; Tobias, R A

    2001-02-01

    This study explores whether poverty areas of Chicago have fewer nursing home beds and unique staffing patterns. Using 1990 census data and Illinois's 1994 Long-Term Care Facility Survey, census tracts were compared by need for long-term care, bed supply, and nursing home characteristics. While facilities cluster on the north side, and the number of beds follow the elderly, the supply of beds per elderly is actually greater in tracts with high proportions of poverty, disability, and African American residents due, in part, to the predominance of larger facilities. Ironically, economic segregation may work together with Medicaid's policy of serving the poorest to increase the supply of beds to those who might otherwise remain unserved. Nursing homes in the poorest communities have high percentages of Medicaid residents, are larger, and employ fewer staff per resident; homes with a high Medicaid population are more likely to employ LPNs, which may reflect labor supply differences.

  10. Motivators for Physical Activity among Ambulatory Nursing Home Older Residents

    PubMed Central

    Chen, Yuh-Min; Li, Yueh-Ping

    2014-01-01

    The purpose of this study was to explore self-identified motivators for regular physical activity among ambulatory nursing home older residents. A qualitative exploratory design was adopted. Purposive sampling was performed to recruit 18 older residents from two nursing homes in Taiwan. The interview transcripts were analyzed by qualitative content analysis. Five motivators of physical activity emerged from the result of analysis: eagerness for returning home, fear of becoming totally dependent, improving mood state, filling empty time, and previously cultivated habit. Research on physical activity from the perspectives of nursing home older residents has been limited. An empirically grounded understanding from this study could provide clues for promoting and supporting lifelong engagement in physical activity among older residents. The motivators reported in this study should be considered when designing physical activity programs. These motivators can be used to encourage, guide, and provide feedback to support older residents in maintaining physical activity. PMID:25054175

  11. Medicaid: Recoveries from Nursing Home Residents' Estates Could Offset Program Costs.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Div. of Human Resources.

    Through asset recovery programs, states can recover from the estates of nursing home residents or their survivors a portion of the expenses the state incurs in providing nursing home care. Estate recovery programs require Medicaid recipients whose primary assets are their homes to contribute toward the cost of their nursing home care in the same…

  12. Ineffective Staff, Ineffective Supervision, or Ineffective Administration? Why Some Nursing Homes Fail to Provide Adequate Care.

    ERIC Educational Resources Information Center

    Sheridan, John E.; And Others

    1992-01-01

    This study involved 530 nursing staff working in 25 for-profit and nonprofit nursing homes, 2 of which failed to meet residential care standards. Nursing home climate in failed homes was perceived as being significantly lower in human relations and higher in laissez-faire and status orientation dimensions that the climate in the successful homes.…

  13. Racial Segregation and Quality of Care Disparity in US Nursing Homes

    PubMed Central

    Rahman, Momotazur; Foster, Andrew D.

    2014-01-01

    In this paper we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality. PMID:25461895

  14. Racial segregation and quality of care disparity in US nursing homes.

    PubMed

    Rahman, Momotazur; Foster, Andrew D

    2015-01-01

    In this paper, we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality. PMID:25461895

  15. Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides.

    PubMed

    Sprangers, Suzan; Dijkstra, Katinka; Romijn-Luijten, Anna

    2015-01-01

    Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home staff and nursing home residents with dementia. These studies have shown that communication skills training can improve nursing aides' communication with nursing home residents. However, these studies tended to be time-consuming and fairly difficult to implement. Moreover, these studies focused on the communicative benefits for the nursing home residents and their well-being, while benefits and well-being for the nursing aides were neglected. The current study focused on implementing a brief communication skills training program to improve nursing aides' (N=24) communication with residents with dementia (N=26) in a nursing home. The effects of the training on nursing aides' communication, caregiver distress, and job satisfaction and residents' psychopathology and agitation were assessed relative to a control group condition. Nursing aides in the intervention group were individually trained to communicate effectively with residents during morning care by using short instructions, positive speech, and biographical statements. Mixed ANOVAs showed that, after training, nursing aides in the intervention group experienced less caregiver distress. Additionally, the number of short instructions and instances of positive speech increased. Providing nursing aides with helpful feedback during care aids communication and reduces caregiver burden, even with a brief intervention that requires limited time investments for nursing home staff.

  16. Unintentional Discontinuation of Chronic Medications for Seniors in Nursing Homes

    PubMed Central

    Stall, Nathan M.; Fischer, Hadas D.; Wu, C. Fangyun; Bierman, Arlene S.; Brener, Stacey; Bronskill, Susan; Etchells, Edward; Fernandes, Olavo; Lau, Davina; Mamdani, Muhammad M.; Rochon, Paula; Urbach, David R.; Bell, Chaim M.

    2015-01-01

    Abstract Transitions of care leave patients vulnerable to the unintentional discontinuation of medications with proven efficacy for treating chronic diseases. Older adults residing in nursing homes may be especially susceptible to this preventable adverse event. The effect of large-scale policy changes on improving this practice is unknown. The objective of this study was to analyze the effect of a national medication reconciliation accreditation requirement for nursing homes on rates of unintentional medication discontinuation after hospital discharge. It was a population-based retrospective cohort study that used linked administrative records between 2003 and 2012 of all hospitalizations in Ontario, Canada. We identified nursing home residents aged ≥66 years who had continuous use of ≥1 of the 3 selected medications for chronic disease: levothyroxine, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). In 2008 medication reconciliation became a required practice for accreditation of Canadian nursing homes. The main outcome measures included the proportion of patients who restarted the medication of interest after hospital discharge at 7 days. We also performed a time series analysis to examine the impact of the accreditation requirement on rates of unintentional medication discontinuation. The study included 113,088 adults aged ≥66 years who were nursing home residents, had an acute hospitalization, and were discharged alive to the same nursing home. Overall rates of discontinuation at 7-days after hospital discharge were highest in 2003–2004 for all nursing homes: 23.9% for thyroxine, 26.4% for statins, and 23.9% for PPIs. In most of the cases, these overall rates decreased annually and were lowest in 2011–2012: 4.0% for thyroxine, 10.6% for statins, and 8.3% for PPIs. The time series analysis found that nursing home accreditation did not significantly lower medication discontinuation rates for any of the 3 drug groups. From 2003

  17. Urinary and Fecal Incontinence in Nursing Home Residents

    PubMed Central

    Leung, Felix W.; Schnelle, John F.

    2008-01-01

    Urinary and fecal incontinence (UI, FI) are co-morbid conditions affecting over 50% of nursing home residents. Both forms of incontinence are risk factors for elderly persons to be placed in the nursing home, and such institutionalization itself is a risk factor for developing incontinence. Management should focus on identifying and treating underlying causes, such as detrusor instability, urinary tract infections, diet- or medication-induced diarrhea, constipation and fecal impaction. Despite appropriate management, residents may remain incontinent because of dementia and health or restraint-related immobility. Nursing homes lack the staff and financial resources to provide residents with sufficiently frequent toileting assistance (including prompted voiding). Use of special undergarments and absorbent pads is the usual practice. The article reviews the results of studies that have documented how prompted voiding programs can significantly reduce UI and FI, particularly if the intervention includes dietary and exercise components. Recent systematic anorectal testing of nursing home residents with FI has documented impaired sphincter function (risk factor for FI), decreased rectal sensation and sphincter dyssynergia (risk factor for constipation and impaction). The data suggest that the use of laxatives and stool softeners for prophylaxis against constipation and impaction related to underlying dyssynergia may have produced sufficient fluidity in the stool to predispose the residents with impaired sphincter function to manifest FI. Documentation of non-invasive and efficacious interventions by RCT and the labor costs of implementing these measures can lead to changes in how nursing home care is provided and funded. PMID:18794004

  18. Predictors of Nursing Home Residents' Time to Hospitalization

    PubMed Central

    O'Malley, A James; Caudry, Daryl J; Grabowski, David C

    2011-01-01

    Objectives To model the predictors of the time to first acute hospitalization for nursing home residents, and accounting for previous hospitalizations, model the predictors of time between subsequent hospitalizations. Data Sources Merged file from New York State for the period 1998–2004 consisting of nursing home information from the minimum dataset and hospitalization information from the Statewide Planning and Research Cooperative System. Study Design Accelerated failure time models were used to estimate the model parameters and predict survival times. The models were fit to observations from 50 percent of the nursing homes and validated on the remaining observations. Principal Findings Pressure ulcers and facility-level deficiencies were associated with a decreased time to first hospitalization, while the presence of advance directives and facility staffing was associated with an increased time. These predictors of the time to first hospitalization model had effects of similar magnitude in predicting the time between subsequent hospitalizations. Conclusions This study provides novel evidence suggesting modifiable patient and nursing home characteristics are associated with the time to first hospitalization and time to subsequent hospitalizations for nursing home residents. PMID:20849556

  19. Teaching home care electronic documentation skills to undergraduate nursing students.

    PubMed

    Nokes, Kathleen M; Aponte, Judith; Nickitas, Donna M; Mahon, Pamela Y; Rodgers, Betsy; Reyes, Nancy; Chaya, Joan; Dornbaum, Martin

    2012-01-01

    Although there is general consensus that nursing students need knowledge and significant skill to document clinical findings electronically, nursing faculty face many barriers in ensuring that undergraduate students can practice on electronic health record systems (EHRS). External funding supported the development of an educational innovation through a partnership between a home care agency staff and nursing faculty. Modules were developed to teach EHRS skills using a case study of a homebound person requiring wound care and the Medicare-required OASIS documentation system. This article describes the development and implementation of the module for an upper-level baccalaureate nursing program located in New York City. Nursing faculty are being challenged to develop creative and economical solutions to expose nursing students to EHRSs in nonclinical settings.

  20. Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes

    ERIC Educational Resources Information Center

    Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.

    2011-01-01

    Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…

  1. Inadequate care in Norwegian nursing homes--as reported by nursing staff.

    PubMed

    Malmedal, Wenche; Ingebrigtsen, Oddbjørn; Saveman, Britt-Inger

    2009-06-01

    Studies have shown that inadequate care, also referred to as abuse, violence, neglect and maltreatment occur in nursing homes in many countries. The aim of this study was to describe the frequency and types of inadequate care committed by staff in nursing homes. Another aim was to investigate if nursing staff reported differently depending on age, education level and years of experience working at nursing homes. A questionnaire survey was conducted among nursing staff (n = 616) in 16 nursing homes in the central part of Norway. Twenty items concerned staff behaviour in forms of acts of inadequate care. The respondents were asked to report how often they had observed colleagues commit acts and how often they themselves had committed such acts. The response rate was 79%. All in all, 91% of the nursing staff reported that they had observed at least one act of inadequate care and 87% reported that they had committed at least one act of inadequate care. Acts of negligent and emotional character were most frequently reported, both as observed and committed. Depending on the higher educational level that the nursing staff had more acts of all types were observed and committed. The oldest staff and those with longest experience at the present nursing home reported more observed and committed acts of physical character than did the others. The extent of inadequate care confirms that this is a common part of activities in nursing homes. Because emotional and negligent acts can be just as harmful as physical acts, more knowledge is needed about the reasons in order to take preventive actions.

  2. Protecting nursing home companies: limiting liability through corporate restructuring.

    PubMed

    Casson, Joseph E; McMillen, Julia

    2003-01-01

    Nursing homes face two potential risks: exclusion from the Medicare and Medicaid programs; and financial liability through Medicare and Medicaid overpayments, false claims, and negligence actions. Given the current budget crisis and the scrutiny of nursing homes, the magnitude of these risks is only expected to increase. The authors address the increasing risks that nursing homes face and propose the creation of single-purpose ownership entities and single-purpose operating entities to minimize risk. In addition, they examine recent cases to show what factors the courts use to allow the United States and private plaintiffs to pierce the corporate veil. The authors conclude by showing how restructuring can reduce the unnecessary risks of exclusion and financial liability.

  3. Raising the standard: palliative care in nursing homes.

    PubMed

    Meier, Diane E; Lim, Betty; Carlson, Melissa D A

    2010-01-01

    More than two-thirds of long-stay nursing home residents suffer from dementia. This illness has a variable and unpredictable course that renders it a poor fit for the six-month life-expectancy requirement of the Medicare hospice benefit. Palliative care-a form of treatment that strives to match care to patient goals, relieve pain, and improve quality of life for people with chronic or life-threatening illnesses-should be the standard of practice for all elderly dementia patients in nursing homes, regardless of prognosis. Similar principles could apply to other long-term residents with underlying chronic diseases who would benefit from palliative care. Indeed, we would argue that the growing acceptance of the culture-change movement centered on elder-directed goals in nursing homes is promising evidence of the goodness-of-fit of palliative care principles in the long-term care setting.

  4. Nursing home residents and celebrities: a tale of morality.

    PubMed

    Claessens, Nathalie

    2014-01-01

    In contemporary Western societies, characterized by global aging and an omnipresent celebrity culture, little is known about the role of celebrities for older adults. This study bridges gerontology and celebrity studies to explore a social role that celebrities can fulfill for nursing home residents: triggering moral discussions. This potential role is examined in four focus groups with 27 nursing home residents in Flanders (Belgium). Here, 20 celebrity pictures are employed to evoke moral discussions, with a focus on adultery and homosexuality. These discussions are subjected to a framing analysis. Results show that celebrities can trigger moral discussions among the nursing home residents. The residents' adultery and homosexuality frames show that they mostly retain dominant values from their youth, often combining them with contemporary dominant values. Further, the residents' frames prove to be relativistic, which can be linked to their multitude of life experiences and complex emotional skills.

  5. An instrument to measure job satisfaction of nursing home administrators

    PubMed Central

    Castle, Nicholas G

    2006-01-01

    Background The psychometric properties of the nursing home administrator job satisfaction questionnaire (NHA-JSQ) are presented, and the steps used to develop this instrument. Methods The NHA-JSQ subscales were developed from pilot survey activities with 93 administrators, content analysis, and a research panel. The resulting survey was sent to 1,000 nursing home administrators. Factor analyses were used to determine the psychometric properties of the instrument. Results Of the 1,000 surveys mailed, 721 usable surveys were returned (72 percent response rate). The factor analyses show that the items were representative of six underlying factors (i.e., coworkers, work demands, work content, work load, work skills, and rewards). Conclusion The NHA-JSQ represents a short, psychometrically sound job satisfaction instrument for use in nursing homes. PMID:17029644

  6. A conceptual model for culture change evaluation in nursing homes.

    PubMed

    Hartmann, Christine W; Snow, A Lynn; Allen, Rebecca S; Parmelee, Patricia A; Palmer, Jennifer A; Berlowitz, Dan

    2013-01-01

    This article describes the development and particulars of a new, comprehensive model of nursing home culture change, the Nursing Home Integrated Model for Producing and Assessing Cultural Transformation (Nursing Home IMPACT). This model is structured into four categories, "meta constructs," "care practices," "workplace practices," and "environment of care," with multiple domains under each. It includes detailed, triangulated assessment methods capturing various stakeholder perspectives for each of the model's domains. It is hoped that this model will serve two functions: first, to help practitioners guide improvements in resident care by identifying particular areas in which culture change is having positive effects, as well as areas that could benefit from modification; and second, to emphasize the importance in culture change of the innumerable perspectives of residents, family members, staff, management, and leadership. PMID:23850129

  7. Staffing Subsidies and the Quality of Care in Nursing Homes

    PubMed Central

    Foster, Andrew D.; Lee, Yong Suk

    2015-01-01

    Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%. PMID:25814437

  8. Nurse Aide Empowerment Strategies and Staff Stability: Effects on Nursing Home Resident Outcomes

    ERIC Educational Resources Information Center

    Barry, Theresa; Brannon, Diane; Mor, Vincent

    2005-01-01

    Purpose: This study examines the moderating effect of staff stability on the relationship between management practices used to empower nurse aides and resident outcomes in a multistate sample of nursing homes. An adaptation of Kanter's theory of structural power in organizations guided the framework for the model used in this study. Design and…

  9. Prevalence of Nursing Assistant Training and Certification Programs within Nursing Homes, 1997-2007

    ERIC Educational Resources Information Center

    Tyler, Denise A.; Jung, Hye-Young; Feng, Zhanlian; Mor, Vincent

    2010-01-01

    Purpose: The purpose of this study was to describe how the prevalence of nurse aide training and competency evaluation programs (NATCEPs) provided in the nursing home (NH) setting changed between 1997 and 2007, to explore the environmental factors that may be influencing the prevalence of these programs, and to examine how the changing prevalence…

  10. Local Medicaid home- and community-based services spending and nursing home admissions of younger adults.

    PubMed

    Thomas, Kali S; Keohane, Laura; Mor, Vincent

    2014-11-01

    We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states' efforts to expand HCBS for this population should continue.

  11. Local Medicaid Home- and Community-Based Services Spending and Nursing Home Admissions of Younger Adults

    PubMed Central

    Keohane, Laura; Mor, Vincent

    2014-01-01

    We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states’ efforts to expand HCBS for this population should continue. PMID:25211711

  12. Nursing Assistant Perceptions of Their Role in Quality Improvement Processes in Nursing Homes.

    PubMed

    Davila, Heather; Abrahamson, Kathleen; Mueller, Christine; Inui, Thomas S; Black, Aaron G; Arling, Greg

    2016-01-01

    Nursing assistants provide the majority of direct resident care in nursing homes and are centrally involved in implementing quality improvement (QI), yet little is known about their experiences in QI. Interviews with nursing assistants found that respondents perceive themselves as having a unique and important role in QI. They described key outcomes of QI as positive gains in the daily lives of residents, improved work processes, and increased time between staff and residents. PMID:26796975

  13. The Relationships Among Licensed Nurse Turnover, Retention, and Rehospitalization of Nursing Home Residents

    PubMed Central

    Thomas, Kali S.

    2013-01-01

    Purpose: Individuals receiving postacute care in skilled nursing facilities often require complex, skilled care provided by licensed nurses. It is believed that a stable set of nursing personnel is more likely to deliver better care. The purpose of this study was to determine the relationships among licensed nurse retention, turnover, and a 30-day rehospitalization rate in nursing homes (NHs). Design and Methods: We combined two data sources: NH facility-level data (including characteristics of the facility, the market, and residents) and the Florida Nursing Home Staffing Reports (which provide staffing information for each NH) for 681 Florida NHs from 2002 to 2009. Using a two-way fixed effects model, we examined the relationships among licensed nurse turnover rates, retention rates, and 30-day rehospitalization rates. Results: Results indicate that an NH’s licensed nurse retention rate is significantly associated with the 30-day rehospitalization rate (est. = −.02, p = .04) controlling for demographic characteristics of the patient population, residents’ preferences for hospitalization, and the ownership characteristics of the NH. The NHs experiencing a 10% increase in their licensed nurse retention had a 0.2% lower rehospitalization rate, which equates to 2 fewer hospitalizations per NH annually. Licensed nurse turnover is not significantly related to the 30-day rehospitalization rate. Implications: These findings highlight the need for NH administrators and policy makers to focus on licensed nurse retention, and future research should focus on the measures of staff retention for understanding the staffing/quality relationship. PMID:22936529

  14. Working Conditions and Mental Health of Nursing Staff in Nursing Homes.

    PubMed

    Zhang, Yuan; Punnett, Laura; Mawn, Barbara; Gore, Rebecca

    2016-07-01

    Nursing staff in nursing homes suffer from poor mental health, probably associated with stressful working conditions. Working conditions may distribute differently among nursing assistants, licensed practical nurses, and registered nurses due to their different levels in the organizational hierarchy. The objectives of this study were to evaluate the association between working conditions and mental health among different nursing groups, and examine the potential moderating effect of job group on this association. Self-administered questionnaires were collected with 1,129 nursing staff in 15 for-profit non-unionized nursing homes. Working conditions included both physical and psychosocial domains. Multivariate linear regression modeling found that mental health was associated with different working conditions in different nursing groups: physical safety (β = 2.37, p < 0.05) and work-family conflict (β = -2.44, p < 0.01) in NAs; work-family conflict (β = -4.17, p < 0.01) in LPNs; and physical demands (β = 10.54, p < 0.05) in RNs. Job group did not moderate the association between working conditions and mental health. Future workplace interventions to improve mental health should reach to nursing staff at different levels and consider tailored working condition interventions in different nursing groups. PMID:27104634

  15. Working Conditions and Mental Health of Nursing Staff in Nursing Homes.

    PubMed

    Zhang, Yuan; Punnett, Laura; Mawn, Barbara; Gore, Rebecca

    2016-07-01

    Nursing staff in nursing homes suffer from poor mental health, probably associated with stressful working conditions. Working conditions may distribute differently among nursing assistants, licensed practical nurses, and registered nurses due to their different levels in the organizational hierarchy. The objectives of this study were to evaluate the association between working conditions and mental health among different nursing groups, and examine the potential moderating effect of job group on this association. Self-administered questionnaires were collected with 1,129 nursing staff in 15 for-profit non-unionized nursing homes. Working conditions included both physical and psychosocial domains. Multivariate linear regression modeling found that mental health was associated with different working conditions in different nursing groups: physical safety (β = 2.37, p < 0.05) and work-family conflict (β = -2.44, p < 0.01) in NAs; work-family conflict (β = -4.17, p < 0.01) in LPNs; and physical demands (β = 10.54, p < 0.05) in RNs. Job group did not moderate the association between working conditions and mental health. Future workplace interventions to improve mental health should reach to nursing staff at different levels and consider tailored working condition interventions in different nursing groups.

  16. [Handling of laundry and garbage in nursing homes. A survey in 22 homes].

    PubMed

    Hansen, D; Ross, B; Hilgenhöner, M; Loss, R; Grandek, M; Blättler, T; Popp, W

    2011-11-01

    Management of infectious diseases in nursing homes is as important as it is in hospitals. Therefore, a standardized questionnaire was used for the detailed assessment of the handling of laundry and garbage with a special focus on methicillin-resistant staphylococcus aureus (MRSA) in 22 nursing homes in Germany. The study focused on the prevention of occupational diseases in the nursing home staff. Despite a few isolated problems, the situation of MRSA-positive patients was not as alarming as expected: guidelines for MRSA as published by KRINKO were often followed by the healthcare workers. However, general problems with managing garbage and laundry were identified. Many nursing homes lacked protective clothing and a sufficient garbage management plan. In addition, the handling of laundry was a problem in that the clothing of the patients and the working clothes of the staff were often washed at home rather than in accredited laundries. Thus, the awareness for hygienic problems needs to be raised, e.g., by expanding hygienic control for the nursing homes.

  17. [Handling of laundry and garbage in nursing homes. A survey in 22 homes].

    PubMed

    Hansen, D; Ross, B; Hilgenhöner, M; Loss, R; Grandek, M; Blättler, T; Popp, W

    2011-11-01

    Management of infectious diseases in nursing homes is as important as it is in hospitals. Therefore, a standardized questionnaire was used for the detailed assessment of the handling of laundry and garbage with a special focus on methicillin-resistant staphylococcus aureus (MRSA) in 22 nursing homes in Germany. The study focused on the prevention of occupational diseases in the nursing home staff. Despite a few isolated problems, the situation of MRSA-positive patients was not as alarming as expected: guidelines for MRSA as published by KRINKO were often followed by the healthcare workers. However, general problems with managing garbage and laundry were identified. Many nursing homes lacked protective clothing and a sufficient garbage management plan. In addition, the handling of laundry was a problem in that the clothing of the patients and the working clothes of the staff were often washed at home rather than in accredited laundries. Thus, the awareness for hygienic problems needs to be raised, e.g., by expanding hygienic control for the nursing homes. PMID:22015787

  18. The impact of nursing home patients on general practitioners' workload.

    PubMed Central

    Groom, L; Avery, A J; Boot, D; O'Neill, C; Thornhill, K; Brown, K; Jones, R

    2000-01-01

    BACKGROUND: Although the number of people in nursing homes has risen substantially in recent years, the shift of responsibility into general practice has rarely been accompanied by extra resources. These patients may be associated with a higher general practitioner (GP) workload than others of similar age and sex. AIM: To assess the GP workload associated with nursing home residents and its associated costs. METHOD: All nursing home residents aged over 65 years and registered with nine Nottinghamshire practices during one year were matched with patients living in the community for general practice, age, and sex. Data were collected retrospectively for both groups on key workload measures. Costs for the workload measures were calculated using published estimates. RESULTS: Data were collected for 270 pairs of patients. Nursing home patients had more face-to-face contacts in normal surgery hours, telephone calls, and out-of-hours visits. The mean workload cost per month of a nursing home patient (assuming that one patient was seen per visit) was estimated to be 18.21 Pounds (10.49 Pounds higher than the cost of controls). A sensitivity analysis demonstrated that potential savings in visiting costs associated with increasing the numbers of patients seen per visit were 27% for one extra patient seen per visit and 44% for four extra patients. CONCLUSION: Nursing home residents were associated with higher workload for GPs than other patients of the same age and sex living in the community. Our costings provide a basis for negotiating suitable reimbursement of GPs for their additional work. PMID:10962786

  19. Placement of undergraduate students in nursing homes: careful consideration versus convenience.

    PubMed

    Lane, Annette M; Hirst, Sandra P

    2012-03-01

    Several decades ago, concerns were raised about using nursing homes as clinical placement sites for undergraduate nursing students. As a result, some nursing programs moved away from using these clinical sites. However, within the past 15 years, a shift back toward reconsidering nursing homes as viable placement options has begun. What has brought about this shift, and what must happen to ensure that nursing homes provide positive learning experiences for students? This article reviews the literature on placing students in nursing home environments and presents a model that is designed to enhance gerontological competence in undergraduate nursing students, as well as to enhance students' learning in nursing home placements. If programs use nursing homes for student placements, a carefully constructed plan that encompasses gerontological education throughout the nursing degree program is recommended.

  20. Leadership, staffing and quality of care in nursing homes

    PubMed Central

    2011-01-01

    Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is

  1. 75 FR 62185 - Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...: Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring...

  2. 78 FR 55778 - Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...: Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring...

  3. 75 FR 45207 - Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...: Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring...

  4. 78 FR 75959 - Agency Information Collection (Regulation on Reduction of Nursing Shortages in State Homes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Regulation on Reduction of Nursing Shortages in State Homes....'' SUPPLEMENTARY INFORMATION: Title: Regulation on Reduction of Nursing Shortages in State Homes; Application...

  5. Staff assignment practices in nursing homes: review of the literature.

    PubMed

    Rahman, Anna; Straker, Jane K; Manning, Lydia

    2009-01-01

    Consistent assignment, whereby nursing home staff members, particularly certified nurse aides, are assigned to the same residents on most shifts, is increasingly viewed as a cornerstone of culture change in nursing homes. It has been advocated as a best-care model that increases residents' quality of life while contributing to a more stable frontline staff. Given these potential benefits, consistent assignment is now widely viewed as superior to rotating assignment, an alternative staffing model that aims to distribute care burden more fairly among staff and ensure that workers are familiar with most residents. Despite favorable anecdotal reports about the benefits of consistent assignment, the research literature reports mixed and sometimes contradictory findings for this staffing practice. This article reviews the research pertaining to staff assignment practices in nursing homes. Reviewed here are 13 reports on experimental trials (6 reports), evaluation research (4 reports), and nursing home surveys (3 reports). The review reveals broad diversity in staffing practices and raises questions that challenge popular assumptions about consistent assignment. The article closes with a discussion of the research, policy, and practice implications of the research findings.

  6. Sexual Abuse of Older Nursing Home Residents: A Literature Review

    PubMed Central

    Malmedal, Wenche; Iversen, Maria Helen; Kilvik, Astrid

    2015-01-01

    Despite an increasing literature related to elder abuse, sexual abuse of older persons in general and of vulnerable adults living in nursing homes in particular is still sparsely described. The purpose of this study was to assess the state of knowledge on the subject of sexual abuse against older nursing home residents through a literature review. Systematic searches in reference databases including Cinahl, Medline, OVID Nursing Database, ISI Web of Science, PsycINFO, Cochrane Library, and SveMed + were conducted. Through several phases of selection of the articles, using strict inclusion and exclusion criteria, six articles were chosen for a deeper examination. Findings from the review show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women. Findings from the literature review show that there is a need for knowledge and further research on the topic of sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step in seriously addressing sexual abuse against older persons. PMID:25642347

  7. Resource dependence and institutional elements in nursing home TQM adoption.

    PubMed Central

    Zinn, J S; Weech, R J; Brannon, D

    1998-01-01

    OBJECTIVE: To examine the contextual attributes that influence nursing home TQM adoption, as informed by resource dependence and institutional theories. DATA SOURCES: A survey of licensed nursing home administrators in the Commonwealth of Pennsylvania during 1994-1995, the Medicare and Medicaid Annual Certification Survey (MMACS) data file, and the Area Resource File (ARF). STUDY DESIGN: Because the dependent variable (TQM adoption vs. non-adoption) is dichotomous, the model was estimated using logistic regression. DATA COLLECTION: Of the 615 facilities that were mailed surveys, 241 (39.2%) returned completed questionnaires. No significant differences were observed between respondents and nonrespondents in size, for-profit status, system membership, registered nurse staffing, cited licensure deficiencies, Medicare census, or Medicaid census. PRINCIPAL FINDINGS: Perceived competition, Medicare's share of total hospital discharges in the market, and facility Medicare census were significant predictors of TQM adoption. CONCLUSIONS: Our results provide limited support for the association between some rational adaptive and institutional factors and TQM adoption in nursing homes. Perceived competition and the influence of the Medicare program both at the facility and the market level are associated with TQM adoption. However, other factors associated with TQM adoption in other industries, such as size, are not associated with TQM adoption in the nursing homes in this study. PMID:9618671

  8. An evaluation of current approaches to nursing home capital reimbursement.

    PubMed

    Cohen, J; Holahan, J

    1986-01-01

    One of the more controversial issues in reimbursement policy is how to set the capital cost component of facilities rates. In this article we examine in detail the various approaches used by states to reimburse nursing homes for capital costs. We conclude that newer approaches that recognize the increasing value of nursing home assets over time, commonly called fair rental systems, are preferable to the methodologies that have been used historically in both the Medicare and the Medicaid programs to set capital rates. When properly designed, fair rental systems should provide more rational incentives and less encouragement of property manipulation than do more traditional systems, with little or no increase in state costs.

  9. Survey-based Indices for Nursing Home Quality Incentive Reimbursement

    PubMed Central

    Willemain, Thomas R.

    1983-01-01

    Incentive payments are a theoretically appealing complement to nursing home quality assurance systems that rely on regulatory enforcement. However, the practical aspects of incentive program design are not yet well understood. After reviewing the rationale for incentive approaches and recent State and. Federal initiatives, the article considers a basic program design issue: creating an index of nursing home quality. It focuses on indices constructed from routine licensure and certification survey results because State initiatives have relied heavily on these readily accessible data. It also suggests a procedure for creating a survey-based index and discusses a sampling of Implementation issues. PMID:10309858

  10. Nursing home bed capacity in the States, 1978-86

    PubMed Central

    Harrington, Charlene; Swan, James H.; Grant, Leslie A.

    1988-01-01

    Trends in nursing home bed supply in the States show large variations in beds per population and a gradual decline in supply per aged population. A cross-sectional time-series regression analysis was used to examine some factors associated with nursing home bed supply. Variation was accounted for by economic factors, supply of alternative services, and climate. State Medicaid reimbursement rates had negative coefficients, with supply suggesting States may be increasing rates to improve access where supply is limited. Medicaid waiver policy was not found to be significant. PMID:10312634

  11. Medicaid payment policies for nursing home care: A national survey

    PubMed Central

    Buchanan, Robert J.; Madel, R. Peter; Persons, Dan

    1991-01-01

    This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access. PMID:10114935

  12. Overcoming challenges of conducting research in nursing homes.

    PubMed

    Jenkins, Catharine; Smythe, Analisa; Galant-Miecznikowska, Magdalena; Bentham, Peter; Oyebode, Jan

    2016-05-27

    In the UK, one third of the 850,000 people with dementia live in care homes. This article explores the process of carrying out research in nursing homes, identifying barriers and enabling factors, and making recommendations for researchers. The authors' experiences derive from an ongoing study investigating the effect of educational interventions to promote and embed person-centred care, designed for nurses caring for the people with dementia in nursing homes. Design issues arose from the need to use cluster randomisation which requires a large sample size, implementation fidelity, poor compliance and high numbers of participants lost to follow up. Further difficulties included gaining ethical approval, recruitment, raising concerns and the practicalities of participant retention. There are many benefits of conducting research in care homes, for the homes themselves, their staff and residents. These include training and education, networking and empowerment of staff and subsequent improved standards of care. For the research team, benefits include opportunities to contribute to an underserved setting, to advance care standards and improve nurses' working lives. PMID:27231082

  13. Families and nursing home placements: a cross-cultural study.

    PubMed

    Fitzgerald, M H; Mullavey-O'Byrne, C; Clemson, L

    2001-01-01

    With the aging of many populations, health care workers and families increasingly find themselves jointly involved in situations involving decisions about nursing home placements. How each approaches such situations is affected by beliefs and assumptions about the role of family members in the care of family members and the decision making process. This paper explores the responses of people from four cultural groups living in Australia (Anglo-Celtic Australian, Chinese, Greek, Lebanese) to a critical incident scenario about a Russian family in Australia faced with such a decision. The responses to this scenario were remarkably similar across the four cultural groups. All saw making such a decision as difficult, but the reasons for the difficulty suggest some interesting cross-cultural distinctions. Some groups viewed care of a family member more in terms of a social and role obligation while others addressed it as a personal responsibility. To not care for elderly parents in the home was accompanied by a sense of guilt among some respondents and a sense of public social shame among others. Ambivalence about nursing homes and placing a family member in a nursing home, culture change and cross-generational differences, and roles and role support were other important themes. The results are consistent with other data analysed in conjunction with the Intercultural Interaction Project. The findings from this research suggests a need to examine more closely the beliefs and assumptions associated with nursing home placements and one way to help students and health professionals to do so. PMID:14617978

  14. Problems of care in a private nursing home.

    PubMed

    Pearson, J; Challis, L; Bowman, C E

    To assess problems of care in a private nursing home an observational study was carried out over two months, during which a research nurse worked as a member of the staff in a home caring for 25 patients aged 62-90. During the second month a consultant physician visited the home weekly to hold case conferences and assess each patient's functional ability and drug regimen. Various problems in medical, nursing, and bureaucratic matters were identified--for example, staff failed to understand the appropriate response to various medical symptoms; no clear policy existed for managing pressure sores; and one patient's anticoagulant state could not be assessed when industrial action meant that transport to take him to hospital was not available--and several changes in drug treatments were recommended. The problems that were identified were mainly due to poor communication between the home and general practitioners and hospitals and to the lack of guidance policy on common issues that arise in long term care. Such a policy could be produced by health authority staff, general practitioners, and representatives of nursing homes.

  15. Examining economic improvements in managing diabetes in the nursing home.

    PubMed

    Dornberger, S; Stone, D; Elliott-Bynum, S

    1999-01-01

    In 1997, two-thirds of the medical cost of diabetes was borne by the elderly and nursing home care attributable to diabetes accounted for a third of that financial burden. The development of the Insulin Delivery Pen system can provide cost efficiency, and concurrently reduce the potential for contamination, free up nursing time, improve the administration process, and maintain dosing accuracy. The insulin pen delivery system (vs. the traditional vial and syringe method) is an attractive and cost effective option in the treatment of diabetes mellitus for residents in nursing facilities.

  16. [The problem of pain in a German nursing home].

    PubMed

    Wörz, R; Blankenhorn, B; Ahr, M

    2005-04-14

    The experience of, and reaction to, pain by the inhabitants of a nursing home (n = 148) were evaluated. They were invited to score their pain status with the aid of a verbal scale, and/or the nursing staff were asked to estimate it on the basis of a numerical rating scale. The regular and as-required prescription of painkillers was also recorded. Acute attacks of pain were symptoms of sometimes life-threatening diseases, and were scored at the highest level of severity. Patients suffering from chronic pain were most often treated with opioid analgesics. Recurrent attacks of pain were preferentially treated with NSAIDs or metamizol. Pain experienced only during nursing measures or while taking exercise was treated too infrequently. When appropriately trained, the nursing staff are well prepared to establish and document the painful situation, and to rapidly identify new pain syndromes. Regular evaluation should be a standard practice of nursing care.

  17. Nursing Home Staff Characteristics and Knowledge Gain from a Didactic Workshop on Depression and Behavior Management

    ERIC Educational Resources Information Center

    Meeks, Suzanne; Burton, Elizabeth G.

    2004-01-01

    Depression is a prevalent and serious problem among nursing home residents. Nursing home staff members are gatekeepers for mental health treatment for residents, but may know little about depression and its management. We evaluated a didactic workshop for nursing home staff on depressive symptoms and management. Results for 58 staff participants…

  18. 75 FR 56662 - Agency Information Collection (Request for Nursing Home Information in Connection With Claim for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-16

    ... AFFAIRS Agency Information Collection (Request for Nursing Home Information in Connection With Claim for... . Please refer to ``OMB Control No. 2900-0652.'' SUPPLEMENTARY INFORMATION: Title: Request for Nursing Home... 21-0779 is used to determine veterans residing in nursing homes eligibility for pension and aid...

  19. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  20. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  1. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  2. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  3. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  4. 78 FR 29439 - Proposed Information Collection (Request for Nursing Home Information in Connection With Claim...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-20

    ... AFFAIRS Proposed Information Collection (Request for Nursing Home Information in Connection With Claim for... who are patients in nursing home. DATES: Written comments and recommendations on the proposed...: Request for Nursing Home Information in Connection with Claim for Aid and Attendance, VA Form 21-0779....

  5. 75 FR 39622 - Proposed Information Collection (Request for Nursing Home Information in Connection with Claim...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-09

    ... AFFAIRS Proposed Information Collection (Request for Nursing Home Information in Connection with Claim for... who are patients in nursing home. DATES: Written comments and recommendations on the proposed.... Title: Request for Nursing Home Information in Connection with Claim for Aid and Attendance, VA Form...

  6. Differences between Newly Admitted Nursing Home Residents in Rural and Nonrural Areas in a National Sample

    ERIC Educational Resources Information Center

    Bolin, Jane Nelson; Phillips, Charles D.; Hawes, Catherine

    2006-01-01

    Purpose: Previous research in specific locales indicates that individuals admitted to rural nursing homes have lower care needs than individuals admitted to nursing homes in urban areas, and that rural nursing homes differ in their mix of short-stay and chronic-care residents. This research investigates whether differences in acuity are a function…

  7. Faith and end of life in nursing homes.

    PubMed

    Rubinstein, Robert L; Black, Helen K; Doyle, Patrick J; Moss, Miriam; Moss, Sidney Z

    2011-01-01

    This paper explores the role of religious belief in the experiences of dying and death in a Catholic nursing home. The home appeals to residents and their families due to the active religious presence. Thus, religion is a salient element of the "local culture" which exists in this long-term care setting. The preeminence of faith within the organization and the personal religious convictions of staff, residents, and families may drive how death and dying are discussed and experienced in this setting, as well as the meanings that are attached to them. This paper examines the relationship between faith and the experience and meaning of death in this nursing home. We present themes that emerged from open-ended interviews with residents, family members, and staff, gathered between 1996 and 2004. The data indicate that people select the home due to their Catholic faith and the home's religious tone. Themes also show that belief in God and an afterlife helps shape the experience of dying and death for our informants. Our paper does not compare ease of dying with other nursing homes or within other belief systems. PMID:21629755

  8. Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes.

    PubMed

    Wagner, Laura M; Capezuti, Elizabeth; Brush, Barbara; Boltz, Marie; Renz, Susan; Talerico, Karen A

    2007-04-01

    Researchers have demonstrated that the use of physical restraints in nursing homes can be reduced, particularly where advanced practice nurses (APNs) are utilized. We examined the link between APN practice, siderail reduction, and the costs of siderail alternatives in 273 residents in four Philadelphia nursing homes. The majority of participants were cognitively and physically impaired with multiple co-morbidities. APNs recommended a total of 1,275 siderail-alternative interventions aimed at reducing fall risk. The median cost of siderail alternatives to prevent falls per resident was $135. Residents with a fall history experienced a significantly higher cost of recommendation compared to non-fallers. Findings suggest that an APN consultation model can effectively be implemented through comprehensive, individualized assessment without incurring substantial costs to the nursing home.

  9. Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes

    PubMed Central

    Hunt, Selina R.; Corazzini, Kirsten; Anderson, Ruth A.

    2014-01-01

    Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided. PMID:24652943

  10. Physical Restraint Initiation in Nursing Homes and Subsequent Resident Health

    ERIC Educational Resources Information Center

    Engberg, John; Castle, Nicholas G.; McCaffrey, Daniel

    2008-01-01

    Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental…

  11. Meaning in Life Categories of Elderly Nursing Home Residents.

    ERIC Educational Resources Information Center

    DePaola, Stephen J.; Ebersole, Peter

    1995-01-01

    Gathered essays from 53 elderly nursing home residents about the strongest meaning in their lives. Most reported family relationships as central, followed by pleasure, and then health. Analysis showed significant differences between residents' and younger adults' types of meaning. Residents did not reveal an absence of meaning in their lives. (RJM)

  12. A Behavioral Intervention to Increase Exercise Among Nursing Home Residents.

    ERIC Educational Resources Information Center

    Perkins, Kenneth A.; And Others

    1986-01-01

    Used a behavioral intervention of goal-setting with feedback and contingent reinforcement to increase stationary bike riding in eight male nursing home residents with multiple major medical and psychiatric disorders. A consistent increase in riding resulted among all participants. Findings support the effectivenes of behavioral strategies in…

  13. [Maintaining the proper distance for nurses working in the home].

    PubMed

    Estève, Sonia

    2016-01-01

    Health professionals must be able to respond to many different situations which require technical knowledge and self-control. Particularly when working in the patient's home, nurses must know how to maintain a proper distance to protect themselves from burnout. In this respect, the practice analysis constitutes an adapted support tool. PMID:27393988

  14. Remote monitoring of nursing home residents using a humanoid robot.

    PubMed

    Bäck, Iivari; Kallio, Jouko; Perälä, Sami; Mäkelä, Kari

    2012-09-01

    We studied the feasibility of using a humanoid robot as an assistant in the monitoring of nursing home residents. The robot can receive alarms via its wireless Internet connection and navigate independently to the room where the alarm originated. Once it has entered the room, the robot can transmit near real time images to the staff and also open a voice connection between the resident and the remote caregivers. This way the remote caregiver is able to check the situation in the room, and take appropriate actions. We tested the prototype robot in three private nursing homes in the Finnish county of South Ostrobothnia. During the testing, 2-4 alarms were produced by each participant and there were 29 alarms in total. The robot was able to navigate correctly to the room from which the alarm was sent and open the speech connection, as well as transmit images via the wireless Internet connection. The experiments provided evidence of the feasibility of using autonomous robots as assistants to nursing home staff in remote monitoring. The response from the nursing home residents was uniformly positive.

  15. Understanding Nursing Home Worker Conceptualizations about Good Care

    ERIC Educational Resources Information Center

    Chung, Gawon

    2013-01-01

    This study explored how direct care workers in nursing homes conceptualize good care and how their conceptualizations are influenced by external factors surrounding their work environment and the relational dynamics between them and residents. Study participants were drawn from a local service employees' union, and in-depth interviews were…

  16. Severity of Neuropsychiatric Symptoms in Nursing Home Residents

    PubMed Central

    Helvik, Anne-Sofie; Engedal, Knut; Wu, Bei; Benth, Jūratė Šaltytė; Corazzini, Kirsten; Røen, Irene; Selbæk, Geir

    2016-01-01

    We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS) in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163) and 2010/2011 (n = 1,858). Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR) sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia. PMID:26933438

  17. Serious Mental Illness in Florida Nursing Homes: Need for Training

    ERIC Educational Resources Information Center

    Molinari, Victor A.; Merritt, Stacy S.; Mills, Whitney L.; Chiriboga, David A.; Conboy, Ann; Hyer, Kathryn; Becker, Marion A.

    2008-01-01

    This study examined how the mental health needs of nursing home (NH) residents with serious mental illness (SMI) are addressed. Data were collected from three sources: interviews with 84 SMI stakeholders; surveys of 206 NH staff members; and focus groups at two psychiatry specialty NHs. Four common themes emerged: placement of older adults with…

  18. Severity of Neuropsychiatric Symptoms in Nursing Home Residents.

    PubMed

    Helvik, Anne-Sofie; Engedal, Knut; Wu, Bei; Benth, Jūratė Šaltytė; Corazzini, Kirsten; Røen, Irene; Selbæk, Geir

    2016-01-01

    We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS) in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163) and 2010/2011 (n = 1,858). Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR) sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia. PMID:26933438

  19. Pottery as Art Therapy with Elderly Nursing Home Residents.

    ERIC Educational Resources Information Center

    Doric-Henry, Lee

    1997-01-01

    Reports on an art therapy intervention which was implemented with 20 elderly nursing home residents so as to improve their psychological well-being. Program evaluation included self-evaluations, case progress notes, journal notes, and photography. Results indicate that participants showed significantly improved measures of self-esteem, and reduced…

  20. Needed: Physical Educators on the Nursing Home Team.

    ERIC Educational Resources Information Center

    Hooks, Bettie; Hooks, Edgar W., Jr.

    1981-01-01

    Social interaction and physical activity are important aspects of health maintenance for the aged. A holistic approach to the care of the elderly in nursing homes would involve a team of professionals who encourage residents to pursue such tasks as adaptation to loss, and maintenance of physical activity to retain function. (JN)

  1. A Profile of the Newly-Admitted Nursing Home Resident.

    ERIC Educational Resources Information Center

    Erber, Joan T.; Dye, Carol J.

    1982-01-01

    Recently admitted nursing home residents received a battery of psychological tests and were rated on a number of behavioral indices. Results revealed the morale/anxiety dimension was independent of cognitive competency, internally controlled residents were rated high by others in behavioral competency, and self-rating scales measure something…

  2. Do Past Experiences Predict Agitation in Nursing Home Residents?

    ERIC Educational Resources Information Center

    Cohen-Mansfield, Jiska; Marx, Marcia S.

    1989-01-01

    Examined relationships between agitated behavior and past personality in 408 nursing home residents. Agitated and nonaggressive behaviors were correlated with past stressful events, and physically aggressive behavior was correlated with the lack thereof; no relationships were found between agitated behavior and history of a mental disorder or past…

  3. Measuring Work Environment and Performance in Nursing Homes

    PubMed Central

    Temkin-Greener, Helena; Zheng, Nan (Tracy); Katz, Paul; Zhao, Hongwei; Mukamel, Dana B.

    2008-01-01

    Background Qualitative studies of the nursing home work environment have long suggested that such attributes as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. Objectives This study is designed to: develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability and validity of the instrument; and identify individual and facility-level factors associated with better facility performance. Research Design and Methods The analysis was based on survey responses provided by managers (N=308) and direct care workers (N=7,418) employed in 162 facilities throughout New York State. Exploratory factor analysis, Chronbach's alphas, analysis of variance, and regression models were used to assess instrument reliability and validity. Multivariate regression models, with fixed facility effects, were used to examine factors associated with work effectiveness. Results The reliability and the validity of the survey instrument for measuring work environment and perceived work effectiveness has been demonstrated. Several individual (e.g. occupation, race) and facility characteristics (e.g. management style, workplace conditions, staffing) that are significant predictors of perceived work effectiveness were identified. Conclusions The organizational performance model used in this study recognizes the multidimensionality of the work environment in nursing homes. Our findings suggest that efforts at improving work effectiveness must also be multifaceted. Empirical findings from such a line of research may provide insights for improving the quality of the work environment and ultimately the quality of residents' care. PMID:19330892

  4. The Coach Is in: Improving Nutritional Care in Nursing Homes

    ERIC Educational Resources Information Center

    Rahman, Anna N.; Simmons, Sandra F.; Applebaum, Robert; Lindabury, Kate; Schnelle, John F.

    2012-01-01

    Purpose: This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. Methods: In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff…

  5. A dog and a "happy person" visit nursing home residents.

    PubMed

    Kaiser, Lana; Spence, Linda J; McGavin, Lily; Struble, Laura; Keilman, Linda

    2002-10-01

    Recent recognition of the importance of the human-animal bond has led to the proliferation of programs designed to improve the lives of nursing home residents through the use of animals. Because human-human interaction in the nursing home setting is often of an obligatory nature, we wondered if a visit from a nonjudgmental, outgoing, enthusiastic young adult ("a happy person") could elicit the same positive influence as a visit from a nonjudgmental dog. The purpose of this study was to determine if elderly residents of a midwestern nursing home had a preference for the type of visitor (dog vs. person) when both visits were nonobligatory and nonjudgmental. Behaviors were evaluated to determine if one visitor was more likely to influence prosocial behaviors (moving closer, patting, smiling). Six residents were visited by both the dog and the happy person: 5 of 6 completed the final interview. Residents were equally likely to smile at and move closer to both visitors. Residents were more likely to pat the dog. Three residents liked both visits equally: 1 preferred the dog, and 1 preferred the happy person. These data suggest that nonobligatory visits to nursing home residents from a happy person may be as beneficial to the resident as visits from a dog. PMID:12365767

  6. Water homeostasis, frailty and congnitive function in the nursing home

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The goal of this study is to develop and test a practical clinical method to assess frailty in nursing homes and to investigate the relationship between cognitive status of the elderly and the balance between water compartments of their body composition. This is a cross-sectional study, conducted a...

  7. A dog and a "happy person" visit nursing home residents.

    PubMed

    Kaiser, Lana; Spence, Linda J; McGavin, Lily; Struble, Laura; Keilman, Linda

    2002-10-01

    Recent recognition of the importance of the human-animal bond has led to the proliferation of programs designed to improve the lives of nursing home residents through the use of animals. Because human-human interaction in the nursing home setting is often of an obligatory nature, we wondered if a visit from a nonjudgmental, outgoing, enthusiastic young adult ("a happy person") could elicit the same positive influence as a visit from a nonjudgmental dog. The purpose of this study was to determine if elderly residents of a midwestern nursing home had a preference for the type of visitor (dog vs. person) when both visits were nonobligatory and nonjudgmental. Behaviors were evaluated to determine if one visitor was more likely to influence prosocial behaviors (moving closer, patting, smiling). Six residents were visited by both the dog and the happy person: 5 of 6 completed the final interview. Residents were equally likely to smile at and move closer to both visitors. Residents were more likely to pat the dog. Three residents liked both visits equally: 1 preferred the dog, and 1 preferred the happy person. These data suggest that nonobligatory visits to nursing home residents from a happy person may be as beneficial to the resident as visits from a dog.

  8. Mental health service use by the elderly in nursing homes.

    PubMed Central

    Burns, B J; Wagner, H R; Taube, J E; Magaziner, J; Permutt, T; Landerman, L R

    1993-01-01

    OBJECTIVES. Because current Omnibus Budget Reconciliation Act regulations influence the disposition of US nursing home residents who have mental illness, National Nursing Home Survey (1985) data are analyzed for predictors of mental health service use. METHODS. Elderly residents' rates of mental health service use are presented. Logistic regression yielded odds ratios for treatment by both mental health specialists and general practitioners for client and service system variables. RESULTS. Among the two thirds of elderly residents with a mental disorder (including dementia), only 4.5% receive any mental health treatment in a 1-month period. The ratio of specialist to general practitioner care is approximately 1:1. Patients seen by a specialist are likely to be younger (aged 65 to 74); live in the Northeast; and have a diagnosis of schizophrenia (13:1), dementia (3:1), or other mental disorders (5:1). Prior residence in a psychiatric hospital predicts care by both health professional types. Rural location, nonproprietary ownership of the nursing home, and aggressive behavior point to general physician care. CONCLUSIONS. Our findings indicate significant neglect of the mental health needs of older nursing home residents and underscore the importance of monitoring the regulations for screening and treatment of mental disorders under the Omnibus Budget Reconciliation Act. PMID:8438968

  9. Cultural Competence in Nursing Homes: Issues and Implications for Education

    ERIC Educational Resources Information Center

    Parker, Victoria A.; Geron, Scott Miyake

    2007-01-01

    A research and intervention project to enhance cultural competence (CC) within nursing home staff is described, with particular emphasis on the qualitative findings generated during baseline assessments of 10 participating facilities. These findings, developed from an analysis of transcripts of 56 focus groups, suggest the importance of five CC…

  10. Nursing Home Care Quality: Insights from a Bayesian Network Approach

    ERIC Educational Resources Information Center

    Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

    2008-01-01

    Purpose: The purpose of this research is twofold. The first purpose is to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes. The second is to provide new insight into the relationships that exist among various measures of quality and how such measures…

  11. Resident-to-resident violence triggers in nursing homes.

    PubMed

    Snellgrove, Susan; Beck, Cornelia; Green, Angela; McSweeney, Jean C

    2013-11-01

    Certified nurses' assistants (CNAs) employed by a rural nursing home in Northeast Arkansas described their perceptions of resident-to-resident violence in order to provide insight on factors, including unmet needs, that may trigger the phenomenon. Semistructured interviews were conducted with 11 CNAs. Data were analyzed using content analysis and constant comparison. Two categories of triggers emerged from the data-active and passive. Active triggers involved the actions of other residents that were intrusive in nature, such as wandering into a residents' personal space, taking a resident's belongings, and so forth. Passive triggers did not involve the actions of residents but related to the internal and external environment of the residents. Examples were factors such as boredom, competition for attention and communication difficulties. Results indicate that there are factors, including unmet needs within the nursing home environment that may be identified and altered to prevent violence between residents.

  12. Developing a fidelity assessment instrument for nurse home visitors.

    PubMed

    Black, Kirsten J; Wenger, Mary Beth; O' Fallon, Molly

    2015-06-01

    Fidelity monitoring is a core component for successful translation of evidence-based interventions, yet little guidance is available on developing tools to assess intervention fidelity that are valid and feasible for use in community settings. We partnered with nurses in the field to develop a fidelity monitoring instrument that would capture the essential elements of the nursing intervention that is the core of Nurse-Family Partnership, a prenatal and early childhood home visitation program. Using a grounded approach, we employed concept mapping to identify the salient behavioral characteristics associated with the program, and then, adapting Dreyfus' model of skill development, created a tool to assess nurse home visitors (NHVs) according to their stage of growth. In a pilot, the Nursing Practice Assessment (NPA) form was used to assess 188 NHVs. The average time to complete the tool was 1 hour, and skill development stage was concordant with years of NHV experience. According to surveys of supervisors and NHVs, the tool captured the essential elements of the program model. Articulating the essential elements of each skill development stage can provide a foundation for professional development for NHVs. In response to feedback, online training modules were developed prior to large-scale implementation in the field. The grounded methods used to develop the NPA enhanced its internal consistency and implementation feasibility and could be utilized by other public health nursing programs.

  13. Developing a fidelity assessment instrument for nurse home visitors.

    PubMed

    Black, Kirsten J; Wenger, Mary Beth; O' Fallon, Molly

    2015-06-01

    Fidelity monitoring is a core component for successful translation of evidence-based interventions, yet little guidance is available on developing tools to assess intervention fidelity that are valid and feasible for use in community settings. We partnered with nurses in the field to develop a fidelity monitoring instrument that would capture the essential elements of the nursing intervention that is the core of Nurse-Family Partnership, a prenatal and early childhood home visitation program. Using a grounded approach, we employed concept mapping to identify the salient behavioral characteristics associated with the program, and then, adapting Dreyfus' model of skill development, created a tool to assess nurse home visitors (NHVs) according to their stage of growth. In a pilot, the Nursing Practice Assessment (NPA) form was used to assess 188 NHVs. The average time to complete the tool was 1 hour, and skill development stage was concordant with years of NHV experience. According to surveys of supervisors and NHVs, the tool captured the essential elements of the program model. Articulating the essential elements of each skill development stage can provide a foundation for professional development for NHVs. In response to feedback, online training modules were developed prior to large-scale implementation in the field. The grounded methods used to develop the NPA enhanced its internal consistency and implementation feasibility and could be utilized by other public health nursing programs. PMID:25778796

  14. [Skin Care to Prevent Development of Pressure Ulcers in Bedridden Nursing Home Residents from Developing Pressure Ulcers in Nursing Home Residents].

    PubMed

    Furukawa, Chie

    2015-12-01

    The purpose of this study was to clarify whether skincare products are effective in preventing development of pressure ulcers in bedridden nursing home residents. The study sample consisted of 21 nursing home residents at a nursing home in Osaka, Japan who use diapers. Participants were assigned to 3 groups and compared to a control group. None of the subjects developed a pressure ulcer and had improved skin condition around the anus. PMID:26809416

  15. A discourse analysis comparing Danish textbooks for nursing and medical students between 1870 and 1956.

    PubMed

    Frederiksen, Kirsten

    2010-06-01

    Based on a discourse analysis inspired by the French philosopher Michel Foucault's late work, the article compares Danish textbooks for nurses and doctors between 1870 and 1956. With the concept of a figure of thought, it is suggested that the discourses of knowledge addressed to nurses were constructed in a pattern in which intertwined arguments formed the figure of orderliness. These arguments were based on knowledge, the patient's needs, the doctor's needs and moral principles, including the needs of the profession and ethical-esthetic principles, whereas the pattern of the discourses of knowledge addressed to the doctor was based on knowledge of diseases reflecting a figure of scientific order. These patterns did not change throughout the period. In the textbooks for nurses, the nurse's relation to self was an explicit subject, whereas the doctor's relation to self was not part of the textbooks addressed to doctors. In light of Foucault's late work, it is suggested that the discourses of knowledge contribute to maintaining the prevailing order in the society; it would be of interest to investigate whether the identified pattern has changed since 1956 and whether it has influenced other areas of nursing education and practice.

  16. Back disorders and lumbar load in nursing staff in geriatric care: a comparison of home-based care and nursing homes

    PubMed Central

    2009-01-01

    Background Back pain is one of the most frequent complaints in the nursing profession. Thus, the 12-month prevalence of pain in the lumbar spine in nursing staff is as high as 76%. Only a few representative studies have assessed the prevalence rates of back pain and its risk factors among nursing staff in nursing homes in comparison to staff in home-based care facilities. The present study accordingly investigates the prevalence in the lumbar and cervical spine and determines the physical workload to lifting and caring in geriatric care. Methods 1390 health care workers in nursing homes and home care participated in this cross sectional survey. The nursing staff members were examined by occupational physicians according to the principals of the multistep diagnosis of musculoskeletal disorders. Occupational exposure to daily care activities with patient transfers was measured by a standardised questionnaire. The lumbar load was calculated with the Mainz-Dortmund dose model. Information on ergonomic conditions were recorded from the management of the nursing homes. Comparisons of all outcome variables were made between both care settings. Results Complete documentation, including the findings from the occupational physicians and the questionnaire, was available for 41%. Staff in nursing homes had more often positive orthopaedic findings than staff in home care. At the same time the values calculated for lumbar load were found to be significant higher in staff in nursing homes than in home-based care: 45% vs. 6% were above the reference value. Nursing homes were well equipped with technical lifting aids, though their provision with assistive advices is unsatisfactory. Situation in home care seems worse, especially as the staff often has to get by without assistance. Conclusions Future interventions should focus on counteracting work-related lumbar load among staff in nursing homes. Equipment and training in handling of assistive devices should be improved especially

  17. Treatment of heart failure in nursing home residents

    PubMed Central

    Daamen, Mariëlle AMJ; Hamers, Jan PH; Gorgels, Anton PM; Tan, Frans ES; Schols, Jos MGA; Rocca, Hans-Peter Brunner-la

    2016-01-01

    Background For the treatment of chronic heart failure (HF), both pharmacological and non-pharmacological treatment should be employed in HF patients. Although HF is highly prevalent in nursing home residents, it is not clear whether the recommendations in the guidelines for pharmacological therapy also are followed in nursing home residents. The aim of this study is to investigate how HF is treated in nursing home residents and to determine to what extent the current treatment corresponds to the guidelines. Methods Nursing home residents of five large nursing home care organizations in the southern part of the Netherlands with a previous diagnosis of HF based on medical records irrespective of the left ventricle ejection fraction (LVEF) were included in this cross-sectional design study. Data were gathered on the (medical) records, which included clinical characteristics and pharmacological- and non-pharmacological treatment. Echocardiography was used as part of the study to determine the LVEF. Results Out of 501 residents, 112 had a diagnosis of HF at inclusion. One-third of them received an ACE-inhibitor and 40% used a β-blocker. In 66%, there was a prescription of diuretics with a preference of a loop diuretic. Focusing on the residents with a LVEF ≤ 40%, only 46% of the 22 residents used an ACE-inhibitor and 64% a β-blocker. The median daily doses of prescribed medication were lower than those that were recommended by the guidelines. Non-pharmacological interventions were recorded in almost none of the residents with HF. Conclusions The recommended medical therapy of HF was often not prescribed; if prescribed, the dosage was usually far below what was recommended. In addition, non-pharmacological interventions were mostly not used at all. PMID:26918012

  18. Geothermal greenhouse heating facilities for the Klamath County Nursing Home, Klamath Falls, Oregon

    NASA Astrophysics Data System (ADS)

    1982-02-01

    The Klamath County Nursing Home, located in Klamath Falls, Oregon, was constructed in 1976. The building of 55,654 square feet currently houses care facilities for approximately 120 persons. During the initial planning for the nursing home, the present site was selected primarily on the basis of its geothermal resource. This resource currently provides space and domestic hot water heating for the nursing home, Merle West Medical Center and the Oregon Institute of Technology. The feasibility of installing a geothermal heating system in a planned greenhouse for the nursing home is explored. The greenhouse system would be tied directly to the existing hot water heating system for the nursing home.

  19. Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

    PubMed Central

    Kane, R L; Garrard, J; Skay, C L; Radosevich, D M; Buchanan, J L; McDermott, S M; Arnold, S B; Kepferle, L

    1989-01-01

    We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care. PMID:2504064

  20. Nursing dependency in registered nursing homes and long term care geriatric wards in Edinburgh.

    PubMed Central

    Capewell, A E; Primrose, W R; MacIntyre, C

    1986-01-01

    There has been growing interest and public investment in registered nursing homes, apparently based on the assumption that these homes are the private equivalent of hospital long term care. We have tested this hypothesis in a survey comparing 400 patients in 18 registered nursing homes with 217 patients in 11 geriatric long term care wards in Edinburgh. The nursing home patients formed a distinct and separate group: 362 (92%) were women, 392 (98%) were single or widowed, and 358 (90%) were self financing, whereas in the geriatric long term care group 148 (68%) were women and 35 (16%) were still married. Patients in nursing homes were also far less dependent than those in geriatric long term care wards (p less than 0.005). This study suggests that there may be large differences between the patients in these two types of institution, particularly with regard to nursing dependency. This finding has important implications in the future planning of long term places for the dependent elderly. PMID:3089370

  1. Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

    PubMed

    Kane, R L; Garrard, J; Skay, C L; Radosevich, D M; Buchanan, J L; McDermott, S M; Arnold, S B; Kepferle, L

    1989-09-01

    We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.

  2. Mennonite Nursing Home passive solar demonstration

    SciTech Connect

    Not Available

    1984-03-01

    A long-term nursing care facility and retirement center was designed for passive solar heating. The system comprises thermal mass, thermal insulation, Trombe walls, and direct gain clerestories. Included here is a topical report, analysis of building performance, owner's perspective, designer's perspective, and summary of information dissemination activities. (MHR)

  3. Characteristics of Absenteeism in Nursing Home Staff.

    ERIC Educational Resources Information Center

    Cohen-Mansfield, Jiska; Rosenthal, Alvin S.

    This study investigated factors associated with absenteeism among nursing staff (N=219) at a long-term care facility. Four absenteeism measures were calculated from personnel records for each month of the year: no pay (the sum of unscheduled, unpaid sick, and leave without pay), part day (the sum of arrived late and left early), paid sick, and…

  4. Low-Quality Nursing Homes Were More Likely Than Other Nursing Homes To Be Bought Or Sold By Chains In 1993-2010.

    PubMed

    Grabowski, David C; Hirth, Richard A; Intrator, Orna; Li, Yue; Richardson, John; Stevenson, David G; Zheng, Qing; Banaszak-Holl, Jane

    2016-05-01

    Two defining features of the nursing home industry are the tremendous churn in chain ownership and the perception of low-quality care at many facilities. We examined whether nursing homes that underwent chain-related transactions, such as mergers and acquisitions, experienced a larger number of health deficiency citations than nursing homes that maintained common ownership over the same period. Using facility-level data for the period 1993-2010, we found that those nursing homes that underwent chain-related transactions had more deficiency citations in the years preceding and following a transaction than those nursing homes that maintained common ownership. Thus, we did not find that these transactions led to a decline in quality. Instead, we found that chains targeted nursing homes that were already having quality problems and that these problems persisted after the transaction. Given the high frequency of nursing home chain transactions, policy makers will need to continue to invest in tracking, reporting, and overseeing these transactions. One important step would be to report more detailed data on chain ownership, transactions, and aggregate chain quality on the Nursing Home Compare website, the federal government's online report card for nursing homes.

  5. Infectious diseases and death among nursing home residents: results of surveillance in 13 nursing homes.

    PubMed

    Beck-Sague, C; Villarino, E; Giuliano, D; Welbel, S; Latts, L; Manangan, L M; Sinkowitz, R L; Jarvis, W R

    1994-07-01

    An increasing proportion of the U.S. population resides in nursing homes (NHs). No surveillance system exists for infections in these facilities. To determine the incidence and types of infections in NH residents, and to identify predictors of death among residents with infections, we initiated a surveillance system at 13 NHs in California during a 6-month period from October 1989 through March 1990. The study included 1754 residents, among whom 835 infections were identified during the study period. The most common infections were urinary tract infections (UTIs; 286, 34.2%), respiratory tract infections (RTIs; 259, 31%), and skin infections (150, 17.9%). Of the 259 residents with respiratory tract infections, 69 (27%) had pneumonia. Antimicrobials were prescribed for 646 (77%) of the infectious episodes. Residents with pneumonia were more likely to die than residents with other infections (4 of 69 versus 12 of 766; P = 0.04). Symptoms of altered body temperature (fever, hypothermia, chills) and change in mental status also were associated with an increased risk of a fatal outcome (10 of 260 versus 6 of 575; P = 0.01) and (7 of 127 versus 9 of 708; P = 0.004). This study suggests that the most common infections among NH residents are UTIs, RTIs, and skin infections. Pneumonia, symptoms of fever, and mental status changes all were associated with increased mortality. The frequency of infections among NH residents and their impact on resident outcome highlights the need for infectious disease surveillance in this population. PMID:7963443

  6. Picture Your Nursing Home: Exploring the Sense of Home of Older Residents through Photography

    PubMed Central

    van Hoof, J.; Verhagen, M. M.; Wouters, E. J. M.; Marston, H. R.; Rijnaard, M. D.; Janssen, B. M.

    2015-01-01

    The quality of the built environment can impact the quality of life and the sense of home of nursing home residents. This study investigated (1) which factors in the physical and social environment correlate with the sense of home of the residents and (2) which environmental factors are most meaningful. Twelve participants engaged in a qualitative study, in which photography was as a supportive tool for subsequent interviews. The data were analysed based on the six phases by Braun and Clarke. The four themes identified are (1) the physical view; (2) mobility and accessibility; (3) space, place, and personal belongings; and (4) the social environment and activities. A holistic understanding of which features of the built environment are appreciated by the residents can lead to the design and retrofitting of nursing homes that are more in line with personal wishes. PMID:26346975

  7. Prescribing for older people in nursing homes: strategies to improve prescribing and medicines use in nursing homes.

    PubMed

    Parsons, Carole; Alldred, David; Daiello, Lori; Hughes, Carmel

    2011-03-01

    Interventions to improve prescribing in the nursing home environment are many and varied. The critical literature review presented in Paper 1 (Parsons et al., 2011, International Journal of Older People Nursing 6, 45-54) in this series discussed the main issues repeatedly identified as problematic, and this paper summarises the main approaches which have been used to attempt to improve prescribing. These include national legislation which demands documented justification for the prescribing of medicines, medication review, approaches to reducing medication errors, improving communication across care boundaries and assessment teams and alternative service models. It is difficult to make global recommendations as some of these approaches are country specific or have been delivered in different ways, involving different professionals. However, a series of prompt questions have been provided which may assist nursing home staff in deciding whether prescribing is optimal in a resident or if an intervention is required which may lead to an overall improvement in outcomes.

  8. Making Difficult Decisions: The Role of Quality of Care in Choosing a Nursing Home

    PubMed Central

    Phelps, Charles E.; Temkin-Greener, Helena; Spector, William D.; Veazie, Peter; Mukamel, Dana B.

    2013-01-01

    Objectives. We investigated how quality of care affects choosing a nursing home. Methods. We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model. Results. In all states, consumers were more likely to choose nursing homes of high hotel services quality but not clinical care quality. Nursing home choice was also significantly associated with shorter distance from prior residence, not-for-profit status, and larger facility size. Conclusions. In the absence of quality report cards, consumers choose a nursing home on the basis of the quality dimensions that are easy for them to observe, evaluate, and apply to their situation. Future research should focus on identifying the quality information that offers the most value added to consumers. PMID:23488519

  9. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  10. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  11. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  12. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  13. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  14. RNs' Transitions into Director of Nursing Positions in Nursing Homes: Hiring Practices and Role Development.

    PubMed

    Siegel, Elena O; Sikma, Suzanne

    2015-06-01

    The current paper discusses RNs' transitions into their first nursing home director of nursing (DON) position, including hiring practice and role development. A convenience sample of 29 current and previous DONs and nursing home administrators completed semistructured interviews for the current qualitative, descriptive study. Using thematic analysis, the finding revealed three primary themes: (a) DON hiring criteria are not necessarily matched to role demands; (b) various pathways to developing DON expertise suggest an undervaluing of the competencies needed to effectively enact this nursing leadership position; and (c) although limited formal training for the DON position was well-acknowledged, concerns or reports of the consequences varied, and there is no consensus as to the optimal route to preparation. Overall, the current study findings highlight gaps across practice, policy, and research, emphasizing the consequences of limited attention to gathering evidence of the breadth and depth of DON role demands and related role qualifications.

  15. Safety culture of nursing homes: opinions of top managers

    PubMed Central

    Castle, Nicholas G.; Wagner, Laura M.; Ferguson, Jamie C.; Handler, Steven M.

    2016-01-01

    Background Examining the perception of the patient safety culture (PSC) of top managers in healthcare settings is important because their orientation to PSC can have a large influence on the facility. Purposes In this research, the perception of the PSC of Nursing Home Administrators (NHAs) and Directors of Nursing (DONs) is examined. Methodology/Approach Primary data were collected to examine the opinions of the PSC from NHAs and DONs. Information was collected from a large nationally representative sample of 4,000 nursing homes. The Nursing Home Survey on Patient Safety Culture (NHSPSC) survey instrument was used as a measure of PSC. This has 12 domains and 38 items. Bias indexes, intraclass correlation coefficients, and Pearson’s product-moment correlation coefficients of the differences between NHA and DON item scores were examined. Findings Using a 0–100 scale, most scores fell into the 55–80 range. Higher scores represent a higher (more favorable) PSC. Agreement between the NHA and DON was excellent for 10 items, good in 15 items, moderate in 4 items, and poor in 8 items. Of the 4 largest differences in scores, the NHA scores were higher than the DON scores for one item and DON scores were higher than the NHA scores for 3 items. Implications The overall perception from both NHAs and DONs, would appear to represent a somewhat “positive” outlook from these top managers on their institution’s PSC. However, NHAs in general report higher scores than DONs. The areas of divergence between these top managers are further discussed, with a view towards directing future patient safety investigations and initiatives in nursing homes. PMID:21317661

  16. Swallowing problems in the nursing home: a novel training response.

    PubMed

    O'Loughlin, G; Shanley, C

    1998-01-01

    Various studies suggest that between 50% and 75% of nursing home residents have some difficulty in swallowing. Some of these residents are assessed and treated by speech pathologists, but many are managed by nursing staff without specialist input. A training program called Swallowing ... on a Plate (SOAP) has been developed by the Centre for Education and Research on Ageing and the Inner West Geriatrics and Rehabilitation Service to help address swallowing-related problems in local nursing homes (Inner West of Sydney, Australia). The training program teaches nursing staff how to identify, assess, and manage swallowing problems, including making appropriate referrals. Several new instruments were developed specifically for this program including two assessment checklists, a set of management guidelines, and a swallowing care plan. Evaluation of the program--including 3 months follow-up--showed it to be highly successful. A stand-alone training resource has been produced for wide distribution to help staff implement the program as a permanent aspect of their nursing care. This paper describes the development, content, presentation, resource, and evaluation of the above program.

  17. Hospitals will send an integrated nurse home with each discharge.

    PubMed

    Morrow, Thomas

    2015-01-01

    Hospitals must adapt to the rapidly changing environment of risk by changing the health behavior of their population. There is only one way to do this efficiently and at scale; send a nurse home with every patient at the time of discharge. That nurse can ensure adherence to medication and slowly, over time, transform personal behavior to evidence based levels ... basically taking their medication as prescribed, changing eating habits, increasing exercise, getting people to throw away their cigarettes, teaching them how to cope, improving their sleep and reducing their stress. But, this approach will require a nurse to basically "live" with the patient for prolonged periods of time, as bad health behaviors are quick to start but slow to change or end. The rapid developments in artificial intelligence and natural language understanding paired with cloud based computing and integrated with a variety of data sources has led to a new marketplace comprised of cognitive technologies that can emulate even the most creative, knowledgeable and effective nurse. Termed the Virtual Health Assistant, your patients can literally talk to these agents using normal conversational language. The possibility to send a nurse home with each patient to maintain adherence and prevent readmissions has arrived. The technology is available. Who will step forward to reap the rewards first? PMID:26571636

  18. Home Health Nurse Collaboration in the Medical Neighborhood of Children with Medical Complexity.

    PubMed

    Nageswaran, Savithri; Golden, Shannon L

    2016-10-01

    The objectives of this study were to describe how home healthcare nurses collaborate with other clinicians caring for children with medical complexity, and identify barriers to collaboration within the medical neighborhood. Using qualitative data obtained from 20 semistructured interviews (15 English, 5 Spanish) with primary caregivers of children with medical complexity and 18 home healthcare nurses, researchers inquired about experiences with home healthcare nursing services for these children. During an iterative analysis process, recurrent themes were identified by their prevalence and salience in the data. Home healthcare nurses collaborate with many providers within the medical neighborhood of children with medical complexity and perform many different collaborative tasks. This collaboration is valued by caregivers and nurses, but is inconsistent. Home healthcare nurses' communication with other clinicians is important to the delivery of good-quality care to children with medical complexity at home, but is not always present. Home healthcare nurses reported inability to share clinical information with other clinicians, not receiving child-specific information, and lack of support for clinical problem-solving as concerns. Barriers for optimal collaboration included lack of preparedness of parents, availability of physicians for clinical support, reimbursement for collaborative tasks, variability in home healthcare nurses' tasks, and problems at nursing agency level. Home healthcare nurses' collaboration with other clinicians is important, but problems exist in the current system of care. Optimizing collaboration between home healthcare nurses and other clinicians will likely have a positive impact on these children and their families. PMID:27677065

  19. Nursing documentation in nursing homes--state-of-the-art and implications for quality improvement.

    PubMed

    Voutilainen, Päivi; Isola, Arja; Muurinen, Seija

    2004-03-01

    This study was designed to gain information on the quality of nursing care based on the comments in nursing records. The specific aims of the study were to find out if the patients' (i) individual needs are assessed, the goals for nursing care are set, and the nursing interventions are determined; (ii) if the patients' needs are met and (iii) if goal achievement is regularly evaluated by including comments in nursing documents. In addition, the study aimed to describe the up-to-dateness of nursing care plans as well as the frequency of making daily notes. The data were collected on 36 wards of four residential homes. A 30% sample of the nursing documents on each ward was collected (n=332) using the Senior Monitor instrument. The documents studied were mainly nursing care plans and daily note sheets. Seventy-three per cent of the nursing home residents had an up-to-date nursing care plan at the time of data collection. The main results demonstrated that a written statement on the patient's mental ability was lacking in every fourth document although 75% of the patients suffer from at least moderate dementia in Finnish long-term care institutions. Development activities should also be targeted to the documentation of clear and concrete means by which patients' independent functioning is supported. In addition, evaluation was the area that warranted attention and development activities since only every fourth record included information on changes in the patients' functional capability. Although a lot of in-service training has been focused on improving the documentation practices, there is still a need for development. The means by which knowledge is transferred to guide the practice should be carefully considered. Also forms should be developed to meet the special requirements for recording nursing care in long-term care settings.

  20. O'Bannon v. Town Court Nursing Center: patients' right to participate in nursing home decertification.

    PubMed

    Rosenfeld, S

    1982-01-01

    A decertification action by the Department of Health and Human Services (formerly the Department of Health, Education and Welfare) substantially impacts on the lives of Medicaid patients who reside in the affected nursing home. Decertification means that the federal government, the state government, or both will no longer pay for the care of Medicaid patients in the decertified home. Thus, a decision to decertify necessitates the transfer of elderly and infirm Medicaid patients out of the decertified home. Since this transfer may threaten the lives and health of these patients, they should be granted the right to participate in pre-decertification proceedings. However, in O'Bannon v. Town Court Nursing Center, the Supreme Court decided that patients do not have the right to participate in predecertification proceedings. The Court rejected the patients' due process arguments, finding: 1) that decertification does not deprive the patients of any constitutionally protected interest in life, liberty, or property; and 2) that any adverse consequences of decertification are only an "indirect and incidental" result of government action. This Comment analyzes the Supreme Court opinion and concludes that the patients have protectable property and life interests that entitle them to participate in some form of hearing prior to the decertification of the nursing home where they reside. In addition, this Comment suggests alternative methods for asserting nursing home patients' legal rights.

  1. Contracts and provider agreements for State home nursing home care. Interim final rule.

    PubMed

    2012-12-01

    This interim final rule amends Department of Veterans Affairs (VA) regulations to allow VA to enter into contracts or provider agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking is required to implement a change in law that revises how VA will pay for care provided to these veterans and authorizes VA to use provider agreements to pay for such care. The change made by this law applies to all care provided to these veterans in State homes on and after February 2, 2013.

  2. Quality of life in elderly diabetic: comparison between home and nursing home.

    PubMed

    Ghassemzadeh, Roya; Nasseh, Homa; Arastoo, Ali Asghar; Kamali, Mohammad; Rahimi Foroushani, Abbas; Arzaghi, Masoud

    2013-05-07

    Research and planning to improve the quality of life for elderly seems to be essential, as the population of this age group has shown an increasing trend. Any chronic disease including diabetes has an impact on lifestyle of the patient. The objective of this study was to compare the quality of life between two groups of elderly diabetic patients who were residence of home as well as nursing home. A descriptive-analytical random study was conducted during 2010-2011 on two groups of 93 elderly diabetic patients, who were living in Kahrizak nursing home of Tehran (Iran), and home residents as well by interview for their demographical information and one standard questionnaire provided by world health organization. SPSS 16 was employed for data analysis. Significant differences were found in physical, psychological and social domains between two groups (P<0.05). In physical and social domains the elderly diabetic patients of nursing home had a higher mean score but in psychological domain the result was in contrast. Regarding the difference between scores in two studied groups it is necessary to study the weak points of each group individually and try to resolve the problems.

  3. A haven of last resort: the consequences of evacuating Florida nursing home residents to nonclinical buildings.

    PubMed

    Christensen, Janelle J; Brown, Lisa M; Hyer, Kathryn

    2012-01-01

    Nursing home administrators (n = 15) and directors of nursing (n = 15) who worked in nursing homes during the 2004-2005 Florida hurricane season participated in a series of 6 focus groups. The purpose of the focus groups was to explore issues faced by nursing home administrators, nurses, and residents during hurricane evacuations. A primary finding was that evacuating nursing home residents to buildings that are not designed to support nursing activities (e.g., a school gymnasium or church) adversely affected resident feeding, sleeping, movement, and security. These nonclinical buildings also presented serious occupational health concerns for nursing staff members who provided care during emergencies. Recommendations for reducing patient and nursing staff injuries for those forced to evacuate to a nonclinical building as the result of an emergency event are provided.

  4. Assisting Cognitively Impaired Nursing Home Residents with Bathing: Effects of Two Bathing Interventions on Caregiving

    ERIC Educational Resources Information Center

    Hoeffer, Beverly; Talerico, Karen Amann; Rasin, Joyce; Mitchell, C. Madeline; Stewart, Babara J.; McKenzie, Darlene; Barrick, Ann Louise; Rader, Joanne; Sloane, Philip D.

    2006-01-01

    Purpose: When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing, nursing home caregivers are in a unique position to improve residents' experience. This report addresses whether certified nursing assistants (CNAs) who received training in a person-centered approach with showering and with the…

  5. Role for a Labor-Management Partnership in Nursing Home Person-Centered Care

    ERIC Educational Resources Information Center

    Leutz, Walter; Bishop, Christine E.; Dodson, Lisa

    2010-01-01

    Purpose: To investigate how a partnership between labor and management works to change the organization and focus of nursing home frontline work, supporting a transition toward person-centered care (PCC) in participating nursing homes. Design and Methods: Using a participatory research approach, we conducted case studies of 2 nursing homes…

  6. Quality of Life in the Nursing Home: Perspectives of Younger and Older Residents

    ERIC Educational Resources Information Center

    Watt, Ashli; Konnert, Candace

    2007-01-01

    Adults aged 65 and younger make up a significant proportion of nursing-home residents. To date, however, there is no research examining their quality of life (QOL), including how their perceptions of QOL compare to those of older nursing-home residents. This study used a multidimensional approach to (a) assess the QOL of younger nursing-home…

  7. Quality assessment in nursing home facilities: measuring customer satisfaction.

    PubMed

    Mostyn, M M; Race, K E; Seibert, J H; Johnson, M

    2000-01-01

    A national study designed to assess the reliability and validity of a nursing home customer satisfaction survey is summarized. One hundred fifty-nine facilities participated, each responsible for the distribution and collection of 200 questionnaires randomly sent to the home of the resident's responsible party. A total of 9053 completed questionnaires were returned, for an average adjusted response rate of 53%. The factor analysis identified 4 scales: Comfort and Cleanliness, Nursing, Food Services, and Facility Care and Services, each with high reliability. Based on a multiple regression analysis, the scales were shown to have good criterion-related validity, accounting for 64% of the variance in overall quality ratings. Comparisons based on select characteristics indicated significantly different satisfaction ratings among facilities. The results are interpreted as providing evidence for the construct validity of a multidimensional customer satisfaction scale with measured reliability and criterion-related validity. Moreover, the scale can be used to differentiate satisfaction levels among facilities. PMID:10763218

  8. An evaluation of current approaches to nursing home capital reimbursement.

    PubMed

    Cohen, J; Holahan, J

    1986-01-01

    One of the more controversial issues in reimbursement policy is how to set the capital cost component of facilities rates. In this article we examine in detail the various approaches used by states to reimburse nursing homes for capital costs. We conclude that newer approaches that recognize the increasing value of nursing home assets over time, commonly called fair rental systems, are preferable to the methodologies that have been used historically in both the Medicare and the Medicaid programs to set capital rates. When properly designed, fair rental systems should provide more rational incentives and less encouragement of property manipulation than do more traditional systems, with little or no increase in state costs. PMID:2937726

  9. Regulation and mindful resident care in nursing homes.

    PubMed

    Colón-Emeric, Cathleen S; Plowman, Donde; Bailey, Donald; Corazzini, Kirsten; Utley-Smith, Queen; Ammarell, Natalie; Toles, Mark; Anderson, Ruth

    2010-09-01

    Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindful staff behavior as it relates to resident health outcomes, and offer a theoretical explanation of why regulations sometimes enhance mindfulness and other times inhibit it. We analyzed data from an in-depth, multiple-case study including field notes, interviews, and documents collected in eight nursing homes. We completed a conceptual/thematic description using the concept of mindfulness to reframe the observations. Shared facility mission strongly impacted staff perceptions of the purpose and utility of regulations. In facilities with a resident-centered culture, regulations increased mindful behavior, whereas in facilities with a cost-focused culture, regulations reduced mindful care practices. When managers emphasized the punitive aspects of regulation we observed a decrease in mindful practices in all facilities. PMID:20479137

  10. Quality improvement for feeding assistance care in nursing homes.

    PubMed

    Simmons, Sandra F

    2007-03-01

    Unintentional weight loss is a common problem among nursing home residents and one that can lead to adverse and costly clinical outcomes. Observational studies have shown that residents often receive inadequate and poor-quality feeding assistance during meals, and residents consume few calories between meals from oral liquid nutritional supplements or other food and fluid items. Improvements in the adequacy and quality of feeding assistance either during or between meals have been shown to improve residents' daily oral food and fluid consumption and promote weight gain. However, these feeding assistance interventions require significantly more time than nursing home staff currently spend on feeding assistance care activities. Alternative staffing models are explored through the recent federal "paid feeding assistant" regulation and an observational tool is described for use in practice to improve feeding assistance care.

  11. Quality assessment in nursing home facilities: measuring customer satisfaction.

    PubMed

    Mostyn, M M; Race, K E; Seibert, J H; Johnson, M

    2000-01-01

    A national study designed to assess the reliability and validity of a nursing home customer satisfaction survey is summarized. One hundred fifty-nine facilities participated, each responsible for the distribution and collection of 200 questionnaires randomly sent to the home of the resident's responsible party. A total of 9053 completed questionnaires were returned, for an average adjusted response rate of 53%. The factor analysis identified 4 scales: Comfort and Cleanliness, Nursing, Food Services, and Facility Care and Services, each with high reliability. Based on a multiple regression analysis, the scales were shown to have good criterion-related validity, accounting for 64% of the variance in overall quality ratings. Comparisons based on select characteristics indicated significantly different satisfaction ratings among facilities. The results are interpreted as providing evidence for the construct validity of a multidimensional customer satisfaction scale with measured reliability and criterion-related validity. Moreover, the scale can be used to differentiate satisfaction levels among facilities.

  12. Visibility and findability of the nursing home compare website.

    PubMed

    Liu, Darren; Lu, Chi-Jung

    2015-01-01

    Nursing Home Compare (NHC) is a federal government website providing information for selecting a nursing home. However, not many consumers were aware of or can locate the site. This study analyzed 50 official state and District of Columbia websites from September through December 2013. Using Google "inlink:" operator, this study evaluated the visibility and findability of NHC links in each state-level website. The results show that a link to NHC is available in all states except for Connecticut, Florida, and Michigan. Although it took only 4.7 clicks on average to the page with a NHC link, consumers may still have difficulty to find NHC from a state website. This article provides a snapshot of the visibility and findability of NHC and indicates a need for further investigation of promising website dissemination strategies not yet adequately evaluated.

  13. Resident-to-Resident Violence Triggers in Nursing Homes

    PubMed Central

    Snellgrove, Susan; Beck, Cornelia; Green, Angela; McSweeney, Jean C.

    2014-01-01

    Certified nurses’ assistants (CNAs) employed by a rural nursing home in Northeast Arkansas described their perceptions of resident-to-resident violence in order to provide insight on factors, including unmet needs, that may trigger the phenomenon. Semistructured interviews were conducted with 11 CNAs. Data were analyzed using content analysis and constant comparison. Two categories of triggers emerged from the data—active and passive. Active triggers involved the actions of other residents that were intrusive in nature, such as wandering into a residents’ personal space, taking a resident’s belongings, and so forth. Passive triggers did not involve the actions of residents but related to the internal and external environment of the residents. Examples were factors such as boredom, competition for attention and communication difficulties. Results indicate that there are factors, including unmet needs within the nursing home environment that may be identified and altered to prevent violence between residents. PMID:23447361

  14. Transitions in men's caring identities: experiences from home-based care to nursing home placement.

    PubMed

    Eriksson, Henrik; Sandberg, Jonas

    2008-06-01

    Objectives.  The aim of this study is to describe, from a gender identity perspective, the experiences of older men involved in the process of caring for a partner at home and the placement into a nursing home. Background.  Few studies have paid attention to the importance of gender when considering the social experiences of older men providing care for an ill spouse and finally placing a partner in a nursing home. Further understanding is much needed of how older men experience the process of caring for a spouse from a gender identity perspective. Design.  A qualitative constructivist approach was adopted for this study. Participants.  Data consists of interviews with seven men that have been informal carers and experienced the placement of their wife in a nursing home. Methods.  Interviews were analysed with a constructivist approach. Results.  The results indicate that men go through two transitions in their gender identity during the caregiving process and placement. From the mutual loving relationship of being a loving husband, the social responsibility of daily care of their wives changes the situation into that of being a caring husband, and finally with the move to a nursing home there is a transition from intimate care to a relationship based on friendship. Conclusions.  The results show that older caregiving men undergo a process involving a reconstruction of gender identity. To formally recognize men's caring activities and to make them sustainable, we believe that men in an informal caring relationship need support. Relevance to clinical practice.  Nurses need to recognize the identity struggles resulting in sadness and suffering that are related to changes in men's lives during the caregiving process. Understanding the dynamics and changes that occur when men take on a caring task is important for the development of their role as carers.

  15. Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents.

    PubMed

    Park, Yeonhwan; Oh, Seieun; Chang, Heekyung; Bang, Hwal Lan

    2015-11-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents" found on pages 30-39, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Explain the development and testing of the Evidence-Based Nursing Care Algorithm of

  16. Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents.

    PubMed

    Park, Yeonhwan; Oh, Seieun; Chang, Heekyung; Bang, Hwal Lan

    2015-11-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents" found on pages 30-39, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Explain the development and testing of the Evidence-Based Nursing Care Algorithm of

  17. [What happened after meprobamate's withdrawal? Survey in two nursing homes].

    PubMed

    Lounis, Yacine; Bonnet-Zamponi, Dominique; Pautas, Éric; Gaubert-Dahan, Marie-Line

    2016-01-01

    We have conducted in two nursing homes a survey to study the impact of meprobamate's withdrawal, at the beginning of 2012, in terms of extent of prescribing to others psychotropic drugs and occurrence of adverse events. After meprobamate's withdrawal, 65 % of residents did not receive alternative medication and within three months after meprobamate stopping, adverse events (drowsiness, falls and hospitalization) decreased while agitation did not increase.

  18. [Interests of an olfactory stimulation activity in a nursing home].

    PubMed

    Garnaud, Mahlia; Rexand, Franck

    2016-01-01

    The comparison between the memories productions of residents in a nursing home through two reminiscence activities, one including olfaction and not the other one, can highlight an increasing occurrence of recent memories in the case of olfactory activity. A longer talk time is also observed and a better self-esteem can be assessed. This suggests the possibility of a specific relational and psychotherapeutic work. PMID:26976316

  19. Impact of human resource management practices on nursing home performance.

    PubMed

    Rondeau, K V; Wagar, T H

    2001-08-01

    Management scholars and practitioners alike have become increasingly interested in learning more about the ability of certain 'progressive' or 'high-performance' human resource management (HRM) practices to enhance organizational effectiveness. There is growing evidence to suggest that the contribution of various HRM practices to impact firm performance may be synergistic in effect yet contingent on a number of contextual factors, including workplace climate. A contingency theory perspective suggests that in order to be effective, HMR policies and practices must be consistent with other aspects of the organization, including its environment. This paper reports on empirical findings from research that examines the relationship between HRM practices, workplace climate and perceptions of organizational performance, in a large sample of Canadian nursing homes. Data from 283 nursing homes were collected by means of a mail survey that included questions on HRM practices, programmes, and policies, on human resource aspects of workplace climate, as well as a variety of indicators that include employee, customer/resident and facility measures of organizational performance. Results derived from ordered probit analysis suggest that nursing homes in our sample which had implemented more 'progressive' HRM practices and which reported a workplace climate that strongly values employee participation, empowerment and accountability tended to be perceived to generally perform better on a number of valued organizational outcomes. Nursing homes in our sample that performed best overall were found to be more likely to not only have implemented more of these HRM practices, but also to report having a workplace climate that reflects the seminal value that it places on its human resources. This finding is consistent with the conclusion that simply introducing HRM practices or programmes, in the absence of an appropriately supportive workplace climate, will be insufficient to attain

  20. The use of mechanical and chemical restraints in nursing homes.

    PubMed

    Covert, A B; Rodrigues, T; Solomon, K

    1977-02-01

    The use of mechanical and chemical restraints in nursing homes is a common practice, fraught with potential abuse. The patient's freedom of movement and right to an adequate medical and psychiatric evaluation are of the utmost importance. Restraints should be used only as a last resort and should not be a substitute for inadequate staffing or incomplete medical appraisal. Guidelines are offered that maximize the patients' freedom, maintain medical responsibility, and assure safety. Alternatives to the use of restraints are discussed.

  1. Nursing Home Medical Staff Organization and 30-Day Rehospitalizations

    PubMed Central

    Lima, Julie C.; Intrator, Orna; Karuza, Jurgis; Wetle, Terrie; Mor, Vincent; Katz, Paul

    2013-01-01

    Objectives To examine the relationship between features of nursing home (NH) medical staff organization and residents’ 30-day rehospitalizations. Design Cross-sectional study combining primary data collected from a survey of medical directors, NH resident assessment data (minimum data set), Medicare claims, and the Online Survey Certification and Reporting (OSCAR) database. Setting A total of 202 freestanding US nursing homes. Participants Medicare fee-for-service beneficiaries who were hospitalized and subsequently admitted to a study nursing home. Measurements Medical staff organization dimensions derived from the survey, NH residents’ characteristics derived from minimum data set data, hospitalizations obtained from Part A Medicare claims, and NH characteristics from the OSCAR database and from www.ltcfocus.org. Study outcome defined within a 30-day window following an index hospitalization: rehospitalized, otherwise died, otherwise survived and not rehospitalized. Results Thirty-day rehospitalizations occurred for 3788 (20.3%) of the 18,680 initial hospitalizations. Death was observed for 884 (4.7%) of residents who were not rehospitalized. Adjusted by hospitalization, resident, and NH characteristics, nursing homes having a more formal appointment process for physicians were less likely to have 30-day rehospitalization (b = −0.43, SE = 0.17), whereas NHs in which a higher proportion of residents were cared for by a single physician were more likely to have rehospitalizations (b = 0.18, SE = 0.08). Conclusion This is the first study to show a direct relationship between features of NH medical staff organization and resident-level process of care. The relationship of a more strict appointment process and rehospitalizations might be a consequence of more formalized and dedicated medical practice with a sense of ownership and accountability. A higher volume of patients per physician does not appear to improve quality of care. PMID:22682694

  2. Arbitration agreements in health care nursing home contracts.

    PubMed

    Infante, Marie C; Lovitch, Karen S

    2003-11-01

    Increasingly, long-term care facilities are adopting alternative dispute resolution measures, such as arbitration, in admission contracts. Whereas avoiding the onus of civil lawsuits is understandable, nursing homes must ensure that the arbitration wording in the contract is precise, enforceable, and most importantly, pursuant to state and federal laws, regulations, and guidelines. Otherwise, the contract itself may be the subject of a court action. PMID:14650372

  3. Building a State Coalition for Nursing Home Excellence

    PubMed Central

    Beck, Cornelia

    2014-01-01

    Purpose of the Study: This article describes the successful evolution of a state coalition for nursing home excellence that brought together organizations that had once worked in silos to improve the quality of care through the implementation of culture change for Arkansas’ 240 nursing homes with 27,700 residents. Design and Methods: The Coalition was established in 2004 when stakeholders were invited to participate in a retreat to explore how they could come together with a common goal to improve the care of older Arkansans. These stakeholders were encouraged to bring their organization’s perspectives to the Coalition and determine ways to work with others. The continuous refinement of the Coalition’s activities involved revisiting goals of the Coalition, assessing the need for other stakeholders, identifying gaps and overlaps in quality and culture change programming, and providing feedback to Coalition members. Results: The Coalition stakeholders had the leadership to articulate and mobilize others around a common vision of improving quality of care in nursing homes through culture change. Over time, the Coalition members developed a willingness to share resources and to speak as one voice. Implications: Stakeholders from diverse organizations and governing bodies can come together to complement each other’s work and collaborate on programs to build a better system of care for the frail and elderly persons across a state. The success of this statewide effort lends support for policies that encourage regional coalitions of providers to improve care. PMID:24443610

  4. Care Instability in Nursing Homes; A Qualitative Study

    PubMed Central

    Rahimi, Majid; Fadayevatan, Reza; Abedi, Heidar Ali

    2016-01-01

    Background: The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Objectives: This study was performed to assess the caring conditions in nursing homes. Patients and Methods: This study was conducted with a qualitative approach using conventional qualitative content analysis. The study was conducted on 23 Iranian participants including 14 elders and 9 caregivers. Data was collected with unstructured interviews and continued to the point of data saturation. Analysis of data was performed continually and concurrently with data collection through a comparative method. Results: Three themes emerged from 595 open codes including care as unpleasant task, sustained care and insufficient resources. Ten subthemes indicated participants’ experiences and understanding of caring conditions in a nursing home. Conclusions: The prevailing given care was the routine one with a focus on physical aspects, although there was some psychological care given to the older people. The findings of this research are guidelines for managers and care planners in nursing homes who should pay attention to physical and psychological care needs of older people. In addition, it is important to pay close attention to the needs of caregivers and provision of instructions for treatment, supervision and education of caregivers and medical students to provide a better care. PMID:27186382

  5. The Effects of Evacuation on Nursing Home Residents With Dementia

    PubMed Central

    Brown, Lisa M.; Dosa, David M.; Thomas, Kali; Hyer, Kathryn; Feng, Zhanlian; Mor, Vincent

    2013-01-01

    Background In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired. Methods Nursing homes in counties located in the path of Hurricane Gustav were identified. The Minimum Data Set resident assessment files were merged with the Centers for Medicare enrollment file to determine date of death for residents in identified facilities. Difference-in-differences analyses were conducted adjusting for residents’ demographic characteristics and acuity. Results The dataset included 21,255 residents living in 119 at risk nursing homes over three years of observation. Relative to the two years before the storm, there was a 2.8 percent increase in death at 30 days and a 3.9 percent increase in death at 90 days for residents with severe dementia who evacuated for Hurricane Gustav, controlling for resident demographics and acuity. Conclusions The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility. PMID:22930698

  6. The changes in caregiver burden following nursing home placement.

    PubMed

    Yeh, Shu-hui; Johnson, Mary Ann; Wang, Shan-Tair

    2002-08-01

    This longitudinal study explored changes in perceived burden among Taiwanese family caregivers (n=77) from nursing home placement of an elder to four months postadmission. Higher burden at placement was related to the level of dependence of the care recipients (p=0.004), or caregiver's poor health (p<0.01). After nursing home placement for four months, global burden decreased (p<0.01) contributed primarily by lessened burden in three sub-scales: lack of family support, impact of schedule and impact of health. Burden scores on caregiver esteem and impact of finances were not decreased after placement. Duration of caregiving was the only demographic factor predicting change in global burden (p<0.001). Changes in impact on finances, and impact on health were, respectively, predicted by the perceived health (p=0.005), and religious preference (p=0.01). These results provide valuable information to healthcare providers for an understanding of the changes of caregiving burden after nursing home placement and the correlates of these changes, which may help devise an appropriate policy for alleviating the caregiver's burden. PMID:12100870

  7. The Effect of State Regulatory Stringency on Nursing Home Quality

    PubMed Central

    Mukamel, Dana B; Weimer, David L; Harrington, Charlene; Spector, William D; Ladd, Heather; Li, Yue

    2012-01-01

    Objective To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Data Sources/Setting Primary and secondary data from all states and U.S. nursing homes between 2005 and 2006. Study Design We estimated seven models, regressing quality measures on the Harrington Regulation Stringency Index and control variables. To account for endogeneity between regulation and quality, we used instrumental variables techniques. Quality was measured by staffing hours by type per case-mix adjusted day, hotel expenditures, and risk-adjusted decline in activities of daily living, high-risk pressure sores, and urinary incontinence. Data Collection All states' licensing and certification offices were surveyed to obtain data about deficiencies. Secondary data included the Minimum Data Set, Medicare Cost Reports, and the Economic Freedom Index. Principal Findings Regulatory stringency was significantly associated with better quality for four of the seven measures studied. The cost-effectiveness for the activities-of-daily-living measure was estimated at about 72,000 in 2011/ Quality Adjusted Life Year. Conclusions Quality regulations lead to better quality in nursing homes along some dimensions, but not all. Our estimates of cost-effectiveness suggest that increased regulatory stringency is in the ballpark of other acceptable cost-effective practices. PMID:22946859

  8. Setting a new standard of care in nursing homes.

    PubMed

    Klaasen, Kathleen; Lamont, Lori; Krishnan, Preetha

    2009-11-01

    The Winnipeg Regional Health Authority's introduction of a full-time nurse practitioner in a 116-bed non-profit nursing home provided an opportunity to explore a collaborative relationship between an NP acting as the primary care provider and a single physician serving as the consultant for complex care and after-hours care. The outcomes were measured in terms of resident and family satisfaction, quality of care indicators and cost effectiveness. Data were collected from pre-existing quality indicators, including a resident/family satisfaction survey, transfers to acute care, and medication use statistics. Unstructured interviews were also conducted with nursing staff and members of the interdisciplinary team. Dramatic improvements in medication use were observed, including a 17 per cent reduction in overall drug costs, a 55 per cent decrease in polypharmacy rates and a 63 per cent reduction in antipsychotic drug use. Transfers to emergency decreased by 20 per cent. Family satisfaction with the quality of health care provided to residents increased by 24 per cent. The collaborative practice of an NP with physician consultation is an effective way of delivering quality care to nursing home residents.

  9. 42 CFR 422.133 - Return to home skilled nursing facility.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Return to home skilled nursing facility. 422.133... Protections § 422.133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled...

  10. 42 CFR 422.133 - Return to home skilled nursing facility.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Return to home skilled nursing facility. 422.133... Protections § 422.133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled...

  11. Use of the certified nursing assistant pain assessment tool (CPAT) in nursing home residents with dementia.

    PubMed

    Cervo, Frank A; Raggi, Robert P; Bright-Long, Lory E; Wright, William K; Rows, Ginette; Torres, Adrian E; Levy, Ronnie B; Komaroff, Eugene

    2007-01-01

    The purpose of this study was to develop a pain assessment tool utilized by certified nursing assistant (CNA) direct-care providers for nursing home residents with dementia and to examine the impact of such a tool on their function, behavior, or medication use. In the first phase, 41 items from an observational pain assessment tool were correlated with an objective pain "gold standard"; 12 statistically significant items were retained and used in the CNA pain assessment tool. Symmetry analysis was then conducted to determine if this resulted in any significant change in resident function, behavior, or medication use. This failed to detect significant change in these characteristics. A pain assessment tool utilized by CNA direct-care providers can be developed for use in nursing home residents with dementia. Further study is required to determine whether the use of such a tool will improve their function or quality of life.

  12. Managing up, down, and across the nursing home: roles and responsibilities of directors of nursing.

    PubMed

    Siegel, Elena O; Young, Heather M; Leo, Michael C; Santillan, Vanessa

    2012-11-01

    The director of nursing (DON) is an essential member of the top management team in nursing homes and in a key position to improve the quality and value of care. This article describes and examines the roles and responsibilities of DONs as perceived by a convenience sample of current/previous DONs and nursing home administrators (n = 29). Data were collected through in-depth semistructured interviews and analyzed using content analysis and thematic analysis. The findings reveal a broad scope and wide variation in the DON position across settings, with inextricable linkages between clinical care and other aspects of care delivery, such as managing fiscal and human resources (HR). As RN licensure is the only Federal requirement for the DON position, suggesting a clinical focus, the findings highlight a policy-practice gap. Research is needed to address this gap, focusing on the requisite preparation DONs need to effectively and cost-efficiently lead initiatives for quality improvement. PMID:23639958

  13. Breastfeeding status and marketing practices of baby food manufactured in nursing homes.

    PubMed

    Mathur, G P; Pandey, P K; Mathur, S; Mishra, V K; Singh, K; Bhatt, O P; Loomba, R K; Luthra, C; Taneja, S; Kapoor, R

    1993-11-01

    In January 1993 in Kanpur, India, a survey of 7 private nursing homes revealed that infant formula was given to most newborns (52.4%). The most common brands included Lactogen-I, Milk Care, Raptakos, Dexolac Special Care, and Lactodex. Staff at 5 nursing homes gave prelacteal feeds (water, glucose water, and infant formula) to newborns when they were separated from their mothers. Staff at only 2 nursing homes gave the newborn to the mother immediately after delivery. The longest period between delivery and giving the newborn to the mother was 24 hours. All but one of the nursing homes did not know about the government policy and the recent bill that bars free or low-cost infant formula supplies to hospitals. The administration of the nursing homes did not inform the procurement department, in writing, of the government policy. 4 nursing homes bought low-cost supplies of infant formula from the companies. The companies sold the infant formula to the nursing homes at a price 48.3% to 86.7% lower than the market price. Medical stores inside or outside the nursing homes sold the infant formula to parents at the other 3 homes. The nursing homes used, on average, 2-50 kg/month. Nestle (Lactogen-I) and Dalmia Industries (Milk Care) had a monopoly in infant formula in 4 and 3 nursing homes, respectively. Infant formula was in stock in 5 nursing homes. None of the nursing homes gave mothers free or low-cost infant formula at discharge. Lower than market price and increased number of calls to the hospitals and physicians by company personnel were marketing techniques used by the manufacturers to maintain market share. These results show that, despite government policy and the bill, hospitals continue to use infant formula. The government should use the mass media to increase awareness about its policy on infant foods and the concept of the Baby Friendly Hospital. PMID:8039859

  14. Breastfeeding status and marketing practices of baby food manufactured in nursing homes.

    PubMed

    Mathur, G P; Pandey, P K; Mathur, S; Mishra, V K; Singh, K; Bhatt, O P; Loomba, R K; Luthra, C; Taneja, S; Kapoor, R

    1993-11-01

    In January 1993 in Kanpur, India, a survey of 7 private nursing homes revealed that infant formula was given to most newborns (52.4%). The most common brands included Lactogen-I, Milk Care, Raptakos, Dexolac Special Care, and Lactodex. Staff at 5 nursing homes gave prelacteal feeds (water, glucose water, and infant formula) to newborns when they were separated from their mothers. Staff at only 2 nursing homes gave the newborn to the mother immediately after delivery. The longest period between delivery and giving the newborn to the mother was 24 hours. All but one of the nursing homes did not know about the government policy and the recent bill that bars free or low-cost infant formula supplies to hospitals. The administration of the nursing homes did not inform the procurement department, in writing, of the government policy. 4 nursing homes bought low-cost supplies of infant formula from the companies. The companies sold the infant formula to the nursing homes at a price 48.3% to 86.7% lower than the market price. Medical stores inside or outside the nursing homes sold the infant formula to parents at the other 3 homes. The nursing homes used, on average, 2-50 kg/month. Nestle (Lactogen-I) and Dalmia Industries (Milk Care) had a monopoly in infant formula in 4 and 3 nursing homes, respectively. Infant formula was in stock in 5 nursing homes. None of the nursing homes gave mothers free or low-cost infant formula at discharge. Lower than market price and increased number of calls to the hospitals and physicians by company personnel were marketing techniques used by the manufacturers to maintain market share. These results show that, despite government policy and the bill, hospitals continue to use infant formula. The government should use the mass media to increase awareness about its policy on infant foods and the concept of the Baby Friendly Hospital.

  15. Deficiencies In Care At Nursing Homes And Racial & Ethnic Disparities Across Homes Declined, 2006–11

    PubMed Central

    Li, Yue; Harrington, Charlene; Temkin-Greener, Helena; Kai, You; Cai, Xueya; Cen, Xi; Mukamel, Dana B.

    2015-01-01

    Despite the increased use of nursing homes by minority residents, nursing home care remains highly segregated. Compared to whites, racial/ethnic minorities tend to be cared for in facilities with limited clinical and financial resources, low nurse staffing levels, and a relatively high number of care deficiency citations. We assessed the trends from 2006 to 2011 in those citations and in disparities across facilities with four different concentrations of racial/ethnic minority residents. We found that the number of health care–related deficiencies and the percentage of facilities with serious deficiencies decreased over time for all four facility groups. From 2006 to 2011, the average annual number of health care–related deficiencies declined from 7.4 to 6.8 for facilities with low minority concentrations (< 5 percent) and from 10.6 to 9.4 for facilities with high minority concentrations (≥ 35 percent). In multivariable analyses, across-site disparities in health care-related deficiencies and in life-safety deficiencies narrowed over time. We also found that increasing the Medicaid payment rate might help improve both overall quality and disparities, but state case-mix payment approaches might worsen both. These results suggest the need to reevaluate quality improvement and cost containment efforts to better foster quality and equity of nursing home care. PMID:26153308

  16. 42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services...

  17. 42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services...

  18. 42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services...

  19. From the hospital to the nursing home: the 75% rule and the transfer process.

    PubMed

    Murphy, Patrick J; Miles, Toni P

    2007-09-01

    This has been a commentary on the implications of policy changes for nursing homes and rehabilitation hospital admissions. Only time will show how greatly this will affect the nursing home. However, since the 2004 implementation of the 75% Rule, nursing homes have already seen a jump in patients who are more acutely ill and have multiple medical needs. To lessen the potential burden of these changes on patient safety and comfort and to increase family satisfaction with care, we propose the following steps be considered. 1. We need better integration between hospital and nursing homes. Indeed, a strategic alliance between hospitals and nursing homes would be something that we should consider sooner rather than later. 2. All providers should understand that this is a continued push by both private and government insurance to get the patient out of the hospital sooner. As a result, patients will be discharged either to the rehab hospital or to the nursing home "sicker and quicker." 3. The implementation of the 75% Rule will probably result in a decreased use of rehab hospitals and an increased use of the nursing home. 4. In looking even further into the future, the nursing homes themselves are likely to be under continued pressure to get patients out of the nursing home more quickly. This in turn will result in what we consider the next big thing-home care. PMID:17941422

  20. The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes

    PubMed Central

    Harrington, Charlene; Schnelle, John F.; McGregor, Margaret; Simmons, Sandra F.

    2016-01-01

    Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819

  1. The Nature of Staff - Family Interactions in Nursing Homes: Staff Perceptions

    PubMed Central

    Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Ammarell, Natalie; Bailey, Donald; Corazzini, Kirsten; Piven, Mary L.; Anderson, Ruth A.

    2008-01-01

    Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home staff members and family members of nursing home residents, as part of a larger multi-method comparative case study. Here, we report on 6- month case studies of two nursing homes where in-depth interviews, shadowing experiences, and direct observations were completed. Staff members from both nursing homes described staff-family interactions as difficult, problematic and time consuming, yet identified strategies that when implemented consistently, influenced the staff-family interaction positively. Findings suggest explanatory processes in staff-family interactions, while pointing toward promising interventions. PMID:19649311

  2. [Practice guideline 'Influenza prevention in nursing homes and care homes', issued by the Dutch Society of Nursing Home Specialists; division of tasks between nursing home specialist, general practitioner and company doctor].

    PubMed

    Cools, H J M; van Essen, G A

    2005-01-15

    The Dutch Society of Nursing Home Specialists has formulated a guideline for the prevention of influenza in nursing homes and care homes in The Netherlands. The guideline recommends the realisation of the highest possible degree of vaccination of both patients and health care workers. At the start of the flu season, the manager of the chronic care institute should organize a scheme for vaccination against influenza and a plan in case of an outbreak of influenza. The division of tasks between the nursing home specialist, the general practitioner and the company doctor should be recorded in both the vaccination scheme and the outbreak plan. In order to decrease the incidence of non-response to the vaccine a double dose of influenza vaccine for nursing home patients should be considered. The outbreak plan should raise the state of alertness for influenza and ensure that virological confirmation of clinical influenza is obtained quickly. Immediately after virological confirmation of clinical influenza, patients with influenza should be treated with oseltamivir and both patients and health care workers in the unit should receive prophylaxis with oseltamivir. Non-vaccinated patients should also be offered vaccination to restrict re-introduction of the virus. During an influenza outbreak, only patients with influenza or those who have had prophylactic treatment may be admitted to the facility. In the case of an influenza pandemic, national guidelines should be followed. PMID:15693586

  3. Intrinsic Job Satisfaction, Overall Satisfaction, and Intention to Leave the Job among Nursing Assistants in Nursing Homes

    ERIC Educational Resources Information Center

    Decker, Frederic H.; Harris-Kojetin, Lauren D.; Bercovitz, Anita

    2009-01-01

    Purpose: We examined predictors of intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants (NAs). Design and Methods: The study focused on NAs who worked 30 or more hours per week in a nursing home. Data on 2,146 NAs meeting this criterion came from the 2004 National Nursing Assistant Survey, the…

  4. Navigating the field of temporally framed care in the Danish home care sector.

    PubMed

    Tufte, Pernille; Dahl, Hanne Marlene

    2016-01-01

    The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in-depth perspective on the broader feminist literature on the dilemmas of care. PMID:26474802

  5. Navigating the field of temporally framed care in the Danish home care sector.

    PubMed

    Tufte, Pernille; Dahl, Hanne Marlene

    2016-01-01

    The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in-depth perspective on the broader feminist literature on the dilemmas of care.

  6. Knowledge and Attitudes of Nursing Home Staff and Surveyors about the Revised Federal Guidance for Incontinence Care

    ERIC Educational Resources Information Center

    DuBeau, Catherine E.; Ouslander, Joseph G.; Palmer, Mary H.

    2007-01-01

    Purpose: We assessed nursing home staff and state nursing home surveyors regarding their knowledge and attitudes about urinary incontinence, its management, and the revised federal Tag F315 guidance for urinary incontinence. Design and Methods: We conducted a questionnaire survey of a convenience sample of nursing home staff and state nursing home…

  7. Social exchange as a framework for client-nurse interaction during public health nursing maternal-child home visits.

    PubMed

    Byrd, Mary E

    2006-01-01

    The purpose of this paper was to develop a nursing-focused use of social exchange theory within the context of maternal-child home visiting. The nature of social exchange theory, its application to client-nurse interaction, and its fit with an existing data set from a field research investigation were examined. Resources exchanged between the nurse and clients were categorized and compared across the patterns of home visiting, nursing strategies based on exchange notions were identified, and variations in exchange were linked with client outcomes. The nurse provided resources within the categories of information, status, service, and goods. Clients provided time, access to the home, space within the home to conduct the visit, opportunities to observe maternal-child interaction, access to the infant, and information. The ease and breadth of resource exchange varied across the patterns of home visiting. The social exchange perspective was useful in categorizing resources, specifying and uncovering new resource categories, understanding nursing strategies to initiate and maintain the client-nurse relationship, and linking client-nurse interactive phenomena with client outcomes. Social exchange theory is potentially useful for understanding client-nurse interaction in the context of maternal-child home visits.

  8. 77 FR 64386 - Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-19

    ... AFFAIRS Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State... currently approved collection. Abstract: VA pays per diem to State homes providing nursing home and adult day health services care to Veterans. VA requires facilities providing nursing home and adult...

  9. 76 FR 70076 - Technical Revisions To Update Reference to the Required Assessment Tool for State Nursing Homes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-10

    ... State homes providing nursing home care to eligible veterans. 74 FR 19426-01 (Apr. 29, 2009). This... Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY: Department of Veterans Affairs... diem from VA for providing nursing home care to veterans. The proposed rule would require State...

  10. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  11. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  12. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  13. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  14. Determinants of staff job satisfaction of caregivers in two nursing homes in Pennsylvania

    PubMed Central

    Castle, Nicholas G; Degenholtz, Howard; Rosen, Jules

    2006-01-01

    Background Job satisfaction is important for nursing home staff and nursing home management, as it is associated with absenteeism, turnover, and quality of care. However, we know little about factors associated with job satisfaction and dissatisfaction for nursing home workers. Methods In this investigation, we use data from 251 caregivers (i.e., Registered Nurses, Licensed Practical Nurses, and Nurse Aides) to examine: job satisfaction scores of these caregivers and what characteristics of these caregivers are associated with job satisfaction. The data were collected from two nursing homes over a two and a half year period with five waves of data collection at six-month intervals. The Job Description Index was used to collect job satisfaction data. Results We find that, overall nursing home caregivers are satisfied with the work and coworkers, but are less satisfied with promotional opportunities, superiors, and compensation. From exploratory factor analysis three domains represented the data, pay, management, and work. Nurse aides appear particularly sensitive to the work domain. Of significance, we also find that caregivers who perceived the quality of care to be high have higher job satisfaction on all three domains than those who do not. Conclusion These results may be important in guiding caregiver retention initiatives in nursing homes. The finding for quality may be especially important, and indicates that nursing homes that improve their quality may have a positive impact on job satisfaction of staff, and thereby reduce their turnover rates. PMID:16723022

  15. Prescription drugs in nursing homes: managing costs and quality in a complex environment.

    PubMed

    Mendelson, Dan; Ramchand, Rajeev; Abramson, Richard; Tumlinson, Anne

    2002-11-12

    This brief provides a description of prescription drug use in nursing homes and a summary of current policy issues in this area. The brief first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The brief then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives.

  16. The influence of knowledge, perceptions, and beliefs, on hand hygiene practices in nursing homes

    PubMed Central

    Aiello, Allison E.; Malinis, Maricar; Knapp, Jennifer K.; Mody, Lona

    2012-01-01

    There are few studies that have assessed factors influencing infection control practices among health care workers (HCW) in nursing homes. We conducted a cross-sectional survey of HCWs (N = 392) in 4 nursing homes to assess whether knowledge, beliefs, and perceptions influence reported hand hygiene habits. Positive perceptions and beliefs regarding effectiveness of infection control in nursing homes were associated with reported appropriate glove use and fingernail characteristics, respectively, among HCWs. Further research on hand hygiene interventions, including targeted educational in-services should be conducted in the nursing home setting. PMID:18945512

  17. Cost and care quality between licensed nursing homes under different types of ownership.

    PubMed

    Lee, Chun-Lan; Liu, Ta-Li; Wu, Ling-Jiuan; Chung, Ue-Lin; Lee, Li-Chuan

    2002-06-01

    In Taiwan, there is some uncertainty and concern regarding the quality and safety of unlicensed nursing homes, as they are typically crowded and poorly equipped. There are data insufficient regarding the quality of care in licensed nursing homes for the government to reliably assist unlicensed facilities to become licensed. The purpose of this study was to examine the relationship between the different nursing home ownership types and the following dependent variables: (1) operating cost per resident day, (2) RN to resident ratio, (3) facility size, (4) occupancy rate, and (5) quality of care amongst licensed nursing homes nationwide. The descriptive study used a survey design. Data were obtained from 28 licensed nursing homes using self-administered questionnaires, on-site interviews and record reviews. Data were analyzed by Kruskal-Wallis test, Mann-Whitney U test and Spearman s correlation. A positive and significant relationship existed between nursing home quality and the RN ratio per resident day. Chain/For-profit and Chain/Non- profit nursing homes tended to have higher operating costs and a better quality of service. Secondary research is still needed to examine the results by detailed cost analysis or by research oriented toward outcomes of residents care. These findings provide basic reference for the government for planning the operation of nursing home facilities and also to assist the many unlicensed nursing homes to ultimately become licensed. The results also present important data for developing reimbursement policies. PMID:12119600

  18. Examining differences in nurses' language, accent, and comprehensibility in nursing home settings based on birth origin and country of education.

    PubMed

    Wagner, Laura M; Brush, Barbara L; Castle, Nicholas G; Eaton, Michelle; Capezuti, Elizabeth

    2015-01-01

    As nursing homes turn abroad to fill vacancies, the diverse linguistic backgrounds of nurse hires are creating new challenges in comprehensibility between nurses, providers, and residents. Accents are a natural part of spoken language that may present difficulty even when the parties involved are speaking the same language. We surveyed 1,629 nurses working in 98 nursing homes (NHs) in five U.S. states to determine if and how language difficulties were perceived by nurses and others (e.g. physicians, residents and family members). We found that when participants were asked how often other care team members and residents/families had difficulty understanding them due to language use or accent, foreign born nurses were significantly more likely to report that they experienced difficulty at least some of the time across all groups. This study supports an assessment of nurses' language, accents, and comprehensibility in these settings.

  19. Physical work load and its assessment among the nursing staff in nursing homes.

    PubMed

    Engels, J A; van der Gulden, J W; Senden, T F; Hertog, C A; Kolk, J J; Binkhorst, R A

    1994-03-01

    A study was conducted to investigate the physical work load and the prevalence of musculoskeletal complaints of nurses in nursing homes. Thirty-six female subjects selected from three nursing homes in the Netherlands participated in an observational study. In addition, the total nursing staff (n = 668) was invited to take part in a questionnaire survey (response was 94%). It was noticed that almost 60% of the observed time was spent on nonpatient-related activities. Moreover, activities alternated rapidly and seldom lasted longer than 4 minutes on average. Twenty percent of the observed time was spent in "poor" work postures as defined by the Ovako Working Posture Analyzing System (Action Category 2 to 4). Activities contributing most to these poor work postures were patient care and household and preliminary tasks. Perceived exertion as scored on the Borg-CR10 scale was highest during patient-related activities. This holds also for a relative increase of heart rate. Questionnaire results showed prevalences of 41%, 35%, and 20% respectively, for back, arm/neck, and leg complaints. From this study it can be concluded that not only patient-related activities should be taken into consideration for the improvement of work postures and other potential strenuous aspects of nursing work. Household and preliminary tasks, ergonomic layout of the ward, and work pressure also deserve attention.

  20. Participant [correction of Patient] observation in nursing home research: who was that masked woman?

    PubMed

    Bland, Marian

    2002-02-01

    Undertaking fieldwork in nursing home environments can present researchers with many challenges, particularly when the researcher also happens to be a registered nurse. This article discusses the issues that one nurse researcher faced during participant observation in three New Zealand nursing homes. These include the complexity of the nurse researcher role, the blurring of role boundaries, and various ethical concerns that arose, including the difficulties of ensuring that all those who were involved in the study were kept informed as to the researcher's role and purpose. Strategies used to maintain ethical and role integrity are outlined, with further debate and discussion around fieldwork issues and experiences for nurse researchers called for.

  1. Weathering the storm: challenges to nurses providing care to nursing home residents during hurricanes.

    PubMed

    Hyer, Kathryn; Brown, Lisa M; Christensen, Janelle J; Thomas, Kali S

    2009-11-01

    This article documents the experience of 291 Florida nursing homes during the 2004 hurricane season. Using quantitative and qualitative methods, the authors described and compared the challenges nurses encountered when evacuating residents with their experiences assisting residents of facilities that sheltered in place. The primary concerns for evacuating facilities were accessing appropriate evacuation sites for residents and having ambulance transportation contracts honored. The main issue for facilities that sheltered in place was the length of time it took for power to be restored. Barriers to maintaining resident health during disasters for those who evacuated or sheltered in place are identified.

  2. Effects of Green House nursing homes on residents' families.

    PubMed

    Lum, Terry Y; Kane, Rosalie A; Cutler, Lois J; Yu, Tzy-Chyi

    2008-01-01

    A longitudinal quasi-experimental study with two comparison groups was conducted to test the effects of a Green House (GH) nursing home program on residents' family members. The GHs are individual residences, each serving 10 elders, where certified nursing assistant (CNA)-level resident assistants form primary relationships with residents and family, family is encouraged to visits, and professionals adapted their roles to support the model. GH family were somewhat less involved in providing assistance to their residents although family contact did not differ among the settings at any time period. GH family were more satisfied with their resident's care and with their own experience as family members, and had no greater family burden. Issues in studying family outcomes are discussed as well as implications for roles of various personnel, including social service and activities staff in a GH model.

  3. Serum zinc and pneumonia in nursing home elderly

    PubMed Central

    Meydani, Simin N.; Barnett, Junaidah B.; Dallal, Gerard E.; Fine, Basil C.; Jacques, Paul F.; Leka, Lynette S.; Hamer, Davidson H.

    2008-01-01

    Background Zinc plays an important role in immune function. The association between serum zinc and pneumonia in the elderly has not been studied. Objective To determine if serum zinc concentrations in nursing home elderly are associated with incidence and duration of pneumonia, total and duration of antibiotic use, and pneumonia-associated and overall deaths. Design This observational study was conducted in residents from 33 nursing homes in Boston, MA, who participated in a one-year randomized, double-blind, and placebo controlled vitamin E supplementation trial; all were given daily doses of ½ RDA of essential vitamins and minerals including zinc. Participants with baseline (N=578) or final (N=420) serum zinc concentrations were categorized as having low (<70 μg/dL) or normal (≥70 μg/dL) serum zinc concentrations. Outcome measures included incidence and number of days with pneumonia, number of new antibiotic prescriptions, days of antibiotic use, death due to pneumonia, and, all-cause mortality. Results Subjects with normal final serum zinc concentrations had lower pneumonia incidence, total antibiotic use (by almost 50%), and shorter duration of pneumonia and antibiotic use (by 3.9 and 2.6 days, respectively) (all p-values ≤0.004) relative to those with low zinc concentrations. Normal baseline serum zinc concentrations were associated with decreased all-cause mortality (p=0.049). Conclusion Normal serum zinc concentrations in nursing home elderly were associated with decreased incidence and duration of pneumonia, and decreased use and duration of antimicrobial therapy. Zinc supplementation to maintain normal serum zinc concentrations in the elderly may help reduce pneumonia incidence and associated morbidity. PMID:17921398

  4. Current marketing practices in the nursing home sector.

    PubMed

    Calhoun, Judith G; Banaszak-Holl, Jane; Hearld, Larry R

    2006-01-01

    Marketing is widely recognized as an essential business function across all industries, including healthcare. While many long-term care facilities adopted basic healthcare marketing practices and hired marketing staff by the early 1990s, a paucity of research on nursing home marketing exists in the literature. This study examines the extent to which nursing homes have developed more formulated marketing and related communication and promotional strategies as market competition has increased in this sector during the past two decades. In addition, we explored managers' perceptions of their control over marketing decision making, the impact of competition on the use of marketing practices, and areas for enhanced competitive positioning. Administrators from 230 nursing homes in 18 Southeastern Michigan counties were surveyed regarding (1) the adoption level of approximately 40 literature-based, best-practice marketing strategies; (2) the types of staff involved with the marketing function; and (3) their perception of their level of control over marketing functions and of local competition. Results from 101 (44 percent) survey participants revealed that although respondents viewed their markets as highly competitive, their marketing practices remained focused on traditional and relatively constrained practices. In relation to the importance of customer relationship management, the majority of the administrators reported intensive efforts being focused on residents and their families, referrers, and staff, with minimal efforts being extended to insurers and other types of payers. A significant positive relation was found between the intensity of marketing initiatives and the size of the facility (number of beds), whereas significant negative correlations were revealed in relation to occupancy and the perceived level of control over the function. PMID:16770906

  5. Work experience, work environment, and blood exposure among home care and hospice nurses.

    PubMed

    Leiss, Jack K

    2012-01-01

    Blood exposure rates among home care and hospice nurses (RNs) in the United States are markedly lower for nurses with more home care/hospice experience, whether or not they have more total years of nursing experience (i.e., in other work environments). This study examined whether the protective effect of home care/hospice experience was greater for nurses who worked under three types of circumstances that are typical of the home care/hospice work environment and conducive to blood exposure. A mail survey was conducted in 2006 among home care/hospice nurses in North Carolina, a largely rural state in the southeastern U.S. The adjusted response rate was 69% (n=833). Blood exposure rates were higher among nurses with ≤5 years' experience in home care/hospice. Contrary to expectations, the protective effect of more experience was greater among nurses who did not have limited access to safety devices/personal protective equipment, did not have to rush during home visits, and did not often visit homes with unrestrained pets, unruly children, poor lighting, or extreme clutter. These results suggest that characteristics of the home care/hospice work environment limit nurses' ability to use their experience to prevent blood exposure.

  6. [End-of-life with dementia in Dutch antroposofic and traditional nursing homes].

    PubMed

    Gijsberts, M J H E; van der Steen, J T; Muller, M T; Deliens, L

    2008-12-01

    Every year more than 20,000 people with dementia die in Dutch nursing homes and this number steadily increases. Therefore, the importance of good end-of-life care for these patients including physical, psychosocial and spiritual care is evident. Although the training standards for Dutch nursing home physicians and nurses share a common standard, the philosophy of a nursing home may affect end-of-life care strategies for the residents. We compared end of life of nursing home residents with dementia in two anthroposophic and two traditional nursing homes in a retrospective study using the most specific instrument available: the End-of-Life in Dementia scales (EOLD). Family caregivers completed the EOLD questionnaire. There was no difference in mean Satisfaction With Care scale scores between both types of nursing homes: 32.9 (SD 4.3) and 31.6 (SD 4.9), respectively. The anthroposophic nursing homes had significant higher scores on the 'Symptom Management' ((32.9 (SD 7.5) versus 26.9 (SD 9.5)), and 'Comfort Assessment in Dying' scales (34.0 (SD 3.9) versus 30.8 (SD 5.8)) and on its subscale Well Being (7.7 (SD 1.2) versus 6.7 (SD 2.1)). Our results suggest that death with dementia was more favourable in anthroposophic nursing homes than in regular homes. The results inform further prospective studies on nursing homes how this and other philosophies are translated into daily nursing home practice, including decision making in multi-disciplinary teams, family consultation, and complementary non-pharmacological therapies.

  7. [A photographic competition on hand hygiene in a nursing home].

    PubMed

    Guerre, Graziella; Aho-Glele, Ludwig-Serge; Astruc, Karine

    2016-01-01

    Hand hygiene is often considered as the attribute of caregivers. However, it is the patient who is increasingly targeted by improved communication around hygiene in care notably in the framework of the "Clean Hands Mission". In this sense, the French regional centres for the fight against nosocomial infections in Burgundy has proved itself innovative on two levels by organising a photo competition in nursing homes. The aim was to show residents how to prevent care-related infections through the simple act of handwashing.

  8. Pre-Service Education for Nurses' Aides in Hospitals, Nursing Homes, Home Health Agencies.

    ERIC Educational Resources Information Center

    Colorado State Dept. of Public Health, Denver. Public Health Nursing Section.

    The guide was developed on the basis of advice from a widely representative committee appointed by the Colorado State Department of Public Health. The materials were tested in a course in an urban center and a course in a rural center. The initial portion of the manual presents: (1) guidelines for organizing preparatory nurse aide courses, (2)…

  9. Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

    ERIC Educational Resources Information Center

    Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

    2010-01-01

    Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

  10. The Association between Changes in Health Status and Nursing Home Resident Quality of Life

    ERIC Educational Resources Information Center

    Degenholtz, Howard B.; Rosen, Jules; Castle, Nicholas; Mittal, Vikas; Liu, Darren

    2008-01-01

    Purpose: Previous research on nursing home resident quality of life (QOL) has mainly been cross-sectional. This study examined the association between changes in QOL and changes in resident clinical factors. Design and Methods: A longitudinal study of resident QOL was conducted in two nursing homes. Self-report interviews using a multidimensional…

  11. Teaching a Course in Abnormal Psychology and Behavior Intervention Skills for Nursing Home Aides.

    ERIC Educational Resources Information Center

    Glenwick, David S.; Slutzsky, Mitchel R.; Garfinkel, Eric

    2001-01-01

    Describes an 11-week course given at a nursing home to nursing home aides that focused on abnormal psychology and behavior intervention skills. Discusses the course goals, class composition, and course description. Addresses the problems and issues encountered with teaching this course to a nontraditional population in an unconventional setting.…

  12. Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives

    ERIC Educational Resources Information Center

    Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.

    2003-01-01

    Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…

  13. Daily Practice Teams in Nursing Homes: Evidence From New York State

    ERIC Educational Resources Information Center

    Temkin-Greener, Helena; Cai, Shubing; Katz, Paul; Zhao, Hongwei; Mukamel, Dana B.

    2009-01-01

    Purpose: Most health care organizations, including nursing homes, report having teams. However, little is known about everyday practice teams among staff providing direct resident care. We assess the prevalence of such teams in nursing homes as reported by direct care staff and administrators, and examine characteristics of facilities that foster…

  14. Factors Predicting Lawsuits against Nursing Homes in Florida 1997-2001

    ERIC Educational Resources Information Center

    Johnson, Christopher E.; Dobalian, Aram; Burkhard, Janet; Hedgecock, Deborah K.; Harman, Jeffrey

    2004-01-01

    Purpose: We explore how nursing home characteristics affect the number of lawsuits filed against the facilities in Florida during the period from 1997 to 2001. Design and Methods: We examined data from 478 nursing homes in 30 Florida counties from 1997 to 2001. We obtained the data from Westlaw's Adverse Filings: Lawsuits database, the Online…

  15. Consequences of Empowered CNA Teams in Nursing Home Settings: A Longitudinal Assessment

    ERIC Educational Resources Information Center

    Yeatts, Dale E.; Cready, Cynthia M.

    2007-01-01

    Purpose: Recent studies have concluded that there is a lack of "patient-centered" care in nursing homes and subsequently a need for nursing home culture change. As a result, a variety of new, promising initiatives have been introduced, with most of these incorporating the use of "empowered" employees. The purpose of this study was to evaluate the…

  16. Training of Home Health Aides and Nurse Aides: Findings from National Data

    ERIC Educational Resources Information Center

    Sengupta, Manisha; Ejaz, Farida K.; Harris-Kojetin, Lauren D.

    2012-01-01

    Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 home health aides (HHAs) from the National Home Health Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the…

  17. Evidence-Based Health Promotion in Nursing Homes: A Pilot Intervention to Improve Oral Health

    ERIC Educational Resources Information Center

    Cadet, Tamara J.; Berrett-Abebe, Julie; Burke, Shanna L.; Bakk, Louanne; Kalenderian, Elsbeth; Maramaldi, Peter

    2016-01-01

    Nursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts' nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an…

  18. [Study on knowledge and practices related to malnutrition in the elderly to the nursing home].

    PubMed

    Brys, Mélissa; Coppieters, Yves; De Breucker, Sandra

    2014-12-01

    The prevalence of malnutrition in nursing homes varies between 50% and 90% in Belgium. There are multiple causes of malnutrition and one of the consequences is the impact on the workload of nursing home staff. The purpose of this study is to better understand the knowledge and the practices of the nursing home staff who would influence the nutritional status of elderly in nursing homes. This study is divided into a quantitative approach with a self-administered questionnaire and a qualitative approach by non-participant observation. We observed that 29% of nursing home staff have good knowledge about the malnutrition and that 64% have good practices in providing nutrition to the elderly. People with good knowledge tend to have better practices. 38% of the nursing home staff engage in continued professional development in the field. There is no systematic screening, nutritional assessment and nutritional intervention in nursing homes. It is of great importance to ensure nursing home staff are aware of this problem through training.

  19. Rethinking Teaching Nursing Homes: Potential for Improving Long-Term Care

    ERIC Educational Resources Information Center

    Mezey, Mathy D.; Mitty, Ethel L.; Burger, Sarah Green

    2008-01-01

    To meet the special needs of and provide quality health care to nursing home residents, the health care workforce must be knowledgeable about the aging process. Health professionals are minimally prepared in their academic programs to care for older adults, and few programs have required rotations in geriatrics. Teaching nursing homes (TNHs) have…

  20. Hospitalization of Nursing Home Residents with Cognitive Impairments: The Influence of Organizational Features and State Policies

    ERIC Educational Resources Information Center

    Gruneir, Andrea; Miller, Susan C.; Intrator, Orna; Mor, Vincent

    2007-01-01

    Purpose: The purpose of this study was to quantify the effect of specific nursing home features and state Medicaid policies on the risk of hospitalization among cognitively impaired nursing home residents. Design and Methods: We used multilevel logistic regression to estimate the odds of hospitalization among long-stay (greater than 90 days)…

  1. Importance of Quality Recreation Activities for Older Adults Residing in Nursing Homes: Considerations for Gerontologists.

    ERIC Educational Resources Information Center

    Haberkost, Michael; And Others

    1996-01-01

    Based on a needs assessment survey (66 responses from 101 nursing home activity coordinators), a recreation manual and training program was developed and tested with 25 coordinators/recreation staff. The 14 who completed evaluations increased their understanding of such topics as depression; goals of nursing home recreation programs; motivation of…

  2. Coming Together for Change: Workshops for Women in the Nursing Home.

    ERIC Educational Resources Information Center

    Lee, Janet; Carr, Marylea Benware

    1994-01-01

    Describes series of therapeutic and educational workshops conducted with women nursing home residents with twin goals of improving self-esteem and self-reliance and facilitating community building and networking. Also notes that nursing home staff trainings were conducted whereby staff were encouraged to articulate their needs and those of…

  3. Relationships of Assertiveness, Depression, and Social Support Among Older Nursing Home Residents

    ERIC Educational Resources Information Center

    Segal, Daniel

    2005-01-01

    This study assessed the relationships of assertiveness, depression, and social support among nursing home residents. The sample included 50 older nursing home residents (mean age=75 years; 75% female; 92% Caucasian). There was a significant correlation between assertiveness and depression (r=-.33), but the correlations between social support and…

  4. Characteristics Predicting Nursing Home Admission in the Program of All-Inclusive Care for Elderly People

    ERIC Educational Resources Information Center

    Friedman, Susan M.; Steinwachs, Donald M.; Rathouz, Paul J.; Burton, Lynda C.; Mukamel, Dana B.

    2005-01-01

    Long term care in a nursing home prior to enrollment in PACE remain at high risk of readmission, despite the availability of comprehensive services. This study determined overall risk and predictors of long-term nursing home admission within the Program of All-Inclusive Care for the Elderly (PACE). Design and Methods: Data PACE records for 4,646…

  5. Increasing Physical Activity in Nursing Home Residents Using Student Power, Not Dollars

    ERIC Educational Resources Information Center

    Romack, Jennifer L.

    2004-01-01

    Nursing home programs committed to providing quality care need to investigate innovative ways to meet today's budget challenges. The purpose of this article is to describe a creative collaboration between a nonprofit nursing home facility and a suburban university. Through service-learning, undergraduate students planned and implemented…

  6. The Characteristics and Utilization Pattern of an Admission Cohort of Nursing Home Patients (II).

    ERIC Educational Resources Information Center

    Liu, Korbin; Manton, Kenneth G.

    1984-01-01

    Projects utilization history of a synthetic cohort of nursing home admissions in 1976 by normalizing length of stay (LOS) specific discharge rates derived from life tables to an estimated 1.1 million persons. Results focus on the LOS distribution, discharge status, and total days of nursing home care used. (Author/JAC)

  7. The Physical and Social Environments of Small Rural Nursing Homes: Assessing Supportiveness for Residents with Dementia

    ERIC Educational Resources Information Center

    Morgan, Debra G.; Semchuk, Karen M.; Stewart, Norma J.; D'Arcy, Carl

    2003-01-01

    The physical and social environments are recognized as important therapeutic tools in the care of nursing home residents with dementia, yet little is known about the environments of rural nursing homes. This study was conducted in one rural health authority (16,000 km[superscript 2]) in the province of Saskatchewan. Long-term institutional care…

  8. Operating environment and USA nursing homes' participation in the subacute care market: a longitudinal analysis.

    PubMed

    Weech-Maldonado, Robert; Qaseem, Amir; Mkanta, William

    2009-02-01

    We examined the impact of environmental factors on USA nursing homes' participation in the subacute care market. Findings suggest that the Balanced Budget Act of 1997 did not have a significant impact in the participation of nursing homes in the subacute care market from 1998 to 2000. However, there was a declining trend in the participation of nursing homes in the subacute care market after the implementation of Medicare prospective payment system (PPS). Furthermore, nursing homes with a higher proportion of Medicare residents were more likely to exit the subacute care market after PPS. Results also suggest that nursing homes have responded strategically to the environmental demand for subacute care services. Nursing homes located in markets with higher Medicare managed care penetration were more likely to offer subacute care services. Environmental munificence was also an important predictor of nursing home innovation into subacute care. Nursing homes in states with higher Medicaid reimbursement and those in less competitive markets were more likely to participate in the subacute care market.

  9. 78 FR 53013 - Agency Information Collection (Request for Nursing Home Information in Connection With Claim for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-27

    ... AFFAIRS Agency Information Collection (Request for Nursing Home Information in Connection With Claim for... INFORMATION: Title: Request for Nursing Home Information in Connection with Claim for Aid and Attendance, VA... collection. Abstract: The data collected on VA Form 21-0779 is used to determine Veterans residing in...

  10. Medicare Cost Differences between Nursing Home Patients Admitted with and without Dementia

    ERIC Educational Resources Information Center

    Stuart, Bruce; Gruber-Baldini, Ann L.; Fahlman, Cheryl; Quinn, Charlene C.; Burton, Lynda; Zuckerman, Illene H.; Hebel, J. Rich; Zimmerman, Sheryl; Singhal, Puneet K.; Magaziner, Jay

    2005-01-01

    Purpose: Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings. Design and Methods: An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures…

  11. Organizational and Individual Conditions Associated with Depressive Symptoms among Nursing Home Residents over Time

    ERIC Educational Resources Information Center

    Cassie, Kimberly M.; Cassie, William E.

    2012-01-01

    Purpose: To examine the effect of organizational culture and climate on depressive symptoms among nursing home residents. Design and Methods: Using a pooled cross-sectional design, this study examines a sample of 23 nursing homes, 1,114 employees, and 5,497 residents. Depressive symptoms were measured using the Minimum Data Set, Depression Rating…

  12. Psychometric Properties of a Korean Measure of Person-Directed Care in Nursing Homes

    ERIC Educational Resources Information Center

    Choi, Jae-Sung; Lee, Minhong

    2014-01-01

    Objective: This study examined the validity and reliability of a person-directed care (PDC) measure for nursing homes in Korea. Method: Managerial personnel from 223 nursing homes in 2010 and 239 in 2012 were surveyed. Results: Item analysis and exploratory factor analysis for the first sample generated a 33-item PDC measure with eight factors.…

  13. Resident-to-Resident Aggression in Nursing Homes: Results from a Qualitative Event Reconstruction Study

    ERIC Educational Resources Information Center

    Pillemer, Karl; Chen, Emily K.; Van Haitsma, Kimberly S.; Teresi, Jeanne; Ramirez, Mildred; Silver, Stephanie; Sukha, Gail; Lachs, Mark S.

    2012-01-01

    Purpose: Despite its prevalence and negative consequences, research on elder abuse has rarely considered resident-to-resident aggression (RRA) in nursing homes. This study employed a qualitative event reconstruction methodology to identify the major forms of RRA that occur in nursing homes. Design and methods: Events of RRA were identified within…

  14. Family Support in Nursing Homes Serving Residents with a Mental Health History

    ERIC Educational Resources Information Center

    Frahm, Kathryn; Gammonley, Denise; Zhang, Ning Jackie; Paek, Seung Chun

    2010-01-01

    Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were…

  15. Effectiveness of Advanced Illness Care Teams for Nursing Home Residents with Dementia

    ERIC Educational Resources Information Center

    Chapman, Dennis G.; Toseland, Ronald W.

    2007-01-01

    This study evaluated the effectiveness of advanced illness care teams (AICTs) for nursing home residents with advanced dementia. The AICTs used a holistic approach that focused on four domains: (1) medical, (2) meaningful activities, (3) psychological, and (4) behavioral. The authors recruited 118 residents in two nursing homes for this study and…

  16. The Nursing Home Culture-Change Movement: Recent Past, Present, and Future Directions for Research

    ERIC Educational Resources Information Center

    Rahman, Anna N.; Schnelle, John F.

    2008-01-01

    This article uses a retrospective approach to critique the research base underlying the nursing home culture-change movement--an effort to radically transform the nation's nursing homes by delivering resident-directed care and empowering staff. The article traces the development of the movement from its inception 10 years ago to 2005, when the…

  17. A Quality-Based Payment Strategy for Nursing Home Care in Minnesota

    ERIC Educational Resources Information Center

    Kane, Robert L.; Arling, Greg; Mueller, Christine; Held, Robert; Cooke, Valerie

    2007-01-01

    This article describes a pay-for-performance system developed for Minnesota nursing homes. In effect, nursing homes can retain a greater proportion of the difference between their costs and the average costs on the basis of their quality scores. The quality score is a derived and weighted composite measure currently composed of five elements:…

  18. Outcomes in a Nursing Home Transition Case-Management Program Targeting New Admissions

    ERIC Educational Resources Information Center

    Newcomber, Robert; Kang, Taewoon; Graham, Carrie

    2006-01-01

    Purpose: The Providing Assistance to Caregivers in Transition (PACT) program offers nursing home discharge planning and case management for individuals in the transitional period following a return to the community. The PACT program targeted individuals newly admitted to nursing homes and worked with a family caregiver to develop and implement a…

  19. BE-ACTIV: A Staff-Assisted Behavioral Intervention for Depression in Nursing Homes

    ERIC Educational Resources Information Center

    Meeks, Suzanne; Looney, Stephen W.; Van Haitsma, Kimberly; Teri, Linda

    2008-01-01

    Purpose: This article (a) describes a 10-week, behavioral, activities-based intervention for depression that can be implemented in nursing homes collaboratively with nursing home activities staff and (b) presents data related to its development, feasibility, and preliminary outcomes. Design and Methods: We developed BE-ACTIV, which stands for…

  20. OBRA '87: has it resulted in positive change in nursing homes?

    PubMed

    Marek, K D; Rantz, M J; Fagin, C M; Krejci, J W

    1996-12-01

    This study examines perspectives of a broad group of nursing home employees, regulators, advocates, and professional associations to describe progress made since the 1990 implementation of the Nursing Home Reform legislation (OBRA '87) and to determine whether the legislation is perceived as effecting positive change for nursing home residents. Interviews were conducted with 132 professional and non-professional staff in six states and 56 residents. Important issues about nursing home staffing and quality of care are explored. In general, OBRA '87 is viewed as positive, with all groups of respondents indicating that nursing staff or quality have not deteriorated; administrators, licensed nurses, and certified nursing assistants indicate the quality of nursing care provided and the nursing staff levels have improved since OBRA '87 implementation. Regulators agree that quality of nursing care has improved, but nursing home advocates, regulators, and professional association staff indicate mostly no change or no opinion. There is a danger in interpreting that quality and staffing are adequate from these results. While both may have improved, they may not be adequate.

  1. Taste detection ability of elderly nursing home residents.

    PubMed

    Ogawa, T; Uota, M; Ikebe, K; Notomi, Y; Iwamoto, Y; Shirobayashi, I; Kibi, M; Masayasu, S; Sasaki, S; Maeda, Y

    2016-07-01

    Due to the rapid rise of aged populations throughout the world, it is essential to elucidate the cause of taste dysfunction, because it may reduce appetite, leading to inadequate dietary intake. We aimed to compare taste detection ability between dependently and independently living geriatric individuals of nearly the same age with oral status. Forty-three elderly individuals considered to be cognitively eligible and residing in nursing homes in Japan were enrolled (n = 43, 82·3 ± 8·5 years) and were compared with an independently living elderly group (n = 949, 79·9 ± 0·8 years), aiming to compare taste detection ability between dependently and independently living elders of nearly the same age. Information regarding comorbidity and medication was obtained as general health status, and oral status including number of present teeth, denture usage and maximal occlusal force was also noted. In the dependently living group, 69·4%, 14·3%, 16·3% and 8·2% of participants could detect sweet, sour, salty and bitter tastes, respectively, which was significantly lower than the independently living group for each taste (97·9%, 70·8%, 89·6% and 43·8% for sweet, sour, salty and bitter tastes, respectively). The multivariate logistic regression analysis revealed that residing in nursing homes was associated with reduced sensitivity for four different tastes. The diseases and the situation of dependent elders were more likely the cause of the decreased taste sensitivity. PMID:27027615

  2. Analgesic medication errors in North Carolina nursing homes.

    PubMed

    Desai, Rishi J; Williams, Charrlotte E; Greene, Sandra B; Pierson, Stephanie; Caprio, Anthony J; Hansen, Richard A

    2013-06-01

    The objective of this study was to characterize analgesic medication errors and to evaluate their association with patient harm. The authors conducted a cross-sectional analysis of individual medication error incidents reported by North Carolina nursing homes to the Medication Error Quality Initiative (MEQI) during fiscal years 2010-2011. Bivariate associations between analgesic medication errors with patient factors, error-related factors, and impact on patients were tested with chi-square tests. A multivariate logistic regression model explored the relationship between type of analgesic medication errors and patient harm, controlling for patient- and error-related factors. A total of 32,176 individual medication error incidents were reported over a 2-year period in North Carolina nursing homes, 12.3% (n = 3949) of which were analgesic medication errors. Of these analgesic medication errors, opioid and nonopioid analgesics were involved in 3105 and 844 errors, respectively. Opioid errors were more likely to be wrong drug errors, wrong dose errors, and administration errors compared with nonopioid errors (P < .0001 for all comparisons). In the multivariate model, opioid errors were found to have higher odds of patient harm compared with nonopioid errors (odds ratio [OR] = 3, 95% confodence interval [CI]: 1.1-7.8). The authors conclude that opioid analgesics represent the majority of analgesic error reports, and these error reports reflect an increased likelihood of patient harm compared with nonopioid analgesics. PMID:23458096

  3. Effect of micronutrient supplementation on mood in nursing home residents.

    PubMed

    Gosney, M A; Hammond, M F; Shenkin, A; Allsup, S

    2008-01-01

    One third of older people in nursing and/or residential homes have significant symptoms of depression. In younger people, deficiencies in selenium, vitamin C and folate are associated with depression. This study examines the association between micronutrient status and mood before and after supplementation. The objective was to determine whether the administration of selenium, vitamin C and folate improved mood in frail elderly nursing home residents. Mood was assessed using the Hospital Anxiety and Depression rating scale (HAD), and Montgomery-Asberg Depression Rating Scale (MADRS). Micronutrient supplementation was provided for 8 weeks in a double-blinded randomised controlled trial. Significant symptoms of depression (29%) and anxiety (24%) were found at baseline. 67% of patients had low serum concentrations of vitamin C, but no-one was below the reference range for selenium. Depression was significantly associated with selenium levels, but not with folate or vitamin C levels. No individual with a HAD depression score of >or=8, had selenium levels >1.2 microM. In those patients with higher HAD depression scores, there was a significant reduction in the score and a significant increase in serum selenium levels after 8 weeks of micronutrient supplementation. Placebo group scores were unchanged. This small study concluded that depression was associated with low levels of selenium in frail older individuals. Following 8 weeks of micronutrient supplementation, there was a significant increase in selenium levels and improved symptoms of depression occurred in a subgroup. PMID:18463429

  4. Meeting communication needs: topics of talk in the nursing home.

    PubMed

    Williams, Kristine Nordlie; Ilten, Teresa Buchhorn; Bower, Helen

    2005-07-01

    Nursing home residents primarily rely on staff for communication and interpersonal relationships. Challenged by staffing shortages and increasingly complex care, staff who provide the most communication with residents lack awareness and skills to effectively communicate with older adults. This study, a secondary analysis of staff-resident interactions from one nursing home, explores communication topics and the effects of an intervention. Staff from one unit were recorded during 2 hours of caregiving to provide a representative sample of their communication with residents. Staff then attended an educational program targeting improved awareness of communication needs and reducing "elderspeak". Recording was repeated post-intervention. Baseline conversations focused on activities of daily living (ADLs), personal-social, technical care, and health assessment. Post-intervention ADL talk decreased in staff-resident interactions, while personal-social topics increased. These findings suggest that residents' limited opportunities for communication with staff are primarily focused on care tasks. With increased communication awareness, staff can learn to modify conversational topics to better meet older adults' psychosocial needs.

  5. On sources of powerlessness in nursing home life.

    PubMed

    Nyström, A E; Segesten, K M

    1994-01-01

    As feelings of identity and integrity are important for old people's efforts to maintain a healthy life, experiences of powerlessness ought to be prevented. This paper describes sources of powerlessness in nursing home life. Participant observations regarding lucid, elderly patients were undertaken in two Swedish nursing home wards. The observations focused on interactions on the wards, observed patient reactions and structural/functional conditions of life on the wards. The constant, comparative analysis searched for events or conditions which seemed to result in reactions signifying positive or negative experiences. Tender, loving care, strong cohesion and affection between patients and personnel were typical of the observations, yet patients complained of imprisonment, powerlessness and hopelessness. Observations are reported as related to legitimate, reward, expert, informational and reference power, self-confidence/respect and socialization. Also existential sources of powerlessness were identified. It is concluded that many factors co-operate to create feelings of powerlessness in the patients. Empowerment measures are suggested on organizational, interactional and personal levels.

  6. Spiritual Needs of Elderly Living in Residential/Nursing Homes

    PubMed Central

    Erichsen, Nora-Beata

    2013-01-01

    While the research on spiritual needs of patients with chronic and life-threatening diseases increases, there is limited knowledge about psychosocial and spiritual needs of elderly living in residential/nursing homes. We were interested in which needs were of relevance at all, and how these needs are related to life satisfaction and mood states. For that purpose we enrolled 100 elderly living in residential/nursing homes (mean age 84 ± 7 years, 82% women) and provided standardized questionnaires, that is, Spiritual Needs Questionnaire (SpNQ), Brief Multidimensional Life Satisfaction Scale (BMLSS), Quality of Life in Elders with Multimorbidity (FLQM) questionnaire, and a mood states scale (ASTS). Religious needs and Existential needs were of low relevance, while inner peace needs were of some and needs for giving/generativity of highest relevance. Regression analyses revealed that the specific needs were predicted best by religious trust and mood states, particularly tiredness. However, life satisfaction and quality of life were not among the significant predictors. Most had the intention to connect with those who will remember them, although they fear that there is limited interest in their concerns. It remains an open issue how these unmet needs can be adequately supported. PMID:24027598

  7. [Behavior profile of psychogeriatric patients in substitute care projects: nursing home care and home for the aged].

    PubMed

    Boom-Poels, P G

    1994-03-01

    This article describes behaviour profiles of psychogeriatric patients participating in some substitute care projects. The behaviour of 55 patients from five residential homes participating in these projects were rated on the Behaviour Rating Scale for Psychogeriatric Inpatients (GIP). These data were compared with GIP-data of two reference groups: elderly people in residential homes and patients in psychogeriatric nursing homes (supervision, intensive care and nursing care requiring patients). Patients in the projects have, compared to the other people in residential homes, more cognitive and social disabilities. Compared to the patients in nursing homes, the patients in the projects have less social, cognitive and psychomotor disabilities, but more emotional problems, like suspicious, melancholic and dependent behaviour. These results show that patients in substitute care projects have a specific behaviour profile. The profile can be used for careful selection of patients in these projects.

  8. Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

    PubMed Central

    Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

    2014-01-01

    Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

  9. Drivers of change: Learning from the lived experiences of nursing home social workers.

    PubMed

    Lee, Ahyoung Anna; Lee, Sharon Narae; Armour, Marilyn

    2016-01-01

    In response to the growing attention to integrated health care and the cultural change movement in nursing homes, this study examines the lived experiences of nursing home social workers to better understand their role perceptions, job satisfaction, and relationship with other staff members. Hermeneutic phenomenology was used in order to understand the lived experience of being a nursing home social worker. Ten nursing home social workers were recruited from a southern state and individual interviews were conducted. From the interviews, four themes emerged: challenge, coping, mattering, and rewarding. Guided by identity negotiation theory and social identity theory, these findings are discussed. Also, implications for social work education, nursing home administration, and policy is discussed.

  10. Competitive spillovers across non-profit and for-profit nursing homes.

    PubMed

    Grabowski, David C; Hirth, Richard A

    2003-01-01

    The importance of non-profit institutions in the health care sector has generated a vast empirical literature examining quality differences between non-profit and for-profit nursing homes. Recent theoretical work has emphasized that much of this empirical literature is flawed in that previous studies rely solely on dummy variables to capture the effects of ownership rather than accounting for the share of non-profit nursing homes in the market. This analysis considers whether competitive spillovers from non-profits lead to higher quality in for-profit nursing homes. Using instrumental variables to account for the potential endogeneity of non-profit market share, this study finds that an increase in non-profit market share improves for-profit and overall nursing home quality. These findings are consistent with the hypothesis that non-profits serve as a quality signal for uninformed nursing home consumers.

  11. Geothermal greenhouse-heating facilities for the Klamath County Nursing Home, Klamath Falls, Oregon

    SciTech Connect

    Not Available

    1982-02-01

    The Klamath County Nursing Home, located in Klamath Falls, Oregon, was constructed in 1976. The building of 55,654 square feet currently houses care facilities for approximately 120 persons. During the initial planning for the Nursing Home, the present site was selected primarily on the basis of its geothermal resource. This resource (approx. 190/sup 0/F) currently provides space and domestic hot water heating for the Nursing Home, Merle West Medical Center and the Oregon Institute of Technology. The feasibility of installing a geothermal heating system in a planned greenhouse for the Nursing Home is explored. The greenhouse system would be tied directly to the existing hot water heating system for the Nursing Home.

  12. 77 FR 60128 - Noncompetitive Supplements to Nursing Assistant and Home Health Aide Program Grantees

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-02

    ... HUMAN SERVICES Health Resources and Services Administration Noncompetitive Supplements to Nursing... Nursing Assistant and Home Health Aide (NAHHA) Program grantees to develop, implement, and evaluate... Sciences Center (TTUHSC) School of Nursing, 302 Pine Street, Abilene, TX 79601, T51HP20702...

  13. What Influences Home Care Nurses to Accept or Reject Precepting Opportunities? A Pilot Study.

    PubMed

    Egan, Judith; Toughill, Eileen Helbig; Painter, Ann; Truex, Rita

    2016-10-01

    Nurse managers and nursing faculty report, anecdotally, on their difficulty identifying nurses willing to precept new staff or students. To understand more about this topic, we queried home care nurses at a small agency on their perceived incentives and barriers to precepting, their preceptor status, generation of birth, and birth order. The purpose of this pilot study was to identify home care nurses' perceived incentives and barriers to becoming a preceptor. We also sought to examine possible relationships between preceptor status, generation of birth, and ordinal position of birth.

  14. What Influences Home Care Nurses to Accept or Reject Precepting Opportunities? A Pilot Study.

    PubMed

    Egan, Judith; Toughill, Eileen Helbig; Painter, Ann; Truex, Rita

    2016-10-01

    Nurse managers and nursing faculty report, anecdotally, on their difficulty identifying nurses willing to precept new staff or students. To understand more about this topic, we queried home care nurses at a small agency on their perceived incentives and barriers to precepting, their preceptor status, generation of birth, and birth order. The purpose of this pilot study was to identify home care nurses' perceived incentives and barriers to becoming a preceptor. We also sought to examine possible relationships between preceptor status, generation of birth, and ordinal position of birth. PMID:27677062

  15. Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study.

    PubMed

    Abrahamson, Kathleen; DeCrane, Susan; Mueller, Christine; Davila, Heather Wood; Arling, Greg

    2015-01-01

    This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Interviews were conducted with 24 nursing home employees from within 8 facilities participating in the quality improvement project. Findings were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges. PMID:25407787

  16. Determinants of hospital-to-nursing home placement delays: a pilot study.

    PubMed Central

    Weissert, W G; Cready, C M

    1988-01-01

    Estimates of hospital-to-nursing home placement delays have always been varied, and given Medicare's new Prospective Payment System (PPS) based on diagnosis-related groups (DRGs), they are likely to have changed again. Theory and previous research suggest that four patient characteristics are the main causes of delays: Medicaid as the patient's nursing home payer source; need for heavy care due to major physical or mental problems; admission to the hospital from a nursing home; and lack of social support. A pilot study of all 1,016 elderly awaiting nursing home placement in two admission cohorts (pre- and post-PPS) from the three largest hospitals in the county surrounding Charlotte, North Carolina--where nursing home beds are in short supply--indicates that other factors are more important. While most placements were delayed, delays were short. Multiple regression results show that Medicaid patients' delays were only about a day longer than those of private-pay patients. Of the many heavy-care conditions studied, only three were associated with delay. Patients without social support and patients admitted from a nursing home, discharged to a hospital-affiliated facility, or placed after PPS had shorter delays. Long delays were found among patients who had applied for Medicaid coverage but had not yet been certified as financially eligible. Nonwhites and males were also delayed. These findings, if replicated in other areas with perceived nursing home bed shortages, appear to have important implications not only for the usefulness of nursing home case-mix reimbursement and subacute levels of nursing home care, but for nursing home bed-need estimates, too, as well as for Medicaid eligibility determination practices and civil rights law enforcement. PMID:3060449

  17. The Potential of Wash-and-Dry Toilets to Improve the Toileting Experience for Nursing Home Residents

    ERIC Educational Resources Information Center

    Cohen-Mansfield, Jiska; Biddison, James R.

    2005-01-01

    Purpose: We investigated the feasibility of using a "wash-and-dry" toilet in the nursing home. Design and Methods: We used a controlled comparison baseline-versus-treatment design with 22 female nursing home residents aged 75 and older living in a 562-bed, not-for-profit nursing home facility in Maryland. The Luscence Luxury Lavage wash-and-dry…

  18. An ergonomic evaluation of nursing assistants' job in a nursing home.

    PubMed

    Garg, A; Owen, B D; Carlson, B

    1992-09-01

    Thirty-eight nursing assistants (NAs) in a nursing home ranked and rated 16 different patient handling tasks for perceived stresses to the low back. The nursing assistants were observed for 79 4 h shifts and were videotaped for 14 4 h shifts to describe a typical workday and to determine the number of patient-handling tasks performed per shift, the use of assistive devices, and biomechanical stresses to the low back. In addition, data were collected on nursing assistants' and patients' characteristics. The top eight ranked tasks included transferring patient from toilet to wheelchair (WC), WC to toilet, WC to bed, bed to WC, bathtub to WC, chairlift to WC, weighing patients and lifting patients up in bed. The mean ratings of perceived exertion for these tasks were between 'somewhat hard' and 'hard'. The estimated compressive force on L5/S1 disc for the 50th percentile patient weight ranged from 3.7 to 4.9 KN. Nursing assistants worked in teams of two and performed 24 patient transfers per 8 h shift by manually lifting and carrying patients. Assistive devices (a hydraulic lift and gait belt) were used less than 2% of the time. Patient safety and comfort, lack of accessibility, physical stresses associated with the devices, lack of skill, increased transfer time, and lack of staffing were some of the reasons for not using these assistive devices. Environmental barriers (such as confined workplaces, an uneven floor surface, lack of adjustability of beds, stationary railings around the toilet, etc.) made the job more difficult. Nursing assistants had a high prevalence of low-back pain and 51% of nursing assistants visited a health care provider in the last three years for work related low-back pain. PMID:1387079

  19. Distance Coursework and Coaching to Improve Nursing Home Incontinence Care: Lessons Learned

    PubMed Central

    Rahman, Anna N.; Schnelle, John F.; Applebaum, Robert; Lindabury, Kate; Simmons, Sandra

    2012-01-01

    Objectives To determine whether a distance coaching course on improving nursing home incontinence care could be replicated and brought to scale with a larger group of nursing homes without sacrificing outcomes. Design The study collected descriptive and comparative data. Setting The setting was comprised of 14 nursing homes in the original course and 34 homes in the replication course. Participants Participants in the study were supervisors and staff from enrolled nursing homes who completed the distance coaching courses on incontinence management. Measures Data for both courses were collected using a resident assessment form to evaluate implementation of new practices, pre- and post-training quizzes, a course evaluation survey, and a supervisor’s report. Results There were few significant differences between the course groups with respect to course participation, knowledge transfer, and training program preferences. Although course 1 nursing homes reported assessing more residents on average than course 2 homes (22 residents vs. 12 residents, respectively), this difference is likely an artifact of differences in the reporting methodologies for the two courses. Conclusion This study found qualified support for using a distance coaching course to facilitate adoption of evidence-based incontinence care practices in nursing homes. The findings also underscore the challenges associated with designing dissemination/implementation programs that are both effective and feasible to implement with nursing homes. We recommend that nursing home educators consider this study’s findings when designing new training programs. Outcomes may improve if some dissemination resources are diverted to distance coaching activities that support nursing home improvement efforts over extended periods. PMID:22642640

  20. Predictors of quality in rural nursing homes using standard and novel methods.

    PubMed

    Towsley, Gail L; Beck, Susan L; Pepper, Ginette A

    2013-04-01

    We examined the effect of market and organizational characteristics on nursing home quality as measured by deficiencies (number and weighted) on states in a rural region of the United States. Rural nursing homes in five Mountain West states (N = 161) were sampled from the Online Survey Certification and Reporting system between January 1, 2004 and June 15, 2005. State comparisons indicated that rural nursing homes in Nevada had a higher number of deficiencies and weighted deficiency score as compared with Utah, Colorado, Wyoming, and Idaho. Using regression analyses, we found that a higher percentage of licensed practical nurses in the staffing mix were predictive of a greater number of deficiencies. Nursing homes with more beds or higher Medicaid occupancy had higher weighted deficiency scores. Although rural Mountain West nursing homes average a similar number of deficiencies as nursing homes nationwide, these nursing homes had a greater number of serious deficiencies and higher weighted deficiency scores, suggesting greater actual harm to resident health and safety.

  1. Nurse Preparation and Organizational Support for Supervision of Unlicensed Assistive Personnel in Nursing Homes: A Qualitative Exploration

    ERIC Educational Resources Information Center

    Siegel, Elena O.; Young, Heather M.; Mitchell, Pamela H.; Shannon, Sarah E.

    2008-01-01

    Purpose: Nursing supervision of the routine daily care (e.g., grooming, feeding, and toileting) that is delegated to unlicensed assistive personnel (UAP) is critical to nursing home service delivery. The conditions under which the supervisory role is organized and operationalized at the work-unit level, taking into account workloads, registered…

  2. Nursing Assistants' Job Commitment: Effect of Nursing Home Organizational Factors and Impact on Resident Well-Being

    ERIC Educational Resources Information Center

    Bishop, Christine E.; Weinberg, Dana Beth; Leutz, Walter; Dossa, Almas; Pfefferle, Susan G.; Zincavage, Rebekah M.

    2008-01-01

    Purpose: The purpose of this study was to investigate (a) whether certified nursing assistants (CNAs) are more committed to nursing home jobs when they perceive their jobs as enhanced (greater autonomy, use of knowledge, teamwork), and (b) whether CNA job commitment affects resident satisfaction. Design and Methods: A qualitative exploration of…

  3. The Factors Influencing the Sense of Home in Nursing Homes: A Systematic Review from the Perspective of Residents

    PubMed Central

    Rijnaard, M. D.; van Hoof, J.; Janssen, B. M.; Verbeek, H.; Pocornie, W.; Eijkelenboom, A.; Beerens, H. C.; Molony, S. L.; Wouters, E. J. M.

    2016-01-01

    Purpose. To provide an overview of factors influencing the sense of home of older adults residing in the nursing home. Methods. A systematic review was conducted. Inclusion criteria were (1) original and peer-reviewed research, (2) qualitative, quantitative, or mixed methods research, (3) research about nursing home residents (or similar type of housing), and (4) research on the sense of home, meaning of home, at-homeness, or homelikeness. Results. Seventeen mainly qualitative articles were included. The sense of home of nursing home residents is influenced by 15 factors, divided into three themes: (1) psychological factors (sense of acknowledgement, preservation of one's habits and values, autonomy and control, and coping); (2) social factors (interaction and relationship with staff, residents, family and friends, and pets) and activities; and (3) the built environment (private space and (quasi-)public space, personal belongings, technology, look and feel, and the outdoors and location). Conclusions. The sense of home is influenced by numerous factors related to the psychology of the residents and the social and built environmental contexts. Further research is needed to determine if and how the identified factors are interrelated, if perspectives of various stakeholders involved differ, and how the factors can be improved in practice. PMID:27313892

  4. How to avoid and prevent coercion in nursing homes: a qualitative study.

    PubMed

    Gjerberg, Elisabeth; Hem, Marit Helene; Førde, Reidun; Pedersen, Reidar

    2013-09-01

    In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home's resources, by the organization of care and by the staff's competence. PMID:23442786

  5. How to avoid and prevent coercion in nursing homes: a qualitative study.

    PubMed

    Gjerberg, Elisabeth; Hem, Marit Helene; Førde, Reidun; Pedersen, Reidar

    2013-09-01

    In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home's resources, by the organization of care and by the staff's competence.

  6. Nursing Home Quality and Financial Performance: Does the Racial Composition of Residents Matter?

    PubMed Central

    Chisholm, Latarsha; Weech-Maldonado, Robert; Laberge, Alex; Lin, Feng-Chang; Hyer, Kathryn

    2013-01-01

    Objective. To examine the effects of the racial composition of residents on nursing homes’ financial and quality performance. The study examined Medicare and Medicaid-certified nursing homes across the United States that submitted Medicare cost reports between the years 1999 and 2004 (11,472 average per year). Data Source. Data were obtained from the Minimum Data Set, the On-Line Survey Certification and Reporting, Medicare Cost Reports, and the Area Resource File. Study Design. Panel data regression with random intercepts and negative binomial regression were conducted with state and year fixed effects. Principal Findings. Financial and quality performance differed between nursing homes with high proportions of black residents and nursing homes with no or medium proportions of black residents. Nursing homes with no black residents had higher revenues and higher operating margins and total profit margins and they exhibited better processes and outcomes than nursing homes with high proportions of black residents. Conclusion. Nursing homes’ financial viability and quality of care are influenced by the racial composition of residents. Policy makers should consider initiatives to improve both the financial and quality performance of nursing homes serving predominantly black residents. PMID:23800123

  7. [Conceptualizations on care for persons with dementia in nursing homes].

    PubMed

    Rodríguez-Martín, Beatriz; Martínez-Andrés, María; Notario-Pacheco, Blanca; Martínez-Vizcaíno, Vicente

    2016-03-01

    Despite the importance of family perceptions when analyzing care for the elderly in nursing homes, little is said about this aspect. This study aims to identify preferences and areas for improvement in care for persons with dementia, as perceived by families. A qualitative study was performed, based on Grounded Theory, combining two data collection techniques (participant observation and in-depth interviews) in a theoretical sample of institutionalized persons with dementia. The ideal model of care for persons with dementia, as perceived by participants, was based on specialized and individualized care and family participation in the care provided. Areas for improvement included aspects pertaining to specialized training in geriatrics, human relations, and the culture of institutional work. Faced with the current trend towards technification of care, families are now demanding personalized, small-scale care in which they form an active part of the team.

  8. Nursing home social services directors who report thriving at work.

    PubMed

    Liu, Jinyu; Bern-Klug, Mercedes

    2013-01-01

    Nationally representative data from a sample (n = 928) of full-time nursing home social services directors were used to investigate whether knowing characteristics of the social environment at work can help to explain which directors report job thriving. Two-thirds of directors reported they were thriving in their jobs. Multiple regression results show that thriving is increased by job autonomy, being treated like an important part of the team, having enough time to identify and meet resident psychosocial needs, not having to do things that others could do, and being clear what the social services role is. Findings suggest that addressing these aspects of the social environment and social services role will likely contribute to increasing a sense of thriving at work among social services staff members. PMID:23350567

  9. Identity cues and dementia in nursing home intervention.

    PubMed

    Vézina, Aline; Robichaud, Line; Voyer, Philippe; Pelletier, Daniel

    2011-01-01

    This study examines the identity cues that family caregivers and healthcare personnel use with seniors living with dementia and living in nursing homes. The identity cues represent biographical knowledge used to stimulate the dementia sufferer, trigger signals and incite interaction. Our grounded approach hinges on three objectives: to identify and categorize identity cues; to document their uses; and to gain a better understanding of their effectiveness. We interviewed nine family caregivers and 12 healthcare workers. Qualitative data indicates that the participants use identity cues that evoke seniors' sociological, relational and individual characteristics. These identity cues play a central role in communication and constitute important information that the family caregivers can share with healthcare personnel. They sustain memory, facilitate care and reinforce seniors' self-value. These results help to define identity, foster a greater role for family caregivers, and constitute a sound basis for the implementation of personalized interventions.

  10. Views on dignity of elderly nursing home residents.

    PubMed

    Franklin, Lise-Lotte; Ternestedt, Britt-Marie; Nordenfelt, Lennart

    2006-03-01

    Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence.

  11. Nursing Home Levels of Care: Problems and Alternatives

    PubMed Central

    Bishop, Christine E.; Plough, Alonzo L.; Willemain, Thomas R.

    1980-01-01

    Providers and recipients of nursing home care under Medicaid are currently classified into two levels of care to facilitate appropriate placement, care, and reimbursement. The inherent imprecision of the two level system leads to problems of increased cost to Medicaid, lowered quality of care, and inadequate access to care for Medicaid recipients. However, a more refined system is likely to encounter difficulties in carrying out the functions performed by the broad two-level system, including assessment of residents, prescription of needed services, and implementation of service plans. The service type-service intensity classification proposed here can work in combination with a three-part reimbursement rate to encourage more accurate matching of resident needs, services, and Medicaid payment, while avoiding disruption of care. PMID:10309329

  12. Day-to-day care: the interplay of CNAs' views of residents & nursing home environments.

    PubMed

    Fisher, Lucy Takesue; Wallhagen, Margaret I

    2008-11-01

    This qualitative study identified certified nursing assistants' (CNAs') perspectives of nursing home residents and how these perspectives translate into care practices. Data included observations of and interviews with 27 CNAs in three dissimilar nursing homes. All participants were people of color, and all but 3 were immigrants. CNAs constructed three views of residents: as fictive kin, as a commodity, and as an autonomous person. Although individual CNAs held one primary view of residents in general, select residents were viewed from an alternative perspective, resulting in variations in care practices. These findings suggest that such distinctions, in tandem with structural, organizational, and cultural differences in nursing homes, present opportunities for nursing leadership to affect the visible, everyday practice of nursing CNAs. To target interventions, further research is needed on how CNAs come to differentially view residents and how these differences influence CNAs' care relationships with residents. PMID:19024427

  13. Indicators of Job Satisfaction of Home Healthcare Nurses in the San Francisco Bay Area of California.

    PubMed

    Li, Xia; Canham, Daryl; Wahl, Sharon

    2016-06-01

    The purpose of this study was to identify the factors that provide job satisfaction for home healthcare nurses and to determine if the nurses' educational level makes a difference in job satisfaction. Data were collected using Ellenbecker's (2004) 21-item Home Healthcare Nurses Job Satisfaction Scale. The study results indicated the majority of this population of home healthcare nurses was satisfied on all items, except in having the power to change agency policy. Educational level made no significant difference in job satisfaction. Recommendations include encouraging agencies to include clinicians in policy decision-making and management of patient care. Nursing education programs should ensure nurses graduate with the skills necessary for policy development and to make decisions that positively impact patient care. PMID:27243430

  14. Quality of care in nursing home organizations: establishing a health services research agenda.

    PubMed

    Harrington, Charlene

    2005-01-01

    Health services research has led to exciting new findings about the critical importance of the amount and type of nursing staff in nursing homes for improving the processes and outcomes of care. This paper reviews recent theoretical and research issues and outlines areas where research is needed. The nursing home research agenda for the future needs to concentrate on: (1) the relationship between structural measures of nursing (eg, staffing levels, education, turnover rates) and the outcomes and processes of care; (2) adequate processes of care and ways to improve the reliability of clinical outcome measures; (3) better ways to risk-adjust for resident characteristics; (4) the impact of nursing home characteristics (eg, ownership) and public policies (eg, reimbursement) on structural factors, processes, and outcomes; and (5) cost-effectiveness studies of nursing care at the organizational or system level.

  15. A partnership model for the teaching nursing home project in Taiwan.

    PubMed

    Chang, Su-Hsien; Corgan, Neva L

    2006-03-01

    The purpose of this article is to describe the structure of a partnership model for a teaching nursing home program in Taiwan. Benner's model of "from novice to expert" was applied to the design of this program. Processes of developing this program began with nursing home administrators and faculty from a University in Taiwan setting mutual goals. Next, faculty members assessed quality of care and then used this knowledge to educate staff and conduct research. The goal of the education was not only to improve the quality of care provided within the nursing home, but to move the staff from novice to experts. Staff were also trained to become clinical health educators and preceptors for nursing students and other staff. In this partnership model, the training programs for clinical nurses, clinical nursing assistants, and healthcare educators were included.

  16. Enterostomal therapy nursing in the Canadian home care sector: what is its value?

    PubMed

    Baich, Linda; Wilson, Donna; Cummings, Greta G

    2010-01-01

    Approximately one-third of all home care patients have wound care needs. Home care patients tend to be older and have multiple chronic diseases rendering them at risk for developing wounds and impairing their ability to heal wounds. Enterostomal therapy (ET) nurses have expertise in wound, ostomy, and continence care, and were recently recognized by the Canadian Nurses Association as a specialty practice. We completed a systematic review in order to identify and synthesize evidence about the value of ET nurses in the Canadian home care sector, focusing on wound care. A literature search was conducted, using 9 computerized library databases. Eight articles were identified for review; each was analyzed using qualitative content analysis. Two themes emerged from our analysis: (1) assessing the outcomes of ET nurse involvement in client care and (2) methods for using ET nurses' expertise. Within these themes, the benefits of ET nurses working in home care were identified: (1) a decreased number of visits, (2) reduced wound-healing times, (3) successful healing, (4) reduced cost of wound care, (5) greater support for nurses and families, (6) fewer emergency department visits, (7) fewer hospital readmissions, (8) increased interest in education in wound care among other nurses, and (9) standardized protocols for wound care. Although only 8 studies were located for this review, their findings provide evidence that ET nurses' contributions to wound care are not only positive but also necessary in the home care sector. PMID:20075693

  17. NURSING HOME PRACTICES FOLLOWING RESIDENT DEATH: THE EXPERIENCE OF CERTIFIED NURSING ASSISTANTS

    PubMed Central

    Barooah, Adrita; Boerner, Kathrin; van Riesenbeck, Isabelle; Burack, Orah R.

    2015-01-01

    This study examined certified nursing assistants’ (CNAs) experiences of nursing home practices following resident death. Participants were 140 CNAs who had experienced recent resident death. In semi-structured, in-person interviews, CNAs were asked about their experiences with the removal of the resident's body, filling the bed with a new resident, and how they were notified about the death. The facilities’ practice of filling the bed quickly was most often experienced as negative. Responses to body removal and staff notification varied, but negative experiences were reported by a substantial minority. Being notified prior to returning to work was associated with a more positive experience. Learning about the death by walking into a room to find the bed empty or already filled was the most negative experience. Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience. PMID:25554351

  18. Nutritional status and chewing capacity in nursing home residents.

    PubMed

    Nordenram, G; Ljunggren, G; Cederholm, T

    2001-10-01

    Chronically ill elderly persons sustain a high risk for protein-energy malnutrition (PEM). In this study we explored some of the complex associations between nutritional status, dental health and cognitive and physical function in 192 nursing home residents (mean age 84+/-8 years, 80% female). Nutrition-related data from the Resident Assessment Instrument (RAI) were compiled into a Nutrition Score (NuSc; 0-1 = non-PEM, 2 = risk for PEM, and 3-7 = PEM). Chewing capacity, according to number and condition of occlusal contacts, was determined by a Clinical Dental Functionality score (CDF). The Cognitive Performance Scale (CPS) and activities of daily living (ADL) were determined according to the RAI. Fifty percent of the residents had NuSc > or = 2, and 25% had NuSc > or = 3. One third did not have the dental prerequisites for chewing. i.e., < 4 occlusal contacts. Almost half of the residents had severe cognitive dysfunction, and over two thirds were severely limited in their ADL activities. Subjects with > or = 4 occlusal contacts, i.e., technical chewing capacity, had better NuSc (1.5+/-1.4) than those not able to chew (2.4+/-1.6, p=0.0005). In univariate logistic regression, the odds for NuSc > or = 2 increased with reduced ADL functions. inability to chew and poor cognition. In multivariate logistic regression, ADL and chewing capacity were significantly related to NuSc > or = 2. When NuSc > or = 3 was chosen as cut-off, only ADL was related to malnutrition. In conclusion, half of this group of nursing home residents appeared to be malnourished, or were at risk for PEM. Reduced physical function was the strongest predictor of PEM, while impaired chewing capacity was associated with risk for PEM.

  19. “It’s a Dignity Thing”: Nursing Home Care Workers’ Use of Emotions1

    PubMed Central

    Rodriquez, Jason

    2011-01-01

    This article examines how nursing home care workers use emotions to construct dignity at work. Previous scholarship has shown how the financial and organizational characteristics of nursing homes shape and constrain emotion work among staff. Using evidence gathered during 18 months of participant observation in two nursing homes and 65 interviews with staff, this article analyzes how, despite obstacles, nursing home care workers generated authentic emotional attachments to residents. Surprisingly, some staff members said they particularly appreciated working with residents difficult to control. They felt accomplished when such residents successfully transitioned from life at home to life in institutional care. Emotions created dignity for staff and induced compliance among residents. Emotions are not only generated by organizations and imposed on workers; staff themselves produced emotions—sometimes in ways consistent with organizational demands, and sometimes not—and they consistently found in their emotions a resource to manage the strains of their work lives. PMID:21743774

  20. The effects of an enhanced environment on nursing home residents who pace.

    PubMed

    Cohen-Mansfield, J; Werner, P

    1998-04-01

    This study sought to enhance the well-being of older nursing home residents who pace and wander by enriching their nursing home environment. Visual, auditory, and olfactory stimuli were added to the nursing home unit environment to simulate two types of environments: a home environment and an outdoor nature environment. Participants seemed to prefer the enhanced environments by choosing to spend more time in them, and by sitting on benches in those environments. There was a trend toward less trespassing, exit-seeking, and other agitated behaviors being exhibited in the enhanced environment, and residents were observed to manifest more pleasure in it. Staff members and family members definitely expressed a preference for the enhanced environment over the regular one. Although effects on residents were limited, this approach offers a low-cost method for making the nursing home environment a better place for those residents.

  1. Does Mandating Nursing Home Participation In Quality Reporting Make A Difference? Evidence from Massachusetts

    PubMed Central

    Mukamel, Dana B.; Ye, Zhiqiu; Glance, Laurent G.; Li, Yue

    2015-01-01

    Background Quality report cards have been shown to be effective in influencing patients' referrals and promoting quality improvement in some instances and not others. In this study we investigate one of the mechanisms that may detract from their effectiveness: voluntary versus mandatory participation of nursing homes in public quality reporting. Objectives To answer two questions: 1) Were the nursing homes choosing not to participate low quality performers relative to those who chose to participate? 2) Once participation became mandatory, did those that did not voluntarily participate initially, improve more than those that participated voluntarily? Research Design Massachusetts published the Massachusetts Satisfaction Survey report card for nursing homes for the years 2005, 2007, and 2009. Nursing homes' participation was voluntary in 2005 and mandatory in 2007 and 2009. We performed a retrospective statistical analysis of the relationship between nursing homes' decision to participate in quality reporting and 12 quality outcomes: deficiency citations, staffing, and 8 survey domains. Subjects 424 Massachusetts nursing homes. Results 67% of nursing homes participated in reporting voluntarily. Volunteer nursing homes had better quality for all measures (significant at the 0.05 level or trending towards significance at the 0.10 level for all but 2). Once reporting became mandatory, non-volunteers improved more than volunteers in all but 2 staffing measures (trending towards significance at the 0.10 level in 5). Conclusions Report cards are more effective if nursing homes' participation is mandated. Non-mandatory reporting systems, as those implemented by some states and professional associations, lead to missed opportunities for quality improvements. PMID:26125418

  2. The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network.

    PubMed

    van den Dool, Carline; Haenen, Anja; Leenstra, Tjalling; Wallinga, Jacco

    2016-07-01

    OBJECTIVE Recerntly, the role of the healthcare network, defined as a set of hospitals linked by patient transfers, has been increasingly considered in the control of antimicrobial resistance. Here, we investigate the potential impact of nursing homes on the spread of antimicrobial-resistant pathogens across the healthcare network and its importance for control strategies. METHODS Based on patient transfer data, we designed a network model representing the Dutch healthcare system of hospitals and nursing homes. We simulated the spread of an antimicrobial-resistant pathogen across the healthcare network, and we modeled transmission within institutions using a stochastic susceptible-infected-susceptible (SIS) epidemic model. Transmission between institutions followed transfers. We identified the contribution of nursing homes to the dispersal of the pathogen by comparing simulations of the network with and without nursing homes. RESULTS Our results strongly suggest that nursing homes in the Netherlands have the potential to drive and sustain epidemics across the healthcare network. Even when the daily probability of transmission in nursing homes is much lower than in hospitals, transmission of resistance can be more effective because of the much longer length of stay of patients in nursing homes. CONCLUSIONS If an antimicrobial-resistant pathogen emerges that spreads easily within nursing homes, control efforts aimed at hospitals may no longer be effective in preventing nationwide outbreaks. It is important to consider nursing homes in planning regional and national infection control and in implementing surveillance systems that monitor the spread of antimicrobial resistance. Infect Control Hosp Epidemiol 2016;37:761-767.

  3. From Doctor to Nurse Triage in the Danish Out-of-Hours Primary Care Service: Simulated Effects on Costs

    PubMed Central

    2013-01-01

    Introduction. General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness. The aim of this study was to estimate changes in fee costs if nurses substituted the GPs. Methods. We applied experiences from The Netherlands on nurse performance in the OOH triage concerning the number of calls per hour. Using the 2011 number of calls in one region, we examined three hypothetical scenarios with nurse triage and calculated the differences in fee costs. Results. A new organisation with 97 employed nurses would be needed. Fewer telephone consultations may result in an increase of face-to-face contacts, resulting in an increase of 23.6% in costs fees. Under optimal circumstances (e.g., a lower demand for OOH services, a high telephone termination rate, and unchanged GP fees) the costs could be reduced by 26.2% though excluding administrative costs of a new organisation. Conclusion. Substituting GPs with nurses in OOH primary care may increase the cost in fees compared to a model with only GPs. Further research is needed involving more influencing factors, such as costs due to nurse training and running the organisation. PMID:24194984

  4. Retrospective review of selective serotonin reuptake inhibitors and falling in older nursing home residents.

    PubMed

    Arfken, C L; Wilson, J G; Aronson, S M

    2001-03-01

    We compared the rate of falling in older nursing home residents who had been prescribed selective serotonin reuptake inhibitors (SSRIs), other classes of antidepressants, and no antidepressants. Data were obtained from pharmacy records, medical records, fall logs, and incidence reports for one nursing home (1995 data). Older adults on SSRIs were more likely to fall than older adults not on antidepressants (p = .003) and were more likely to have an injurious fall (p = .03). The association with falling remained significant even when including potential confounders (p = .007). Older nursing home residents should be treated for depression. However, SSRIs may also carry an increased risk for falling.

  5. The controversy inherent in managing frail nursing home residents during complex hurricane emergencies.

    PubMed

    Dosa, David M; Hyer, Kathryn; Brown, Lisa M; Artenstein, Andrew W; Polivka-West, Lumarie; Mor, Vincent

    2008-10-01

    Emergency planning for vulnerable populations constitutes a major element of community disaster preparedness and is an area in which guidance is particularly sparse. As evidenced by the well-publicized deaths of nursing home residents following Hurricanes Katrina and Rita, the need to improve nursing home emergency preparedness is self-evident. Nevertheless, as efforts to improve preparedness develop, a central controversy remains. Aside from mandatory complete evacuations, is it better to evacuate or not to evacuate frail elderly nursing home residents in the setting of hurricane emergencies? This paper reviews the historical evidence on both sides of the argument and suggests a policy and research agenda.

  6. The Effect of Pay-for-Performance in Nursing Homes: Evidence from State Medicaid Programs

    PubMed Central

    Werner, Rachel M; Konetzka, R Tamara; Polsky, Daniel

    2013-01-01

    Objective Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on quality of care in a large-scale setting—the implementation of P4P for nursing homes by state Medicaid agencies. Data Sources/Study Setting 2001–2009 nursing home Minimum Data Set and Online Survey, Certification, and Reporting (OSCAR) datasets. Study Design Between 2001 and 2009, eight state Medicaid agencies adopted P4P programs in nursing homes. We use a difference-in-differences approach to test for changes in nursing home quality under P4P, taking advantage of the variation in timing of implementation across these eight states and using nursing homes in the 42 non-P4P states plus Washington, DC as contemporaneous controls. Principal Findings Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change. Conclusions Medicaid-based P4P in nursing homes did not result in consistent improvements in nursing home quality. Expectations for improvement in nursing home care under P4P should be tempered. PMID:23398330

  7. Perceptions of Home Health Nurses Regarding Suffering, Artificial Nutrition, and Hydration in Late-Stage Dementia.

    PubMed

    Smith, Lenora; Amella, Elaine J; Nemeth, Lynne

    2016-10-01

    The purpose of this study was to explore perceptions of home healthcare nurses related to suffering, artificial nutrition and hydration in people with late-stage dementia, and if these perceptions influence care to people with dementia and their families. Part of a mixed-methods study, the qualitative portion examined perceptions of home healthcare nurses in a rural area in the southern United States. Seventeen home healthcare nurses participated in this study. Semistructured focus group interview questions were used. Constant comparative analysis was the method used for coding transcripts. Three themes emerged from the analysis: patient/family comfort, futility, and symbols of suffering. Although many of the nurses reported that artificial nutrition and hydration was of comfort to the patient and family because of the potential for "starving," they also felt it prolonged the patient's suffering due to the invasive procedure, need for restraints, and possibility of fluid overload. Several nurses felt that artificial nutrition and hydration gave a sense of false hope to the family that the patient would live longer. The perceptions of these home healthcare nurses influence their care to people with dementia and their families related to artificial nutrition and hydration, possibly based on experience. Their perceptions could influence family decisions regarding treatment options. Further research and education with home healthcare nurses is vital to ensure nurses are appropriately caring for patients with dementia and their families.

  8. Perceptions of Home Health Nurses Regarding Suffering, Artificial Nutrition, and Hydration in Late-Stage Dementia.

    PubMed

    Smith, Lenora; Amella, Elaine J; Nemeth, Lynne

    2016-10-01

    The purpose of this study was to explore perceptions of home healthcare nurses related to suffering, artificial nutrition and hydration in people with late-stage dementia, and if these perceptions influence care to people with dementia and their families. Part of a mixed-methods study, the qualitative portion examined perceptions of home healthcare nurses in a rural area in the southern United States. Seventeen home healthcare nurses participated in this study. Semistructured focus group interview questions were used. Constant comparative analysis was the method used for coding transcripts. Three themes emerged from the analysis: patient/family comfort, futility, and symbols of suffering. Although many of the nurses reported that artificial nutrition and hydration was of comfort to the patient and family because of the potential for "starving," they also felt it prolonged the patient's suffering due to the invasive procedure, need for restraints, and possibility of fluid overload. Several nurses felt that artificial nutrition and hydration gave a sense of false hope to the family that the patient would live longer. The perceptions of these home healthcare nurses influence their care to people with dementia and their families related to artificial nutrition and hydration, possibly based on experience. Their perceptions could influence family decisions regarding treatment options. Further research and education with home healthcare nurses is vital to ensure nurses are appropriately caring for patients with dementia and their families. PMID:27677061

  9. [Being a nursing home resident--a challenge for one's identity].

    PubMed

    Riedl, Maria; Mantovan, Franco; Them, Christa

    2012-05-01

    When entering the nursing home, elderly people are afraid of losing their independence and identity. That is why the entry into a nursing home turns out be a critical experience for the people affected. A systematic literature research on this topic illustrates that the impacts of a nursing home entry on the identity of these people have only scarcely been investigated so far. In the present study, 20 problem-centred interviews with residents of three different nursing homes were conducted and analysed according to the summarizing content analysis developed by Mayring (2007). The result shows that moving into a nursing home is accompanied by a strong emotional burden as these people have to leave behind their friends, families, pets, long-time neighbours and property. Moreover, other residents of the nursing home create fear through their need of care. The test persons participating in the present study do not want to have their decisions and actions imposed from outside because of their need of nursing care. They protest against it. They draw enough strength from the social network they maintain, from conversations and from their faith in order to fight for their independence. They develop a new identity close to their former identity by maintaining autonomy and mobility, and they stay future-oriented. PMID:22642199

  10. Marie Curie nurses: enabling patients with cancer to die at home.

    PubMed

    Higginson, Irene J; Wilkinson, Susie

    2002-05-01

    Marie Curie Cancer Care established its nursing service in 1958; however, the service has had little formal evaluation. This study aimed to describe and evaluate the care provided by Marie Curie nurse, and in particular to determine whether patients in their care remained and died at home. Two existing data sets were used: data on all patients referred to the Marie Curie Nursing Services in 147 areas of England, Wales, Scotland and Northern Ireland for 26 months, and data on cancer death registrations in England. A request for a Marie Curie nurse was made for 26,632 patients, 97% of whom had cancer and 11% of whom lived alone. The amount of care provided varied enormously (<1 hour-2862 hours), although the vast majority of patients less than 300 hours of nursing care. Place of death was recorded for only half these patients; 94% died at home, 2.5% in a hospice, 2.3% in a hospital, 0.2% in a nursing home and 0.6% other. Home death was most often associated with patients receiving medication via a syringe driver, patients living with other people, patients with cancer, other than prostate cancer, shorter time between referral and death and younger age. The results lend support to the theory that the care given to patients in their homes by Marie Curie nurses facilitated home death for many patients. Services need to ensure that mechanisms are in place to achieve data collection. Rigorous prospective evaluation is needed in the future.

  11. Nursing home staff’s views on residents’ dignity: a qualitative interview study

    PubMed Central

    2013-01-01

    Background Maintaining dignity is an important element of end-of-life care and also of the care given in nursing homes. Factors influencing personal dignity have been studied from both nursing home residents’ and staff’s perspective. Little is however known about the way nursing home staff perceive and promote the personal dignity of individual residents in daily practice, or about staff’s experiences with preserving dignity within the nursing home. The aim of this study is to gain more insight in this. Methods A qualitative descriptive interview study was designed, in which in-depth interviews were performed with 13 physicians and 15 nurses. They expressed their views on the personal dignity of 30 recently admitted nursing home residents on the general medical wards of four nursing homes in The Netherlands. Interviews were transcribed and analyzed following the principles of thematic analysis. Results According to both physicians and nurses, physical impairment and being dependent on others threatened the residents’ dignity. Whether or not this led to a violation of an individual resident’s dignity, depended - in staff’s opinion - on the resident’s ability to show resilience and to keep his/her individuality. Staff mentioned treating residents with respect and taking care of their privacy as most important elements of dignity-conserving care and strived to treat the residents as they would like to be treated themselves. They could often mention aspects that were important for a particular resident’s dignity. But, when asked what they could contribute to a particular resident’s dignity, they often mentioned general aspects of dignity-conserving care, which could apply to most nursing home residents. By attempting to give dignity-conserving care, physicians and nurses often experienced conflicting values in daily care and barriers caused by the lack of resources. Conclusions Tailoring dignity-conserving care to an individual nursing home resident

  12. General practitioners’ home visit tendency and readmission-free survival after COPD hospitalisation: a Danish nationwide cohort study

    PubMed Central

    Lykkegaard, Jesper; Larsen, Pia V; Paulsen, Maja S; Søndergaard, Jens

    2014-01-01

    Background: The tendency of general practitioners (GPs) to conduct home visits is considered an important aspect of practices’ accessibility and quality of care. Aims: To investigate whether GPs’ tendency to conduct home visits affects 30-day readmission or death after hospitalisation with chronic obstructive pulmonary disease. Methods: All Danish patients first-time hospitalised with COPD during the years 2006–2008 were identified. The association between the GP’s tendency to conduct home visits and the time from hospital discharge until death or all-cause readmission was analysed by means of Cox regression adjusted for multiple patient and practice characteristics. Results: The study included 14,425 patients listed with 1,389 general practices. Approximately 31% of the patients received a home visit during the year preceding their first COPD hospitalisation, and within 30 days after discharge 19% had been readmitted and 1.6% had died without readmission. A U-shaped dose–response relationship was found between GP home visit tendency and readmission-free survival. The lowest adjusted risk of readmission or death was recorded among patients who were listed with a general practice in which >20–30% of other listed first-time COPD-hospitalised patients had received a home visit. The risk was higher if either 0% (hazard rate ratio 1.18 (1.01–1.37)) or >60% (hazard rate ratio 1.23 (1.04–1.44)) of the patients had been visited. Conclusion: A moderate GP tendency to conduct home visits is associated with the lowest 30-day risk of COPD readmission or death. A GP’s tendency to conduct home visits should not be used as a unidirectional indicator of the ability to prevent COPD hospital readmissions. PMID:25429436

  13. Nursing homes: a suitable alternative to hospital care for older people in the UK?

    PubMed

    Turrell, A

    2001-08-01

    Over the past two decades nursing homes have become the major supplier of long-stay care for frail older people in the UK. Demographic projections indicate that the volume of nursing home places will continue to increase to keep pace with demand and that the population of homes will become steadily more dependent. Little systematic research exists to indicate how nursing home care compares with hospital care; the evidence that does exists tends to be restricted to local studies and thus is not generalizable. Local studies indicate that in both care settings there are shortfalls in terms of meeting basic quality of care standards. Despite this, there is obvious potential for nursing homes to act as an alternative to hospitalization, provided that there is suitable access for residents to specialist care and, for example, appropriate administration of medicines. Proposed changes in government policy will introduce more uniform standards in nursing homes and associated inspection structures and procedures. However, further research is needed to ascertain the clinical and consumer value of different interventions in nursing homes, and the cost-benefit of enhancing provision available in terms of preventing or forestalling demand on hospitals or reducing hospital length of stay. In the light of the commitment to develop evidence based practice, it is important that such research is urgently advanced to eliminate poor practice. In our rights conscious society, future generations of older people are unlikely to be as tolerant of substandard care.

  14. Cost control in nursing homes by means of economies of scale and care profile optimization.

    PubMed

    Hoess, Victoria; Bachler, Adi; Ostermann, Herwig; Staudinger, Roland

    2009-01-01

    The call to enlarge or merge nursing homes in order to lower costs rests on the assumption that economies of scale exist within the cost structure of these homes. Economies of scale means that an increasing number of residents will reduce the costs per person needing care. However, the existence and the extent of economies of scale as such in nursing homes are the subject of controversy because studies of this issue performed in nursing homes up to now have yielded contradictory results. In this study, researchers demonstrated economies of scale in Tyrolean, Austria, nursing homes and showed that the composition of the nursing home residents in respect to their care needs influences the development of the average costs. Changing the size of the facility and/or influencing the average care level can have a considerable influence on the progression of average costs in nursing homes. Cost reductions can be achieved by increasing the size of the facility or by improved distribution of the care levels of the persons in need of care.

  15. Excess demand, consumer rationality, and the quality of care in regulated nursing homes.

    PubMed Central

    Nyman, J A

    1989-01-01

    This article investigates whether an empirical basis exists for the hypothesis that nursing homes exploit the irrationality of some nursing home patients by providing inadequate quality care. Evidence from Wisconsin in 1983 shows that violations of the Medicaid certification code in nursing homes are not statistically related to two measures of consumer rationality. Violations are, however, related to a measure of the need to compete for patients, despite the presence of an effective program to enforce these certification standards through fines. Specifically, it is found that, where the bed supply is tight, an additional empty bed in every nursing home in a county is associated with between five and six fewer class C violations (or their equivalent) in every home. This evidence is consistent with the hypothesis that the quality problems that nursing homes have traditionally exhibited are linked to the absence of a need to complete for patients, created by the bed shortage conditions that continue to characterize a large portion of nursing home care markets in the United States. The implications for public policy are discussed. PMID:2654084

  16. Efficiency and quality of care in nursing homes: an Italian case study.

    PubMed

    Garavaglia, Giulia; Lettieri, Emanuele; Agasisti, Tommaso; Lopez, Silvano

    2011-03-01

    This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency. PMID:20922483

  17. Nurse's Aid And Housekeeping Mobile Robot For Use In The Nursing Home Workplace

    NASA Astrophysics Data System (ADS)

    Sines, John A.

    1987-01-01

    The large nursing home market has several natural characteristics which make it a good applications area for robotics. The environment is already robot accessible and the work functions require large quantities of low skilled services on a daily basis. In the near future, a commercial opportunity for the practical application of robots is emerging in the delivery of housekeeping services in the nursing home environment. The robot systems will assist in food tray delivery, material handling, and security, and will perform activities such as changing a resident's table side drinking water twice a day, and taking out the trash. The housekeeping work functions will generate cost savings of approximately 22,000 per year, at a cost of 6,000 per year. Technical system challenges center around the artificial intelligence required for the robot to map its own location within the facility, to find objects, and to avoid obstacles, and the development of an energy efficient mechanical lifting system. The long engineering and licensing cycles (7 to 12 years) required to bring this type of product to market make it difficult to raise capital for such a venture.

  18. Restraint use in home care: a qualitative study from a nursing perspective

    PubMed Central

    2014-01-01

    Background Despite the growing demand for home care and preliminary evidence suggesting that the use of restraint is common practice in home care, research about restraint use in this setting is scarce. Methods To gain insight into the use of restraints in home care from the perspective of nurses, we conducted a qualitative explorative study. We conducted semi-structured face-to-face interviews of 14 nurses from Wit-Gele Kruis, a home-care organization in Flanders, Belgium. Interview transcripts were analyzed using the Qualitative Analysis Guide of Leuven. Results Our findings revealed a lack of clarity among nurses about the concept of restraint in home care. Nurses reported that cognitively impaired older persons, who sometimes lived alone, were restrained or locked up without continuous follow-up. The interviews indicated that the patient’s family played a dominant role in the decision to use restraints. Reasons for using restraints included “providing relief to the family” and “keeping the patient at home as long as possible to avoid admission to a nursing home.” The nurses stated that general practitioners had no clear role in deciding whether to use restraints. Conclusions These findings suggest that the issue of restraint use in home care is even more complex than in long-term residential care settings and acute hospital settings. They raise questions about the ethical and legal responsibilities of home-care providers, nurses, and general practitioners. There is an urgent need for further research to carefully document the use of restraints in home care and to better understand it so that appropriate guidance can be provided to healthcare workers. PMID:24498859

  19. Designing and Validating Procedures for Insuring Quality Adult Education in Nursing Homes and Convalescent Centers. Toward a Theory of Practice for Insuring Quality Education in Nursing Homes: A Section 310 Final Report, May 15, 1980-June 12, 1981.

    ERIC Educational Resources Information Center

    McDermott, Bill P.

    The Senior Adult Education Program (SAEP) for Monroe County, Michigan, conducted a documentation and analysis of the program component that provides high school completion classes in two local nursing homes. Three general research questions were (1) benefits to nursing home residents from the programs, (2) design of classes in nursing homes…

  20. Elementary Rehabilitation Nursing Care; a Manual for Nurses and Ancillary Workers in Nursing Homes, Hospitals, Convalescent Facilities, and Public Health Agencies. Public Health Service Publication No. 1436.

    ERIC Educational Resources Information Center

    Colorado State Dept. of Public Health, Denver. Public Health Nursing Section.

    This guide for teacher and student use presents a comprehensive program of physical rehabilitation for aged and physically disabled patients. Developed by the Public Health Nursing Section, the manual was tested by state health department personnel and persons doing inservice teaching in their respective nursing homes. The program is designed to…

  1. Knowledge, Attitude, and Practices Toward Blood Pressure Measurement at Home Among Japanese Nurses.

    PubMed

    Ishikuro, Mami; Ubeda, Sergio Ramón Gutiérrez; Obara, Taku; Watanabe, Ikue; Metoki, Hirohito; Kikuya, Masahiro; Kuriyama, Shinichi; Maruyama, Ryoko; Ohkubo, Takayoshi; Imai, Yutaka

    2016-04-01

    The self-measurement of blood pressure (BP) at home is useful in predicting the level of target organ damage and in managing hypertension. Nurses are essential practitioners for managing hypertension; however, it is unclear whether they have adequate knowledge of home BP management. This study assessed the knowledge, attitudes, and practices of home BP measurement among Japanese nurses. A questionnaire regarding home BP measurement was distributed among nurses and collected by mail. A total of 6,002 (61.8%) responses were eligible for the study. The proportion of participants who correctly recognized the reference values for clinic BP and home BP was 9.9% and 2.8%. Midwives and those working for the government had the highest proportion of correct responses of reference values among all nursing subgroups. Participants who thought that home BP gave the most important BP information were 62.7%. About 60% of the participants who recommended home BP measurement to hypertensive patients preferred to recommend an upper-arm cuff device. Our findings suggested that more knowledge of home BP measurement among nurses is warranted. PMID:27023297

  2. Efficacy of an in-home nursing intervention following short-stay breast cancer surgery.

    PubMed

    Wyatt, Gwen K; Donze, Laurie Friedman; Beckrow, Kathryn Christensen

    2004-10-01

    This randomized controlled trial (n = 240) was designed to test the efficacy of a sub-acute home nursing intervention following short-stay surgery for breast cancer. Intervention participants received the in-home nursing protocol, whereas non-intervention participants received agency nursing care or no nursing care. Data, collected via questionnaire, telephone interview, and chart audit, included surgical recovery/self-care knowledge, functional status, anxiety, quality of life (QOL), and health service utilization. There were no significant group differences on postoperative functional status, anxiety, QOL, further surgeries, or complications. Intervention participants were more likely to receive instruction on surgical self-care (p home visits (p nursing protocol may, at reasonable cost, improve QOL and enhance health-related knowledge.

  3. Staffing Ratios and Quality: An Analysis of Minimum Direct Care Staffing Requirements for Nursing Homes

    PubMed Central

    Bowblis, John R

    2011-01-01

    Objective To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. Data Sources U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. Study Design Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Data Extraction Method Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. Principle Findings The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. Conclusions MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care practices associated with lower quality. PMID:21609329

  4. Filipino Health Care Aides and the Nursing Home Labour Market in Winnipeg.

    PubMed

    Novek, Sheila

    2013-12-01

    Canada’s nursing homes have become increasingly dependent on immigrant health care aides. More than any other ethnic group, Filipino women are over-represented among health care aides in the Canadian health care system. This qualitative study explored the employment experiences of Filipino health care aides in nursing homes from their own perspectives as well as those of policy stakeholders. Fourteen in-depth interviews were conducted with Filipino health care aides and long-term-care policy stakeholders in Winnipeg, Manitoba. The results indicated that migrant social networks act as pathways linking immigrant women with employment opportunities in nursing homes. The composition of the labour force is also shaped by management strategies and labour market accommodations that respond to, and reinforce, these social networks. These findings have implications for workforce planning and the quality of care provision in nursing homes.

  5. Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement.

    PubMed

    Crnich, Christopher J; Jump, Robin; Trautner, Barbara; Sloane, Philip D; Mody, Lona

    2015-09-01

    The emerging crisis in antibiotic resistance and concern that we now sit on the precipice of a post-antibiotic era have given rise to advocacy at the highest levels for widespread adoption of programmes that promote judicious use of antibiotics. These antibiotic stewardship programmes, which seek to optimize antibiotic choice when clinically indicated and discourage antibiotic use when clinically unnecessary, are being implemented in an increasing number of acute care facilities, but their adoption has been slower in nursing homes. The antibiotic prescribing process in nursing homes is fundamentally different from that observed in hospital and clinic settings, with formidable challenges to implementation of effective antibiotic stewardship. Nevertheless, an emerging body of research points towards ways to improve antibiotic prescribing practices in nursing homes. This review summarizes the findings of this research and presents ways in which antibiotic stewardship can be implemented and optimized in the nursing home setting. PMID:26316294

  6. 42 CFR 422.133 - Return to home skilled nursing facility.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... elects to furnish SNF care in the absence of a prior qualifying hospital stay under § 422.101(c), then that SNF care is also subject to the home skilled nursing facility rules in this section. In...

  7. Is the experience of meaningful activities understood in nursing homes? A qualitative study.

    PubMed

    Palacios-Ceña, Domingo; Gómez-Calero, Cristina; Cachón-Pérez, José Miguel; Velarde-García, Juan Francisco; Martínez-Piedrola, Rosa; Pérez-De-Heredia, Marta

    2016-01-01

    Lack of occupation can lead to boredom, apathy, social exclusion and solitude. Occupation should incorporate meaningful activities. The aim of this study is to describe how Spanish Nursing Home residents experienced and made sense of meaningful activities. A qualitative phenomenological approach was followed. Data were collected over an 18-month period between 2012 and 2014. Purposeful sampling was conducted with Spanish residents in nursing homes in Madrid. Data were collected using unstructured and semi-structured interviews. The data were analyzed using the Giorgi proposal. Thirty-eight residents (20 female and 18 male) participated. Three main themes describing the significance of meaningful activity in nursing homes emerged from the data: Feeling the passage of time, Seeking an occupation, and Living with restrictions. Nursing homes should strive to develop diverse and meaningful activity programs for residents in order to occupy their time and provide them with a greater sense of purpose. PMID:26626463

  8. Does government oversight improve access to nursing home care? Longitudinal evidence from US counties.

    PubMed

    Howard, Larry L

    2014-01-01

    Gains in life expectancy around the world have increasingly placed pressure on governments to ensure that the elderly receive assistance with activities of daily living. This research examines the impact of government oversight of Medicaid payment policies on access to nursing home care services in the United States. Variation in price levels induced by a federal policy shift in 1997 is used to identify the effect of Medicaid reimbursements on the number of nursing homes and beds available. Court rulings prior to the policy change are used to categorically define a range of oversight treatments at the state level. Difference-in-differences estimates indicate a significant decline in access to nursing home care services for individuals living in states in which courts consistently ruled that Medicaid reimbursements did not meet the minimum standard implied by federal law. The findings suggest that nursing home care services were made more accessible through a combination of legislative and judicial oversight of Medicaid payment policies.

  9. Alzheimer disease. Donepezil and nursing home placement--benefits and costs.

    PubMed

    Jelic, Vesna; Winblad, Bengt

    2016-01-01

    The recent DOMINO-AD trial suggests that continued treatment with donepezil delays nursing home placement for patients with severe Alzheimer disease, but more work is needed to support strong conclusions about whether the benefits outweigh the costs.

  10. The Effect of Depression on Social Engagement in Newly Admitted Dutch Nursing Home Residents.

    ERIC Educational Resources Information Center

    Achterberg, Wilco; Pot, Anne Margriet; Kerkstra, Ada; Ooms, Marcel; Muller, Martien; Ribbe, Miel

    2003-01-01

    Studies the effect of depression on social engagement among newly admitted nursing home residents. Results reveal that residents with depression were significantly more often found to have low social engagement. (Contains 26 references and 3 tables.) (GCP)

  11. Ethical considerations when conducting ethnographic research in a nursing home setting.

    PubMed

    Schuster, E

    1996-01-01

    In this article I provide an overview of ethical concerns when conducting ethnographic research in nursing home settings where participants are vulnerable and submissive to authority, and I consider how particular research methodologies may benefit the participants. The focus of the article is primarily on the issues of privacy and autonomy and the relationship between the researcher and the participant. My own experiences of doing research in a nursing home will be woven throughout the article, as will the accounts of other researchers who have studied life in nursing homes. In reflecting on my work as a researcher I have come to a deeper understanding of the ethical issues involved in doing research in a nursing home and of the importance of ethically sound research.

  12. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...

  13. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...

  14. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...

  15. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...

  16. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing...

  17. Does empowering resident families or nursing home employees in decision making improve service quality?

    PubMed

    Hamann, Darla J

    2014-08-01

    This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses. PMID:24652909

  18. The contributions of the nurse and the machine in home uterine activity monitoring systems.

    PubMed

    Merkatz, R B; Merkatz, I R

    1991-05-01

    The relative contributions of home tokodynamometry and daily nursing telephone contact to the success of preterm birth prevention programs remains a subject of debate. Because investigators have obtained conflicting data, a reinterpretation of published results was undertaken by proposing a dynamic interface between the nurse and the machine. Experience gained from the technology and the development of nursing expertise with assessment of patient symptoms are presented as interdependent factors, both of which are critical to a therapeutic nurse-patient relationship. It is proposed that this combined interactive expertise increases sensitivity to the early recognition of preterm labor. The nurse's role in providing social support to high-risk pregnant women is then identified as a potential additional independent contributing factor to reported observed reductions in preterm births. Discussion focuses on future research, public policy issues, and the need for expanding nurse-patient interactions into the home.

  19. Does empowering resident families or nursing home employees in decision making improve service quality?

    PubMed

    Hamann, Darla J

    2014-08-01

    This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses.

  20. Nursing home-acquired pneumonia presenting at the emergency department.

    PubMed

    Pereira, Rui; Oliveira, Sara; Almeida, André

    2016-10-01

    Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old (IQR 77-90). Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age ≥ 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillin-resistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.