The ALIVE program: developing a web-based professional development program for nursing leaders in the home healthcare sector.

PubMed

Lankshear, Sara; Huckstep, Sherri; Lefebre, Nancy; Leiterman, Janis; Simon, Deborah

2010-05-01

Home healthcare nurses often work in isolation and rarely have the opportunity to meet or congregate in one location. As a result, nurse leaders must possess unique leadership skills to supervise and manage a dispersed employee base from a distance. The nature of this dispersed workforce creates an additional challenge in the ability to identify future leaders, facilitate leadership capacity, and enhance skill development to prepare them for future leadership positions. The ALIVE (Actively Leading In Virtual Environments) web-based program was developed to meet the needs of leaders working in virtual environments such as the home healthcare sector. The program, developed through a partnership of three home healthcare agencies, used nursing leaders as content experts to guide program development and as participants in the pilot. Evaluation findings include the identification of key competencies for nursing leaders in the home healthcare sector, development of program learning objectives and participant feedback regarding program content and delivery.

Pay-for-performance in nursing homes.

PubMed

Briesacher, Becky A; Field, Terry S; Baril, Joann; Gurwitz, Jerry H

2009-01-01

Information on the impact of pay-for-performance programs is lacking in the nursing home setting. This literature review (1980-2007) identified 13 prior examples of pay-for-performance programs in the nursing home setting: 7 programs were active as of 2007, while 6 had been terminated. The programs were mostly short-lived, varied considerably in the choice of performance measures and pay incentives, and evaluations of the impact were rare.

Governmental efforts to improve quality of care for nursing home residents and to protect them from mistreatment: a survey of federal and state laws.

PubMed

Gittler, Josephine

2008-10-01

There are many federal and state laws addressing, directly and indirectly, the quality of care provided to nursing home residents and the protection of residents from mistreatment. They include: (a) state laws that govern the licensing of nursing homes, (b) federal laws that govern the certification of nursing homes for participation in the Medicare and Medicaid programs, (c) elder abuse laws prohibiting mistreatment of older adults in nursing homes and other settings, (d) health care fraud abuse laws that are increasingly being used to combat the provision of substandard care to Medicare and Medicaid beneficiaries in nursing homes, and (e) laws that have established long-term care ombudsman programs to promote the health, safety, well-being, and rights of nursing home residents. While these laws are generally viewed as having improved the care and treatment of nursing home residents, much remains to be done, particularly with respect to the implementation of these laws.

The resource utilization group system: its effect on nursing home case mix and costs.

PubMed

Thorpe, K E; Gertler, P J; Goldman, P

1991-01-01

Using data from 1985 and 1986, we examine how New York state's prospective payment system affected nursing homes. The system, called Resource Utilization Group (RUG-II), aimed to limit nursing home cost growth and improve access to nursing homes by "heavy-care" patients. As in Medicare's prospective hospital reimbursement system, payments to nursing homes were based on a "price," rather than facility-specific rates. With respect to cost growth, we observed considerable diversity among homes. Specifically, those nursing homes most financially constrained by the RUG-II methodology exhibited the slowest rates of cost growth; we observed higher cost growth among the homes least constrained. This higher rate of cost growth raises a question about the desirability of using a pricing methodology to determine nursing home payment rates. In addition to moderating cost growth, we also observed a significant change in the mix of patients admitted to nursing homes. During the first year of the RUG-II program, nursing homes admitted more heavy-care patients and reduced days of care to lighter-care patients. Thus, through 1986, the RUG-II program appeared to satisfy at least one of its major policy objectives.

Effects of a 10-week multimodal exercise program on physical and cognitive function of nursing home residents: a psychomotor intervention pilot study.

PubMed

Pereira, Catarina; Rosado, Hugo; Cruz-Ferreira, Ana; Marmeleira, José

2018-05-01

Nursing home institutionalization tends to exacerbate loss of functioning. Examine the feasibility and the effect of a psychomotor intervention-a multimodal exercise program promoting simultaneous cognitive and motor stimulation-on the executive (planning ability and selective attention) and physical function of nursing home residents. Seventeen participants engaged in a 10-week multimodal exercise program and 17 maintained usual activities. Exercise group improved planning ability (25-32%), selective attention (19-67%), and physical function [aerobic endurance, lower body strength, agility, balance, gait, and mobility (19-41%)], corresponding to an effect size ranging from 0.29 (small) to 1.11 (high), p < 0.05. The multimodal exercise program was feasible and well tolerated. The program improved executive and physical functions of the nursing home residents, reverting the usual loss of both cognitive and motor functioning in older adult institutionalized. Multimodal exercise programs may help to maintain or improve nursing home residents' functioning.

Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol.

PubMed

Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta

2015-10-01

To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. © 2015 John Wiley & Sons Ltd.

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…

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…

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…

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…

Articulation Matrix for Home Health Aide, Nursing Assistant, Patient Care Assistant, Practical Nursing.

ERIC Educational Resources Information Center

Florida State Univ., Tallahassee. Center for Instructional Development and Services.

This document demonstrates the relationships among four Florida nursing education programs (home health aide, nursing assistant, patient care assistant, and practical nursing) by listing student performance standards and indicating which ones are required in each program. The 268 student performance standards are arranged in 23 areas of…

Evaluation of a Behavior Management Training Program for Nursing Home Caregivers.

ERIC Educational Resources Information Center

Marsiske, Michael; And Others

This study examined the effectiveness of a new skills training program designed to increase nurse aides' knowledge of behavior management. The training program, designed as five 90-minute group learning modules, was implemented in two Western Pennsylvania nursing homes over a 5-month period. Topics covered within the training program included…

Annual expenditures for nursing home care: Private and public payer price growth, 1977–2004

PubMed Central

Stewart, Kate A.; Grabowski, David C.; Lakdawalla, Darius N.

2009-01-01

Background Long-term nursing home care is primarily funded by out-of-pocket payments and public Medicaid programs. Few studies have explored price growth in nursing home care, particularly trends in the real cost of a year spent in a nursing home. Objectives To evaluate changes in private and public prices for annual nursing home care from 1977 to 2004, and to compare nursing home price growth to overall price growth and growth in the price of medical care. Research Design We estimated annual private prices for nursing home care between 1977 and 2004 using data from the National Nursing Home Survey. We compared private nursing home price growth to public prices obtained from surveys of state Medicaid offices, and evaluated the Bureau of Labor Statistics Consumer Price Indexes to compare prices for nursing homes, medical care, and general goods and services over time. Results Annual private pay nursing homes prices grew by 7.5% annually from $8,645 in 1977 to $60,249 in 2004. Medicaid prices grew by 6.7% annually from $9,491 in 1979 to $48,056 in 2004. Annual price growth for private pay nursing home care outpaced medical care and other goods and services (7.5% vs. 6.6% and 4.4%, respectively) between 1977 and 2004. Conclusions The recent rapid growth in nursing home prices is likely to persist, due to an aging population and greater disability among the near-elderly. The result will place increasing financial pressure on Medicaid programs. Better data on nursing prices are critical for policy-makers and researchers. PMID:19194339

State Regulatory Enforcement and Nursing Home Termination from the Medicare and Medicaid Programs

PubMed Central

Li, Yue; Harrington, Charlene; Spector, William D; Mukamel, Dana B

2010-01-01

Objectives Nursing homes certified by the Medicare and/or Medicaid program are subject to federally mandated and state-enforced quality and safety standards. We examined the relationship between state quality enforcement and nursing home terminations from the two programs. Study Design Using data from a survey of state licensure and certification agencies and other secondary databases, we performed bivariate and multivariate analyses on the strength of state quality regulation in 2005, and nursing home voluntary terminations (decisions made by the facility) or involuntary terminations (imposed by the state) in 2006–2007. Principal Findings Involuntary terminations were rarely imposed by state regulators, while voluntary terminations were relatively more common (2.16 percent in 2006–2007) and varied considerably across states. After controlling for facility, market, and state covariates, nursing homes in states implementing stronger quality enforcement were more likely to voluntarily terminate from the Medicare and Medicaid programs (odds ratio=1.53, p=.018). Conclusions Although involuntary nursing home terminations occurred rarely in most states, nursing homes in states with stronger quality regulations tend to voluntarily exit the publicly financed market. Because of the consequences of voluntary terminations on patient care and access, state regulators need to consider the effects of increased enforcement on both enhanced quality and the costs of termination. PMID:20819106

State “Technical Assistance Programs” for nursing home quality improvement: variations and potential implications

PubMed Central

Li, Yue; Spector, Williams D.; Glance, Laurent G.; Mukamel, Dana B.

2013-01-01

Context To improve nursing home quality, many states developed “Technical Assistance Programs” that provide on-site consultation and training for nursing facility staff. Methods We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. Results As of 2010, 17 states have developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. Conclusion State “Technical Assistance Programs” for nursing homes varies in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives. PMID:23216345

Implementation and Evaluation of LVN LEAD: A Leadership and Supervisory Training Program for Nursing Home Charge Nurses

PubMed Central

Harahan, Mary F.; Sanders, Alisha; Stone, Robyn I.; Bowers, Barbara J.; Nolet, Kimberly A.; Krause, Melanie R.; Gilmore, Andrea L.

2014-01-01

Licensed practical/vocational nurses (LVNs) play an important role in U.S. nursing homes with primary responsibility for supervising unlicensed nursing home staff. Research has shown that the relationship between supervisors and nurse aides has a significant impact on nurse aide job satisfaction and turnover as well as quality of care, yet nurses rarely receive supervisory training. The purpose of this project was to develop, pilot, and evaluate a leadership/supervisory training program for LVNs. Upon completion of the training program, many LVNs expressed and demonstrated a new understanding of their supervisory leadership and supervisory responsibilities. Directors of staff development are a potential vehicle for supporting LVNs in developing as supervisors. PMID:21417197

A university-sponsored home health nursing program in Karachi, Pakistan.

PubMed

Smego, Raymond A; Khan, Mohammad Aslam; Khowaja, Khurshid; Rafique, Rozina; Datoo, Farida

2005-11-01

This article describes a university-sponsored home health nursing program in a large urban center in Pakistan and details the essential elements needed in implementing such a program in a developing country. Compared to in-hospital treatment, home healthcare reduced hospital stay from 12.8 days to 3.9 days, and resulted in a net savings of Pakistani rupees (PRs) 5,374,135 (USD 89,569). A cost-effective home treatment program in a resource-limited country can be successfully implemented by using the hospital pharmacy as the central point for the preparation and distribution of medications and specialty nursing services.

Nursing Homes as Teaching Institutions: Legal Issues.

ERIC Educational Resources Information Center

Kapp, Marshall B.

1984-01-01

Discusses the trend toward affiliation of nursing homes with educational programs as clinical teaching institutions for medical, nursing, and allied health students. Reviews potential ethical and legal issues for the nursing home administrator, professional staff member, educator, and student, including informed consent, supervisory…

A home visiting asthma education program: challenges to program implementation.

PubMed

Brown, Josephine V; Demi, Alice S; Celano, Marianne P; Bakeman, Roger; Kobrynski, Lisa; Wilson, Sandra R

2005-02-01

This study describes the implementation of a nurse home visiting asthma education program for low-income African American families of young children with asthma. Of 55 families, 71% completed the program consisting of eight lessons. The achievement of learning objectives was predicted by caregiver factors, such as education, presence of father or surrogate father in the household, and safety of the neighborhood, but not by child factors, such as age or severity of asthma as implied by the prescribed asthma medication regimen. Incompatibility between the scheduling needs of the families and the nurse home visitors was a major obstacle in delivering the program on time, despite the flexibility of the nurse home visitors. The authors suggest that future home-based asthma education programs contain a more limited number of home visits but add telephone follow-ups and address the broader needs of low-income families that most likely function as barriers to program success.

[Current Status of Home Visit Programs: Activities and Barriers of Home Care Nursing Services].

PubMed

Oh, Eui Geum; Lee, Hyun Joo; Kim, Yukyung; Sung, Ji Hyun; Park, Young Su; Yoo, Jae Yong; Woo, Soohee

2015-10-01

The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services. A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program. Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling. The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.

A Post-Hospital Nursing Home Rehabilitation Program.

ERIC Educational Resources Information Center

Petchers, Marcia K.; And Others

1987-01-01

Describes program of short-term rehabilitation care provided to elderly patients through collaboration between hospital and nursing home. Discusses program planning and implementation experiences, patient satisfaction, and rehabilitation outcomes. Notes that program, although successful, was discontinued due to financial and interorganizational…

76 FR 79193 - Medicare Program; Independence at Home Demonstration Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-21

... physician and nurse practitioner directed home-based primary care teams aimed at improving health outcomes... Demonstration will test a service delivery model that utilizes physician and nurse practitioner directed primary... physicians, nurse practitioners, physician assistants, pharmacists, social workers, and other supporting...

[Developing a home care nursing information system by utilizing wire-wireless network and mobile computing system].

PubMed

Park, Jung-Ho; Park, Sung-Ae; Yoon, Soon-Nyoung; Kang, Sung-Rye

2004-04-01

The purpose of this study was to develop a home care nursing network system for operating home care effectively and efficiently by utilizing a wire-wireless network and mobile computing in order to record and send patients' data in real time, and by combining the headquarter office and the local offices with home care nurses over the Internet. It complements the preceding research from 1999 by adding home care nursing standard guidelines and upgrading the PDA program. Method/1 and Prototyping were adopted to develop the main network system. The detailed research process is as follows : 1)home care nursing standard guidelines for Diabetes, cancer and peritoneal-dialysis were added in 12 domains of nursing problem fields with nursing assessment/intervention algorithms. 2) complementing the PDA program was done by omitting and integrating the home care nursing algorithm path which is unnecessary and duplicated. Also, upgrading the PDA system was done by utilizing the machinery and tools where the PDA and the data transmission modem are integrated, CDMX-1X base construction, in order to reduce a transmission error or transmission failure.

Actualizing culture change: The Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK 2.0) program.

PubMed

Doll, Gayle A; Cornelison, Laci J; Rath, Heath; Syme, Maggie L

2017-08-01

Nursing homes have been challenged in their attempts to achieve deep, organizational change (i.e., culture change) aimed at providing quality of care and quality of life for nursing home residents through person-centered care. To attain deep change, 2 well-defined components must be in place: a shared understanding of (a) the what, or content goals, and (b) the how, or process of change. However, there are few examples of this at a macro or micro level in long-term care. In an effort to enact true culture change in nursing homes statewide, the Kansas Department for Aging and Disability Services implemented the Promoting Excellent Alternatives in Kansas Nursing Homes program. This program is a Medicaid, pay-for-performance program that formalizes the content and process of achieving culture change through person-centered care principles. This article aims to detail the content (what) and process (how) of a model macro-level program of culture change throughout the State of Kansas. Applications to the micro level (individual homes) are presented, and implications for psychologists' roles in facilitating culture change are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Relationship work in an early childhood home visiting program.

PubMed

Heaman, Maureen; Chalmers, Karen; Woodgate, Roberta; Brown, Judy

2007-08-01

A significant component of the work of public health nurses and paraprofessional home visitors who provide home visits to families with young children involves establishing relationships to effectively deliver the visiting program. The purpose of this qualitative and descriptive study was to describe the relationships among participants in a home visiting program in one regional health authority in the Canadian province of Manitoba. Interviews were carried out with 24 public health nurses, 14 home visitors, and 20 parents. The findings related to establishing, maintaining, and terminating relationships as well as factors influencing relationship work are described. Public health nurses and home visitors put significant effort into the work of establishing relationships with each other and their clients and require adequate training, sufficient human resources, and support from the program's administration to sustain these relationships.

The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care.

PubMed

Ouslander, Joseph G; Bonner, Alice; Herndon, Laurie; Shutes, Jill

2014-03-01

Interventions to Reduce Acute Care Transfers (INTERACT) is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and accountable care organizations, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust quality assurance performance improvement program, which is being rolled out by the federal government over the next year. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Effects of a Multicomponent Restraint Reduction Program for Korean Nursing Home Staff.

PubMed

Kong, Eun-Hi; Song, Eunjin; Evans, Lois K

2017-05-01

Physical restraints are used frequently in Korea, suggesting a growing need for access to programs focused on reduction. The aim of this study was to evaluate the effects of a multicomponent restraint reduction program (MRRP) for nursing staff in Korean nursing homes. A cluster-randomized, single-blind, controlled pretest-posttest design was used. A total of 122 nursing staff (nurses and geriatric care assistants) in two Korean nursing homes participated in this study: 62 in the experimental group (EG) and 60 in the control group (CG). Nursing staff in the EG home received the MRRP comprising three educational sessions (two classroom-based and one web-based) and two unit-based consultations. Three instruments were used to measure nursing staff's knowledge, perceptions, and attitudes regarding physical restraints. Data were collected immediately before and after the intervention, and again 1 and 3 months later. Repeated measures analysis of variance showed significant differences between groups in knowledge (p < .001), perceptions (p < .001), and attitudes (p = .011) over time. These significant improvements in the MRRP group (EG) were sustained over the 3-month period. The MRRP effectively improved the knowledge, perceptions, and attitudes of nursing home staff about restraint use with older adults. Additional studies are recommended to evaluate effects of its components while using larger samples and rigorous research methods and measurements, and the inclusion of boosters or other supports to sustain change. These results provide valuable knowledge regarding a multicomponent intervention for changing nursing home staff attributes that likely influence clinical practice. Elements of the educational content and methods found useful for nursing home staff may also be effective in vocational and continuing education as well as for families of older nursing home residents. © 2017 Sigma Theta Tau International.

Animal-Assisted Interventions in Dutch Nursing Homes: A Survey.

PubMed

Schuurmans, Lonneke; Enders-Slegers, Marie-Jose; Verheggen, Theo; Schols, Jos

2016-07-01

Animal-assisted interventions (AAI) have become more and more popular in nursing homes in the past decade. Various initiatives for using animals in nursing homes have been developed over the years (eg, animal visiting programs, residential companion animals, petting zoos) and, on the whole, the number of nursing homes that refuse animals on their premises has declined. In this survey, we aimed to determine how many Dutch nursing homes offer AAIs, what type of interventions are used, and with what aim. We also focus on the use of underlying health, hygiene, and (animal) safety protocols. Using an online Dutch nursing home database, we invited all listed (457) nursing home organizations in the Netherlands (encompassing a total of 804 nursing home locations) to participate in our digital survey, powered by SurveyMonkey. The survey consisted of a total of 45 questions, divided into general questions about the use of animals in interventions; the targeted client population(s); and specific questions about goals, guidelines, and protocols. The results were analyzed with SPSS Statistics. In the end, 244 surveys, representing 165 organizations, were returned: 125 nursing homes used AAI in one way or another, 40 did not. Nursing homes that did not offer AAI cited allergy and hygiene concerns as the most important reasons. Most nursing homes offering AAI used visiting animals, mostly dogs (108) or rabbits (76). A smaller number of nursing homes had resident animals, either living on the ward or in a meadow outside. Almost all programs involved animal-assisted activities with a recreational purpose; none of the participating nursing homes provided animal assisted therapy with therapeutic goals. Psychogeriatric patients were most frequently invited to participate. A total of 88 nursing homes used alternatives when animals were not an option or not available. The most popular alternative was the use of stuffed animals (83) followed by FurReal Friends robotic toys (14). The sophisticated robot seal Paro was used in 7 nursing homes. A large percentage (80%) of nursing homes that worked with animals did not have AAI-specific health protocols or animal welfare and safety protocols underlying the animal activities or specific selection criteria for the selection of suitable animals. Most of the participating Dutch nursing homes offer AAI in recreational programs (animal-assisted activities) for psychogeriatric clients (using visiting animals, especially dogs). Most nursing homes do not have specific AAI protocols for animal welfare, hygiene, and safety during animal activities, nor do they employ specific selection criteria for participating animals and their handlers. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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…

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…

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.]. Copyright 2016, SLACK Incorporated.

42 CFR 431.714 - Waivers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION State Programs for Licensing Nursing Home... subpart for any person who has served in the capacity of a nursing home administrator during all of the 3...

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…

Home care nurses' knowledge of evidence-based education topics for management of heart failure.

PubMed

Delaney, Colleen; Apostolidis, Beka; Lachapelle, Leeanne; Fortinsky, Richard

2011-01-01

We primarily sought to evaluate home care nurses' knowledge of evidence-based education topics in managing heart failure (HF). Moreover, we wanted to determine if differences were evident in nurses' knowledge based on education and work experience, and to identify home care nurses' specific educational needs. A cross-sectional survey design was used. Home care nurses (n = 94) were recruited from 4 home care agencies. A previously published 20-item HF knowledge questionnaire was administered to participants, and an open-ended question determined participants' need for further HF-related education. Home care nurses' scores demonstrated a 78.9% knowledge level in overall HF education principles. The mean HF knowledge score was 15.78 (SD, ±1.69) out of a possible 20 points. Nurses scored lowest on knowledge related to asymptomatic hypotension (24.5% answered correctly), daily weight monitoring (26.6% answered correctly), and transient dizziness (30.9% answered correctly). Nurses requested further information on all HF topics addressed in the survey as well as on psychosocial issues, research evidence, and more information from other healthcare providers. Our findings suggest that home care nurses may not be sufficiently knowledgeable in evidence-based education topics for managing HF. The results help confirm the need to develop educational programs for home care nurses in managing HF, which may lead to improved quality of patient education. Further research is needed to address specific deficits in the knowledge of home care nurses, and to determine if HF educational programs for nurses would enhance and sustain nurses' knowledge of HF management education. Copyright © 2011 Elsevier Inc. All rights reserved.

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

Long-Term Effectiveness of a Multifactorial Fall and Fracture Prevention Program in Bavarian Nursing Homes: An Analysis Based on Health Insurance Claims Data.

PubMed

Schulz, Claudia; Lindlbauer, Ivonne; Rapp, Kilian; Becker, Clemens; König, Hans-Helmut

2017-06-01

Femoral fractures are frequently consequences of falls in nursing homes and are associated with considerable costs and unfavorable outcomes such as immobility and mortality. The purpose of this study was to examine the long-term effectiveness of a multifactorial fall and fracture prevention program in nursing homes in terms of reducing femoral fractures. Retrospective cohort study. Nursing homes. Health insurance claims data for 2005-2013 including 85,148 insurants of a sickness fund (Allgemeine Ortskrankenkasse Bayern), aged 65 years or older and living in 802 nursing homes in Bavaria, Germany. The fall prevention program was implemented stepwise in 4 time-lagged waves in almost 1,000 nursing homes in Bavaria, Germany, and was financially supported by a Bavarian statutory health insurance for the initial period of 3 years after implementation. The components of Bavarian Fall and Fracture Prevention Program were related to the staff (education), to the residents (progressive strength and balance training, medication, hip protectors), and suggested environmental adaptations as well as fall documentation and feedback on fall statistics. Data were used to create an unbalanced panel data set with observations per resident and quarterly period. We designed each wave to have 9 quarters (2.25 years) before implementation and 15 quarters (3.75 years) as follow-up period, respectively. Time trend-adjusted logistic generalized estimating equations were used to examine the impact of implementation of the fall prevention program on the likelihood of femoral fractures, controlling for resident and nursing home characteristics. The analysis took into account that the fall prevention program was implemented in 4 time-lagged waves. The implementation of the fall prevention program was not associated with a significant reduction in femoral fractures. Only a transient reduction of femoral fractures in the first wave was observed. Patient characteristics were positively associated with the likelihood of femoral fractures (P < .001); women compared to men [odds ratio (OR) = 0.877], age category 2 (OR = 1.486) and 3 (OR = 1.973) compared to category 1, care level 1 compared to 2 (OR = 0.897) and 3 (OR = 0.426), and a prior fracture (OR = 2.230) significantly increased the likelihood of a femoral fracture. There was no evidence for the long-term effectiveness of the fall prevention program in nursing homes. The restriction of the transient reduction to the first implementation wave may be explainable by a higher motivation of nursing homes starting first with the fall prevention program. Efforts should be directed to further identify factors that determine the long-term effectiveness of fall prevention programs in nursing homes. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

78 FR 78258 - Duty Periods for Establishing Eligibility for Health Care

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

...; 64.009, Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.014, Veterans State Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64.018, Sharing Specialized Medical Resources; 64...; Health professions; Health records; Homeless; Mental health programs; Nursing homes; Philippines...

Long-term care for the elderly. The future of nursing homes.

PubMed

Vladeck, B C

1989-02-01

Continuing growth in the number of impaired elderly persons necessitates a continued reliance on nursing homes to care for at least those who are most impaired or most lacking in other supports, despite dissatisfaction over the quality of nursing home services and anxiety about the costs. Nursing home care now costs more than $30 billion annually, half of which comes from governmental sources. The Medicaid program, in particular, is central to all aspects of the nursing home industry. Private long-term care insurance is unlikely to solve the problem of nursing home financing. Rationalizing public expenditures will hinge critically on greater clarity as to just what roles nursing homes are expected to fulfill in the system of care, especially how they are supposed to relate to other services provided to Medicare beneficiaries.

A Report on Nursing Programs in Illinois Community Colleges.

ERIC Educational Resources Information Center

Illinois Community Coll. Board, Springfield.

As part of a fiscal year 1995 annual review of programs, the Illinois community colleges reviewed four nursing programs to assess how effectively they met the economic, social, and technological needs of the community. The nursing programs reviewed included registered nursing, practical nursing, nurse aide, and home health aide. Although the costs…

75 FR 21175 - Medicare and Medicaid Programs; Waiver of Disapproval of Nurse Aide Training Program in Certain...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

... skilled nursing facilities, in the Medicare program, and nursing facilities, in the Medicaid program, that... skilled nursing facilities (SNFs) for Medicare and nursing facilities (NFs) for Medicaid. The Federal... services provided by a nursing home are important, Congressional intent about what constitutes ``quality of...

Frontier nursing: nursing work and training in Alberta, 1890-1905.

PubMed

Richardson, S

1996-01-01

This article analyzes the relationship of nursing work and training from 1890 to 1905 in that part of the North West Territory which in 1905 became the province of Alberta. Primary (archival) and secondary (published) data are analyzed to determine the nature of salaried nursing work, how nurses were recruited, the conditions of employment, how women were prepared for nursing work, and the relationship between hospital training programs and the salaried work of graduate nurses. Prior to 1905, most graduate nurses in Alberta were employed in hospitals. Their work involved administration as well as attending to patients and assisting physicians. Hospital boards had difficulty recruiting graduate nurses and began training programs to remedy their labour shortage. Programs were begun by the Medicine Hat General Hospital in 1894 and the Calgary General Hospital in 1895. Hospitals with training programs soon came to rely on pupil nurses for staffing. The success of these programs stimulated other Alberta hospitals to begin training programs, and by 1915 there were 10 programs in existence. Graduates of hospital programs were expected to be entrepreneurs, seeking employment in private practice and being reimbursed on a free-for-service basis by their patients. Although they were not designed to prepare nurses for private practice, hospital training programs did achieve some integration between hospital and home nursing work, partly because the primitive conditions of Alberta hospitals matched those of the ranches, homesteads, and even town homes. Pupil nurses became oriented to private duty when they were "hired out" during their period of training to care for ill individuals in their homes.

The effects of a short-term death training program on nursing home nursing staff.

PubMed

Mullins, L C; Merriam, S

1984-01-01

This study examines the effects on nursing home nurses of a two-day training program concerned with nurses and their response to the dying patient. Utilizing the Solomon four-group design, the study investigates whether exposure to information on death and dying (a) results in the acquisition of greater knowledge about death and dying, (b) is accompanied by a more positive attitude toward the elderly, and (c) is accompanied by a change in anxiety about death. Based on t tests and one-way analyses of covariance, the results point up the mixed nature of short-term training programs. It was found that there was a significant increase in the nurses' knowledge about death and dying, there was no change in their attitudes toward the elderly, and there was a significant increase among the nurses in the death anxiety experienced. This is not to suggest that training programs of this sort should not be conducted with nursing home staff. On the one hand such programs provide information useful for job performance. On the other hand they create some sensitization to death, which at the very least could give nurses greater insights into the concerns of the patients and perhaps stimulate empathetic responses.

Does Person-Centered Care Improve Residents' Satisfaction With Nursing Home Quality?

PubMed

Poey, Judith L; Hermer, Linda; Cornelison, Laci; Kaup, Migette L; Drake, Patrick; Stone, Robyn I; Doll, Gayle

2017-11-01

Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents' needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents. A longitudinal, retrospective cohort study using an in-person survey. Three hundred twenty nursing homes in Kansas enrolled or not enrolled in a pay-for-performance program, Promoting Excellent Alternatives in Kansas (PEAK 2.0), to promote PCC in nursing homes. A total of 6214 nursing home residents in 2013-2014 and 5538 residents in 2014-2015, with a Brief Interview for Mental Status score ≥8, participated in face-to-face interviews. Results were aggregated to the nursing home level. My InnerView developed a Resident Satisfaction Survey for Kansas composed of 32 questions divided into QOL, QOC, QOS, and global satisfaction subdomains. After controlling for facility characteristics, satisfaction with overall QOL and QOC was higher in homes that had fully implemented PCC. Although some individual measures in the QOS domain (eg, food) showed greater satisfaction at earlier levels of implementation, high satisfaction was observed primarily in homes that had fully implemented PCC. These findings provide evidence for the effectiveness of PCC implementation on nursing home resident satisfaction. The PEAK 2.0 program may provide replicable methods for nursing homes and states to implement PCC systematically. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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…

Educational program for nursing home physicians and staff to reduce use of non-steroidal anti-inflammatory drugs among nursing home residents: a randomized controlled trial.

PubMed

Stein, C M; Griffin, M R; Taylor, J A; Pichert, J W; Brandt, K D; Ray, W A

2001-05-01

The risk for serious gastrointestinal complications due to nonsteroidal anti-inflammatory drugs (NSAIDs) is high in the elderly. Acetaminophen-based regimens are safer and may be as effective as NSAIDs for the treatment of osteoarthritis in many patients. To determine the effects of an educational program on NSAID use and clinical outcomes in nursing homes. Randomized controlled study. Ten pairs of Tennessee nursing homes with > or = 8% of residents receiving NSAIDs were randomized to intervention or control. Nursing home residents (intervention n = 76 and control n = 71) aged 65 years and older taking NSAIDs regularly. An educational program for physicians and nursing home staff that included the risks and benefits of NSAIDs in the elderly and an algorithm that substituted acetaminophen, topical agents, and nonpharmacologic measures for the treatment of noninflammatory musculoskeletal pain. Intervention and control subjects were assessed at baseline and 3 months later. Differences in NSAID and acetaminophen use, and pain, function, and disability scores in intervention and control nursing home subjects. The intervention was effective resulting in markedly decreased NSAID use and increased acetaminophen use. Mean number of days of NSAID use in the 7 day periods before the baseline and 3 month assessments decreased from 7.0 to 1.9 days in intervention home subjects compared with a decrease from 7.0 to 6.2 days in control homes (P = 0.0001). Acetaminophen use in the 7 days immediately before the 3 month assessment increased by 3.1 days in intervention home subjects compared with 0.31 days in control homes (P = 0.0001). A similar proportion of subjects in control (32.5%) and intervention (35.4%) groups had worsening of their arthritis pain score (P = 0.81). An educational intervention effectively reduced NSAID use in nursing homes without worsening of arthritis pain.

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

76 FR 11815 - Request for Certification of Compliance-Rural Industrialization Loan and Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-03

..., nursing home and a skilled nursing facility for a total of 376 beds in a 1.77 cuerdas lot. The company is... (Assisted Living); 623110 (Nursing Home and Skilled Nursing Facility). DATES: All interested parties may...

Effectiveness of Mailing "Bathing without a Battle" to All US Nursing Homes

ERIC Educational Resources Information Center

Calleson, Diane C.; Sloane, Philip D.; Cohen, Lauren W.

2006-01-01

An educational CD-ROM/video program was developed to educate nursing home staff about two research-based techniques for reducing agitation and aggression during bathing of persons with Alzheimer's disease, including person-centered showering and the towel bath. This educational program was distributed free of charge to all 15,453 US nursing homes…

The Community Options Program: An Evaluation of Early Implementation Experience.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Health and Social Services, Madison.

This document contains a preliminary report on the implementation of Wisconsin's Community Options Program (COP), a program designed both to divert persons from entering nursing homes and to deinstitutionalize current nursing home residents who can be effectively served by community-based alternatives. The introduction of this report provides a…

76 FR 78343 - HOME Investment Partnerships Program: Improving Performance and Accountability; and Updating...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... their programs and in managing their growing portfolios of older HOME projects. These challenges include... program. Examples of such uses are hospice buildings, nursing homes, foster homes, halfway houses, and...

Nursing staff intentions towards managing deteriorating health in nursing homes: A convergent parallel mixed-methods study using the theory of planned behaviour.

PubMed

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

2018-03-01

To predict the factors that are most important in explaining nursing staff intentions towards early detection of the deteriorating health of a resident and providing subacute care in the nursing home setting. Nursing staff play a pivotal role in managing the deteriorating resident and determining whether the resident needs to be transferred to hospital or remain in the nursing home; however, there is a dearth of literature that explains the factors that influence their intentions. This information is needed to underpin hospital avoidance programs that aim to enhance nursing confidence and skills in this area. A convergent parallel mixed-methods study, using the theory of planned behaviour as a framework. Surveys and focus groups were conducted with nursing staff (n = 75) at a 94-bed nursing home at two points in time, prior to and following the implementation of a hospital avoidance program. The quantitative and qualitative data were analysed separately and merged during final analysis. Nursing staff had strong intentions, a positive attitude that became significantly more positive with the hospital avoidance program in place, and a reasonable sense of control; however, the influence of important referents was the strongest predictor of intention towards managing residents with deteriorating health. Support from a hospital avoidance program empowered staff and increased confidence to intervene. The theory of planned behaviour served as an effective framework for identifying the strong influence referents had on nursing staff intentions around managing residents with deteriorating health. Although nursing staff had a reasonable sense of control over this area of their work, they believed they benefitted from a hospital avoidance program initiated by the nursing home. Managers implementing hospital avoidance programs should consider the role of referents, appraise the known barriers and facilitators and take steps to identify those unique to their local situation. All levels of nursing staff play a role in preventing hospitalisation and should be consulted in the design, implementation and evaluation of any hospital avoidance strategies. © 2017 John Wiley & Sons Ltd.

24 CFR 50.17 - Decision points for projects.

Code of Federal Regulations, 2013 CFR

2013-04-01

... (including sections 202 and 811), nursing homes, hospitals, group practice facilities and manufactured home... Disposition. Multifamily structures, college housing, nursing homes, manufactured homes and parks, group.... (e) HUD programs subject to 24 CFR part 58. For cases in which HUD exercises environmental...

24 CFR 50.17 - Decision points for projects.

Code of Federal Regulations, 2014 CFR

2014-04-01

... (including sections 202 and 811), nursing homes, hospitals, group practice facilities and manufactured home... Disposition. Multifamily structures, college housing, nursing homes, manufactured homes and parks, group.... (e) HUD programs subject to 24 CFR part 58. For cases in which HUD exercises environmental...

24 CFR 50.17 - Decision points for projects.

Code of Federal Regulations, 2011 CFR

2011-04-01

... (including sections 202 and 811), nursing homes, hospitals, group practice facilities and manufactured home... Disposition. Multifamily structures, college housing, nursing homes, manufactured homes and parks, group.... (e) HUD programs subject to 24 CFR part 58. For cases in which HUD exercises environmental...

Nurses' reflections on pain management in a nursing home setting.

PubMed

Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine

2006-06-01

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

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. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Transition of Premature Infants From Hospital to Home Life

PubMed Central

Lopez, Greta L.; Anderson, Kathryn Hoehn; Feutchinger, Johanna

2013-01-01

Purpose To conduct an integrative literature review to studies that focus on the transition of premature infants from neonatal intensive care unit (NICU) to home. Method A literature search was performed in Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and MEDLINE to identify studies consisting on the transition of premature infants from hospital to home life. Results The search yielded seven articles that emphasized the need for home visits, child and family assessment methods, methods of keeping contact with health care providers, educational and support groups, and described the nurse’s role in the transition program. The strategy to ease the transition differed in each article. Conclusion Home visits by a nurse were a key component by providing education, support, and nursing care. A program therefore should consist of providing parents of premature infants with home visits implemented by a nurse or staying in contact with a nurse (e.g., via video-conference). PMID:22763247

Nurse mentor perceptions in the delivery of a home-based cardiac rehabilitation program to support patients living in rural areas: An interpretive study.

PubMed

Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

2017-05-01

Home-based cardiac rehabilitation (CR) programs improve health outcomes for people diagnosed with heart disease. Mentoring of patients by nurses trained in CR has been proposed as an innovative model of cardiac care. Little is known however, about the experience of mentors facilitating such programs and adapting to this new role. The aim of this qualitative study was to explore nurse mentor perceptions of their role in the delivery of a home-based CR program for rural patients unable to attend a hospital or outpatient CR program. Seven nurses mentored patients by telephone providing patients with education, psychosocial support and lifestyle advice during their recovery. An open-ended survey was administered to mentors by email and findings revealed mentors perceived their role to be integral to the success of the program. Nurses were satisfied with the development of their new role as patient mentors. They believed their collaborative skills, knowledge and experience in coronary care, timely support and guidance of patients during their recovery and use of innovative audiovisual resources improved the health outcomes of patients not able to attend traditional programs. Cardiac nurses in this study perceived that they were able to successfully transition from their normal work practices in hospital to mentoring patients in their homes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

OCCUPATIONAL TRENDS IN IDAHO HOSPITALS AND LICENSED NURSING HOMES.

ERIC Educational Resources Information Center

BEEMAN, ADDISON C.

THE PURPOSE OF THIS STUDY WAS TO OBTAIN INFORMATION ON THE CURRENT LABOR FORCE IN HOSPITALS AND NURSING HOMES AND FUTURE MANPOWER NEEDS WHICH WOULD BE HELPFUL TO PLANNERS OF VOCATIONAL EDUCATIONAL PROGRAMS, EMPLOYERS, WORKERS, AND YOUTH ENTERING THE LABOR MARKET. ADMINISTRATORS OR PERSONNEL OFFICERS OF 14 HOSPITALS AND 13 NURSING HOMES,…

Volume of home- and community-based services and time to nursing-home placement.

PubMed

Sands, Laura P; Xu, Huiping; Thomas, Joseph; Paul, Sudeshna; Craig, Bruce A; Rosenman, Marc; Doebbeling, Caroline C; Weiner, Michael

2012-01-01

The purpose of this study was to determine whether the volume of Home- and Community-Based Services (HCBS) that target Activities of Daily Living disabilities, such as attendant care, homemaking services, and home-delivered meals, increases recipients' risk of transitioning from long-term care provided through HCBS to long-term care provided in a nursing home. Data are from the Indiana Medicaid enrollment, claims, and Insite databases. Insite is the software system that was developed for collecting and reporting data for In-Home Service Programs. Enrollees in Indiana Medicaid's Aged and Disabled Waiver program were followed forward from time of enrollment to assess the association between the volume of attendant care, homemaking services, home-delivered meals, and related covariates, and the risk for nursing-home placement. An extension of the Cox proportional hazard model was computed to determine the cumulative hazard of nursing-home placement in the presence of death as a competing risk. Of the 1354 Medicaid HCBS recipients followed in this study, 17% did not receive any attendant care, homemaking services, or home-delivered meals. Among recipients who survived through 24 months after enrollment, one in five transitioned from HCBS to a nursing-home. Risk for nursing-home placement was significantly lower for each five-hour increment in personal care (HR=0.95, 95% CI=0.92-0.98) and homemaking services (HR=0.87, 95% CI=0.77-0.99). Future policies and practices that are focused on optimizing long-term care outcomes should consider that a greater volume of HCBS for an individual is associated with reduced risk of nursing-home placement.

Nursing Home Consultation: Difficult Residents and Frustrated Staff.

ERIC Educational Resources Information Center

Block, Christopher; And Others

1987-01-01

Night shift nursing home aides who received in-service training in behavior therapy designed and implemented intervention programs for two of their most difficult residents. Describes programs and their outcomes. Discusses use of staff members as agents of behavior change. (Author/NB)

Regulating the Behavior of Nursing Homes through Positive Incentives: An Analysis of Illinois' Quality Incentive Program (QUIP).

ERIC Educational Resources Information Center

Geron, Scott Miyake

1991-01-01

Nursing homes in Illinois Quality Incentive Program receive separate bonus payment per Medicaid day for achieving each of six quality standards. Of 809 participating homes (1985-88), over 90 percent of eligible facilities chose to participate annually. Success in achieving bonus payments in multiple standards increased over time, with 27 percent…

Responding to the 2015 CMS Proposed Rule Changes for LTC Facilities: A Call to Redouble Efforts to Prepare Students and Practitioners for Nursing Homes.

PubMed

Bern-Klug, Mercedes; Connolly, Robert; Downes, Deirdre; Galambos, Colleen; Kusmaul, Nancy; Kane, Rosalie; Hector, Paige; Beaulieu, Elise

2016-01-01

In July of 2015, the Federal Register published for public comment proposed rule changes for nursing homes certified to receive Medicare and/or Medicaid. If the final rules are similar to the proposed rules, they will represent the largest change in federal rules governing nursing homes since the Nursing Home Reform Act which was part of OBRA 1987. The proposed changes have the potential to enhance the quality of care and quality of life of nursing home residents. Many of the proposed changes would directly affect the practice of social work and would likely expand the role for nursing home social workers. This article discusses the role that members of the National Nursing Home Social Work Network (NNHSW Network) played in developing and submitting a response to CMS. The article provides the context for the publication of the proposed rules, describes the process used by the NNHSW Network to develop and build support for comments on these rules, and also includes the actual comments submitted to CMS. Social work education programs and continuing education programs throughout the country will continue to have an important role to play in helping to prepare social work students and practitioners for a career in long-term care.

78 FR 73441 - Grants to States for Construction or Acquisition of State Homes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

... of State home facilities that furnish domiciliary, nursing home, or adult day health care to veterans... States of State home facilities that furnish domiciliary, nursing home, or adult day health care to... Providers Grant and Per Diem Program; and 64.026, Veterans State Adult Day Health Care. Signing Authority...

A Qualitative Evaluation of Engagement and Attrition in a Nurse Home Visiting Program: From the Participant and Provider Perspective.

PubMed

Beasley, Lana O; Ridings, Leigh E; Smith, Tyler J; Shields, Jennifer D; Silovsky, Jane F; Beasley, William; Bard, David

2018-05-01

Beginning parenting programs in the prenatal and early postnatal periods have a large potential for impact on later child and maternal outcomes. Home-based parenting programs, such as the Nurse Family Partnership (NFP), have been established to help address this need. Program reach and impact is dependent on successful engagement of expecting mothers with significant risks; however, NFP attrition rates remain high. The current study qualitatively examined engagement and attrition from the perspectives of NFP nurses and mothers in order to identify mechanisms that enhance service engagement. Semi-structured interviews were conducted in focus groups composed of either engaged (27 total mothers) or unengaged (15 total mothers) mothers from the NFP program. NFP nurses (25 total nurses) were recruited for individual semi-structured interviews. Results suggest that understanding engagement in the NFP program requires addressing both initial and sustained engagement. Themes associated with enhanced initial engagement include nurse characteristics (e.g., flexible, supportive, caring) and establishment of a solid nurse-family relationship founded on these characteristics. Factors impacting sustained engagement include nurse characteristics, provision of educational materials on child development, individualized services for families, and available family support. Identified barriers to completing services include competing demands and lack of support. Findings of this study have direct relevance for workforce planning, including hiring and training through integrating results regarding effective nurse characteristics. Additional program supports to enhance parent engagement may be implemented across home-based parenting programs in light of the current study's findings.

The role of the hospice social worker in the nursing home setting.

PubMed

Amar, D F

1994-01-01

Data and case examples from two major metropolitan hospice programs are examined in order to arrive at a definition of the hospice social worker's role in the nursing home, and how it differs from that of the hospice social worker in home care. The nursing home population tends to be older, frailer, and with poorer mental status, making them less available to "talk therapies". The nursing home environment itself needs to be assessed as a significant part of the patient/family system. Social work interventions may focus on the patient, the family, the nursing home staff, or any combination of these elements. The hospice social worker on a nursing home team may do less counseling with patients, but the role draws on diverse other skills such as groupwork, negotiation, education, and advocacy.

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

The effect of pay-for-performance in nursing homes: evidence from state Medicaid programs.

PubMed

Werner, Rachel M; Konetzka, R Tamara; Polsky, Daniel

2013-08-01

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. 2001-2009 nursing home Minimum Data Set and Online Survey, Certification, and Reporting (OSCAR) datasets. 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. 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. 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. © Health Research and Educational Trust.

Nurse-patient interaction: a resource for hope in cognitively intact nursing home patients.

PubMed

Haugan, Gørill; Moksnes, Unni Karin; Espnes, Geir Arild

2013-09-01

Nursing home care increasingly targets those elderly with the greatest needs in terms of personal daily activities, whereas services supporting spiritual needs such as hope tend to be ignored. Hope is seen to be a dynamic life force vital to well-being. Nursing home patients are frail, vulnerable, and dependent, which may lead to their hope being intimately related to the nurse-patient interaction. The purpose of this study was to investigate the relationship between nurse-patient interaction and hope among cognitively intact nursing home patients. Cross-sectional data were obtained by means of one-on-one interviews; 202 cognitively intact nursinghome patients representing 44 Norwegian nursing homes responded to the Herth Hope Index and the Nurse-Patient Interaction Scale. The hypothesized relationships between a two-factor construct of hope and nurse-patient interaction were assessed by means of structural equation modelling. The structural equation model revealed a good fit to the data, showing significant influence of nurse-patient interaction on nursing home patients' level of hope. Nurse-patient interaction significantly influences hope in cognitively intact nursing home patients. Offering connectedness should be a central and integral aspect of holistic nursing home care. Providing continuing educational programs for caregivers focusing on how to interact with patients in a health-promoting and hopeful manner seems essential.

Nursing Home Patient Outcomes: The Results of an Incentive Reimbursement Experiment. Long-Term Care Studies Program Research Report.

ERIC Educational Resources Information Center

Thorburn, Phyllis; Meiners, Mark R.

A major demonstration and evaluation project was undertaken to study the consequences of using incentive payments to change admission, discharge, and outcome patterns for Medicaid patients in nursing homes. Thirty-six proprietary, Medicaid-certified, skilled nursing homes in San Diego County with a combined Medicaid inpatient census of…

77 FR 10663 - Due Date of Initial Application Requirements for State Home Construction Grants

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-23

... professions; Health records; Homeless; Mental health programs; Nursing homes; Philippines, Reporting and... constructing, remodeling, altering, or expanding State home facilities that will furnish specified types of..., Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.014, Veterans State Domiciliary Care...

Health of health care workers in Canadian nursing homes and pediatric hospitals: a cross-sectional study

PubMed Central

Hoben, Matthias; Knopp-Sihota, Jennifer A.; Nesari, Maryam; Chamberlain, Stephanie A.; Squires, Janet E.; Norton, Peter G.; Cummings, Greta G.; Stevens, Bonnie J.; Estabrooks, Carole A.

2017-01-01

Background: Poor health of health care workers affects quality of care, but research and health data for health care workers are scarce. Our aim was to compare physical/mental health among health care worker groups 1) within nursing homes and pediatric hospitals, 2) between the 2 settings and 3) with the physical/mental health of the Canadian population. Methods: Using cross-sectional data collected as part of the Translating Research in Elder Care program and the Translating Research on Pain in Children program, we examined the health of health care workers. In nursing homes, 169 registered nurses, 139 licensed practical nurses, 1506 care aides, 145 allied health care providers and 69 managers were surveyed. In pediatric hospitals, 63 physicians, 747 registered nurses, 155 allied health care providers, 49 nurse educators and 22 managers were surveyed. After standardization of the data for age and sex, we applied analyses of variance and general linear models, adjusted for multiple testing. Results: Nursing home workers and registered nurses in pediatric hospitals had poorer mental health than the Canadian population. Scores were lowest for registered nurses in nursing homes (mean difference -4.4 [95% confidence interval -6.6 to -2.6]). Physicians in pediatric hospitals and allied health care providers in nursing homes had better physical health than the general population. We also found important differences in physical/mental health for care provider groups within and between care settings. Interpretation: Mental health is especially poor among nursing home workers, who care for a highly vulnerable and medically complex population of older adults. Strategies including optimized work environments are needed to improve the physical and mental health of health care workers to ameliorate quality of patient care. PMID:29162609

42 CFR 431.703 - Licensing requirement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Licensing Nursing Home Administrators § 431.703 Licensing requirement. The State licensing program must provide that only nursing homes supervised by an administrator licensed in accordance with the...

The Caregiver Education and Training Project: A Comprehensive Training Program for Family Caregivers.

ERIC Educational Resources Information Center

Grossmont District Hospital, La Mesa, CA.

This demonstration program was designed to impart specific nursing, psychosocial, and community knowledge skills to caregivers, particularly those who themselves were older adults and were caring for a family member at home. Begun in October 1986, this program featured basic home nursing instruction and an orientation to the demands and rewards of…

Evaluation of AHRQ's on-time pressure ulcer prevention program: a facilitator-assisted clinical decision support intervention for nursing homes.

PubMed

Olsho, Lauren E W; Spector, William D; Williams, Christianna S; Rhodes, William; Fink, Rebecca V; Limcangco, Rhona; Hurd, Donna

2014-03-01

Pressure ulcers present serious health and economic consequences for nursing home residents. The Agency for Healthcare Research & Quality, in partnership with the New York State Department of Health, implemented the pressure ulcer module of On-Time Quality Improvement for Long Term Care (On-Time), a clinical decision support intervention to reduce pressure ulcer incidence rates. To evaluate the effectiveness of the On-Time program in reducing the rate of in-house-acquired pressure ulcers among nursing home residents. We employed an interrupted time-series design to identify impacts of 4 core On-Time program components on resident pressure ulcer incidence in 12 New York State nursing homes implementing the intervention (n=3463 residents). The sample was purposively selected to include nursing homes with high baseline prevalence and incidence of pressure ulcers and high motivation to reduce pressure ulcers. Differential timing and sequencing of 4 core On-Time components across intervention nursing homes and units enabled estimation of separate impacts for each component. Inclusion of a nonequivalent comparison group of 13 nursing homes not implementing On-Time (n=2698 residents) accounts for potential mean-reversion bias. Impacts were estimated via a random-effects Poisson model including resident-level and facility-level covariates. We find a large and statistically significant reduction in pressure ulcer incidence associated with the joint implementation of 4 core On-Time components (incidence rate ratio=0.409; P=0.035). Impacts vary with implementation of specific component combinations. On-Time implementation is associated with sizable reductions in pressure ulcer incidence.

Women's reasons for attrition from a nurse home visiting program.

PubMed

Holland, Margaret L; Christensen, Julie J; Shone, Laura P; Kearney, Margaret H; Kitzman, Harriet J

2014-01-01

To describe mothers' reasons for leaving a home visiting program early. Qualitative descriptive study using semistructured interviews of mothers who dropped out of the Nurse-Family Partnership (NFP) and two focus groups with nurses and nurse supervisors at an NFP site. A New York State site of a NFP home visitation program for low-income new mothers designed to improve the physical and emotional care of children. Participants included 21 mothers, 8 nurses, and 3 nurse-supervisors. Semistructured interviews and focus groups were used to collect data, which were analyzed using content analysis. The program was not perceived to fit a mother's needs when she was overwhelmed with other responsibilities, the nurse did not meet her expectations, the content was not of interest, or the mother did not desire visits after the infant was born. Nurses and mothers described the need for mothers to have organizational and communication skills, such as keeping track of appointments, calling to reschedule, articulating needs, and asking for assistance. Disruptive external influences included nurse turnover and unstable living situations, including frequent moves and crowded housing. Each of these types of barriers had potential to interact with the others, creating complex combinations of challenges to retention. NFP retention might be improved by reframing program relevance to individual mothers and increasing maternal organizational and communication skill development. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Structures, processes and outcomes of the Aussie Heart Guide Program: A nurse mentor supported, home based cardiac rehabilitation program for rural patients with acute coronary syndrome.

PubMed

Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

2018-03-01

Cardiac rehabilitation has a number of benefits for patients, yet participation in it is sub-optimal, especially in regional Australia. Innovative models of cardiac rehabilitation are needed to improve participation. Providing nurse mentors to support patients transitioning from hospital to home represents a new model of service delivery in Australia. To explore the impact of a home-based cardiac rehabilitation program in assisting patients to recover from Acute Coronary Syndrome and meeting the expectations of nurse mentors delivering the program. This case study was underpinned by the structure, process and outcomes model and occurred in three Australian hospitals 2008-2011. Thirteen patients recovering from acute coronary syndrome were interviewed by telephone and seven nurse mentors completed a survey after completing the program. Mentor perceptions concerning the structures of the home-based CR program included the timely recruitment of patients, mentor training to operationalise the program, commitment to development of the mentor role, and the acquisition of knowledge and skills about cognitive behavioural therapy and patient centred care. Processes included the therapeutic relationship between mentors and patients, suitability of the program and the promotion of healthier lifestyle behaviours. Outcomes identified that patients were satisfied with the program's audiovisual resources, and the level of support and guidance provided by their nurse mentors. Mentors believed that the program was easy to use in terms of its delivery. Patients believed the program assisted their recovery and were satisfied with the information, guidance and support received from mentors. There were positive signs that the program influenced patients' decisions to change unhealthy lifestyle behaviours. Outcomes highlighted both rewards and barriers associated with mentoring patients in their homes by telephone. Experience gained from developing a therapeutic relationship with patients during their recovery, assisted nurses in developing the mentor role. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Train the trainer in dementia care. A program to foster communication skills in nursing home staff caring for dementia patients.

PubMed

Franzmann, J; Haberstroh, J; Pantel, J

2016-04-01

Improvement of communication skills in nursing home staff is key to provide better care for dementia patients and decrease occupational mental stress. An innovative train-the-trainer program to improve and maintain professional caregivers' social competencies in nursing home dementia care is described. Over a period of 6 months, a group of 6 senior staff members were qualified as program trainers (multiplicators) for the TANDEM training program, which qualified them to design, deliver, and evaluate training sessions that foster specific social competencies in dementia care. In a subsequent intervention study with 116 geriatric caregivers in 14 nursing homes, training was provided either by multiplicators (intervention group) or directly by project coworkers (control group). Participants in both groups improved their dementia-specific communication skills. In a follow-up survey, the intervention group also reported lasting reductions in mental stressors at work (p < 0.05) and occupational mental stress (p < 0.01) compared with the control group. The qualification of staff members in German nursing homes to be multiplicators for the TANDEM train-the-trainer program for dementia-specific communication skills has a beneficial influence on social competencies, mental stressors at work, and occupational mental stress of staff who care for dementia patients and may contribute to a sustainable implementation of dementia-specific social competencies.

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

PubMed Central

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. PMID:25653513

Enhancing Resident Safety by Preventing Healthcare-Associated Infection: A National Initiative to Reduce Catheter-Associated Urinary Tract Infections in Nursing Homes

PubMed Central

Mody, Lona; Meddings, Jennifer; Edson, Barbara S.; McNamara, Sara E.; Trautner, Barbara W.; Stone, Nimalie D.; Krein, Sarah L.; Saint, Sanjay

2015-01-01

Preventing healthcare-associated infection (HAI) is a key contributor to enhancing resident safety in nursing homes. In 2013, the U.S. Department of Health and Human Services approved a plan to enhance resident safety by reducing HAIs in nursing homes, with particular emphasis on reducing indwelling catheter use and catheter-associated urinary tract infection (CAUTI). Lessons learned from a recent multimodal Targeted Infection Prevention program in a group of nursing homes as well as a national initiative to prevent CAUTI in over 950 acute care hospitals called “On the CUSP: STOP CAUTI” will now be implemented in nearly 500 nursing homes in all 50 states through a project funded by the Agency for Healthcare Research and Quality (AHRQ). This “AHRQ Safety Program in Long-Term Care: HAIs/CAUTI” will emphasize professional development in catheter utilization, catheter care and maintenance, and antimicrobial stewardship as well as promoting patient safety culture, team building, and leadership engagement. We anticipate that an approach integrating technical and socio-adaptive principles will serve as a model for future initiatives to reduce other infections, multidrug resistant organisms, and noninfectious adverse events among nursing home residents. PMID:25814630

42 CFR 431.714 - Waivers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION State Programs for Licensing Nursing Home... subpart for any person who has served in the capacity of a nursing home administrator during all of the 3... 42 Public Health 4 2010-10-01 2010-10-01 false Waivers. 431.714 Section 431.714 Public Health...

Effects of Pet and/or People Visits on Nursing Home.

ERIC Educational Resources Information Center

Hendy, Helen M.

1987-01-01

Compared effects of different visiting programs (people, people and pets, pets, no visit) on behaviors of nursing home residents. Found all three visiting programs increased behaviors of smiling and alertness in comparison to control conditions. Close proximity to person-alone visitor was associated with greatest number of positive resident…

An Incentive Program for Nurse Aides Implementation Report: Description and Evaluation. Illinois Long Term Care Research and Demonstration Projects Series. Final Report.

ERIC Educational Resources Information Center

Sinke, Mary

This study examined a nursing aide recognition program in a nursing home with 50 nurses and 200 nurse aides. Before the program was implemented, baseline data on job satisfaction were gathered with a questionnaire. A one-page description of the program and an evaluation tool were distributed to the nurse aides at their information sessions. Nurse…

Nursing Assistant/Homemaker-Home Health Aide Component.

ERIC Educational Resources Information Center

East Hartford Board of Education, CT.

The demand for the services of homemaker-home health aides has increased tremendously. In one year, for example, the Visiting Nurse and Home Care Association of East Hartford, Connecticut, had a nearly 155 percent increase in the demand for homemaker-home health aide service. The East Hartford Public Schools developed a vocational program that…

42 CFR 431.705 - Licensing authority.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Nursing Home Administrators § 431.705 Licensing authority. (a) The State licensing program must provide for licensing of nursing home administrators by— (1) The agency designated under the healing arts act...

Women’s Reasons for Attrition from a Nurse Home Visiting Program

PubMed Central

Holland, Margaret L.; Christensen, Julie J.; Shone, Laura P.; Kearney, Margaret H.; Kitzman, Harriet J.

2015-01-01

Objective To describe mothers’ reasons for leaving a home visiting program early. Design Qualitative descriptive study using semi-structured interviews of mothers who dropped out of the Nurse-Family Partnership (NFP) and two focus groups with nurses and nurse supervisors at an NFP site. Setting A New York State site of a NFP home visitation program for low-income new mothers designed to improve the physical and emotional care of children. Participants Participants included 21 mothers, 8 nurses, and 3 nurse-supervisors Methods Semi-structured interviews and focus groups were used to collect data, which were analyzed using content analysis. Results The program was not perceived to fit a mother’s needs when she was overwhelmed with other responsibilities, the nurse did not meet her expectations, the content was not of interest, or the mother did not desire visits after the infant was born. Nurses and mothers described need for mothers to have organizational and communication skills, such as keeping track of appointments, calling to reschedule, articulating needs, and asking for assistance. Disruptive external influences included nurse turnover and unstable living situations, including frequent moves and crowded housing. Each of these types of barriers had potential to interact with the others, creating complex combinations of challenges to retention. Conclusion NFP retention might be improved by reframing program relevance to individual mothers and increasing maternal organizational and communication skill development. PMID:24354411

76 FR 9646 - Copayments for Medications After June 30, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

...; 64.008, Veterans Domiciliary Care; 64.009, Veterans Medical Care Benefits; 64.010, Veterans Nursing... Prosthetic Appliances; 64.014, Veterans State Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64...; Medical research; Mental health programs; Nursing homes; Philippines, Reporting and recordkeeping...

The Effects of a Life Review Program on Disorientation, Social Interaction and Self-Esteem of Nursing Home Residents.

ERIC Educational Resources Information Center

Tabourne, Carla E. S.

1995-01-01

Examined the effects on veteran and novice participants of a life review program for nursing home residents with Alzheimers disease or severe cognitive dysfunction. Results confirm the impact of the Life Review Program on level of disorientation, social interaction, and life review. Evidence suggests that life improvements may be stored in memory…

The effect of Medicaid wage pass-through programs on the wages of direct care workers.

PubMed

Baughman, Reagan A; Smith, Kristin

2010-05-01

Despite growing demand for nursing and home health care as the US population ages, compensation levels in the low-skill nursing labor market that provides the bulk of long-term care remain quite low. The challenge facing providers of long-term care is that Medicaid reimbursement rates for nursing home and home health care severely restrict the wage growth that is necessary to attract workers, resulting in high turnover and labor shortages. Almost half of US states have responded by enacting "pass-through" provisions in their Medicaid programs, channeling additional long-term care funding directly to compensation of lower-skill nursing workers. We test the effect of Medicaid wage pass-through programs on hourly wages for direct care workers. We estimate several specifications of wage models using employment data from the 1996 and 2001 panels of the Survey of Income and Program Participation for nursing, home health, and personal care aides. The effect of pass-through programs is identified by an indicator variable for states with programs; 20 states adopted pass-throughs during the sample period. Workers in states with pass-through programs earn as much as 12% more per hour than workers in other states after those programs are implemented. Medicaid wage pass-through programs appear to be a viable policy option for raising compensation levels of direct care workers, with an eye toward improving recruitment and retention in long-term care settings.

Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

ERIC Educational Resources Information Center

Davitt, Joan K.

2014-01-01

Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

42 CFR 431.713 - Continuing study and investigation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Programs for Licensing Nursing Home Administrators § 431.713 Continuing study and investigation. The agency or board must conduct a continuing study of nursing homes and administrators within the State to...

Process evaluation to explore internal and external validity of the "Act in Case of Depression" care program in nursing homes.

PubMed

Leontjevas, Ruslan; Gerritsen, Debby L; Koopmans, Raymond T C M; Smalbrugge, Martin; Vernooij-Dassen, Myrra J F J

2012-06-01

A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). Before effect analyses, to evaluate AiD process data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, extent to which AiD was performed), which can be used for understanding internal and external validity. In this article, a model is presented that divides process evaluation data into first- and second-order process data. Qualitative and quantitative data based on personal files of residents, interviews of nursing home professionals, and a research database were analyzed according to the following process evaluation components: sampling quality and intervention quality. Nursing home. The pattern of residents' informed consent rates differed for dementia special care units and somatic units during the study. The nursing home staff was satisfied with the AiD program and reported that the program was feasible and relevant. With the exception of the first screening step (nursing staff members using a short observer-based depression scale), AiD components were not performed fully by NH staff as prescribed in the AiD protocol. Although NH staff found the program relevant and feasible and was satisfied with the program content, individual AiD components may have different feasibility. The results on sampling quality implied that statistical analyses of AiD effectiveness should account for the type of unit, whereas the findings on intervention quality implied that, next to the type of unit, analyses should account for the extent to which individual AiD program components were performed. In general, our first-order process data evaluation confirmed internal and external validity of the AiD trial, and this evaluation enabled further statistical fine tuning. The importance of evaluating the first-order process data before executing statistical effect analyses is thus underlined. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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

75 FR 39641 - Medicare and Medicaid Programs; Civil Money Penalties for Nursing Homes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-12

... Medicare and Medicaid Services 42 CFR Part 488 [CMS-2435-P] Medicare and Medicaid Programs; Civil Money... regarding the imposition and collection of civil money penalties by CMS when nursing homes are not in... address facility noncompliance are civil money penalties. Authorized by sections 1819(h) and 1919(h) of...

Agents of Nursing Home Quality of Care: Ombudsmen and Staff Ratios Revisited.

ERIC Educational Resources Information Center

Cherry, Ralph L.

1991-01-01

Compared effects of ombudsman programs on quality of nursing home care on random sample of 134 Medicare/Medicaid-certified long-term care facilities in Missouri. Found that presence of ombudsman program was most important factor associated with quality for intermediate-care facilities, and was significantly associated with quality for skilled…

State adoption of nursing home pay-for-performance.

PubMed

Werner, Rachel M; Tamara Konetzka, R; Liang, Kevin

2010-06-01

Whereas numerous policies have been adopted to improve quality of care in nursing homes over the past several decades-with varying degrees of success-health care payment has been a largely untapped but potentially powerful policy tool to improve quality of care. Recently, however, payers have invested significant resources in the development and implementation of pay-for-performance (P4P) programs for nursing homes. The authors present results from a survey of state Medicaid agencies documenting the use and structure of P4P in nursing homes. Although the number of states that are implementing nursing home P4P is growing, the structure of these incentives varies across states, and little evidence exists to guide the planning or implementation of these initiatives.

PROTECTING CHILDREN FROM ENVIRONMENTAL THREATS - A CONTINUING EDUCATION PROGRAM FOR NURSES OF THE AMERICAN NURSES FOUNDATION/ASSOCIATION

EPA Science Inventory

The American Nurses Association/Foundation will develop online, in print and pre conference continuing education (CE) children's environmental health protection programs to meet the objective of the program. The first CE program is on school environments, the second on home and ...

Providing More Home-Delivered Meals Is One Way To Keep Older Adults With Low Care Needs Out Of Nursing Homes

PubMed Central

Thomas, Kali S.; Mor, Vincent

2014-01-01

Programs that help older adults live independently in the community can also deliver net savings to states on the costs of long-term supports and services. We estimate that if all states had increased by 1 percent the number of adults age sixty-five or older who received home-delivered meals in 2009 under Title III of the Older Americans Act, total annual savings to states’ Medicaid programs could have exceeded $109 million. The projected savings primarily reflect decreased Medicaid spending for an estimated 1,722 older adults with low-care needs who would no longer require nursing home care— instead, they could remain at home, sustained by home-delivered meals. Twenty-six states could have realized net savings in 2009 from the expansion of their home-delivered meals programs, while twenty-two states would have incurred net costs. Programs such as home-delivered meals have the potential to provide substantial savings to some states’ Medicaid programs. PMID:24101071

[REHABILITATION OF MOBILITY AND MOTOR FUNCTION IN NURSING HOME RESIDENTS WITH DEMENTIA].

PubMed

Aizen, Efraim; Lubosky, Enna; Sobeh, Saleh; Ibrahim, Rasha; Pressburger, Dina; Oliven, Roni

2018-04-01

Few clinical trials have evaluated exercise programs developed specifically for patients with dementia in nursing home settings. To determine if a training program tailored for demented patients, can be implemented in a nursing home setting in order to improve motor performances in patients with dementia who suffered functional decline. The present intervention was conducted in wards of patients suffering from dementia in three nursing homes. Patients suffering from dementia and hospitalized in a rehabilitation hospital were the control arm. Eligible patients in the wards assigned to the intervention group (NH; n = 24) received exercise training specifically designed for patients with dementia. Patients in the rehabilitation hospital were observed as a control group (RH; n = 50) and received usual care treatment. Primary endpoints were changes in Functional Independence Measure (FIM), 5X Sit-to-Stand Test, Timed up and go test and ADL. Basic parameters were examined as predictors of positive training response. Both the nursing home residents and rehabilitation hospital patients improved significantly in both primary endpoints (change: in Functional Independence Measure, NH: +119.2 ± 30.8 % versus RH: +83.3 ± 41.9%, p < 0.001; ADL, NH: +143.5 ± 102.6% versus RH: +59.0 ± 90.2%, p < 0.001). Age was found to be a predictor of positive training response. This functional training program tailored for demented patients can be implemented in a nursing home setting to improve motor performances in patients with dementia. Such interventions should be further evaluated in larger randomized controlled trials.

Teaching and Maintaining Behavior Management Skills in the Nursing Home.

ERIC Educational Resources Information Center

Burgio, Louis D.; Stevens, Alan; Burgio, Kathryn L.; Roth, David L.; Paul, Penelope; Gerstle, John

2002-01-01

Examines the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants' (CNAs) skill performance in the nursing home. Results reveal improvement in five out of seven communication skills. Although CNAs showed a reduction in the use of ineffective behavior management strategies, they did not…

PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting.

PubMed

Mor, Vincent; Volandes, Angelo E; Gutman, Roee; Gatsonis, Constantine; Mitchell, Susan L

2017-04-01

Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the "real world" application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization prior to recruitment feasible with 100% participation of facilities randomized to the intervention arm. Critical regulatory issues included minimal risk determination, waiver of informed consent, and determination that nursing home providers were not engaged in human subjects research. Intervention training and implementation were initiated on 5 January 2016 using corporate infrastructures for new program roll-out guided by standardized training elements designed by the research team. Video Status Reports in facilities' electronic medical records permitted "real-time" adherence monitoring and corrective actions. The Centers for Medicare and Medicaid Services Virtual Research Data Center allowed for rapid outcomes ascertainment. Conclusion We must rigorously evaluate interventions to deliver more patient-focused care to an increasingly frail nursing home population. Video decision support is a practical approach to improve advance care planning. PRagmatic trial Of Video Education in Nursing homes has the potential to promote goal-directed care among millions of older Americans in nursing homes and establish a methodology for future pragmatic randomized controlled trials in this complex healthcare setting.

Sleep quality and depression of nursing home older adults in wheelchairs after exercises.

PubMed

Chen, Kuei-Min; Huang, Hsin-Ting; Cheng, Yin-Yin; Li, Chun-Huw; Chang, Ya-Hui

2015-01-01

Sleep disturbances and depression are costly and potentially disabling conditions that affect a considerable proportion of older adults. The purpose of this study was to test the effectiveness of 6 months of elastic band exercises on sleep quality and depression of wheelchair-bound older adults in nursing homes. One hundred twenty-seven older adults from 10 nursing homes participated in this cluster randomized controlled trial, and 114 completed the study. Participants were randomly assigned to two groups: experimental group (five nursing homes, n = 59) and control group (five nursing homes, n = 55). A 40-minute wheelchair-bound senior elastic band exercise program was implemented 3 times per week for 6 months. Sleep quality and depression of the participants were examined at baseline, after 3 months, and at the end of the 6-month study. Participants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study. Nursing home directors could recruit volunteers to learn the program and lead the elderly residents in wheelchairs in practicing the wheelchair-bound senior elastic band exercises regularly in the facilities. Copyright © 2015 Elsevier Inc. All rights reserved.

42 CFR 431.702 - State plan requirement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Licensing Nursing Home Administrators § 431.702 State plan requirement. A State plan must provide that the State has a program for licensing administrators of nursing homes that meets the requirements of §§ 431...

42 CFR 431.700 - Basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Nursing Home Administrators § 431.700 Basis and purpose. This subpart implements sections 1903(a)(29) and 1908 of the Act which require that the State plan include a State program for licensing nursing home...

42 CFR 431.700 - Basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Nursing Home Administrators § 431.700 Basis and purpose. This subpart implements sections 1903(a)(29) and 1908 of the Act which require that the State plan include a State program for licensing nursing home...

42 CFR 431.702 - State plan requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Licensing Nursing Home Administrators § 431.702 State plan requirement. A State plan must provide that the State has a program for licensing administrators of nursing homes that meets the requirements of §§ 431...

Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.

PubMed

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

2011-12-01

To evaluate the impact of rural geographic location on nursing home quality of care in the United States. 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 multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

Swedish District Nurses' experiences on the use of information and communication technology for supporting people with serious chronic illness living at home--a case study.

PubMed

Nilsson, Carina; Skär, Lisa; Söderberg, Siv

2010-06-01

The aim of this case study was to describe two District Nurses' (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi-structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.

A comparison of home care clients and nursing home residents: can community based care keep the elderly and disabled at home?

PubMed

Shugarman, L R; Fries, B E; James, M

1999-01-01

Admission cohorts from the Michigan Medicaid Home and Community-Based Waiver program and Ohio nursing homes were compared on measures of resource utilization including a modified Resource Utilization Groups (RUG-III) system, Activities of Daily Living (ADLs), and overall case mix. We found that, contrary to previous research, the two samples were remarkably similar across RUG-III categories. However, the nursing home sample was more functionally impaired on measures of ADL functioning and overall case mix. Results of this study may inform policymakers and providers of the potential for maintaining the appropriate population in the home with government-funded home care.

Consumer Satisfaction in Long-Term Care: State Initiatives in Nursing Homes and Assisted Living Facilities

ERIC Educational Resources Information Center

Lowe, Timothy J.; Lucas, Judith A.; Castle, Nicholas G.; Robinson, Joanne P.; Crystal, Stephen

2003-01-01

Purpose: We report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programs for legislators and public administrators contemplating the initiation of their own state programs. Design and Methods: Data on state initiatives and programs…

Creative Drama: A Useful Tool for the Institutionalized Aged.

ERIC Educational Resources Information Center

Coffman, Victoria T.

Noting that creative drama activities can have a therapeutic value when used with the elderly in nursing homes, this paper outlines a creative drama program that was used in such a setting. Various sections of the paper describe (1) the nursing home setting, the nature of the participants, and the effects the program had upon them; (2) dramatic…

Goals and Characteristics of Long-Term Care Programs: An Analytic Model.

ERIC Educational Resources Information Center

Braun, Kathryn L.; Rose, Charles L.

1989-01-01

Used medico-social analytic model to compare five long-term care programs: Skilled Nursing Facility-Intermediate Care Facility (SNF-ICF) homes, ICF homes, foster homes, day hospitals, and home care. Identified similarities and differences among programs. Preliminary findings suggest that model is useful in the evaluation and design of long-term…

Medicaid nursing home pay for performance: where do we stand?

PubMed

Arling, Greg; Job, Carol; Cooke, Valerie

2009-10-01

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 recommendations for further development of nursing home P4P. We surveyed the six states with operational P4P systems in 2007. The range of performance measures employed by the states is quite broad: staffing level and satisfaction, findings from the regulatory system, clinical quality indicators, resident quality of life or satisfaction with care, family satisfaction, access to care for special populations, and efficiency. The main data sources for the measures are the Minimum Data Set (MDS), nursing home inspections, special surveys of nursing home residents, consumers or employees, and facility cost reports or other administrative systems. The most common financial incentive for better performance is a percentage bonus or an add-on to a facility's per diem rate. The bonus is generally proportional to a facility performance score, which consists of simple or weighted sums of scores on individual measures. States undertaking nursing home P4P programs should involve key stakeholders at all stages of P4P system design and implementation. Performance measures should be comprehensive, valid and reliable, risk adjusted where appropriate, and communicated clearly to providers and consumers. The P4P system should encourage provider investment in better care yet recognize state fiscal restraints. Consumer report cards, quality improvement initiatives, and the regulatory process should complement and reinforce P4P. Finally, the P4P system should be transparent and continuously evaluated.

A Pilot Study Evaluating the Feasibility of Psychological First Aid for Nursing Home Residents.

PubMed

Brown, Lisa M; Bruce, Martha L; Hyer, Kathryn; Mills, Whitney L; Vongxaiburana, Elizabeth; Polivka-West, Lumarie

2009-07-01

OBJECTIVES: The objectives of the pilot study were to modify existing psychological first aid (PFA) materials so they would be appropriate for use with institutionalized elders, evaluate the feasibility of using nursing home staff to deliver the intervention to residents, and solicit feedback from residents about the intervention. The STORM Study, an acronym for "services for treating older residents' mental health", is the first step in the development of an evidence-based disaster mental health intervention for this vulnerable and underserved population. METHOD: Demographic characteristics were collected on participating residents and staff. Program evaluation forms were completed by staff participants during the pilot test and nurse training session. Staff and resident discussion groups were conducted during the pilot test to collect qualitative data on the use of PFA in nursing homes. RESULTS: Results demonstrate the feasibility of the PFA program to train staff to provide residents with PFA during disasters. CONCLUSIONS: Future research should focus on whether PFA improves coping and reduces stress in disaster exposed nursing home residents.

Continuing Education Preferences, Facilitators, and Barriers for Nursing Home Nurses.

PubMed

Dyck, Mary J; Kim, Myoung Jin

2018-01-01

The purpose of the study was to determine the continuing education needs for nursing home nurses in rural central Illinois and to determine any potential facilitators or barriers to obtaining continuing education. Data were collected using the Educational Needs Assessment questionnaire. Descriptive statistics were computed to examine continuing education preferences, facilitators, and barriers among nursing home nurses. Independent samples t tests were used to compare preferences between administrative and staff nurses. The sample included 317 nurses from 34 facilities. The five top needs were related to clinical problems. Administrative nurses had greater needs for professional issues, managerial skills, and quality improvement than staff nurses. Barriers included rural settings, need for vacation time for programs, and inadequate staffing. Continuing education needs of nursing home nurses in Illinois are similar to previous studies conducted in Arizona and North Carolina. Continuing education barriers were mostly organizational, rather than personal. J Contin Nurs Educ. 2018;49(1):26-33. Copyright 2018, SLACK Incorporated.

The determinants of nursing home costs in Nebraska's proprietary nursing homes.

PubMed

Palm, D W; Nelson, S

1984-01-01

In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.

42 CFR 431.715 - Federal financial participation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Programs for Licensing Nursing Home Administrators § 431.715 Federal financial participation. No FFP is... licensing of nursing home administrators. ... 42 Public Health 4 2010-10-01 2010-10-01 false Federal financial participation. 431.715 Section...

Repeated Hospital Transfers and Associated Outcomes by Residency Time Among Nursing Home Residents in Taiwan.

PubMed

Tsai, Hsiu-Hsin; Tsai, Yun-Fang; Liu, Chia-Yih

2016-11-01

Nursing home residents' repeated transfers to hospital are costly and can lead to in-hospital complications and high mortality for frail residents. However, no research has examined the trajectory of residents' symptoms over their nursing home residency and its relationship to hospital transfer. The purpose of this retrospective chart-review study was to examine associations between nursing home residents' characteristics, including length of residency, and repeated hospital transfers as well as the trajectory of transfers during residency. For this retrospective study, we reviewed 583 residents' charts in 6 randomly selected nursing homes from northern Taiwan. Data were analyzed by descriptive statistics, chi-squared tests, and 1-way analysis of variance. About half of nursing home residents who had been transferred to hospital (n = 320) were transferred more than twice during their residency (50.97%). Residents who had been transferred 1, 2, 3, or ≥4 times differed significantly in length of residency (F = 3.85, P = .01), physical status (F = 2.65, P = .05), medical history of pneumonia (χ 2  = 13.03, P = .01), and fractures (χ 2  = 8.52, P = .04). Residents with different numbers of transfers differed significantly in their reasons for transfer, that is, falls (χ 2  = 13.01, P = .01) and tube problems (χ 2  = 8.87, P = .03). Among 705 total transfers, fever was the top reason for transfer, and transfer prevalence increased with nursing home residency. To decrease the chance of residents' hospital transfer, nursing home staff should be educated about recognizing and managing fever symptoms, infection-control programs such as influenza vaccination should be initiated, and fall-prevention/education programs should be started when residents first relocate to nursing homes. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Registered nurse retention strategies in nursing homes: a two-factor perspective.

PubMed

Hunt, Selina R; Probst, Janice C; Haddock, Kathlyn S; Moran, Robert; Baker, Samuel L; Anderson, Ruth A; Corazzini, Kirsten

2012-01-01

As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention. In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg's two-factor theory of motivation as a framework for nursing home retention studies was evaluated. This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships. Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses. To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg's two-factor theory.

76 FR 9503 - Medicare and Medicaid Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-18

... nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program. These..., as of April 2010, there are 15,713 long-term care (LTC) facilities (commonly referred to as nursing homes) in the U.S. LTC facilities are also referred to as skilled nursing facilities (SNFs) in the...

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

PubMed

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: a cluster randomized trial.

PubMed

Chen, Kuei-Min; Li, Chun-Huw; Chang, Ya-Hui; Huang, Hsin-Ting; Cheng, Yin-Yin

2015-01-01

The number of older adults using wheelchairs in nursing homes is over 50% of that population, and many of them use wheelchairs due to muscle weakness in the lower extremities. Muscles of older adults are trainable, and progressive resistance exercises using elastic bands can increase muscle strength in older adults. To test the effectiveness of six-month Wheelchair-bound Senior Elastic Band exercises on the functional fitness of older adults in nursing homes. Cluster randomized trial. Ten nursing homes, southern Taiwan. 127 participants were recruited, and 114 of them completed the study. Inclusion criteria were: (1) aged 65 and over, (2) using wheelchairs for mobility, (3) living in the facility for at least three months, (4) cognitively intact, and (5) heavily or moderate dependency in their activities of daily living. The mean age of the participants was 79.15 (7.03) years, and 98.20% of them had chronic illnesses. Participants were randomly assigned to the experimental (five nursing homes, n=59) or the control (five nursing homes, n=55) group based on the nursing homes where they stayed. A 40-min Wheelchair-bound Senior Elastic Band exercise program was implemented three times per week for six months for the experimental group participants. The functional fitness (activities of daily living, lung capacity, body flexibilities, muscle power and endurance) of the participants was examined at baseline, after three months, and at the end of the six months study. The mixed-design, two-way analysis of variance was used to detect the interaction effects, and one-way repeated measures analysis of variance and analysis of covariance were performed to analyze the within-group and between-group differences. At the end of the six-month study, the Wheelchair-bound Senior Elastic Band group had better performances in all of the functional fitness indicators than the control group (all p<0.05). The Wheelchair-bound Senior Elastic Band exercises significantly improved the functional fitness of the older adults in wheelchairs. It is suggested that the program be incorporated as a part of daily activities for nursing home older adults in wheelchairs. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Prevention of Child Maltreatment Through the Nurse Family Partnership Program: Mediating Effects in a Long-Term Follow-Up Study.

PubMed

Eckenrode, John; Campa, Mary I; Morris, Pamela A; Henderson, Charles R; Bolger, Kerry E; Kitzman, Harriet; Olds, David L

2017-05-01

We examine maternal life-course mediators of the impact of a nurse home visitation program on reducing child maltreatment among participants in the Elmira trial of the Nurse Family Partnership program from the first child's birth through age 15. For women having experienced low to moderate levels of domestic violence, program effects on the number of confirmed maltreatment reports were mediated by reductions in numbers of subsequent children born to mothers and their reported use of public assistance. Together, the two mediators explained nearly one half of the total effect of nurse home visiting on child maltreatment. The long-term success of this program on reducing child maltreatment can be explained, at least in part, by its positive effect on pregnancy planning and economic self-sufficiency.

Medicaid Bed-Hold Policies and Hospitalization of Long-Stay Nursing Home Residents

PubMed Central

Unruh, Mark Aaron; Grabowski, David C; Trivedi, Amal N; Mor, Vincent

2013-01-01

Objective To evaluate the effect of Medicaid bed-hold policies on hospitalization of long-stay nursing home residents. Data Sources A nationwide random sample of long-stay nursing home residents with data elements from Medicare claims and enrollment files, the Minimum Data Set, the Online Survey Certification and Reporting System, and Area Resource File. The sample consisted of 22,200,089 person-quarters from 754,592 individuals who became long-stay residents in 17,149 nursing homes over the period beginning January 1, 2000 through December 31, 2005. Study Design Linear regression models using a pre/post design adjusted for resident, nursing home, market, and state characteristics. Nursing home and year-quarter fixed effects were included to control for time-invariant facility influences and temporal trends associated with hospitalization of long-stay residents. Principal Findings Adoption of a Medicaid bed-hold policy was associated with an absolute increase of 0.493 percentage points (95% CI: 0.039–0.946) in hospitalizations of long-stay nursing home residents, representing a 3.883 percent relative increase over the baseline mean. Conclusions Medicaid bed-hold policies may increase the likelihood of hospitalization of long-stay nursing home residents and increase costs for the federal Medicare program. PMID:23521571

The Effect of a High-Fidelity Home Health Simulations on Nursing Students' Clinical Performance

ERIC Educational Resources Information Center

Crytzer, Michele Leigh

2011-01-01

With an increasing number of patients receiving nursing care in outpatient settings, it is the responsibility of nursing education programs to provide students with adequate training to enable them to develop the skills necessary to provide safe, effective care in diverse environments, including the home. Providing care to patients in their own…

Effect of an Incontinence Training Program on Nursing Home Staff's Knowledge, Attitudes, and Behavior.

ERIC Educational Resources Information Center

Campbell, Emily B; And Others

1991-01-01

Nursing staff (n=166) in four nursing homes participated in quasi-experimental study to measure knowledge and attitudes about urinary incontinence and compliance with toileting protocols. Intervention group (n=96) showed slight increase in knowledge; their attitudes remained positive over four testing times. Compliance with protocol was only 72…

Developing case managers for chronically ill children: Florida's registered nurse specialist program.

PubMed

Urbano, M T; vonWindeguth, B; Siderits, P; Parker, J; Studenic-Lewis, C

1991-01-01

This article describes the Florida Health and Rehabilitative Services/Children's Medical Services Nurse Specialist Program. This program is a statewide training and service delivery system designed to prepare selected nurses to provide comprehensive, family-centered case management services to children with special health care needs, within the home and community settings.

Improving activities of daily living for nursing home elder persons in Taiwan.

PubMed

Chang, Su-Hsien; Wung, Shu-Fen; Crogan, Neva L

2008-01-01

Excess disability among nursing home elder persons can be prevented or remediated. Because of self-selected disuse and caregiver support of dependency, nursing home residents are likely to develop excess disability. No study was found to test a theory-based program aimed at improving elder persons' self-care abilities for Taiwanese nursing home elder persons who are at risk for developing excess disability. The purpose of this study was to test the effectiveness of a theory-based intervention program on self-care, specifically on activities of daily living (ADLs) performance among nursing home elder persons in Taiwan. A secondary aim was to determine the correlation between ADLs performance and three bliss concepts: life satisfaction, self-esteem, and motivation in health behavior. This study used a quasi-experimental, two-group, pretest-posttest design. Forty-two qualified participants were recruited from two nursing homes located in southern Taiwan and assigned to either the experimental group (n = 21) or the comparison group (n = 21). Participants in the experimental group received the Self-Care Self-Efficacy Enhancement Program (SCSEEP), and those in the comparison group received biweekly social visits for 6 weeks. Levels of ADLs performance were measured by Tappen's Refined ADL Assessment Scale. Life satisfaction was measured by Adams' Life Satisfaction Index A. Self-esteem was measured by Rosenberg's Self-Esteem Scale. Motivation in health behavior was measured by Cox's Health Self-Determinism Index. Elder persons receiving the SCSEEP had significant improvement in feeding, dressing, grooming, and washing activities. Self-esteem (p = .011) and life satisfaction (p = .033) but not motivation in health behavior (p = .282) were positively correlated with levels of ADLs performance. The SCSEEP provides a theory-based intervention model for Taiwanese nursing home elder persons aimed at improving ADLs performance. Further research with a larger sample size is needed to determine the long-term maintenance and effectiveness of this theory-driven SCSEEP in specific culture groups.

[Development and evaluation of a training program for nursing home professionals to improve communication in dementia care].

PubMed

Haberstroh, J; Neumeyer, K; Schmitz, B; Pantel, J

2009-04-01

The purpose of this study was to develop and evaluate a skill training aimed at increasing the social competence of caregivers of nursing home residents suffering from dementia. Herewith, the professional burden and occupational stress of the caregivers should be reduced and the quality of life of dementia patients should be increased. The contents of the training focused on problems and strategies in the communication with dementia patients and the communication with colleagues. The effectiveness of the intervention was tested in a controlled training study using a multiple control group design and process measurement. The participants of the trainings were 53 nursing home professionals, who were in daily contact with residents suffering from dementia. The results of the study verify effects for all relevant variables. The "social competence" of the caregivers increased and their "work stress" decreased while the "quality of life of dementia patients" increased. Therefore it can be concluded that training the social competence of nursing home professionals is a method to indirectly reduce their work stress and support dementia patients. The results of research in this program underline very clearly that the developed training is an effective option to improve the situation of dementia care in nursing homes. To make the intervention widely applicable we are currently developing a "multiplier program" in a follow-up project.

Best practices in nursing homes. Clinical supervision, management, and human resource practices.

PubMed

Dellefield, Mary Ellen

2008-07-01

Human resource practices including supervision and management are associated with organizational performance. Evidence supportive of such an association in nursing homes is found in the results of numerous research studies conducted during the past 17 years. In this article, best practices related to this topic have been culled from descriptive, explanatory, and intervention studies in a range of interdisciplinary research journals published between 1990 and 2007. Identified best practices include implementation of training programs on supervision and management for licensed nurses, certified nursing assistant job enrichment programs, implementation of consistent nursing assignments, and the use of electronic documentation. Organizational barriers and facilitators of these best practices are described. Copyright 2009, SLACK Incorporated.

Case-mix payment for nursing home care: lessons from Maryland.

PubMed

Feder, J; Scanlon, W

1989-01-01

Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.

VA Health Care: Further Action Needed to Address Weaknesses in Management and Oversight of Non-VA Medical Care

DTIC Science & Technology

2014-06-18

medical centers. VA also provides care to veterans in VA-operated community-based outpatient clinics, community living centers ( nursing homes...facility or nursing home up to the point that the veteran can be safely returned to the VA facility following the emergency care treatment at the non-VA... nursing home care, compensation and pension exams, and most pharmacy expenses paid for through the Non-VA Medical Care Program. (See fig. 1.) 8VA

An education initiative modifies opinions of hemodialysis nurses towards home dialysis.

PubMed

Phillips, Matthew; Wile, Colleen; Bartol, Carolyn; Stockman, Cynthia; Dhir, Minakshi; Soroka, Steven D; Hingwala, Jay; Bargman, Joanne M; Chan, Christopher T; Tennankore, Karthik K

2015-01-01

It has been shown that in-center hemodialysis (HD) nurses prefer in-center HD for patients with certain characteristics; however it is not known if their opinions can be changed. To determine if an education initiative modified the perceptions of in-center HD nurses towards home dialysis. Cross-sectional survey of in-center HD nurses before and after a three hour continuing nursing education (CNE) initiative. Content of the CNE initiative included a didactic review of benefits of home dialysis, common misconceptions about patient eligibility, cost comparisons of different modalities and a home dialysis patient testimonial video. All in-center HD nurses (including those working in satellite dialysis units) affiliated with a single academic institution. Survey themes included perceived barriers to home dialysis, preferred modality (home versus in-center HD), ideal modality distribution in the local program, awareness of home dialysis and patient education about home modalities. Paired comparisons of responses before and after the CNE initiative. Of the 115 in-center HD nurses, 100 registered for the CNE initiative and 89 completed pre and post surveys (89% response rate). At baseline, in-center HD nurses perceived that impaired cognition, poor motor strength and poor visual acuity were barriers to peritoneal dialysis and home HD. In-center HD was preferred for availability of multidisciplinary care and medical personnel in case of catastrophic events. After the initiative, perceptions were more in favor of home dialysis for all patient characteristics, and most patient/system factors. Home dialysis was perceived to be underutilized both at baseline and after the initiative. Finally, in-center HD nurses were more aware of home dialysis, felt better informed about its benefits and were more comfortable teaching in-center HD patients about home modalities after the CNE session. Single-center study. CNE initiatives can modify the opinions of in-center HD nurses towards home modalities and should complement the multitude of strategies aimed at promoting home dialysis.

Quality improvement nursing facilities: a nursing leadership perspective.

PubMed

Adams-Wendling, Linda; Lee, Robert

2005-11-01

The purposes of this study were to characterize the state of quality improvement (QI) in nursing facilities and to identify barriers to improvement from nursing leaders' perspectives. The study employed a non-experimental descriptive design, using closed- and open-ended survey questions in a sample of 51 nursing facilities in a midwestern state. Only two of these facilities had active QI programs. Furthermore, turnover and limited training among these nursing leaders represented major barriers to rapid implementation of such programs. This study is consistent with earlier findings that QI programs are limited in nursing homes.

A systematic review protocol of educational programs for nursing staff on management of resident-to-resident elder mistreatment in residential aged care homes.

PubMed

Ellis, Julie M; Ayala Quintanilla, Beatriz Paulina; Ward, Louise; Campbell, Fergus; Hillel, Stav; Downing, Carolyn; Teresi, Jeanne; Ramirez, Mildred

2018-05-06

To review evidence concerning educational programs for nursing staff on management of resident-to-resident elder mistreatment with the aim of preventing and reducing this abuse in residential aged care homes. Although elder abuse has received considerable attention, very little is known regarding resident-to-resident elder mistreatment in residential aged care homes and about interventions/programs to prevent and reduce this harm. Nurses play an essential role in identifying and managing aggressive interactions. However, many nurses may not recognize these behaviours as forms of abuse. Thus, it is important to ascertain if educational programs for nursing staff have been developed and implemented. Quantitative systematic review registered on PROSPERO (CRD42017080925). A systematic search of English published studies between 1980 - 2017 will be conducted in CINAHL, Embase, MEDLINE, ProQuest, PsychInfo and Scopus. Risk of bias and quality of the studies will be evaluated by using the Cochrane Collaboration's tool and the Methodological Index for Nonrandomized studies. A meta-analysis will be performed, if sufficient homogeneity exists; otherwise, data will be summarized by using a narrative description. This study was funded in January 2017. Nursing staff should play a pivotal role in preventing and/or reducing resident-to-resident elder mistreatment. Therefore, it is important to identify available educational programs for nursing staff dealing with this abuse. Consequently, this review may provide evidence-based care for nursing staff to assist them in protecting older residents from experiencing abuse or being abused and in improving their well-being. © 2018 John Wiley & Sons Ltd.

75 FR 65282 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid program. We are proposing these requirements to ensure that long... According to CMS data, at any point in time, approximately 1.4 million elderly and disabled nursing home...

[A study on participation in clinical decision making by home healthcare nurses].

PubMed

Kim, Se Young

2010-12-01

This study was done to identify participation by home healthcare nurses in clinical decision making and factors influencing clinical decision making. A descriptive survey was used to collect data from 68 home healthcare nurses in 22 hospital-based home healthcare services in Korea. To investigate participation, the researcher developed 3 scenarios through interviews with 5 home healthcare nurses. A self-report questionnaire composed of tools for characteristics, factors of clinical decision making, and participation was used. Participation was relatively high, but significantly lower in the design phase (F=3.51, p=.032). Competency in clinical decision making (r=.45, p<.001), perception of the decision maker role (r=.47, p<.001), and perception of the utility of clinical practice guidelines (r=.25, p=.043) were significantly correlated with participation. Competency in clinical decision making (Odds ratio [OR]=41.79, p=.007) and perception of the decision maker role (OR=15.09, p=.007) were significant factors predicting participation in clinical decision making by home healthcare nurses. In order to encourage participation in clinical decision making, education programs should be provided to home healthcare nurses. Official clinical practice guidelines should be used to support home healthcare nurses' participation in clinical decision making in cases where they can identify and solve the patient health problems.

Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs

ERIC Educational Resources Information Center

Hahn, Elizabeth A.; Thomas, Kali S.; Hyer, Kathryn; Andel, Ross; Meng, Hongdao

2011-01-01

Purpose of the study: To examine the relationship between county-level Medicaid home- and community-based service (HCBS) waiver expenditures and the prevalence of low-care residents in Florida nursing homes (NHs). Design and Methods: The present study used a cross-sectional design. We combined two data sources: NH facility-level data (including…

42 CFR 431.703 - Licensing requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Licensing Nursing Home Administrators § 431.703 Licensing requirement. The State licensing program must provide that only nursing homes supervised by an administrator licensed in accordance with the... 42 Public Health 4 2010-10-01 2010-10-01 false Licensing requirement. 431.703 Section 431.703...

78 FR 76061 - Authorization for Non-VA Medical Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-16

..., Health professions, Health records, Homeless, Mental health programs, Nursing homes, Reporting and... final rule adopts the proposed rule without changes. We received several comments urging VA to expand....009, Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans Dental Care...

Father Attendance in Nurse Home Visitation

PubMed Central

Holmberg, John R.; Olds, David L.

2015-01-01

Our aim was to examine the rates and predictors of father attendance at nurse home visits in replication sites of the Nurse-Family Partnership (NFP). Early childhood programs can facilitate father involvement in the lives of their children, but program improvements require an understanding of factors that predict father involvement. The sample consisted of 29,109 low-income, first-time mothers who received services from 694 nurses from 80 sites. We conducted mixed-model multiple regression analyses to identify population, implementation, site, and nurse influences on father attendance. Predictors of father attendance included a count of maternal visits (B = 0.12, SE = 0.01, F = 3101.77), frequent contact between parents (B = 0.61, SE = 0.02, F = 708.02), cohabitation (B = 1.41, SE = 0.07, F = 631.51), White maternal race (B = 0.77, SE = 0.06, F = 190.12), and marriage (B = 0.42, SE = 0.08, F = 30.08). Random effects for sites and nurses predicted father-visit participation (2.7 & 6.7% of the variance, respectively), even after controlling for population sociodemographic characteristics. These findings suggest that factors operating at the levels of sites and nurses influence father attendance at home visits, even after controlling for differences in populations served. Further inquiry about these influences on father visit attendance is likely to inform program-improvement efforts. PMID:25521707

End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000–2003

PubMed Central

O’Brien, Meaghan B.; Gao, Jun; Dewar, Ron

2013-01-01

Introduction With our population aging, an increasing proportion of cancer deaths will occur in nursing homes, yet little is known about their end-of-life care. This paper identifies associations between residing in a nursing home and end-of-life palliative cancer care, controlling for demographic factors. Methods For this population-based study, a data file was created by linking individual-level data from the Nova Scotia Cancer Centre Oncology Patient Information System, Vital Statistics, and the Halifax and Cape Breton Palliative Care Programs for all persons 65 years and over dying of cancer from 2000 to 2003. Multivariate logistic regression was used to compare nursing home residents to nonresidents. Results Among the 7,587 subjects, 1,008 (13.3%) were nursing home residents. Nursing home residents were more likely to be female [adjusted odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2–1.7], older (for ≥90 vs 65–69 years OR 5.4, CI 4.1–7.0), rural (OR 1.5, CI 1.2–1.8), have only a death certificate cancer diagnosis (OR 4.2, CI 2.8–6.3), and die out of hospital (OR 8.5, CI 7.2–10.0). Nursing home residents were less likely to receive palliative radiation (OR 0.6, CI 0.4–0.7), medical oncology consultation (OR 0.2, CI 0.1–0.4), and palliative care program enrollment (Halifax OR 0.2, CI 0.2–0.3; Cape Breton OR 0.4, CI 0.3–0.7). Conclusion Demographic characteristics and end-of-life services differ between those residing and those not residing in nursing homes. These inequalities may or may not reflect inequities in access to quality end-of-life care. PMID:17277924

Restraint reduction in a nursing home and its impact on employee attitudes.

PubMed

Sundel, M; Garrett, R M; Horn, R D

1994-04-01

To reduce physical restraint use in a nursing home and increase employee support for the restraint-reduction program. A one-group pretest-posttest design with repeated measures was used to determine changes in restraint use with participants over a 14-month interval. All individuals employed at the nursing home were surveyed at two time periods to determine their opinions on restraint use. A 265-bed private, non-profit nursing home in Dallas, Texas. A restrained cohort of 170 residents with a mean age of 84 years; 84% were female. A total of 182 employees participated in the first survey and 209 in the second. Formation of a project team that planned and supervised restraint removal. Inservice training on restraint use was conducted for all employees. Type and frequency of restraint use among the restrained cohort at four evaluation points within a 14-month interval. The frequency of restraint use in the nursing home population was also recorded. Survey measures included employee responses to a 16-item closed-end questionnaire before and after training. The mean number of restraints used with each resident in the restrained cohort decreased from 1.56 to 0.67. The number of residents on restraints in the nursing home was reduced during the course of the study (67.5% vs. 36.7%, P < 0.0001). Changes in employee opinions about restraint use were found after training. On the second survey, more than twice as many employees indicated that restraints should be removed from almost all residents who have them (15.2% vs 36.3%, P < 0.0001). A restraint-reduction program in a nursing home can produce positive results in terms of decreased restraint use and supportive employee attitudes. More practical alternatives to restraints need to be developed for application in the training of nursing home employees. Future studies on resident, employee, and family attitudes about restraint use are suggested.

Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions

PubMed Central

Garcia, Theresa J.; Harrison, Tracie C.; Goodwin, James S.

2017-01-01

Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged. PMID:25721717

Implementation of a Complex Intervention to Support Leadership Development in Nursing Homes: A Multimethod Participatory Study.

PubMed

Dewar, Belinda; Barrie, Karen; Sharp, Cathy; Meyer, Julienne

2017-04-01

Leadership is key to quality improvement in nursing homes. This article reports on the initial analysis of the transformational My Home Life Leadership Support program for nursing home managers being implemented in Scotland. It analyses learning from a multimethod participatory descriptive study. Contribution analysis theory informed the evaluation. Evidence-Based Practice, Relationship-Centered Care, Appreciative Inquiry, and Caring Conversations informed the intervention to develop transformational leadership. Data generation methods included baseline and postintervention questionnaires to describe culture change within the study population, together with more in-depth qualitative data generated from group discussions throughout the leadership support program. Qualitative data analysis was an iterative collaborative process with participants to generate themes about the impact of the program on themselves and their practice. Data showed positive changes in managers' perceptions of their self-awareness, leadership communication and relationship skills, and development of positive cultures. This model offers lessons for those interested in ways to approach the emotional, educational, and cultural dynamics of change in other human service contexts.

A Design of Inservice Education for Nurses' Aides in a Nursing Home Setting

ERIC Educational Resources Information Center

Hameister, Dennis R.

1977-01-01

Describes a study designed to identify the specific needs (as identified by administrators and charge nurses) of nurses' aides and to determine the appropriateness for inclusion in an inservice training program. (WL)

Facility and market factors affecting transitions from nursing home to community.

PubMed

Arling, Greg; Abrahamson, Kathleen A; Cooke, Valerie; Kane, Robert L; Lewis, Teresa

2011-09-01

Research into nursing home transitions has given limited attention to the facility or community contexts. To identify facility and market factors affecting transitions of nursing home residents back to the community. Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional conditions. Facility discharge rates were adjusted using Empirical Bayes estimation. Annual cohort of first-time admissions (N=24,648) to 378 Minnesota nursing facilities in 75 nursing home markets from July 2005 to June 2006. Community discharge within 90 days of admission; facility occupancy, payer mix, ownership, case-mix acuity, size, admissions from hospitals, nurse staffing level, and proportion of admissions preferring or having support to return to the community; and nursing market population size, average occupancy, market concentration, and availability of home and community-based services. Rates of community discharge (Empirical Bayes residual) were highest in facilities with more residents preferring community discharge, more Medicare days, higher nurse staffing levels, and higher occupancy. In addition, facilities had higher community discharge rates if they were located in markets with a greater ratio of home and community-based services recipients to nursing home residents and with larger populations. State Medicaid programs should undertake system-level interventions that encourage nursing facilities to reduce unused bed capacity, balance the mix of payers, invest in nurse staffing, and take other steps to promote community discharges. In addition, states should increase home and community-based services, particularly in markets with low community discharge rates.

Effects of Horticultural Therapy on Psychosocial Health in Older Nursing Home Residents: A Preliminary Study.

PubMed

Chen, Yuh-Min; Ji, Jeng-Yi

2015-09-01

This preliminary study examined the effect of horticultural therapy on psychosocial health in older nursing home residents. A combined quantitative and qualitative design was adopted. Convenience sampling was used to recruit 10 older residents from a nursing home in Taichung, Taiwan. Participants joined a 10-week indoor horticultural program once a week, with each session lasting for about 1.5 hours. A single-group design with multiple measurements was adopted for the quantitative component of this study. Interviews held 1-2 days before the intervention (T0) were used to collect baseline data. The two outcome variables of this study, depression and loneliness, were reassessed during the 5th (T1) and 10th (T2) weeks of the intervention. Generalized estimating equations were used to test the mean differences among T0, T1, and T2 measures. After the 10-week program, qualitative data were collected by asking participants to share their program participation experiences. The results of generalized estimating equation showed significant improvements in depression and loneliness. Four categories emerged from the qualitative data content analysis: social connection, anticipation and hope, sense of achievement, and companionship. Given the beneficial effects of the horticulture therapy, the inclusion of horticultural activities in nursing home activity programs is recommended.

Leading nurses: emotional intelligence and leadership development effectiveness.

PubMed

Crowne, Kerri Anne; Young, Thomas M; Goldman, Beryl; Patterson, Barbara; Krouse, Anne M; Proenca, Jose

2017-07-03

Purpose The purpose of this paper is to examine the effectiveness of an emotional intelligence (EI) and leadership development education program involving 20 nurse leaders at nursing homes. Also, it investigates the relationship between EI and transformational leadership. Design/methodology/approach Three research questions are posed. Correlation analysis and t-tests were conducted to answer the questions posed. Findings The findings of this paper indicate that the EI educational development was effective, while the personal leadership development was not. The data also showed a positive significant relationship between EI and transformational leadership. Research limitations/implications This paper is limited by the small sample size; thus, a causal relationship between EI and leadership could not be investigated. Additionally, the sample was not randomly selected because of the commitment needed from the participants. Furthermore, the paper was focused on nurse leaders in nursing homes, so it may not be generalizable to other populations. Practical implications With the increasing need for nursing home facilities and the limited training generally provided to nurses who move into managerial roles in these facilities, it is critical for organizations to understand the effectiveness of educational programs that exist. Moreover, the findings of this paper may provide information that would be useful to others who wish to develop EI and/or leadership education for nurses. Originality/value While much research exists on EI and transformational leadership, little of this research focuses on nurses in nursing home facilities. Thus, this paper fills a gap in the literature.

Increased self-efficacy: the experience of high-intensity exercise of nursing home residents with dementia - a qualitative study.

PubMed

Olsen, Cecilie Fromholt; Telenius, Elisabeth Wiken; Engedal, Knut; Bergland, Astrid

2015-09-14

There has been increasing interest in the use of non-pharmacological interventions, such as physical exercise, to improve the well-being of nursing home residents with dementia. For reasons regarding disease symptoms, persons with dementia might find it difficult to participate in exercise programs. Therefore, it is important to find ways to successfully promote regular exercise for patients in residential care. Several quantitative studies have established the positive effects of exercise on biopsychosocial factors, such as self-efficacy in older people; however, little is known regarding the qualitative aspects of participating in an exercise program among older people with dementia. From the perspective of residents, we explored the experiences of participating in a high-intensity functional exercise program among nursing home residents with dementia. The participants were eight elderly people with mild-to-moderate dementia. We conducted semi-structured interviews one week after they had finished a 10-week supervised high-intensity exercise program. We analyzed the data using an inductive content analysis. Five overreaching and interrelated themes emerged from the interviews: "Pushing the limits," "Being invested in," "Relationships facilitate exercise participation," "Exercise revives the body, increases independence and improves self-esteem" and "Physical activity is a basic human necessity--use it or lose it!" The results were interpreted in light of Bandura's self-efficacy theory. The exercise program seemed to improve self-efficacy through several mechanisms. By being involved, "being invested in" and having something expected of them, the participants gained a sense of empowerment in their everyday lives. The importance of social influences related to the exercise instructor and the exercise group was accentuated by the participants. The nursing home residents had, for the most part, positive experiences with regard to participating in the exercise program. The program seemed to increase their self-efficacy through several mechanisms. The instructor competence emerged as an important facilitating factor. The participants emphasized the importance of physical activity in the nursing home.

The effectiveness of physical exercise training in pain, mobility, and psychological well-being of older persons living in nursing homes.

PubMed

Tse, Mimi M Y; Tang, Shuk Kwan; Wan, Vanessa T C; Vong, Sinfia K S

2014-12-01

Pain is common in the aging population, particularly among older residents of nursing homes. It has been found that 50% of older people living in the community have been experiencing chronic pain, and the number increased to 80% for older residents of nursing homes. Exercise is an effective non-pharmacological intervention that can reduce pain and improve physical and psychological functions. A quasi-experimental study with a pretest-posttest control group designed was conducted to evaluate the effects of a physical exercise program (PEP) on older residents of nursing homes who have chronic pain. Three-hundred-ninety-six older residents with chronic pain were recruited from 10 nursing homes run by non-governmental organizations in Hong Kong. The average age of the older residents was 85.44 ± 6.29. Five nursing homes were randomized to the experimental group with PEP (n = 225, age = 85.45 ± 6.25); the other five nursing homes were randomized to the control group without the PEP (n = 171, age = 85.44 ± 6.35). PEP was an eight-week training program given by a physiotherapist and nurses once a week. It consisted of warm-up exercises, muscle strengthening, stretching, balancing, and self-administered massage to acupressure points. At the end of each PEP session, pamphlets with pictures illustrating the "exercise of the day" were given to the older residents of nursing homes as a tool to enhance their self-management skills. The control group received no training during the eight weeks. Upon completion of the PEP, the experimental group experienced a significantly greater reduction in pain intensity from 4.19 ± 2.25 (on an 11 point scale) to 2.67 ± 2.08, as compared to the control group (p < .05). In addition, the psychological well-being (happiness, loneliness, life satisfaction, and depression) of the experimental group was significantly improved (p < .05). Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The chaotic journey: Recovering from hip fracture in a nursing home.

PubMed

Killington, Maggie; Walker, Ruth; Crotty, Maria

2016-01-01

To understand the journey experienced by nursing home residents following hip fracture and impressions of an outreach rehabilitation program offered after their return home. A qualitative investigation was undertaken in parallel with a randomised controlled trial investigating the efficacy and cost utility of providing a hospital outreach rehabilitation program for older nursing home residents who have recently returned from hospital following hip fracture. Family members and nursing home staff of 28 (out of the first 30) participants (14 from intervention and 14 from control) agreed to participate in interviews and focus groups to provide information and perceptions of each person's journey. NVivo 10 qualitative data analysis software package was used to identify major themes (via open, then axial and finally selective coding). Both family members and staff described nursing home residents with dementia as receiving poor post-operative care from hospital staff who seemed unfamiliar with dementia and delirium. Discharge from hospital soon after surgery (median 4.5days) occurred with poor transfer of information. Difficulties with residents' emotions, pain management and commencing mobilisation seemed more prevalent within usual care group, whereas fewer overall problems were encountered by those with access to a geriatrician and additional therapy. This research suggests that an integrated care pathway including the hospital stay and first weeks back at nursing homes should be developed. Performance indicators should include carer measures on the quality of the transfer, pain management measures in the first month and return to walking. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

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…

48 CFR 822.305 - Contract clause.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Hours and Safety Standards Act—nursing home care contract supplement, in solicitations and contracts for nursing home care when the FAR clause at 52.222-4, Contract Work Hours and Safety Standards Act—Overtime... PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Contract Work Hours and Safety Standards Act...

48 CFR 822.305 - Contract clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Hours and Safety Standards Act—nursing home care contract supplement, in solicitations and contracts for nursing home care when the FAR clause at 52.222-4, Contract Work Hours and Safety Standards Act—Overtime... PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Contract Work Hours and Safety Standards Act...

[Infection control and hand hygiene in nursing homes in Oslo].

PubMed

Sie, Ingrid; Thorstad, Margrete; Andersen, Bjørg Marit

2008-06-26

Nosocomial infections and transmission can be substantially reduced by good infection control. The laws and regulations for infection control in heath care institutions emphasize establishment of infection control programs and improved hand hygiene. Our study reviews some factors that are important for practicing adequate hand hygiene (knowledge about infection control and hand-washing facilities). Health care workers (HCW) in nursing homes in Oslo participated in this study in 2006-2007. A questionnaire was made and SPSS was used to analyse the data . 70.7% of 324 HCW (in 42 nursing homes) answered the questionnaires. Nearly all of the respondents (95.6%) knew about the written procedures for hygiene and infection control; 88.5% knew that an infection control program was in place and about 50% had received information through internal education. Three of four had read the National guidelines for hand hygiene, 77.5% thought that hand disinfection was more effective than hand washing, and 97% reported hand hygiene after contact with a patient having an infection. Dispensers for hand disinfection were situated at central work places. At the same time, 17.9% informed that they worked in more than one place at the same time. This study confirms that most nursing homes in Oslo have an infection control program and training that improves the knowledge and awareness of hand hygiene among HCWs. However, the fact that nursing homes in Oslo have the resources, knowledge and education, is not the same as compliance.

Barriers and Facilitators for Sustainability of Tele-Homecare Programs: A Systematic Review.

PubMed

Radhakrishnan, Kavita; Xie, Bo; Berkley, Amy; Kim, Miyong

2016-02-01

To identify the barriers and facilitators for sustainability of tele-homecare programs implemented by home health nursing agencies for chronic disease management. English-language articles on home telehealth in the CINAHL, PubMed/MEDLINE, PsychInfo, Web of Science, and Cochrane Reviews databases published from January 1996 to December 2013. We performed a systematic literature review. Data extraction using PRISMA guidelines and quality appraisal using the Mixed Methods Appraisal Tool (MMAT) were conducted on relevant empirical studies. Thematic analysis across the studies and narrative summaries were used to synthesize the findings from the included studies. Of the initial 3,920 citations, we identified 16 articles of moderate quality meeting our inclusion criteria. Perceptions on effectiveness of tele-homecare programs for achieving intended outcomes; tailoring of tele-homecare programs to patient characteristics and needs; relationship and communication between patient, nurse, and other health care professional users of tele-homecare; home health organizational process and culture; and technology quality, capability, and usability impacted the sustainability of tele-homecare programs. The findings of this systematic review provide implications for sustained usage of tele-homecare programs by home health nursing agencies and can help such programs realize their potential for chronic disease management. © Health Research and Educational Trust.

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

Predictors of Nursing Home Residents' Participation in Activity Programs.

ERIC Educational Resources Information Center

Voelkl, Judith E.; And Others

1995-01-01

Examines the relationship between resident characteristics and time participating in activities. For the 2,672 nursing home residents studied, measures of resource use, cognitive abilities, depression, sense of initiative/involvement, activity repertoire, location preferences, and gender were all found to be significant in explaining the amount of…

42 CFR 431.705 - Licensing authority.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Nursing Home Administrators § 431.705 Licensing authority. (a) The State licensing program must provide for licensing of nursing home administrators by— (1) The agency designated under the healing arts act... 42 Public Health 4 2010-10-01 2010-10-01 false Licensing authority. 431.705 Section 431.705 Public...

42 CFR 431.713 - Continuing study and investigation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Continuing study and investigation. 431.713 Section... Programs for Licensing Nursing Home Administrators § 431.713 Continuing study and investigation. The agency or board must conduct a continuing study of nursing homes and administrators within the State to...

42 CFR 431.713 - Continuing study and investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Continuing study and investigation. 431.713 Section... Programs for Licensing Nursing Home Administrators § 431.713 Continuing study and investigation. The agency or board must conduct a continuing study of nursing homes and administrators within the State to...

38 CFR 53.31 - Annual report.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TO STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.31... incentive program has been in improving nurse staffing in the SVH. The report shall be provided to VA within...

38 CFR 53.31 - Annual report.

Code of Federal Regulations, 2011 CFR

2011-07-01

... TO STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.31... incentive program has been in improving nurse staffing in the SVH. The report shall be provided to VA within...

Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment.

PubMed

Alonso-Marsden, Shelley; Dodge, Kenneth A; O'Donnell, Karen J; Murphy, Robert A; Sato, Jeannine M; Christopoulos, Christina

2013-08-01

As nurse home visiting to prevent child maltreatment grows in popularity with both program administrators and legislators, it is important to understand engagement in such programs in order to improve their community-wide effects. This report examines family demographic and infant health risk factors that predict engagement and follow-through in a universal home-based maltreatment prevention program for new mothers in Durham County, North Carolina. Trained staff members attempted to schedule home visits for all new mothers during the birthing hospital stay, and then nurses completed scheduled visits three to five weeks later. Medical record data was used to identify family demographic and infant health risk factors for maltreatment. These variables were used to predict program engagement (scheduling a visit) and follow-through (completing a scheduled visit). Program staff members were successful in scheduling 78% of eligible families for a visit and completing 85% of scheduled visits. Overall, 66% of eligible families completed at least one visit. Structural equation modeling (SEM) analyses indicated that high demographic risk and low infant health risk were predictive of scheduling a visit. Both low demographic and infant health risk were predictive of visit completion. Findings suggest that while higher demographic risk increases families' initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

A facility specialist model for improving retention of nursing home staff: results from a randomized, controlled study.

PubMed

Pillemer, Karl; Meador, Rhoda; Henderson, Charles; Robison, Julie; Hegeman, Carol; Graham, Edwin; Schultz, Leslie

2008-07-01

This article reports on a randomized, controlled intervention study designed to reduce employee turnover by creating a retention specialist position in nursing homes. We collected data three times over a 1-year period in 30 nursing homes, sampled in stratified random manner from facilities in New York State and Connecticut and randomly assigned to treatment and control conditions. Staff outcomes were measured through certified nursing assistant interviews, and turnover rates were measured over the course of the year. In the intervention condition, a staff member was selected to be the facility retention specialist, who would advocate for and implement programs to improve staff retention and commitment throughout the facility. Retention specialists received an intensive 3-day training in retention leadership and in a number of evidence-based retention programs. Ongoing support was provided throughout the project. Treatment facilities experienced significant declines in turnover rates compared to control facilities. As predicted, we found positive effects on certified nursing assistant assessments of the quality of retention efforts and of care provided in the facility; we did not find effects for job satisfaction or stress. The study provides evidence for the effectiveness of the retention specialist model. Findings from a detailed process evaluation suggest modifications of the program that may increase program effects.

Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention.

PubMed

Markle-Reid, Maureen F; McAiney, Carrie; Forbes, Dorothy; Thabane, Lehana; Gibson, Maggie; Hoch, Jeffrey S; Browne, Gina; Peirce, Thomas; Busing, Barbara

2011-08-25

Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. ClinicalTrials.gov: NCT01407926.

Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention

PubMed Central

2011-01-01

Background Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. Methods/Design This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Discussion Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. Trial Registration ClinicalTrials.gov: NCT01407926 PMID:21867539

CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

PubMed Central

2012-01-01

Background Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures. Methods/design Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model. Discussion By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate. Trial Registration ClinicalTrials.gov: NCT00636675 PMID:22376375

Do Medicaid Wage Pass-through Payments Increase Nursing Home Staffing?

PubMed Central

Feng, Zhanlian; Lee, Yong Suk; Kuo, Sylvia; Intrator, Orna; Foster, Andrew; Mor, Vincent

2010-01-01

Objective To assess the impact of state Medicaid wage pass-through policy on direct-care staffing levels in U.S. nursing homes. Data Sources Online Survey Certification and Reporting (OSCAR) data, and state Medicaid nursing home reimbursement policies over the period 1996–2004. Study Design A fixed-effects panel model with two-step feasible-generalized least squares estimates is used to examine the effect of pass-through adoption on direct-care staff hours per resident day (HPRD) in nursing homes. Data Collection/Extraction Methods A panel data file tracking annual OSCAR surveys per facility over the study period is linked with annual information on state Medicaid wage pass-through and related policies. Principal Findings Among the states introducing wage pass-through over the study period, the policy is associated with between 3.0 and 4.0 percent net increases in certified nurse aide (CNA) HPRD in the years following adoption. No discernable pass-through effect is observed on either registered nurse or licensed practical nurse HPRD. Conclusions State Medicaid wage pass-through programs offer a potentially effective policy tool to boost direct-care CNA staffing in nursing homes, at least in the short term. PMID:20403054

Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model.

PubMed

Mills, Whitney L; Pimentel, Camilla B; Palmer, Jennifer A; Snow, A Lynn; Wewiorski, Nancy J; Allen, Rebecca S; Hartmann, Christine W

2018-05-08

Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.

38 CFR 52.130 - Nursing services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Nursing services. 52.130... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.130 Nursing services. The program management must provide an organized nursing service with a sufficient number of qualified nursing personnel...

38 CFR 52.130 - Nursing services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nursing services. 52.130... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.130 Nursing services. The program management must provide an organized nursing service with a sufficient number of qualified nursing personnel...

38 CFR 52.130 - Nursing services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Nursing services. 52.130... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.130 Nursing services. The program management must provide an organized nursing service with a sufficient number of qualified nursing personnel...

38 CFR 52.130 - Nursing services.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Nursing services. 52.130... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.130 Nursing services. The program management must provide an organized nursing service with a sufficient number of qualified nursing personnel...

38 CFR 52.130 - Nursing services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Nursing services. 52.130... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.130 Nursing services. The program management must provide an organized nursing service with a sufficient number of qualified nursing personnel...

Nursing home staff members' subjective frames of reference on residents' achievement of ego integrity: A Q-methodology study.

PubMed

Lim, Sun-Young; Chang, Sung-Ok

2018-01-01

To discover the structure of the frames of reference for nursing home staff members' subjective judgment of residents' achievement of ego integrity. Q-methodology was applied. Twenty-eight staff members who were working in a nursing home sorted 34 Q-statements into the shape of a normal distribution. A centroid factor analysis and varimax rotation, using the PQ-method program, revealed four factors: identifying clues to residents' positive acceptance of their whole life span, identifying residents' ways of enjoying their current life, referencing residents' attitudes and competencies toward harmonious relationships, and identifying residents' integrated efforts to establish self-esteem. These subjective frames of reference need to be investigated in order to improve the relationships with nursing home residents and their quality of life. Consequently, the fundamental monitoring tools to help staff members make subjective judgments can be formed. © 2017 Japan Academy of Nursing Science.

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…

Complaints against Nursing Homes: Comparing Two Sources of Complaint Information and Predictors of Complaints

ERIC Educational Resources Information Center

Troyer, Jennifer L.; Sause, Wendy L.

2011-01-01

Purpose of the Study: Two consumer-derived measures of nursing home quality that have been underutilized by researchers are consumer complaints to the state certification agency between inspections and complaints to the Long-Term Care Ombudsman Program. This article describes these complaints, considers facility-level predictors of complaints, and…

Motivators for physical activity among ambulatory nursing home older residents.

PubMed

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.

Pilot Study of a Novel Partnership for Installing Smoke Alarms.

PubMed

Omaki, Elise C; Frattaroli, Shannon; Shields, Wendy C; McDonald, Eileen M; Rizzutti, Nicholas; Appy, Meri-K; Voiles, Denise; Jamison, Shelly; Gielen, Andrea C

2018-02-07

Objectives To demonstrate the feasibility of partnering fire department personnel and home visiting nurses to increase the number of low-income homes protected by smoke alarms. Methods During a regularly scheduled home visit, nurses at the Nurse-Family Partnership of Maricopa County (NFP) informed their clients about an opportunity to have smoke alarms installed in their homes for free. For interested families, nurses sent a referral to the Phoenix Fire Department (PFD), scheduled an appointment, and accompanied the PFD volunteers during the installation. During the appointment, PFD personnel installed alarms and provided safety education. Clients completed a follow-up survey 1-3 months after the installation visit. In-depth interviews were completed with key informants from NFP and PFD to solicit feedback on the program. Results Fifty-two smoke alarm installation visits were completed. Before the fire department arrived, 55% of homes had no working smoke alarm. Almost all (94%) homes received at least one new smoke alarm, and every home had at least one working smoke alarm at the end of the fire department visit. At follow-up, all homes maintained at least one working smoke alarm. Members from both organizations were enthusiastic about, and supportive of the project. NFP nurses appreciated the skill and knowledge of the firefighters; PFD representatives noted that the nurses' relationships with clients made it easier for them to gain access to families who are often described as "hard-to-reach". Conclusions Partnering home visiting nurses and fire departments can be successful to increase the number of vulnerable homes with smoke alarms.

A Home Visiting Asthma Education Program: Challenges to Program Implementation

ERIC Educational Resources Information Center

Brown, Josephine V.; Demi, Alice S.; Celano, Marianne P.; Bakeman, Roger; Kobrynski, Lisa; Wilson, Sandra R.

2005-01-01

This study describes the implementation of a nurse home visiting asthma education program for low-income African American families of young children with asthma. Of 55 families, 71% completed the program consisting of eight lessons. The achievement of learning objectives was predicted by caregiver factors, such as education, presence of father or…

38 CFR 53.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TO STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.1... nurses for the purpose of reducing nursing shortages at that SVH. (Authority: 38 U.S.C. 101, 501, 1744) ...

38 CFR 53.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... TO STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.1... nurses for the purpose of reducing nursing shortages at that SVH. (Authority: 38 U.S.C. 101, 501, 1744) ...

Trials, tribulations, and triumphs of a pilot initiative to optimize the management of wounds complicated by diabetes within the home.

PubMed

Hodgins, Marilyn J; Logan, Susan M; Price, Karla; Thompson, Carol

2014-01-01

To support home health care nurses in their efforts to optimize the management of patients with wounds complicated by diabetes, an initiative was introduced that incorporated a standardized assessment tool, electronic data entry, and the provision of written treatment recommendations with supporting rationale prepared by nurses with expertise in diabetes and wound care. A pilot study was conducted that provided preliminary evidence of the feasibility of this initiative as well as its potential effect on outcomes for patients, nurses, and the home care program.

The Kansas PEAK 2.0 Program Facilitates the Diffusion of Culture-Change Innovation to Unlikely Adopters.

PubMed

Hermer, Linda; Cornelison, Laci; Kaup, Migette L; Poey, Judith L; Stone, Robyn; Doll, Gayle

2018-05-08

Recent studies have shown that nursing homes adopting culture change are disproportionately not-for-profit and CCRC-affiliated, with greater quality of care. Through the lens of diffusion-of-innovation theory, we examined whether Kansas' Medicaid pay-for-performance program PEAK 2.0, which incents the adoption of person-centered care (PCC) and worker empowerment, succeeded in its goal of spreading adoption to atypical- as well as typical-adopting nursing homes. We conducted a retrospective cohort study of 349 nursing homes in the state during PEAK 2.0's existence, 2012-2016. We constructed a data set combining state program data, provider characteristics from CMS data sets, and other demographic information from the 2010 Census. With a series of logistic regression models, we tested whether program joiners differed from nonjoiners by profit status and other demographic factors, as well as quality-related and case-mix factors. We found that in PEAK 2.0's first year, 2012, adopters were more likely to be not-for-profit and part of a CCRC, with higher occupancy rates and greater quality. However, by 2013 these associations became marginal, and in 2014 and 2015, we found no differences between program joiners and nonjoiners. The results show that by PEAK 2.0's third year, the program-with its large financial incentive and other potentially important characteristics-succeeded in attracting a large set of nursing homes whose demographics were representative of those in the state. This is important because other studies have found that the adoption of PCC is associated with improved health and well-being for residents.

Effect of Oral Health Care Program on Oral Health Status of Elderly People Living in Nursing Homes: a Quasi-experimental Study.

PubMed

Ildarabadi, Es-Hagh; Armat, Mohammad Reza; Motamedosanaye, Vahideh; Ghanei, Farzaneh

2017-12-01

Oral health of elderly people plays a major role in their overall health and quality of life, and is an integral part of personal care. The aim of this study was to evaluate the effect of implementing the oral health care program (OHCP) on oral health status of elderly people resident in nursing homes. This quasi-experimental study was carried out using a pretest-posttest design on 101 elderly people (46 in the intervention group and 55 in the control group) resident in two randomly selected nursing homes in Mashhad, Iran. In the intervention group, the OHCP was carried out by caregivers for 8 weeks. The control group received routine care. Using the oral health assessment tool, the oral health status of elderly people was assessed in both groups at three times; onset of the study, 4th, and 8th week after the start of the study. The oral health status of the elderly people in both groups was not statistically significantly different at baseline, but it changed significantly at the 4 th , and 8 th weeks (p<.001). The implementation of the OHCP for elderly people resident in nursing homes may improve their oral health status after 4 weeks. It is recommended that OHCP be included in care plans of all nursing homes to improve the elderly people's oral health status.

The effects of ownership and ownership change on nursing home industry costs.

PubMed

Holmes, J S

1996-08-01

This study examines the effects of ownership type and ownership change on nursing home cost structures, differentiating patient care costs from plant costs. Administrative data from the Michigan Department of Social Services, Medical Services Administration (Medicaid), and the Michigan Department of Public Health are used. Cost data are based on audited cost reports for 393 nursing care facilities in Michigan in 1989. Other facility characteristics are based on data from the 1989 annual licensing and certification survey conducted by the Michigan Department of Public Health. A series of ordinary least squares regressions is estimated, in which the dependent variable is either per diem patient costs or per diem plant costs. Ownership types are defined as chain, proprietary non-chain, freestanding non-profit, government-owned, and hospital-based facilities. Pooled estimation techniques, as well as separate regressions by ownership type, are presented to test for interaction effects. Key variables include whether a facility changed ownership in the preceding five years and whether chain facilities are in-state- or out-of-state-owned, in addition to size, payer mix, and case mix. Behavioral differences among nursing home ownership types in respect to patient care costs tended to distinguish government-owned and hospital-based facilities from the freestanding homes rather than the usual distinction between for-profit and not-for-profit classes. Variables traditionally included in nursing home cost studies, such as size, occupancy, payer mix and case mix, were found to have similar effects on per diem patient care costs for freestanding non-profit homes as well as for chain proprietary facilities. With regard to the effects of ownership change on per diem plant and per diem patient costs, however, there are few differences among ownership types. Chain and non-chain for-profit facilities, non-profit homes, and hospital long-term care units that had changed ownership reported significantly higher per diem plant costs than facilities without a change of ownership, but did not spend more on patient-related costs. Michigan Medicaid plant reimbursement system policy changes instituted in 1985 to promote continued ownership of facilities were not entirely successful. Non-profit homes look increasingly like their for-profit counterparts with respect to spending on patient care costs. Increased competition for the more lucrative private-pay patients, coupled with declining state Medicaid reimbursement to nursing homes, may have blurred the historical distinctions between the non-profit and for-profit sectors in the nursing home industry. An exception to increasing homogeneity within the nursing home industry is the tendency of proprietary homes to experience more frequent changes of ownership, which results in higher capital costs passed on to state Medicaid programs. Findings from this study indicate that while facility sales increase per diem plant costs, they do not result in increased spending for direct patient care, suggesting that state Medicaid programs may be indirectly subsidizing facility sales with no accompanying increase in expenditures for patient care. To discourage frequent facility sales, state Medicaid programs may need to consider alternative methods of reimbursing nursing home owners for capital costs.

Targeting nursing homes under the Quality Improvement Organization program's 9th statement of work.

PubMed

Stevenson, David G; Mor, Vincent

2009-09-01

In the Quality Improvement Organization (QIO) program's latest Statement of Work, the Centers for Medicare and Medicaid Services (CMS) is targeting its nursing home activities toward facilities that perform poorly on two quality measures-pressure ulcers and restraint use. The designation of target facilities is a shift in strategy for CMS and a direct response to criticism that QIO program resources were not being targeted effectively to facilities or clinical areas that most needed improvement. Using administrative data, this article analyzes implications of using narrowly defined criteria to identify facilities that need improvement, particularly in light of considerable evidence showing that nursing home quality is multidimensional and may change over time. The analyses show that one in four facilities is targeted for improvement nationally but that approximately half of some states' facilities are targeted while other states have almost none targeted. The analyses also convey deeper limitations to using threshold values on individual measures to identify poorly performing homes. Target facilities can be among the top performers on a range of other quality measures, and their performance on targeted measures themselves may change over time. The implication of these features is that a very different group of facilities would have been chosen had the QIO program targeted other measures or examined performance at a different point in time. Ultimately, CMS has chosen a blunt instrument to identify poorly performing nursing homes, and supplemental strategies-such as soliciting input from state survey agencies and more closely aligning quality improvement and quality assurance efforts-should be considered to address potential limitations.

Telecommuting. Factors to consider.

PubMed

D'Arruda, K A

2001-10-01

1. Telecommuting is a work arrangement in which employees work part time or full time from their homes or smaller telework centers. They communicate with employers via computer. 2. Telecommuting can raise legal issues for companies. Can telecommuting be considered a reasonable accommodation under the Americans With Disabilities Act? When at home, is a worker injured within the course and scope of their employment for purposes of workers' compensation? 3. Occupational and environmental health nurses may need to alter existing programs to meet the distinct needs of telecommuters. Often, there are ergonomic issues and home office safety issues which are not of concern to other employees. Additionally, occupational and environmental health nurses may have to offer programs in new formats (e.g., Internet or Intranet programs) to effectively communicate with teleworkers.

Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care

PubMed Central

Mor, Vincent; Zinn, Jacqueline; Angelelli, Joseph; Teno, Joan M; Miller, Susan C

2004-01-01

Nursing home care is currently a two-tiered system. The lower tier consists of facilities housing mainly Medicaid residents and, as a result, has very limited resources. The nearly 15 percent of U.S. nonhospital-based nursing homes that serve predominantly Medicaid residents have fewer nurses, lower occupancy rates, and more health-related deficiencies. They are more likely to be terminated from the Medicaid/Medicare program, are disproportionately located in the poorest counties, and are more likely to serve African-American residents than are other facilities. The public reporting of quality indicators, intended to improve quality through market mechanisms, may result in driving poor homes out of business and will disproportionately affect nonwhite residents living in poor communities. This article recommends a proactive policy stance to mitigate these consequences of quality competition. PMID:15225329

Peer Mentoring in Long-Term Care: Rational, Design, and Retention

ERIC Educational Resources Information Center

Hegeman, Carol; Hoskinson, Debi; Munro, Heather; Maiden, Patricia; Pillemer, Karl

2007-01-01

This article describes two successful peer-mentoring programs designed to improve the quality of care in nursing homes and retention rates among direct care staff. The first program, "Growing Strong Roots," examined CNA retention rates and the second program, "Peer Mentoring for Long Term Charge Nurses," examined RN and LPN retention rates. These…

Acceptability of an e-learning program to help nursing assistants manage relationship conflict in nursing homes.

PubMed

Marziali, Elsa; Mackenzie, Corey Scott; Tchernikov, Illia

2015-02-01

Management of nursing assistants' (NAs) emotional stress from relationship conflicts with residents, families, and coworkers is rarely the focus of educational programs. Our objective was to gather feedback from NAs and their nursing supervisors (NSs) about the utility of our e-learning program for managing relationship stress. A total of 147 NAs and their NSs from 17 long-term care homes viewed the educational modules (DVD slides with voice-over), either individually or in small groups, and provided feedback using conference call focus groups. Qualitative analysis of NA feedback showed that workplace relationship conflict stress was associated with workload and the absence of a forum for discussing relationship conflicts that was not acknowledged by NSs. This accessible e-learning program provides NAs with strategies for managing stressful emotions arising from workplace relationship conflict situations and underscores the importance of supervisory support and team collaboration in coping with emotionally evoked workplace stress. © The Author(s) 2014.

First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service.

PubMed

Pouliot, Katherine; Weisse, Carol S; Pratt, David S; DiSorbo, Philip

2017-03-01

There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District. This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P < .05) and stable symptom management over time. Fewer emergency department ( P < .001) and inpatient hospital admissions ( P < .001) occurred among enrollees while on the palliative care service. An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.

Pain management for older persons living in nursing homes: a pilot study.

PubMed

Tse, Mimi M Y; Ho, Suki S K

2013-06-01

Because the prevalence of chronic pain among the elderly in nursing homes is high and decreases their quality of life, effective nonpharmacologic pain management should be promoted. The purpose of this quasiexperimental pretest and posttest control design was to enhance pain management in nursing homes via an integrated pain management program (IPMP) for staff and residents. Nursing staff and residents from the experimental nursing home were invited to join the 8-week IPMP, whereas staff and residents from the control nursing home did not receive the IPMP. Baseline data were collected from nursing staff and residents in both groups before and after the IPMP. The IPMP consisted of eight lectures on pain assessment, drug knowledge,and nondrug strategies for the nursing staff, and 8 weeks of activities, including gardening therapy and physiotherapy exercise, for the residents. There were 48 and 42 older people in the experimental and control groups, respectively. No significant differences were found in their educational level, sleep quality, bowel habits, past and present health conditions, pain conditions and psychologic well-being parameters (p > .05) at baseline. After the IPMP, the experimental nursing staff showed a significant improvement in their knowledge of and attitudes to pain management (p < .05), and the experimental residents reported significantly lower pain scores and used more nondrug strategies for pain relief compared with the control group (p < .05). Moreover, the psychologic well-being parameters, including happiness, loneliness, life satisfaction, and geriatric depression, had significantly improved among the experimental residents (p < .05). The IPMP was effective in enhancing the knowledge and attitudes of nursing staff, as well as reducing pain conditions and enhancing psychologic well-being for older persons in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Saving our backs: safe patient handling and mobility for home care.

PubMed

Beauvais, Audrey; Frost, Lenore

2014-01-01

Predicted work-related injuries for nurses and home healthcare workers are on the rise given the many risk factors in the home environment and the escalating demands for home healthcare workers in the United States. Fortunately, safe patient handling and mobility programs can dramatically decrease injuries. Despite strides being made to promote safe patient handling and mobility programs in acute care, more can be done to establish such initiatives in the home care setting.

Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) Project.

PubMed

Ersek, Mary; Hickman, Susan E; Thomas, Anne C; Bernard, Brittany; Unroe, Kathleen T

2017-10-17

The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes. Published by Oxford University Press on behalf of The Gerontological Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Medicaid Home Care Services and Survival in New York City

ERIC Educational Resources Information Center

Albert, Steven M.; Simone, Bridget; Brassard, Andrea; Stern, Yaakov; Mayeux, Richard

2005-01-01

Purpose: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. Design and Methods: Administrative data from New York City's Medicaid…

Relationship between staff-reported culture change and occupancy rate and organizational commitment among nursing homes in South Korea.

PubMed

Lee, Minhong; Choi, Jae-Sung; Lim, Jinseop; Kim, Young Sun

2013-04-01

This study aims to examine culture change in nursing homes in South Korea and to identify the outcomes of culture change implementation. Data were taken from survey responses from 223 top- or mid-level staff among nursing homes in South Korea that were selected through a proportionate random-stratified sampling method from four regions nationwide. Culture change in nursing homes was operationalized by five person-directed care (PDC) constructs and three organizational environment constructs, and outcome quality was indicated by changes to occupancy rate and organizational commitment. After controlling for facility characteristics, the effect of staff-reported culture change on occupancy rate and organizational commitment was analyzed through the multiple-regression method. Consistent with previous research, this study revealed positive effects of culture change for nursing homes in South Korea. The study found that staff-reported culture change correlated with occupancy rate and organizational commitment. Given that culture change variables were significantly related to occupancy rate and organizational commitment, the findings of the study provide a persuasive argument that policies and/or programs to support culture change in nursing homes should be enhanced. Management-level workers in these facilities should have the skills and knowledge to foster more PDC and a more person-directed environment.

Cost Analysis of a Home-Based Nurse Care Coordination Program

PubMed Central

Marek, Karen Dorman; Stetzer, Frank; Adams, Scott J; Bub, Linda Denison; Schlidt, Andrea; Colorafi, Karen Jiggins

2014-01-01

Objectives To determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost. Design Randomized, controlled, three-arm longitudinal study. Setting Participant homes in a large Midwestern urban area. Participants Older adults identified as having difficulty managing their medications at discharge from Medicare Home Health Care (N = 414). Intervention A team consisting of advanced practice nurses (APNs) and registered nurses (RNs) coordinated care for two groups: home-based nurse care coordination (NCC) plus a pill organizer group and NCC plus a medication-dispensing machine group. Measurements To measure cost, participant claims data from 2005 to 2011 were retrieved from Medicare Part A and B Standard Analytical Files. Results Ordinary least squares regression with covariate adjustment was used to estimate monthly dollar savings. Total Medicare costs were $447 per month lower in the NCC plus pill organizer group (P = .11) than in a control group that received usual care. For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC plus pill organizer group (P = .06) than in the control group. The cost of the NCC plus pill organizer intervention was $151 per month, yielding a net savings of $296 per month or $3,552 per year. The cost of the NCC plus medication-dispensing machine intervention was $251 per month, and total Medicare costs were $409 higher per month than in the NCC plus pill organizer group. Conclusion Nurse care coordination plus a pill organizer is a cost-effective intervention for frail elderly Medicare beneficiaries. The addition of the medication machine did not enhance the cost effectiveness of the intervention. PMID:25482242

Depression training in nursing homes: lessons learned from a pilot study.

PubMed

Smith, Marianne; Stolder, Mary Ellen; Jaggers, Benjamin; Liu, Megan Fang; Haedtke, Chris

2013-02-01

Late-life depression is common among nursing home residents, but often is not addressed by nurses. Using a self-directed CD-based depression training program, this pilot study used mixed methods to assess feasibility issues, determine nurse perceptions of training, and evaluate depression-related outcomes among residents in usual care and training conditions. Of 58 nurses enrolled, 24 completed the training and gave it high ratings. Outcomes for 50 residents include statistically significant reductions in depression severity over time (p < 0.001) among all groups. Depression training is an important vehicle to improve depression recognition and daily nursing care, but diverse factors must be addressed to assure optimal outcomes.

Depression Training in Nursing Homes: Lessons Learned from a Pilot Study

PubMed Central

Smith, Marianne; Stolder, Mary Ellen; Jaggers, Benjamin; Liu, Megan; Haedke, Chris

2014-01-01

Late-life depression is common among nursing home residents, but often is not addressed by nurses. Using a self-directed, CD-based depression training program, this pilot study used mixed methods to assess feasibility issues, determine nurse perceptions of training, and evaluate depression-related outcomes among residents in usual care and training conditions. Of 58 nurses enrolled, 24 completed the training and gave it high ratings. Outcomes for 50 residents include statistically significant reductions in depression severity over time (p<0.001) among all groups. Depression training is an important vehicle to improve depression recognition and daily nursing care, but diverse factors must be addressed to assure optimal outcomes. PMID:23369120

Residents' engagement in everyday activities and its association with thriving in nursing homes.

PubMed

Björk, Sabine; Lindkvist, Marie; Wimo, Anders; Juthberg, Christina; Bergland, Ådel; Edvardsson, David

2017-08-01

To describe the prevalence of everyday activity engagement for older people in nursing homes and the extent to which engagement in everyday activities is associated with thriving. Research into residents' engagement in everyday activities in nursing homes has focused primarily on associations with quality of life and prevention and management of neuropsychiatric symptoms. However, the mere absence of symptoms does not necessarily guarantee experiences of well-being. The concept of thriving encapsulates and explores experiences of well-being in relation to the place where a person lives. A cross-sectional survey. A national survey of 172 Swedish nursing homes (2013-2014). Resident (n = 4831) symptoms, activities and thriving were assessed by staff using a study survey based on established questionnaires. Descriptive statistics, simple and multiple linear regression, and linear stepwise multiple regression were performed. The most commonly occurring everyday activities were receiving hugs and physical touch, talking to relatives/friends and receiving visitors, having conversation with staff not related to care and grooming. The least commonly occurring everyday activities were going to the cinema, participating in an educational program, visiting a restaurant and doing everyday chores. Positive associations were found between activity engagement and thriving, where engagement in an activity program, dressing nicely and spending time with someone the resident likes had the strongest positive association with resident thriving. Engagement in everyday activities can support personhood and thriving and can be conceptualized and implemented as nursing interventions to enable residents to thrive in nursing homes. © 2017 John Wiley & Sons Ltd.

Adult foster care for the elderly in Oregon: a mainstream alternative to nursing homes?

PubMed Central

Kane, R A; Kane, R L; Illston, L H; Nyman, J A; Finch, M D

1991-01-01

BACKGROUND. In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. METHODS. In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive cross-tabulations; hierarchial loglinear models for judging the effects of care setting and payment status on resident characteristics; and logit analyses for predicting care setting and payment status within care settings. RESULTS. On average, nursing home residents were more physically and cognitively impaired than AFC residents, but there was considerable overlap in patterns of frailty in the two settings. Medicaid AFC residents were less disabled than privately paying AFC residents. AFC residents reported more social activity, even when we controlled for disability status. AFC residents and their families were more likely to value privacy and homelike settings when choosing a care setting, whereas nursing home residents were more likely to value rehabilitation and organized activity programs. CONCLUSIONS. Both AFC and nursing homes are viable components of a long-term care repertoire. The greater disability levels of private-pay AFC residents refutes the criticisms that disabled Medicaid residents were being inappropriately channeled to AFC. PMID:1951820

Environment and quality of life: a reaction from the perspective of social science and environmental design.

PubMed

Grant, L A

1989-11-01

While it is a truism that nursing homes should reflect a homelike setting, relatively few nursing homes have been successful in avoiding a hospital-like image. In this reaction to the paper by Dr. Kayser-Jones, I have reviewed major theoretical models of how environment influences adaptation in the aged and presented some ways in which the nursing home environment can be modified. The delivery of long-term care services to the aged can be improved by addressing their physical, social, and psychological needs through better architectural and interior design, as well as efforts on the part of nursing professionals to ensure adequate patient care. Nurses can play a key role in the design process by assisting architects in programming buildings that meet the basic requirements for good patient care.

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.

Health Facilities: New York State's Oversight of Nursing Homes and Hospitals. Report to the Honorable Bill Green, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, New York, NY. Regional Office.

At the request of Congressman William Green, the General Accounting Office (GAO) evaluated the validity of allegations about deficiencies in the New York State Department of Health's nursing home and hospital inspection processes for certification for participation in the Medicare and Medicaid programs. Health Care Financing Administration and…

Adherence rates and health care costs in Crohn's disease patients receiving certolizumab pegol with and without home health nurse assistance: results from a retrospective analysis of patient claims and home health nurse data.

PubMed

Wolf, Douglas C; Jaganathan, Srihari; Burudpakdee, Chakkarin; Seetasith, Arpamas; Low, Robert; Lee, Edward; Gucky, Jay; Yassine, Mohamed; Schwartz, David A

2018-01-01

Patient support programs have a positive effect on adherence to therapy. Certolizumab pegol (CZP) is a tumor necrosis factor antagonist for the treatment of Crohn's disease. To assess, using real-world claims data, whether home health nurse assistance had an effect on patients' adherence to CZP and to measure its impact on health care use and costs. A retrospective analysis of medical and pharmacy claims data from the IQVIA Real-World Data Adjudicated Claims Database was conducted using data from January 1, 2007 through September 30, 2015. CZP patients with Crohn's disease were eligible to receive self-administration instructions from a nurse or nurse-administered CZP injections, or both. These services were provided by CIMplicity ® , a home health nurse program sponsored by UCB Pharma. Cohorts were based on patients with and without nurse assistance and were matched based on gender and categorical age. Adherence to CZP was determined using the medication possession ratio (MPR) and proportion of days covered (PDC). A Kaplan-Meier analysis was performed to compare time to discontinuation of CZP between the two cohorts. Multivariate regression analyses were performed, adjusting for additional covariates to compare the effect of CZP with and without nurse assistance on hospitalization and total health care costs. Patients with at least 12 months of continuous enrollment post-index date were evaluated for adherence to CZP (n=276 in each cohort). The mean and median PDC and MPR values were higher with nurse assistance than without. Time to discontinuation was significantly longer in patients who received CZP with nurse assistance than without ( P =0.0004). Results from the multivariate analyses showed a significant reduction in all-cause hospitalization (-55.8%; P =0.0026) and total health care costs (-14.3%; P =0.0045) with nurse assistance. This analysis suggests that home health nurse assistance increases adherence to CZP and reduces health care costs in patients with Crohn's disease.

The place of assisted living in long-term care and related service systems.

PubMed

Stone, Robyn I; Reinhard, Susan C

2007-01-01

The purpose of this article is to describe how assisted living (AL) fits with other long-term-care services. We analyzed the evolution of AL, including the populations served, the services offered, and federal and state policies that create various incentives or disincentives for using AL to replace other forms of care such as nursing home care or home care. Provider models that have emerged include independent senior housing with services, freestanding AL, nursing home expansion, and continuing care retirement communities. Some integrated health systems have also built AL into their array of services. Federal and state policy rules for financing and programs also shape AL, and states vary in how deliberately they try to create an array of options with specific roles for AL. Among state policies reviewed are reimbursement and rate-setting policies, admission and discharge criteria, and nurse practice policies that permit or prohibit various nursing tasks to be delegated in AL settings. Recent initiatives to increase flexible home care, such as nursing home transition programs, cash and counseling, and money-follows-the-person initiatives may influence the way AL emerges in a particular state. There is no single easy answer about the role of AL. To understand the current role and decide how to shape the future of AL, researchers need information systems that track the transitions individuals make during their long-term-care experiences along with information about the case-mix characteristics and service needs of the clientele.

Fire Safety in Nursing Facilities: Participant's Coursebook.

ERIC Educational Resources Information Center

Walker (Bonnie) and Associates, Inc., Crofton, MD.

Fewer people die in nursing facility fires than in fires occurring in other places where older people live. Fire remains, however, a significant threat in nursing facilities. This book is centered around six "modules" that present a fire safety training program for managers and staff in nursing homes. These modules present the following…

Predictors of acceptance of a postpartum public health nurse home visit: findings from an Ontario survey.

PubMed

Sword, Wendy A; Krueger, Paul D; Watt, M Susan

2006-01-01

To determine 1) rates of offer and uptake of a home visit provided through Ontario's universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit. Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge. Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation. The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.

76 FR 41032 - Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy Changes and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... practitioner or clinical nurse specialist (as those terms are defined in section 1861(aa)(5) of the Act) who is...-to-face encounter as a nurse practitioner or clinical nurse specialist, as those terms are defined in... following NPPs: A nurse practitioner or clinical nurse specialist (as those terms are defined in section...

Pediatric cardiac surgery Parent Education Discharge Instruction (PEDI) program: a pilot study.

PubMed

Staveski, Sandra L; Zhelva, Bistra; Paul, Reena; Conway, Rosalind; Carlson, Anna; Soma, Gouthami; Kools, Susan; Franck, Linda S

2015-01-01

In developing countries, more children with complex cardiac defects now receive treatment for their condition. For successful long-term outcomes, children also need skilled care at home after discharge. The Parent Education Discharge Instruction (PEDI) program was developed to educate nurses on the importance of discharge teaching and to provide them with a structured process for conducting parent teaching for home care of children after cardiac surgery. The aim of this pilot study was to generate preliminary data on the feasibility and acceptability of the nurse-led structured discharge program on an Indian pediatric cardiac surgery unit. A pre-/post-design was used. Questionnaires were used to evaluate role acceptability, nurse and parent knowledge of discharge content, and utility of training materials with 40 nurses and 20 parents. Retrospective audits of 50 patient medical records (25 pre and 25 post) were performed to evaluate discharge teaching documentation. Nurses' discharge knowledge increased from a mean of 81% to 96% (P = .001) after participation in the training. Nurses and parents reported high levels of satisfaction with the education materials (3.75-4 on a 4.00-point scale). Evidence of discharge teaching documentation in patient medical records improved from 48% (12 of 25 medical records) to 96% (24 of 25 medical records) six months after the implementation of the PEDI program. The structured nurse-led parent discharge teaching program demonstrated feasibility, acceptability, utility, and sustainability in the cardiac unit. Future studies are needed to examine nurse, parent, child, and organizational outcomes related to this expanded nursing role in resource-constrained environments. © The Author(s) 2014.

Patient preferences and willingness-to-pay for a home or clinic based program of chronic heart failure management: findings from the Which? trial.

PubMed

Whitty, Jennifer A; Stewart, Simon; Carrington, Melinda J; Calderone, Alicia; Marwick, Thomas; Horowitz, John D; Krum, Henry; Davidson, Patricia M; Macdonald, Peter S; Reid, Christopher; Scuffham, Paul A

2013-01-01

Beyond examining their overall cost-effectiveness and mechanisms of effect, it is important to understand patient preferences for the delivery of different modes of chronic heart failure management programs (CHF-MPs). We elicited patient preferences around the characteristics and willingness-to-pay (WTP) for a clinic or home-based CHF-MP. A Discrete Choice Experiment was completed by a sub-set of patients (n = 91) enrolled in the WHICH? trial comparing home versus clinic-based CHF-MP. Participants provided 5 choices between hypothetical clinic and home-based programs varying by frequency of nurse consultations, nurse continuity, patient costs, and availability of telephone or education support. Participants (aged 71±13 yrs, 72.5% male, 25.3% NYHA class III/IV) displayed two distinct preference classes. A latent class model of the choice data indicated 56% of participants preferred clinic delivery, access to group CHF education classes, and lower cost programs (p<0.05). The remainder preferred home-based CHF-MPs, monthly rather than weekly visits, and access to a phone advice service (p<0.05). Continuity of nurse contact was consistently important. No significant association was observed between program preference and participant allocation in the parent trial. WTP was estimated from the model and a dichotomous bidding technique. For those preferring clinic, estimated WTP was ≈AU$9-20 per visit; however for those preferring home-based programs, WTP varied widely (AU$15-105). Patient preferences for CHF-MPs were dichotomised between a home-based model which is more likely to suit older patients, those who live alone, and those with a lower household income; and a clinic-based model which is more likely to suit those who are more socially active and wealthier. To optimise the delivery of CHF-MPs, health care services should consider their patients' preferences when designing CHF-MPs.

Designing, testing, and implementing a sustainable nurse home visiting program: right@home.

PubMed

Goldfeld, Sharon; Price, Anna; Kemp, Lynn

2018-05-01

Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of The New York Academy of Sciences.

Annual Report of Indian Education in Montana. Johnson-O'Malley Activities, Fiscal Year 1975.

ERIC Educational Resources Information Center

Montana State Office of the Superintendent of Public Instruction, Helena.

In fiscal year 1975, Montana's Johnson-O'Malley (JOM) funds provided services for 6,869 eligible Indian students. JOM funds provided transportation, boarding homes, home-school coordinators, cultural enrichment programs, nurse coordinators, study centers, consultation service, writing projects, summer programs, special teachers, and workshops for…

Leveraging certified nursing assistant documentation and knowledge to improve clinical decision making: the on-time quality improvement program to prevent pressure ulcers.

PubMed

Sharkey, Siobhan; Hudak, Sandra; Horn, Susan D; Spector, William

2011-04-01

The goal of this article was to enhance understanding of the On-Time Quality Improvement for Long-term Care Program, a practical approach to embed health information technology into quality improvement in nursing homes that leverages certified nursing assistant documentation and knowledge, supports frontline clinical decision making, and establishes proactive intervention for pressure ulcer prevention.

SAIDO learning as a cognitive intervention for dementia care: a preliminary study.

PubMed

Kawashima, Ryuta; Hiller, Deborah Lewis; Sereda, Sheryl L; Antonczak, Michelle; Serger, Kara; Gannon, Denise; Ito, Shinji; Otake, Hiroshi; Yunomae, Daisaku; Kobayashi, Akihito; Muller, Christopher; Murata, Hiroyuki; FallCreek, Stephanie

2015-01-01

The purpose of this study was to examine the beneficial effects on cognitive function by a cognitive intervention program designed for dementia care called Learning Therapy in Japan and SAIDO Learning in the United States (hereinafter "SAIDO Learning," as appropriate). SAIDO Learning is a working memory training program that uses systematized basic problems in arithmetic and language, including reading aloud, as well as writing. Twenty-three nursing home residents with dementia were assigned as an intervention group, and another 24 people with dementia at another nursing home were assigned as a control group. Both nursing homes were operated by the same organization, and residents of both nursing homes received essentially the same nursing care. Thirteen and 6 subjects of the intervention and control groups, respectively, were clinically diagnosed as Alzheimer disease (AD). After the 6-month intervention, the participants with AD of the intervention group showed statistically significant improvement in cognitive function, as measured by the Mini-Mental State Examination (MMSE) compared with the control participants. In addition, post hoc analysis revealed that the Frontal Assessment Battery at Bedside (FAB) scores of the intervention group tended to improve after 6-month intervention. Based on MDS scores, improvements in total mood severity scores also were observed, but only in the intervention group of the participants with AD. These results suggest that SAIDO Learning is an effective cognitive intervention and is useful for dementia care. An additional outcome of this intervention, which has not yet been evaluated in detail, appears to be that it promotes greater positive engagement of a diversity of nursing home staff in the residents' individual progress and care needs. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Maintaining Continuity of Care for Nursing Home Residents: Effect of States’ Medicaid Bed-Hold Policies and Reimbursement Rates

PubMed Central

Intrator, Orna; Schleinitz, Mark; Grabowski, David C; Zinn, Jacqueline; Mor, Vincent

2009-01-01

Objective Recent public concern in response to states’ intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies. Data Sources/Study Design Minimum Data Set assessments of long-stay nursing home residents in April–June 2000 linked to Medicare claims enabled tracking residents’ hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics. Results Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52–0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer. Conclusions Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective. PMID:18783452

Enhancing knowledge and attitudes in pain management: a pain management education program for nursing home staff.

PubMed

Tse, Mimi Mun Yee; Ho, Suki S K

2014-03-01

The aim of the study was to examine the effectiveness of a pain management program (PMP) in enhancing the knowledge and attitudes of health care workers in pain management. Many nursing home residents suffer from pain, and treatment of pain is often inadequate. Failure of health care workers to assess pain and their insufficient knowledge of pain management are barriers to adequate treatment. It was a quasiexperimental pretest and posttest study. Four nursing homes were approached, and 88 staff joined the 8-week PMP. Demographics and the knowledge and attitudes regarding pain were collected with the use of the Nurse's Knowledge and Attitudes Survey Regarding Pain-Chinese version (NKASRP-C) before and after the PMP. A deficit in knowledge and attitudes related to pain management was prominent before the PMP, and there was a significant increase in pain knowledge and attitudes from 7.9 ± SD 3.52 to 19.2 ± SD4.4 (p < .05) after the 8-week PMP. A PMP can improve the knowledge and attitudes of nursing staff and enable them to provide adequate and appropriate care to older persons in pain. PMPs for nurses and all health care professionals are important in enhancing care for older adults and to inform policy on the provision of pain management. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

A mixed-method evaluation of a workforce development intervention for nursing assistants in nursing homes: the case of WIN A STEP UP.

PubMed

Morgan, Jennifer Craft; Konrad, Thomas R

2008-07-01

The purpose of this study was to evaluate WIN A STEP UP, a workforce development program for nursing assistants (NAs) in nursing homes (NHs) involving continuing education by onsite trainers, compensation for education modules, supervisory skills training of frontline supervisors, and short-term retention contracts for bonuses and/or wage increases upon completion. We collected longitudinal semistructured interview and survey data from NAs, supervisors, and managers at 8 program NHs and 10 comparison NHs. To control for selection bias, we matched 77 NA program participants to 81 participating site and 135 comparison site controls using propensity scores in a quasi-experimental design supplemented by qualitative assessments. Managers at seven of eight participating NHs wanted to repeat the program. At 3 months after baseline, participants differed from controls by having (a) more improved nursing care and supportive leadership scores, (b) greater improvement in team care, and (c) stronger ratings of career and financial rewards. Nurse supervisors participating in supervisory skills training reported positive changes in management practices for themselves and peers. Modest 3-month turnover reductions occurred in six settings where the program was fully implemented without incident. Managers', supervisors', and participating NAs' consistent perceptions of improved quality of care and job quality, along with a promise of increased retention, suggest that interventions like WIN A STEP UP are beneficial.

COSMOS--improving the quality of life in nursing home patients: protocol for an effectiveness-implementation cluster randomized clinical hybrid trial.

PubMed

Husebo, Bettina S; Flo, Elisabeth; Aarsland, Dag; Selbaek, Geir; Testad, Ingelin; Gulla, Christine; Aasmul, Irene; Ballard, Clive

2015-09-15

Nursing home patients have complex mental and physical health problems, disabilities and social needs, combined with widespread prescription of psychotropic drugs. Preservation of their quality of life is an important goal. This can only be achieved within nursing homes that offer competent clinical conditions of treatment and care. COmmunication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, Safety (COSMOS) is an effectiveness-implementation hybrid trial that combines and implements organization of activities evidence-based interventions to improve staff competence and thereby the patients' quality of life, mental health and safety. The aim of this paper is to describe the development, content and implementation process of the COSMOS trial. COSMOS includes a 2-month pilot study with 128 participants distributed among nine Norwegian nursing homes, and a 4-month multicenter, cluster randomized effectiveness-implementation clinical hybrid trial with follow-up at month 9, including 571 patients from 67 nursing home units (one unit defined as one cluster). Clusters are randomized to COSMOS intervention or current best practice (control group). The intervention group will receive a 2-day education program including written guidelines, repeated theoretical and practical training (credited education of caregivers, physicians and nursing home managers), case discussions and role play. The 1-day midway evaluation, information and interviews of nursing staff and a telephone hotline all support the implementation process. Outcome measures include quality of life in late-stage dementia, neuropsychiatric symptoms, activities of daily living, pain, depression, sleep, medication, cost-utility analysis, hospital admission and mortality. Despite complex medical and psychosocial challenges, nursing home patients are often treated by staff possessing low level skills, lacking education and in facilities with a high staff turnover. Implementation of a research-based multicomponent intervention may improve staff's knowledge and competence and consequently the quality of life of nursing home patients in general and people with dementia in particular. ClinicalTrials.gov NCT02238652.

Nurse Assistant Instructor Guide.

ERIC Educational Resources Information Center

Connecticut State Dept. of Education, Hartford. Div. of Vocational, Technical, and Adult Education.

This document is designed to assist the teacher in a nurse assistant certification program. The program is intended to prepare students for entry-level employment in a long-term care facility or with a licensed home health care agency. The 135-hour course teaches basic skills in patient care that will qualify the student to assist the licensed…

The success and repeal of the Medicare Catastrophic Coverage Act: a paradoxical lesson for health care reform.

PubMed

Aaronson, W E; Zinn, J S; Rosko, M D

1994-01-01

Congress intended the Medicare Catastrophic Coverage Act (MCCA) of 1988 to reduce the risk for illness-related catastrophic financial losses in the elderly. The act was short-lived, facing repeal just one year after passage. Many elderly persons were convinced that the costs of the program outweighed the benefits. However nursing home payment provisions of the MCCA may have affected out-of-pocket expenses paid by the elderly for long-term care more than consumers realized at the time of repeal. A transmittal memorandum, issued by the Health Care Financing Administration independent of Congressional action, enhanced consumers' ability to qualify for Medicare nursing home benefits. We investigated the effects of the Medicare policy change on nursing home payer mix and out-of-pocket expenses in 489 Pennsylvania nursing homes. We found that substantial shifts in payer mix from self-pay to Medicare payment sources occurred, reducing out-of-pocket expenses. Unfortunately the debate over the MCCA's repeal did not include discussion of the improved nursing home benefit structure. These findings, and the fate of the MCCA legislation, reinforce the importance of comprehensive information and clear communication in promoting health care reform.

A review of the present state and future policy alternatives for home visit nursing services in Korea.

PubMed

Lim, Ji Young; Noh, Wonjung; Kim, Eunjoo; Choi, Kyung Won

2014-01-01

The aim of this study was to describe the current state of home visit nursing services in the Korean context and to suggest future policy directions. First, the three home visit nursing services that have developed in Korea are compared using the analytic framework provided by Gilbert and Terrell in 2012. The framework is based on four dimensions of social welfare: users, services, source of funds, and service delivery process. Second, we perform a strength, weakness, opportunity, and threat analysis to suggest comprehensive and constructive home visit nursing service policies for the future. Specifically, we advocate the creation of an organization that steers the central government to operate an integrated management organization to distribute services and reduce redundancy for preventing the waste of both medical and state financial resources. This study also recommends the development of educational programs to improve the quality of services and service evaluation criteria for the objective assessment of those services. These policy guidelines may prove useful both for Korea and for other countries that intend to prepare or revise their home visit nursing service systems. © 2014 Wiley Periodicals, Inc.

76 FR 38342 - Medicare Program; Clinical Laboratory Fee Schedule: Signature on Requisition

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... cases, the physician may keep abreast of the patient's condition by calling the nursing staff. If a patient's condition indicates that a clinical diagnostic laboratory test is required, the nursing staff... signature on the requisition. Another example that occurs in many settings, including nursing homes, all...

76 FR 11187 - Due Date of Initial Application Requirements for State Home Construction Grant

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-01

..., Health professions, Health records, Homeless, Mental health programs, Nursing homes, Philippines... in constructing, remodeling, altering, or expanding State home facilities that will furnish specified... regulation. We note that the proposal does not otherwise expand the application requirements or in any way...

Clinical learning environment and supervision: experiences of Norwegian nursing students - a questionnaire survey.

PubMed

Skaalvik, Mari Wolff; Normann, Hans Ketil; Henriksen, Nils

2011-08-01

To measure nursing students' experiences and satisfaction with their clinical learning environments. The primary interest was to compare the results between students with respect to clinical practice in nursing homes and hospital wards. Clinical learning environments are important for the learning processes of nursing students and for preferences for future workplaces. Working with older people is the least preferred area of practice among nursing students in Norway. A cross-sectional design. A validated questionnaire was distributed to all nursing students from five non-randomly selected university colleges in Norway. A total of 511 nursing students completed a Norwegian version of the questionnaire, Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale in 2009. Data including descriptive statistics were analysed using the Statistical Program for the Social Sciences. Factor structure was analysed by principal component analysis. Differences across sub-groups were tested with chi-square tests and Mann-Whitney U test for categorical variables and t-tests for continuous variables. Ordinal logistic regression analysis of perceptions of the ward as a good learning environment was performed with supervisory relationships and institutional contexts as independent variables, controlling for age, sex and study year. The participating nursing students with clinical placements in nursing homes assessed their clinical learning environment significantly more negatively than those with hospital placements on nearby all sub-dimensions. The evidence found in this study indicates that measures should be taken to strengthen nursing homes as learning environments for nursing students. To recruit more graduated nurses to work in nursing homes, actions to improve the learning environment are needed. © 2011 Blackwell Publishing Ltd.

Integrating Behavioral Psychology Services into Adult Day Programming for Individuals with Dementia

ERIC Educational Resources Information Center

LeBlanc, Linda A.

2010-01-01

Many individuals with dementia and problem behavior are served in nursing home settings long before health issues necessitate constant medical care. Alternative community-based adult day health care programs allow individuals with dementia to remain in their home with their families at a substantially reduced cost; however, many adult day programs…

Eldercare. Technical Advisory Committee on Occupational Curriculum Development.

ERIC Educational Resources Information Center

Northern Montana Coll., Havre. Montana Center for Vocational Education, Research, Curriculum and Personnel Development.

This document contains the secondary education model curriculum for the secondary education preparation of home health aides in Montana. The document includes: (1) an introduction and a rationale for the program; (2) skills required by programs that meet certification requirements for a long-term care nurse aide (75 hours) and home health aide (an…

From Family Involvement to Family Inclusion in Nursing Home Settings: A Critical Interpretive Synthesis

PubMed Central

Puurveen, Gloria; Baumbusch, Jennifer; Gandhi, Preet

2018-01-01

The provision of care work by families plays an integral role in the quality of life of older adults living in a nursing home setting. This critical interpretive synthesis examines family members’ perceptions of their roles and responsibilities in nursing home settings and interrogates the structural and relational barriers and enablers to family involvement as they relate to fostering an inclusive environment. Electronic databases and published literature were searched for empirical studies that were conducted in a nursing home setting and described involvement from the perspective of family members. Thirty-two articles published between 2006 and 2016 were included in the review. Although involvement comprised a variety of roles and responsibilities, it was grounded in family–resident relationships, influenced by family–staff relationships, and deeply affected by broader sociopolitical factors. We conclude that involvement should be understood as a democratic process with supporting policies and programs to encourage family inclusion in facility life. PMID:29455580

Use of Quality Indicators in Nursing Homes in Victoria, Australia: A Cross-Sectional Descriptive Survey.

PubMed

Ibrahim, Joseph E; Chadwick, Liam; MacPhail, Aleece; McAuliffe, Linda; Koch, Susan; Wells, Yvonne

2014-08-01

This study aimed to characterize the use of mandated quality indicators (QIs) in public sector nursing homes by describing their adherence to established principles of measurement and whether nursing homes respond to QI data to improve care. Data were collected from a descriptive cross-sectional quantitative study using a confidential survey questionnaire distributed electronically to senior staff in all public sector nursing homes in Victoria, Australia. Staff from 113 of 196 facilities completed the survey (58%). Adherence to principles of measurement was suboptimal, with variation in applying QI definitions and infrequent random audits of data (n = 54, 48%). QI data triggered reviews of individual residents (62%-79%), staff practice (44%-65%), and systems of care (45%-55%). Most facilities (58%-75%) reported that beneficial changes in care occurred as a result of using QIs. QI performance data are positively received and used to improve care. Standardization of data collection, analysis, and reporting should strengthen the program's utility. © The Author(s) 2014.

Efficacy of a Transition Theory-Based Discharge Planning Program for Childhood Asthma Management.

PubMed

Ekim, Ayfer; Ocakci, Ayse Ferda

2016-02-01

This study tested the efficacy of a nurse-led discharge planning program for childhood asthma management, based on transition theory. A quasi-experimental design was used. The sample comprised 120 children with asthma and their parents (intervention group n = 60, control group n = 60). The asthma management self-efficacy perception level of parents in the intervention group increased significantly and the number of triggers their children were exposed to at home was reduced by 60.8%. The rates of admission to emergency departments and unscheduled outpatient visits were significantly lower in the intervention group compared with the control group. Transition theory-based nursing interventions can provide successful outcomes on childhood asthma management. Transition theory-based discharge planning program can guide nursing interventions to standardize care of the child with asthma. Combining care at home with hospital care strengthens ongoing qualified asthma management. © 2015 NANDA International, Inc.

How to Overcome Barriers and Establish a Successful Home HD Program

PubMed Central

Chan, Christopher; Blagg, Christopher; Lockridge, Robert; Golper, Thomas; Finkelstein, Fred; Shaffer, Rachel; Mehrotra, Rajnish

2012-01-01

Summary Home hemodialysis (HD) is an underused dialysis modality in the United States, even though it provides an efficient and probably cost-effective way to provide more frequent or longer dialysis. With the advent of newer home HD systems that are easier for patients to learn, use, and maintain, patient and provider interest in home HD is increasing. Although barriers for providers are similar to those for peritoneal dialysis, home HD requires more extensive patient training, nursing education, and infrastructure support in order to maintain a successful program. In addition, because many physicians and patients do not have experience with home HD, reluctance to start home HD programs is widespread. This in-depth review describes barriers to home HD, focusing on patients, individual physicians and practices, and dialysis facilities, and offers suggestions for how to overcome these barriers and establish a successful home HD program. PMID:23037981

Job control, work-family balance and nurses' intention to leave their profession and organization: A comparative cross-sectional survey.

PubMed

Yamaguchi, Yoshiko; Inoue, Takahiro; Harada, Hiroko; Oike, Miyako

2016-12-01

The shortage of nurses is a problem in many countries. In Japan, the distribution of nurses across different care settings is uneven: the shortage of nurses in home healthcare and nursing homes is more serious than in hospitals. Earlier research has identified numerous factors affecting nurses' intention to leave work (e.g., job control, family-related variables, work-family conflict); however, these factors' levels and effect size may vary between nurses in hospitals, home healthcare, and nursing homes. This study measured job control, family-related variables, and work-family conflict among nurses in hospitals, home healthcare, and nursing homes, and compared these variables' levels and effect size on nurses' intention to leave their organization or profession between these care settings. The research design was cross-sectional. Participating nurses from hospitals, home healthcare facilities, and nursing homes self-administered an anonymous questionnaire survey; nurses were recruited from the Kyushu district of Japan. Nurses from nine hospitals, 86 home healthcare offices, and 107 nursing homes participated. We measured nurses' intention to leave nursing or their organization, perceived job control, family variables and work-family conflict. We analyzed 1461 participants (response rate: 81.7%). The level of job control, family variables, and work-family conflict affecting nurses varied between hospitals, home healthcare, and nursing homes; additionally, these variables' effect on nurses' intention to leave their organization or profession varied between these care settings. Work-family conflict, family variables, and job control most strongly predicted nurses' intention to leave their organization or profession in hospitals, home healthcare, and nursing homes, respectively. Interventions aiming to increase nurse retention should distinguish between care settings. Regarding hospitals, reducing nurses' work-family conflict will increase nurse retention. Regarding home healthcare, allowing nurses to fulfill family responsibilities will increase nurse retention. Regarding nursing home nurses, increasing nurses' job control will increase nurse retention. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Understanding organizational and cultural premises for quality of care in nursing homes: an ethnographic study.

PubMed

Nakrem, Sigrid

2015-11-13

Internationally, there are concerns about the quality of care in nursing homes. The concept of 'corporate culture' as an internal variable could be seen as the means to improve quality of care and quality of life for the residents. The aim of this article was to describe the nursing home culture from the staff's perspective and to include how the residents describe quality of care. An ethnographic design was employed. A purposive sample of four municipal public nursing homes in Norway with long-term care residents was included in the study. Data were collected by participant observation including informal conversation with the staff, and in-depth interviews with 15 residents using a narrative approach. The main findings were that organizational cultures could be seen as relatively stable corporate cultures described as 'personalities' with characteristics that were common for all nursing homes (conformity) and typical traits that were present in some nursing homes, but that they were also like no other nursing home (distinctiveness). Conformity ('Every nursing home is like all other nursing homes') meant that nursing home organizations formed their services according to a perception of what residents in general need and expect. Trait ('Every nursing home is like some other nursing homes') expressed typologies of nursing homes: residency, medical, safeguard or family orientation. The distinctness of each nursing home ('Every nursing home is like no other nursing home') was expressed in unique features of the nursing home; the characteristics of the nursing home involved certain patterns of structure, cultural assumptions and interactions that were unique in each nursing home. Nursing home residents experienced quality of care as 'The nursing home as my home' and 'Interpersonal care quality'. The resident group in the different types of nursing homes were unique, and the experience of quality of care seemed to depend on whether their unique needs and expectations were met or not. In order to create a sustainable nursing home service the service needs to be characterized by learning and openness to change and must actually implement practices that respond to the resident and his or her family's values.

Cost analysis of a home-based nurse care coordination program.

PubMed

Marek, Karen Dorman; Stetzer, Frank; Adams, Scott J; Bub, Linda Denison; Schlidt, Andrea; Colorafi, Karen Jiggins

2014-12-01

To determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost. Randomized, controlled, three-arm longitudinal study. Participant homes in a large Midwestern urban area. Older adults identified as having difficulty managing their medications at discharge from Medicare Home Health Care (N = 414). A team consisting of advanced practice nurses (APNs) and registered nurses (RNs) coordinated care for two groups: home-based nurse care coordination (NCC) plus a pill organizer group and NCC plus a medication-dispensing machine group. To measure cost, participant claims data from 2005 to 2011 were retrieved from Medicare Part A and B Standard Analytical Files. Ordinary least squares regression with covariate adjustment was used to estimate monthly dollar savings. Total Medicare costs were $447 per month lower in the NCC plus pill organizer group (P = .11) than in a control group that received usual care. For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC plus pill organizer group (P = .06) than in the control group. The cost of the NCC plus pill organizer intervention was $151 per month, yielding a net savings of $296 per month or $3,552 per year. The cost of the NCC plus medication-dispensing machine intervention was $251 per month, and total Medicare costs were $409 higher per month than in the NCC plus pill organizer group. Nurse care coordination plus a pill organizer is a cost-effective intervention for frail elderly Medicare beneficiaries. The addition of the medication machine did not enhance the cost effectiveness of the intervention. © 2014 The Authors.The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

Improving the Quality of Nursing Documentation in Home Health Care Setting

ERIC Educational Resources Information Center

Obioma, Chidiadi

2017-01-01

Poor nursing documentation of patient care was identified in daily nurse visit notes in a health care setting. This problem affects effective communication of patient status with other clinicians, thereby jeopardizing clinical decision-making. The purpose of this evidence-based project was to determine the impact of a retraining program on the…

Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial green house program.

PubMed

Kane, Rosalie A; Lum, Terry Y; Cutler, Lois J; Degenholtz, Howard B; Yu, Tzy-Chyi

2007-06-01

To determine the effects of a small-house nursing home model, THE GREEN HOUSE (GH), on residents' reported outcomes and quality of care. Two-year longitudinal quasi-experimental study comparing GH residents with residents at two comparison sites using data collected at baseline and three follow-up intervals. Four 10-person GHs, the sponsoring nursing home for those GHs, and a traditional nursing home with the same owner. All residents in the GHs (40 at any time) at baseline and three 6-month follow-up intervals, and 40 randomly selected residents in each of the two comparison groups. The GH alters the physical scale environment (small-scale, private rooms and bathrooms, residential kitchen, dining room, and hearth), the staffing model for professional and certified nursing assistants, and the philosophy of care. Scales for 11 domains of resident quality of life, emotional well-being, satisfaction, self-reported health, and functional status were derived from interviews at four points in time. Quality of care was measured using indicators derived from Minimum Data Set assessments. Controlling for baseline characteristics (age, sex, activities of daily living, date of admission, and proxy interview status), statistically significant differences in self-reported dimensions of quality of life favored the GHs over one or both comparison groups. The quality of care in the GHs at least equaled, and for change in functional status exceeded, the comparison nursing homes. The GH is a promising model to improve quality of life for nursing home residents, with implications for staff development and medical director roles.

Training of medical staff positively influences postoperative pain management at home in children.

PubMed

Sepponen, K; Kokki, H; Ahonen, R

1999-08-01

The aim of this study was to describe how parents manage their child's postoperative pain at home following day-case surgery. The incidence of pain, different analgesics used and problems related to administering medications were the main interests of the study. A postal questionnaire was sent to the parents of 275 children who were under 8 years of age and had undergone an ear, nose and throat (ENT) day-case operation. The questionnaire was sent to the parents a week after discharge from hospital. Altogether, the parents of 227 children answered the questionnaire (response rate 83%). The study was divided into two phases (preintervention and postintervention), and incorporated a training program for doctors and nurses between these two phases. The training program aimed to improve the treatment practices of postoperative pain in children. Seventy-eight per cent of the children in the preintervention study and 75% in the postintervention study experienced at least mild pain after discharge. The training program for doctors and nurses affected the home treatment practices of postoperative pain. The proportion of parents treating their children increased from 68% to 80% after the training program (p = 0.028). Many parents faced problems while treating their children; for example, 19% (n = 30) of the children refused to take their medicine, and suppositories were regarded to be an especially unpleasant dosage form. However, no serious adverse effects were reported. We conclude that due to the pain experienced at home by the great majority of children following day-case ENT operations, parents need information on how to manage their child's pain. A training program for doctors and nurses can improve the treatment of children's pain even at home. Since some children dislike suppositories, it would be worth considering the use of small tablets or mixtures instead.

Appropriate prescribing in nursing homes demonstration project (APDP) study protocol: pragmatic, cluster-randomized trial and mixed methods process evaluation of an Ontario policy-maker initiative to improve appropriate prescribing of antipsychotics.

PubMed

Desveaux, Laura; Gomes, Tara; Tadrous, Mina; Jeffs, Lianne; Taljaard, Monica; Rogers, Jess; Bell, Chaim M; Ivers, Noah M

2016-03-29

Antipsychotic medications are routinely prescribed in nursing homes to address the behavioral and psychological symptoms of dementia. Unfortunately, inappropriate prescribing of antipsychotic medications is common and associated with increased morbidity, adverse drug events, and hospitalizations. Multifaceted interventions can achieve a 12-20 % reduction in antipsychotic prescribing levels in nursing homes. Effective interventions have featured educational outreach and ongoing performance feedback. This pragmatic, cluster-randomized control trial and embedded process evaluation seeks to determine the effect of adding academic detailing to audit and feedback on prescribing of antipsychotic medications in nursing homes, compared with audit and feedback alone. Nursing homes within pre-determined regions of Ontario, Canada, are eligible if they express an interest in the intervention. The academic detailing intervention will be delivered by registered health professionals following an intensive training program including relevant clinical issues and techniques to support health professional behavior change. Physicians in both groups will have the opportunity to access confidential reports summarizing their prescribing patterns for antipsychotics in comparison to the local and provincial average. Participating homes will be allocated to one of the two arms of the study (active/full intervention versus standard audit and feedback) in two waves, with a 2:1 allocation ratio. Homes will be randomized after stratifying for geography, baseline antipsychotic prescription rates, and size, to ensure a balance of characteristics. The primary outcome is antipsychotic dispensing in nursing homes, measured 6 months after allocation; secondary outcomes include clinical outcomes and healthcare utilization. Policy-makers and the public have taken note that antipsychotics are used in nursing homes in Ontario far more than other jurisdictions. Academic detailing can be an effective technique to address challenges in appropriate prescribing in nursing homes, but effect sizes vary widely. This opportunistic, policy-driven evaluation, embedded within a government-initiated demonstration project, was designed to ensure policy-makers receive the best evidence possible regarding whether and how to scale up the intervention. ClinicalTrials.gov NLM Identifier: NCT02604056 .

Caseload management skills for improved efficiency.

PubMed

Ervin, Naomi E

2008-03-01

This article provides information about caseload management, which was one of a group of six competencies identified by nurse administrators as needed by new baccalaureate graduates. Caseload management is an important skill for nurses who work with caseloads of patients or clients (e.g., home health nurses, public health nurses, case managers, ambulatory care nurses). Because inadequate information about caseload management is contained in community health nursing textbooks, continuing education and staff development programs need to include caseload management skills to improve the efficiency and quality of nursing care.

Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs.

PubMed

Halvorsen, Kjell H; Granas, Anne Gerd; Engeland, Anders; Ruths, Sabine

2012-09-01

To examine and compare the quality of drug prescribing for older patients in nursing homes and home nursing services. Cross-sectional study comprising 11,254 patients aged ≥ 65 years in nursing homes (n = 2986) and home nursing services (n = 8268). Potentially inappropriate medications were identified by using the Norwegian General Practice criteria and drug-drug interactions through a Norwegian Web-based tool. The impact of care setting on exposure to selected drug groups, potentially inappropriate medications, and drug interactions was calculated, adjusting for patients' age, gender, and number of drugs used. Patients in nursing homes and home nursing services used on average 5.7 (SD = 2.6) multidose dispensed regular drugs. Twenty-six percent used at least one potentially inappropriate medication, 31% in nursing homes and 25% in home nursing services, p < .001. Concomitant use of three or more psychotropic and/or opioid drugs was the criterion most commonly identified in nursing homes (18%) and home nursing services (9%), p < .001. Compared with nursing homes, more patients in home nursing services used cardiovascular drugs and fewer patients used psychotropic drugs. Altogether, 8615 drug-drug interactions were identified in 55% of patients, 48% in nursing homes and 57% in home nursing services, p < .001. There are significant differences in the quality of drug prescribing in nursing homes compared with home nursing services. Explanations as to why these differences exist need to be further explored. Copyright © 2011 John Wiley & Sons, Ltd.

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.

Pros and cons of using paid feeding assistants in nursing homes.

PubMed

Remsburg, Robin E

2004-01-01

Recently the Centers for Medicare and Medicaid Services (CMS), citing increasing resident acuity, staffing shortages, and high turnover rates that make it difficult for nursing homes to provide adequate feeding assistance to residents who need minimal help at mealtimes, began allowing nursing facilities to use single-task workers to provide assistance during mealtimes. This article describes the use of single-task workers to provide feeding assistance to nutritionally at-risk residents during a 6-month clinical study designed to evaluate the effectiveness and feasibility of implementing a buffet-dining program in an academic long-term care facility.

The effect of community health nurse home visit on self-care self-efficacy of the elderly living in selected Falavarjan villages in Iran in 2010.

PubMed

Hosseini, Habibollah; Torkani, Sara; Tavakol, Khosrow

2013-01-01

Perceived self-efficacy is a strong predictor for behavior. Considering the importance of health-promoting self-care behaviors in increasing quality of life in the elderly, this study was aimed at defining the effect of nurse home visits on self-care self-efficacy of the elderly in rural areas. This is a pre and post quasi-experimental study conducted on 33 older adults randomly selected from five villages in Falavarjan province in Iran. Intervention program was in the direction of self-care self-efficacy in four domains including nutrition, health practice, physical activity, and well-being in the form of five home visit programs and one group session by a nurse during 6 weeks, and included two different sections of education and nursing interventions administered based on needs assessment and determination of the tasks for the clients and their families. Theoretical framework of this study was supported by Bandura's self-efficacy, Orem's self-care theory, and Pender's revised health promotion model. The data were collected by self-care self-efficacy and demographic information questionnaire before and after the intervention. Data were analyzed by descriptive statistics and paired t-test. The mean elderly score in the four aforementioned domains increased after the home visit program. A significant difference was seen in the mean total scores of self-care self-efficacy and its subscales by paired t-test before and after intervention (P < 0.001). It was observed that home visit program, integrated with the theories, had a positive influence on improving self-care self-efficacy of the elderly, and was supported by Bandura's theory of self-efficacy suggesting four sources of performance accomplishment, vicarious experience, verbal persuasion, and emotional arousal. With regard to the importance of self-care behavior in health promotion of the elderly, multifaceted low-cost interventions with the highest effect seem essential.

The effect of community health nurse home visit on self-care self-efficacy of the elderly living in selected Falavarjan villages in Iran in 2010

PubMed Central

Hosseini, Habibollah; Torkani, Sara; Tavakol, Khosrow

2013-01-01

Background: Perceived self-efficacy is a strong predictor for behavior. Considering the importance of health-promoting self-care behaviors in increasing quality of life in the elderly, this study was aimed at defining the effect of nurse home visits on self-care self-efficacy of the elderly in rural areas. Materials and Methods: This is a pre and post quasi-experimental study conducted on 33 older adults randomly selected from five villages in Falavarjan province in Iran. Intervention program was in the direction of self-care self-efficacy in four domains including nutrition, health practice, physical activity, and well-being in the form of five home visit programs and one group session by a nurse during 6 weeks, and included two different sections of education and nursing interventions administered based on needs assessment and determination of the tasks for the clients and their families. Theoretical framework of this study was supported by Bandura's self-efficacy, Orem's self-care theory, and Pender's revised health promotion model. The data were collected by self-care self-efficacy and demographic information questionnaire before and after the intervention. Data were analyzed by descriptive statistics and paired t-test. Results: The mean elderly score in the four aforementioned domains increased after the home visit program. A significant difference was seen in the mean total scores of self-care self-efficacy and its subscales by paired t-test before and after intervention (P < 0.001). Conclusions: It was observed that home visit program, integrated with the theories, had a positive influence on improving self-care self-efficacy of the elderly, and was supported by Bandura's theory of self-efficacy suggesting four sources of performance accomplishment, vicarious experience, verbal persuasion, and emotional arousal. With regard to the importance of self-care behavior in health promotion of the elderly, multifaceted low-cost interventions with the highest effect seem essential. PMID:23983728

Changes in Depressive Symptoms, Social Support, and Loneliness Over 1 Year After a Minimum 3-Month Videoconference Program for Older Nursing Home Residents

PubMed Central

Tsai, Hsiu-Hsin

2011-01-01

Background A 3-month videoconference interaction program with family members has been shown to decrease depression and loneliness in nursing home residents. However, little is known about the long-term effects on residents’ depressive symptoms, social support, and loneliness. Objective The purpose of this longitudinal quasi-experimental study was to evaluate the long-term effectiveness of a videoconference intervention in improving nursing home residents’ social support, loneliness, and depressive status over 1 year. Methods We purposively sampled 16 nursing homes in various areas of Taiwan. Elderly residents (N = 90) of these nursing homes meeting our inclusion criteria were divided into an experimental (n = 40) and a comparison (n = 50) group. The experimental group received at least 5 minutes/week for 3 months of videoconference interaction with their family members in addition to usual family visits, and the comparison group received regular family visits only. Data were collected in face-to face interviews on social support, loneliness, and depressive status using the Social Support Behaviors Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at four times (baseline, 3 months, 6 months, and 12 months after baseline). Data were analyzed using the generalized estimating equation approach. Results After the videoconferencing program, participants in the experimental group had significantly lower mean change in instrumental social support scores at 6 months (–0.42, P = .03) and 12 months (–0.41, P = .03), and higher mean change in emotional social support at 3 (0.74, P < .001) and 12 months (0.61, P = .02), and in appraisal support at 3 months (0.74, P = .001) after adjusting for confounding variables. Participants in the experimental group also had significantly lower mean loneliness and depressive status scores at 3 months (–5.40, P < .001; –2.64, P < .001, respectively), 6 months (–6.47, P < .001; –4.33, P < .001), and 12 months (–6.27, P = .001; –4.40, P < .001) compared with baseline than those in the comparison group. Conclusion Our videoconference program had a long-term effect in alleviating depressive symptoms and loneliness for elderly residents in nursing homes. This intervention also improved long-term emotional social support and short-term appraisal support, and decreased residents’ instrumental social support. However, this intervention had no effect on informational social support. PMID:22086660

The Relative Benefits and Cost of Medicaid Home- and Community-Based Services in Florida

ERIC Educational Resources Information Center

Mitchell, Glenn, II; Salmon, Jennifer R.; Polivka, Larry; Soberon-Ferrer, Horacio

2006-01-01

Purpose: We compared inpatient days, nursing home days, and total Medicaid claims for five Medicaid-funded home- and community-based services (HCBS) programs for in-home and assisted living services in Florida. Design and Methods: We studied a single cohort of Medicaid enrollees in Florida aged 60 and older, who were enrolled for the first time in…

Does Nursing Facility Use of Habilitation Therapy Improve Performance on Quality Measures?

PubMed

Fitzler, Sandra; Raia, Paul; Buckley, Fredrick O; Wang, Mei

2016-12-01

The purpose of the project, Centers for Medicare & Medicaid Services (CMS) Innovation study, was to evaluate the impact on 12 quality measures including 10 Minimum Data Set (MDS) publicly reported measures and 2 nursing home process measures using habilitation therapy techniques and a behavior team to manage dementia-related behaviors. A prospective design was used to assess the changes in the measures. A total of 30 Massachusetts nursing homes participated in the project over a 12-month period. Project participation required the creation of an interdisciplinary behavior team, habilitation therapy training, facility visit by the program coordinator, attendance at bimonthly support and sharing calls, and monthly collection of process measure data. Participating facilities showed improvement in 9 of the 12 reported measures. Findings indicate potential quality improvement in having nursing homes learn habilitation therapy techniques and know how to use the interdisciplinary team to manage problem behaviors. © The Author(s) 2016.

Identifying Care Coordination Interventions Provided to Community-Dwelling Older Adults Using Electronic Health Records

PubMed Central

Kim, Tae Youn; Marek, Karen D.; Coenen, Amy

2016-01-01

Although care coordination is a popular intervention, there is no standard method of delivery. Also little is known about who most benefits or characteristics that predict the amount of care coordination needed, especially with chronically ill older adults. The purpose of this study was to identify types and amount of nurse care coordination interventions provided to 231 chronically ill older adults who participated in a 12-month home care medication management program in the Midwestern. For each participant, the nurse care coordinator spent an average of 134 minutes/month providing in-person home care, 48 minutes/month of travel, and 18 minutes/month of indirect care occurring outside the home visit. This accounted for 67.2%, 23.8%, and 9.0% of nursing time respectively for home visits, travel, and indirect care. Four of 11 nursing interventions focused on medication management were provided to all participants. Seven of the 11 main interventions were individualized according to each person’s special needs. Wide variations were observed in time provided with in-person home care and communications with multiple stakeholders. Study findings indicate the importance of individualizing interventions and the variability in the amount of nursing time needed to provide care coordination to chronically ill older adults. PMID:26985762

Association between Traditional Nursing Home Quality Measures and Two Sources of Nursing Home Complaints

PubMed Central

Troyer, Jennifer L; Sause, Wendy

2013-01-01

Objective To test for an association between traditional nursing home quality measures and two sources of resident- and caregiver-derived nursing home complaints. Data Sources Nursing home complaints to the North Carolina Long-Term Care Ombudsman Program and state certification agency from October 2002 through September 2006 were matched with Online Survey Certification and Reporting data and Minimum Data Set Quality Indicators (MDS-QIs). Study Design We examine the association between the number of complaints filed against a facility and measures of inspection violations, staffing levels, and MDS-QIs. Data Extraction One observation per facility per quarter is constructed by matching quarterly data on complaints to OSCAR data from the same or most recent prior quarter and to MDS-QIs from the same quarter. One observation per inspection is obtained by matching OSCAR data to complaint totals from both the same and the immediate prior quarter. Principal Findings There is little relationship between MDS-QIs and complaints. Ombudsman complaints and inspection violations are generally unrelated, but there is a positive relationship between state certification agency complaints and inspection violations. Conclusions Ombudsman and state certification agency complaint data are resident- and caregiver-derived quality measures that are distinctive from and complement traditional quality measures. PMID:23216541

Randomized controlled resistance training based physical activity trial for central European nursing home residing older adults.

PubMed

Barthalos, Istvan; Dorgo, Sandor; Kopkáné Plachy, Judit; Szakály, Zsolt; Ihász, Ferenc; Ráczné Németh, Teodóra; Bognár, József

2016-10-01

Nursing home residing older adults often experience fear of sickness or death, functional impairment and pain. It is difficult for these older adults to maintain a physically active lifestyle and to keep a positive outlook on life. This study evaluated the changes in quality of life, attitude to aging, assertiveness, physical fitness and body composition of nursing home residing elderly through a 15-week organized resistance training based physical activity program. Inactive older adults living in a state financed nursing home (N.=45) were randomly divided into two intervention groups and a control group. Both intervention groups were assigned to two physical activity sessions a week, but one of these groups also had weekly discussions on health and quality of life (Mental group). Data on anthropometric measures, fitness performance, as well as quality of life and attitudes to aging survey data were collected. Due to low attendance rate 12 subjects were excluded from the analyses. Statistical analysis included Paired Samples t-tests and Repeated Measures Analysis of Variance. Both intervention groups significantly improved their social participation, and their upper- and lower-body strength scores. Also, subjects in the Mental group showed improvement in agility fitness test and certain survey scales. No positive changes were detected in attitude towards aging and body composition measures in any groups. The post-hoc results suggest that Mental group improved significantly more than the Control group. Regular physical activity with discussions on health and quality of life made a more meaningful difference for the older adults living in nursing home than physical activity alone. Due to the fact that all participants were influenced by the program, it is suggested to further explore this area for better understanding of enhanced quality of life.

Maternal Jail Time, Conviction, and Arrest as Predictors of Children's 15-Year Antisocial Outcomes in the Context of a Nurse Home Visiting Program

ERIC Educational Resources Information Center

Shlafer, Rebecca J.; Poehlmann, Julie; Donelan-McCall, Nancy

2012-01-01

Data from the Nurse-Family Partnership intervention program were analyzed to compare the "selection" versus "unique" effects of maternal jail time on adolescent antisocial and health risk outcomes. Data from 320 women and their firstborn children were available from the prenatal, birth, and 15-year assessments. Consistent with…

Emergency Department Visits by Nursing Home Residents in the United States

PubMed Central

Wang, Henry E.; Shah, Manish N.; Allman, Richard M.; Kilgore, Meredith

2012-01-01

BACKGROUND/OBJECTIVES The Emergency Department (ED) is an important source of health care for nursing home residents. The objective of this study was to characterize ED use by nursing home residents in the United States (US). DESIGN Analysis of the National Hospital Ambulatory Medical Care Survey SETTING US Emergency Departments, 2005-2008 PARTICIPANTS Individuals visiting US EDs, stratified by nursing home and non-nursing home residents. INTERVENTIONS None MEASUREMENTS We identified all ED visits by nursing home residents. We contrasted the demographic and clinical characteristics between nursing home residents and non-nursing home residents. We also compared ED resource utilization, length of stay and outcomes. RESULTS During 2005-2008, nursing home residents accounted for 9,104,735 of 475,077,828 US ED visits (1.9%; 95% CI: 1.8-2.1%). The annualized number of ED visits by nursing home residents was 2,276,184. Most nursing home residents were elderly (mean 76.7 years, 95% CI: 75.8-77.5), female (63.3%), and non-Hispanic White (74.8%). Compared with non-nursing home residents, nursing home residents were more likely have been discharged from the hospital in the prior seven days (adjusted OR 1.4, 95% CI: 1.1-1.9). Nursing home residents were more likely to present with fever (adjusted OR 1.9; 95% CI: 1.5-2.4) or hypotension (systolic blood pressure ≤90 mm Hg, OR 1.8; 95% CI: 1.5-2.2). Nursing home patients were more likely to receive diagnostic test, imaging and procedures in the ED. Almost half of nursing home residents visiting the ED were admitted to the hospital. Compared with non-nursing home residents, nursing home residents were more likely to be admitted to the hospital (adjusted OR 1.8; 95% CI 1.6-2.1) and to die (adjusted OR 2.3; 95% CI 1.6-3.3). CONCLUSIONS Nursing home residents account for over 2.2 million ED visits annually in the US. Compared with other ED patients, nursing home residents have higher medical acuity and complexity. These observations highlight the national challenges of organizing and delivering ED care to nursing home residents in the US. PMID:22091500

76 FR 5755 - Medicare and Medicaid Programs; Patient Notification of Right To Access State Survey Agencies and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

... skilled nursing care and related services to residents that require medical or nursing care or... primarily engaged in providing to residents: Skilled nursing care and related services for residents who... provided home health services to 3.2 million patients nationwide in FY 2006. The effective delivery of...

Long-term care: a substantive factor in financial planning.

PubMed

Willis, D A

2000-01-01

More than 50 percent of women will enter a nursing home at some point in their lives. About one-third of men living to age 65 will also need nursing home care. Planning for long-term care is even more important since Medicare covers very little of the cost of such care. The Indiana Partnership Plan is one program designed to help fund the long-term care costs while allowing individuals protect other financial assets.

Effects of a Peer-Led Pain Management Program for Nursing Home Residents with Chronic Pain: A Pilot Study.

PubMed

Tse, Mimi Mun Yee; Yeung, Suey Shuk Yu; Lee, Paul Hong; Ng, Shamay Sheung Mei

2016-09-01

OBJECTIVES : To examine the feasibility of a peer-led pain management program among nursing home residents. DESIGN : A quasi-experimental design. SETTING : Two nursing homes. SUBJECTS : Fifty nursing home residents. METHODS : The experimental group (n = 32) was given a 12-week group-based peer-led pain management program. There were two 1-hour sessions per week. Education in pain and demonstrations of nonpharmacological pain management strategies were provided. The research team and 12 trained peers led the sessions. The control group (n = 18) received one 1-hour session of pain management program each week over 12 weeks from the research team only. Outcome measures for the participants were collected at baseline (P1) and at week 12 (P2). Data from peer volunteers were collected prior to training (V1) and at week 12 (V2). T-tests were used to compare the differences in outcome measures collected at two time points. RESULTS : There was a significant reduction in pain intensity from 5.8 ± 2.6 (P1) to 3.4 ± 2.5 (P2) for the experimental group (p = 0.003) and from 6.3 ± 3.0 (P1) to 3.1 ± 2.4 (P2) for the control group (p = 0.001). Activities of daily living significantly improved for both the experimental group (p = 0.008) and the control group (p = 0.014). There was an enhancement in happiness level for the experimental group (p < 0.001), while the loneliness level dropped significantly for the experimental group (p < 0.001) and the control group (p = 0.031). The peer volunteers showed a significant increase in self-rated pain management knowledge (2.9 ± 2.6 to 8.1 ± 1.2, p < 0.001) and self-efficacy in volunteering (5.8 ± 2.9 to 8.3 ± 1.5, p = 0.032). CONCLUSION : The peer-led pain management program was feasible and has potential in relieving chronic pain and enhancing the physical and psychological health of nursing home residents. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Symbiotic and synergistic community-based volunteer home visiting program for postpartum families.

PubMed

Misener, T R; Knox, P D

1990-09-01

Community health nurses who focus on the needs of the community as client, and not simply individual and family services, are aware of the demand for increased services. This demand, however, is usually coupled with the absence of resources to deliver the needed services. Therefore, leaders in community agencies must consider attracting nurses as volunteers to augment resources. Volunteer service can be highly synergistic when a symbiotic relationship exists between the agency and the volunteer. A one-year volunteer home visiting program was developed to provide services to families with new infants at one U.S. Army installation in the western United States. We assume the program methodology would be successful in civilian communities as well as other client populations.

Animal assisted therapy and perception of loneliness in geriatric nursing home residents.

PubMed

Vrbanac, Zoran; Zecević, Iva; Ljubić, Marijana; Belić, Maja; Stanin, Damir; Bottegaro, Nika Brkljaca; Jurkić, Gabrijela; Skrlin, Branimir; Bedrica, Ljiljana; Zubcić, Damir

2013-09-01

Use of animals for therapeutic purposes, animal assisted therapy or AAT is a method for improving quality of life for long-term inpatients. The object of this paper was to evaluate dog companionship as a form of AAT and its effects on perception of loneliness in geriatric nursing home residents. The participants were involved in a six-month program of dog companionship three times weekly for 90 minutes. There were 21 residents included in the program, with a mean age of 80 years. Loneliness was measured by the short version of the UCLA Scale of loneliness. Comparison of test results before and after participation in the program showed that dog companionship reduces the perception of loneliness.

Outsourcing veterans for long-term care: comparison of community and state veterans' nursing homes.

PubMed

Laberge, Alexandre; Weech-Maldonado, Robert; Johnson, Christopher E; Jia, Huanguang; Dewald, Lloyd

2008-01-01

This study compares the characteristics of state veterans' nursing homes and community nursing homes with VA per-diem residentes between 1999 - 2002. A structure, process, and outcome model was used to examine whether there was any difference in the multi-dimensional quality measures among the three types of community nursing homes (for profit, not-for-profit, and government) and state veterans' nursing homes. For profit community nursing homes were less likely to achieve nurse staffing standards while government facilities were more likely to achieve CNA staffing standards when compared to the state veterans' homes. All community nursing homes had a lower prevelance of tube feeds and catheterization when compared to state veterans' nursing homes. Only government community nursing homes had significantly lower quality of life deficiencies and pressure sore prevelance when compared to state veterans' nursing homes. Vigilant monitoring of all long-term care facilities utilized by veterans is needed.

Nursing Homes

MedlinePlus

... our e-newsletter! Aging & Health A to Z Nursing Homes Basic Facts & Information Nursing homes have changed ... guide care in nursing homes. Who lives in nursing homes? Almost half of all people who live ...

24 CFR 882.401 - Eligible properties.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) Ineligible properties. (1) Nursing homes, units within the grounds of penal, reformatory, medical, mental and similar public or private institutions, and facilities providing continual psychiatric, medical or nursing... State or unit of general local government is not eligible for assistance under this program. (3) High...

24 CFR 882.401 - Eligible properties.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) Ineligible properties. (1) Nursing homes, units within the grounds of penal, reformatory, medical, mental and similar public or private institutions, and facilities providing continual psychiatric, medical or nursing... State or unit of general local government is not eligible for assistance under this program. (3) High...

24 CFR 882.401 - Eligible properties.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) Ineligible properties. (1) Nursing homes, units within the grounds of penal, reformatory, medical, mental and similar public or private institutions, and facilities providing continual psychiatric, medical or nursing... State or unit of general local government is not eligible for assistance under this program. (3) High...

24 CFR 882.401 - Eligible properties.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Ineligible properties. (1) Nursing homes, units within the grounds of penal, reformatory, medical, mental and similar public or private institutions, and facilities providing continual psychiatric, medical or nursing... State or unit of general local government is not eligible for assistance under this program. (3) High...

Effects of nurse home-visiting on maternal life course and child development: age 6 follow-up results of a randomized trial.

PubMed

Olds, David L; Kitzman, Harriet; Cole, Robert; Robinson, JoAnn; Sidora, Kimberly; Luckey, Dennis W; Henderson, Charles R; Hanks, Carole; Bondy, Jessica; Holmberg, John

2004-12-01

To test, with an urban, primarily black sample, the effects of prenatal and infancy home visits by nurses on mothers' fertility and economic self-sufficiency and the academic and behavioral adjustment of their children as the children finished kindergarten, near their sixth birthday. We conducted a randomized, controlled trial of a program of prenatal and infancy home-visiting in a public system of obstetric and pediatric care in Memphis, Tennessee. A total of 743 primarily black women at <29 weeks of gestation, with no previous live births and with > or =2 sociodemographic risk characteristics (unmarried, <12 years of education, or unemployed), were randomly assigned to receive nurse home visits or comparison services. Outcomes consisted of women's number and timing of subsequent pregnancies, months of employment, use of welfare, food stamps, and Medicaid, educational achievement, behavioral problems attributable to the use of substances, rates of marriage and cohabitation, and duration of relationships with partners and their children's behavior problems, responses to story stems, intellectual functioning, receptive language, and academic achievement. In contrast to counterparts assigned to the comparison group, women visited by nurses had fewer subsequent pregnancies and births (1.16 vs 1.38 pregnancies and 1.08 vs 1.28 births, respectively), longer intervals between births of the first and second children (34.28 vs 30.23 months), longer relationships with current partners (54.36 vs 45.00 months), and, since the previous follow-up evaluation at 4.5 years, fewer months of using welfare (7.21 vs 8.96 months) and food stamps (9.67 vs 11.50 months). Nurse-visited children were more likely to have been enrolled in formal out-of-home care between 2 and 4.5 years of age (82.0% vs 74.9%). Children visited by nurses demonstrated higher intellectual functioning and receptive vocabulary scores (scores of 92.34 vs 90.24 and 84.32 vs 82.13, respectively) and fewer behavior problems in the borderline or clinical range (1.8% vs 5.4%). Nurse-visited children born to mothers with low levels of psychologic resources had higher arithmetic achievement test scores (score of 88.61 vs 85.42) and expressed less aggression (score of 98.58 vs 101.10) and incoherence (score of 20.90 vs 29.84) in response to story stems. There were no statistically significant program effects on women's education, duration of employment, rates of marriage, being in a partnered relationship, living with the father of the child, or domestic violence, current partner's educational level, or behavioral problems attributable to the use of alcohol or drugs. This program of prenatal and infancy home-visiting by nurses continued to improve the lives of women and children at child age 6 years, 4 years after the program ended.

Restructuring in response to case mix reimbursement in nursing homes: A contingency approach

PubMed Central

Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

2013-01-01

Background Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. Purpose The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. Methodology/Approach The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Findings Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Practice Implications Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring. PMID:18360162

Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

PubMed

Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

2008-01-01

Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring.

Evaluation of a caregiver education program to support memory and communication in dementia: a controlled pretest-posttest study with nursing home staff.

PubMed

Broughton, Megan; Smith, Erin R; Baker, Rosemary; Angwin, Anthony J; Pachana, Nancy A; Copland, David A; Humphreys, Michael S; Gallois, Cindy; Byrne, Gerard J; Chenery, Helen J

2011-11-01

There is a need for simple multimedia training programs designed to upskill the dementia care workforce. A DVD-based training program entitled RECAPS and MESSAGE has been designed to provide caregivers with strategies to support memory and communication in people with dementia. The aims of this study were: (1) to evaluate the effects of the RECAPS and MESSAGE training on knowledge of support strategies, and caregiver satisfaction, in nursing home care staff, and (2) to evaluate staff opinion of the training. A multi-centre controlled pretest-posttest trial was conducted between June 2009 and January 2010, with baseline, immediately post-training and 3-month follow-up assessment. Four nursing homes in Queensland, Australia. All care staff were invited to participate. Of the 68 participants who entered the study, 52 (37 training participants and 15 controls) completed outcome measures at baseline and 3-month follow-up. 63.5% of participants were nursing assistants, 25% were qualified nurses and 11.5% were recreational/activities officers. The training and control groups were compared on the following outcomes: (1) knowledge of memory and communication support strategies, and (2) caregiver satisfaction. In the training group, the immediate effects of training on knowledge, and the effects of role (nurse, nursing assistant, recreational staff) on both outcome measures, were also examined. Staff opinion of the training was assessed immediately post-training and at 3-month follow-up. The training group showed a significant improvement in knowledge of support strategies from baseline to immediately post-training (p=0.001). Comparison of the training and control groups revealed a significant increase in knowledge for the training group (p=0.011), but not for the control group (p=0.33), between baseline and 3-month follow-up. Examination of caregiver satisfaction by care staff role in the training group revealed that only the qualified nurses showed higher levels of caregiver satisfaction at 3-month follow-up (p=0.013). Staff rated the training positively both for usefulness and applicability. The RECAPS and MESSAGE training improved nursing home care staff's knowledge of support strategies for memory and communication, and gains were maintained at 3-month follow-up. Moreover, the training was well received by staff. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Children of Aged Parents: A Self Help Network.

ERIC Educational Resources Information Center

Pierskalla, Carol S.

This paper describes a program providing support, education, and skill-building within a self-help format for the children of aged parents. The selection of the 18 initial program members, each with relatives living either in their homes, in a nearby location, or in nursing homes is reviewed. The 90-minute group sessions which met weekly for 8…

Intergenerational Education: Young and Old Learning Together.

ERIC Educational Resources Information Center

Ginnane, Patrick

A compilation of descriptions of 8 intergenerational educational programs, this report emphasizes the positive relationship between children and older people. These programs were selected to highlight differing program components, administrative structures, and funding bases. Two programs involve children visiting nursing homes. Elders work in…

Interaction effect of Medicaid census and nursing home characteristics on quality of psychosocial care for residents.

PubMed

Kang-Yi, Christina D; Mandell, David S; Mui, Ada C; Castle, Nicholas G

2011-01-01

Numerous studies have identified disparities in nursing home quality of care. Although previous studies have found the overlap among Medicaid census, nursing home characteristics, and negative quality of care outcomes, few studies have examined how the psychosocial well-being of nursing home residents is associated with Medicaid census and other nursing home characteristics. The purpose of this study was to elucidate the intertwined relationships between Medicaid census and other important nursing home factors and its impact on psychosocial care for residents. This study examined the interactive effects of (1) nursing home ownership status and Medicaid census, (2) staffing level and Medicaid census, and (3) resident ethnic mix and Medicaid census on psychosocial well-being outcomes. The sample, derived from a combined data set of New York State nursing homes' Online Survey Certification and Reporting System and Minimum Data Set, included 565 nursing homes in rural and urban areas of the state. Medicaid census had no main effect on psychosocial well-being outcomes of nursing home care but had a significant interactive effect with other nursing home characteristics. High Medicaid census was associated with lower level of psychosocial symptom detection in nonprofit nursing homes and nursing homes with a higher proportion of ethnic minority residents. Nursing staff training on better psychosocial well-being care, in particular, better psychosocial assessment, is important. To obtain the training resources, nursing homes with high Medicaid census can collaborate with other nursing homes or social service agencies. Considering that nursing homes with a high proportion of ethnic minority residents have lower level of detection rate for psychosocial well-being issues, culturally competent care should be a component of quality improvement plans.

SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.

PubMed

Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson

2016-01-01

The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.

Communication and effectiveness in a US nursing home quality-improvement collaborative.

PubMed

Arling, Priscilla A; Abrahamson, Kathleen; Miech, Edward J; Inui, Thomas S; Arling, Greg

2014-09-01

In this study, we explored the relationship between changes in resident health outcomes, practitioner communication patterns, and practitioner perceptions of group effectiveness within a quality-improvement collaborative of nursing home clinicians. Survey and interview data were collected from nursing home clinicians participating in a quality-improvement collaborative. Quality-improvement outcomes were evaluated using US Federal and State minimum dataset measures. Models were specified evaluating the relationships between resident outcomes, staff perceptions of communication patterns, and staff perceptions of collaborative effectiveness. Interview data provided deeper understanding of the quantitative findings. Reductions in fall rates were highest in facilities where respondents experienced the highest levels of communication with collaborative members outside of scheduled meetings, and where respondents perceived that the collaborative kept them informed and provided new ideas. Clinicians observed that participation in a quality-improvement collaborative positively influenced the ability to share innovative ideas and expand the quality-improvement program within their nursing home. For practitioners, a high level of communication, both inside and outside of meetings, was key to making measurable gains in resident health outcomes. © 2013 Wiley Publishing Asia Pty Ltd.

The development of an ergonomics training program to identify, evaluate, and control musculoskeletal disorders among nursing assistants at a state-run veterans' home.

PubMed

Peterson, Erica L; McGlothlin, James D; Blue, Carolyn L

2004-01-01

Nursing assistants (NAs) who work in nursing and personal care facilities are twice and five times more likely, respectively, to suffer a musculoskeletal disorder compared to service industries and other health care facilities, respectively. The purpose of this study was to develop an ergonomics training program for selected NAs at a state-run veterans' home to decrease musculoskeletal disorders by 1) developing questionnaires to assess musculoskeletal stress, 2) evaluating the work environment, 3) developing and using a training package, and 4) determining the application of the information from the training package by NAs on the floor. Results show two new risk factors not previously identified for nursing personnel in the peer-reviewed literature. Quizzes given to the nursing personnel before and after training indicated a significant improvement in understanding the principles of ergonomics and patient-handling techniques. Statistical analysis comparing the pre-training and post-training questionnaires indicated no significant decrease in musculoskeletal risk factors and no significant reduction in pain or discomfort or overall mental or physical health.

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 ...

[Exposure to aggressive patient behaviour and its' association with the nurses' "work ability" in Germany].

PubMed

Galatsch, Michael; Iskenius, Mario; Schlarmann, Jörg Grosse; Schmidt, Sascha G; Müller, Bernd Hans; Hasselhorn, Hans Martin

2013-11-01

Aggressive behavior and violence in patients, residents or clients are growing challenges in nursing. Aggressive behavior can have both, physical and psychological consequences for nurses and can lead to a reduced performance at work, demotivation, sickness absence and the premature exit from the nursing profession. To develop purposive strategies and to deal with aggressive behavior and health promotion programs, it is crucial to know more about the prevalence of aggressive behavior from patients and the effect on the work ability of nurses in different types of institutions. Data of 1735 German nurses was derived from the European NEXT-Study. Description and analysis of variance for each working area (hospital ward, Intensive Care Unit, psychiatric ward, nursing home and home care) were conducted. The work ability was measured with the Work Ability Index (WAI). The aggressive behavior was measured by one item developed by the NEXT Study Group. Linear regression models were applied to analyze the effect of aggressive behavior on the work ability of nurses in a comparison of the five different working areas. A total of 84.9 percent of the nurses were "sometimes" or "often/always" confronted with aggressive behavior from patients. In the comparison of the five working areas, nurses were exposed to different levels of aggressive behavior, while differences in the work ability of nurses were also observed. It was found that aggressive behavior from patients was associated with reduced work ability in nurses working in hospital wards, nursing homes and home care, but not nurses working in ICUs and psychiatric wards. The findings indicate that many nurses in Germany are exposed to aggressive behavior from patients, which has negative effect on the nurses' work ability. However, it is assumed that strategies to deal with aggressive behavior could play a buffer role between aggressive behavior and work ability of nurses, highlighting one possibility of intervention in future.

Health care and social service professionals' perceptions of a home-visit program for young, first-time mothers.

PubMed

Li, S A; Jack, S M; Gonzalez, A; Duku, E; MacMillan, H L

2015-01-01

Little is known about health care and social service professionals' perspective on the acceptability of long-term home-visit programs serving low-income, first-time mothers. This study describes the experiences and perspectives of these community care providers involved with program referrals or service delivery to mothers who participated in the Nurse-Family Partnership (NFP), a targeted nurse home-visit program. The study included two phases. Phase I was a secondary qualitative data analysis used to analyze a purposeful sample of 24 individual interviews of community care providers. This was part of a larger case study examining adaptations required to increase acceptability of the NFP in Hamilton, Ontario, Canada. In Phase II (n = 4), themes identified from Phase I were further explored through individual, semi-structured interviews with community health care and social service providers, giving qualitative description. Overall, the NFP was viewed as addressing an important service gap for first-time mothers. Providers suggested that frequent communication between the NFP and community agencies serving these mothers could help improve the referral process, avoid service duplication, and streamline the flow of service access. The findings can help determine key components required to enhance the success of integrating a home-visit program into an existing network of community services. The function of home-visit programs should not be viewed in isolation. Rather, their potential can be maximized when they collaborate and share information with other agencies to provide better services for first-time mothers.

Intrapersonal self-transcendence, meaning-in-life and nurse-patient interaction: powerful assets for quality of life in cognitively intact nursing-home patients.

PubMed

Haugan, Gørill; Moksnes, Unni Karin; Løhre, Audhild

2016-12-01

Spirituality has demonstrated a significant impact on quality of life in nursing-home patients. Likewise, as essential aspects of spirituality, hope, self-transcendence, and meaning are found to be vital resources to nursing-home patients' global well-being. Further, nurse-patient interaction has demonstrated a powerful influence on patient's hope, self-transcendence, and meaning-in-life, as well as on anxiety and depression. The present study investigated the associations of hope, self-transcendence, meaning, and perceived nurse-patient interaction with quality of life. In a cross-sectional design, a sample of 202 cognitively intact nursing-home patients in Mid-Norway responded to the Herth Hope Index, the Self-Transcendence scale, the Purpose-in-Life test, the Nurse-Patient Interaction scale, and a one-item overall measure on quality of life. Using SPSS ordinal regression, bivariate and multivariate analyses were conducted with quality of life as dependent variable. Controlling for gender, age, and residential time, all the scales were significantly related to quality of life in the bivariate analyses. Intrapersonal self-transcendence showed an exceptional position presenting a very high odds ratio in the bivariate analysis, and also the strongest association with quality of life in multivariate analyses. Meaning and nurse-patient interaction also showed independent and significant associations with quality of life. The associations found encourage the idea that intrapersonal self-transcendence, meaning-in-life, and nurse-patient interaction are powerful health-promoting factors that significantly influence on nursing-home patients' quality of life. Therefore, pedagogical approaches for advancing caregivers' presence and confidence in health-promoting interaction should be upgraded and matured. Proper educational programs for developing interacting skills including assessing and supporting patients' intrapersonal self-transcendence and meaning-in-life should be utilised and their effectiveness evaluated. © 2016 Nordic College of Caring Science.

The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: effects on process quality.

PubMed

Hawes, C; Mor, V; Phillips, C D; Fries, B E; Morris, J N; Steele-Friedlob, E; Greene, A M; Nennstiel, M

1997-08-01

To characterize changes in key aspects of process quality received by nursing home residents before and after the implementation of the national nursing home Resident Assessment Instrument (RAI) and other aspects of the Omnibus Budget Reconciliation Act (OBRA) nursing home reforms. A quasi-experimental study using a complex, multistage probability-based sample design, with data collected before (1990) and after (1993) implementation of the RAI and other OBRA provisions. Two independent cohorts (n > 2000) of residents in a random sample of 254 nursing facilities located in metropolitan statistical areas in 10 states. OBRA-87 enhanced the regulation of nursing homes and included new requirements on quality of care, resident assessment, care planning, and the use of neuroleptic drugs and physical restraints. One of the key provisions, used to help implement the OBRA requirements in daily nursing home practice, was the mandatory use of a standardized, comprehensive system, known as the RAI, to assist in assessment and care planning. OBRA provisions went into effect in federal law on October 1, 1990, although delays issuing the regulations led to actual implementation of the RAI during the Spring of 1991. MEASUREMENTS AND ANALYSES: Research nurses spent an average of 4 days per facility in each data collection round, assessing a sample of residents, collecting data through interviews with and observations of residents, interviews with multiple shifts of direct staff caregivers for the sampled residents, and review of medical records, including physician's orders, treatment and care plans, nursing progress notes, and medication records. The RNs collected data on the characteristics of the sampled residents, on the care they received, and on facility practices. The effect of being a member of the 1990 pre-OBRA or the 1993 post-OBRA cohort was assessed on the accuracy of information in the residents' medical records, the comprehensiveness of care plans, and on other key aspects of process quality while controlling for any changes in resident case-mix. The data were analyzed using contingency tables and logistic regression and a special statistical software (SUDAAN) to assure proper variance estimation. Overall, the process of care in nursing homes improved in several important areas. The accuracy of information in residents' medical records increased substantially, as did the comprehensiveness of care plans. In addition, several problematic care practices declined during this period, including use of physical restraints (37.4 to 28.1% (P < .001)) and indwelling urinary catheters (9.8 to 7% (P < .001)). There were also increases in good care practices, such as the presence of advanced directives, participation in activities, and use of toileting programs for residents with bowel incontinence. These results were sustained after controlling for differences in the resident characteristics between 1990 and 1993. Other practices, such as use of antipsychotic drugs, behavior management programs, preventive skin care, and provision of therapies were unaffected, or the differences were not statistically significant, after adjusting for changes in resident case-mix. The OBRA reforms and introduction of the RAI constituted an unprecedented implementation of comprehensive geriatric assessment in Medicare- and Medicaid-certified nursing homes. The evaluation of the effects of these interventions demonstrates significant improvements in the quality of care provided to residents. At the same time, these findings suggest that more needs to be done to improve process quality. The results suggest the RAI is one tool that facility staff, therapists, pharmacy consultants, and physicians can use to support their continuing efforts to provide high quality of care and life to the nation's 1.7 million nursing home residents.

Workplace Participatory Occupational Health/Health Promotion Program

PubMed Central

Zhang, Yuan; Flum, Marian; Kotejoshyer, Rajashree; Fleishman, Jane; Henning, Robert; Punnett, Laura

2018-01-01

Nursing home employees experience high physical and psychosocial workloads, resulting in poor health outcomes. An occupational health/health promotion program, designed to facilitate employee participation, was initiated in three nursing homes. The aim of the current study was to evaluate facilitators and barriers of the program after 3-year implementation. Focus groups with employees and in-depth interviews with top and middle managers were conducted. The Social Ecological Model was used to organize the evaluation. Facilitators and barriers were reported from both managers’ and employees’ perspectives, and were categorized as intrapersonal, interpersonal, institutional, and corporate level. Management support, financial resources, and release time for participation were identified as the three most important factors. Supports from multiple levels including both human and environment, and managers and employees, are important for a successful participatory occupational health/health promotion program. PMID:26977705

Findings From a Prospective Randomized Controlled Trial of an Individualized Music Listening Program for Persons With Dementia.

PubMed

Kwak, Jung; Anderson, Keith; O'Connell Valuch, Katharine

2018-06-01

Music & Memory (M&M) is a passive music intervention that uses personalized music playlists delivered on digital music players. This program has been increasingly adopted in nursing homes across the United States to facilitate communication, engagement, and socialization among persons with dementia (PWDs); however, few studies have evaluated the program's effect on PWDs' outcomes. In the present study, a randomized controlled crossover design was used to examine the impact of the M&M program on 59 PWDs in 10 nursing homes over a 14-week period. Residents' evaluated outcomes included agitation, behavioral symptoms, and use of psychotropic medications. Although trends supported the positive effects of M&M, no statistically significant differences were found in any of the outcomes measured over time. Methodological limitations withstanding, these findings call into question the effectiveness of the M&M program and the ability of facility staff to implement this intervention with fidelity.

[Development of a nurse-led family counseling program for families of the elderly: the first cycle of a Community-Based Action Research Project (CBPR)].

PubMed

Mahrer-Imhof, Romy; Hediger, Hannele; Naef, Rahel; Bruylands, Michelle

2014-08-01

With the support of family members many elderly people can live an independent life at home. Accepting support respectively providing support might be a challenge for both elder and family member. Families often have little professional support to manage those challenges. Therefore, a nurse-led counseling program for families of the elders has been established. The counseling program was developed with community-based participatory research (CBPR) methodology using individual and focus group interviews, as well as a written survey and tested in a pilot study. Managing disease in everyday life, helpful means of support at home, changes in family relations, information about services as well as information how to navigate the healthcare system have been themes to discuss in the counseling sessions. Participants in the pilot study showed a statistically not significant increase in well-being, and preparedness for care and were highly satisfied with the counseling program. Families of the elderly could actively participate in developing and researching a nurse-led family counseling program. Several family members still engage as co-researcher in the program and participate to improve the new service.

Nursing practice environment and registered nurses' job satisfaction in nursing homes.

PubMed

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

2012-08-01

 Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs in nursing homes.   The sample included 863 RNs working as staff RNs in 282 skilled nursing facilities in New Jersey. Two-level hierarchical linear modeling was used to account for the RNs nested by nursing homes.   Controlling for individual and nursing home characteristics, staff RNs' participation in facility affairs, supportive manager, and resource adequacy were positively associated with RNs' job satisfaction. Ownership status was significantly related to job satisfaction; RNs working in for-profit nursing homes were less satisfied.   A supportive practice environment is significantly associated with higher job satisfaction among RNs working in nursing homes. Unlike other nursing home characteristics, specific dimensions of the nursing practice environment can be modified through administrative actions to enhance RN job satisfaction.

Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design.

PubMed

Garne, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Clemensen, Jane

2016-07-08

For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. To identify parental needs when wanting to provide neonatal home care supported by telemedicine. The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a "bell cord" to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.

The development of a community and home-based chronic care management program for older adults.

PubMed

Cooper, Jennifer; McCarter, Kathryn A

2014-01-01

The objective of this paper was to evaluate a chronic care management program piloted by a visiting nurses association. Desired outcomes were to increase nurses' knowledge of self-management of chronic conditions and improve patient self-efficacy and clinical measures. The program provided educational development for nurses and piloted encounters with patients with chronic conditions targeting community health nurses for a chronic care professional (CCP) certification and invited 300 faith community nurses to an education program on chronic condition(s). Thirteen patients with chronic condition(s) were enrolled. Chronic care professional modules were used to increase nurses' knowledge and were measured by successful completion of a certification exam. Faith community nurses participated in an education program and completed a posttest to measure knowledge of content. Patient improvement in self-management was measured by pre- and postintervention self-efficacy scores and clinical measures. Seventeen nurses successfully completed the exam, and 38 faith community nurses participated in the program and completed the posttest. Three patients showed improvement in self-efficacy scores and eight in clinical measures. The educational development of community nurses prepared them to provide effective encounters to improve self-efficacy and clinical outcomes for older adults with chronic conditions. © 2013 Wiley Periodicals, Inc.

[Test on the cost and development on the payment system of home health care nursing].

PubMed

Ryu, Hosihn; Jung, Keysun; Lim, Jiyoung

2006-06-01

This study focused on analysing costs per home health care nursing visit based on home health care nursing activities in medical institutes. The data was collected in three stages. First, the cost elements of home health care nursing services were collected and 31 home care nurses participated. Second, the workload and caseload of home care nursing activities were measured by the Easley-Storfjell Instrument(1997). Third, the opinions on improving the home health care nursing reimbursement system were collected by a nation-wide mailing survey from a total of 125 home care agencies. The cost of home health care nursing per visit was calculated as 50,626 won. This was composed of a basic visiting fee of 35,090 won (about 35 $) and travel fee of 15,536 won (about 15 $). The major problems of the home care nursing payment system were the low level of the cost per visit, no distinction between first visit and revisits, and the limitations in health insurance coverage for home health care nursing services. This study's results will contribute as a baseline for establishing policies for improvement of the home health care nursing cost and for applying a community-based visiting nursing service cost.

Prenatal and infancy home visiting by nurses: from randomized trials to community replication.

PubMed

Olds, David L

2002-09-01

This paper summarizes a 25-year program of research that has attempted to improve the early health and development of low-income mothers and children and their future life trajectories with prenatal and infancy home visiting by nurses. The program has been tested in two separate large-scale randomized controlled trials with different populations living in different contexts. The program has been successful in improving parental care of the child as reflected in fewer injuries and ingestions that may be associated with child abuse and neglect; and maternal life-course, reflected in fewer subsequent pregnancies, greater work force participation, and reduced use of public assistance and food stamps. In the first trial, the program also produced long-term effects on the number of arrests, convictions, emergent substance use, and promiscuous sexual activity of 15-year-old children whose nurse-visited mothers were low-income and unmarried when they registered in the study during pregnancy. Since 1996, the program has been offered for public investment outside of research contexts. Careful attention has been given to ensuring that the program is replicated with fidelity to the model tested in the scientifically controlled studies by working with community leaders to ensure that organization and community contexts are favorable for the program; by providing the nurses with excellent training and technical assistance and detailed visit-by-visit guidelines; and by providing organizations with a web-based clinical information system that creates a basis for monitoring program performance and continuous quality improvement.

Ambiguities: residents' experience of 'nursing home as my home'.

PubMed

Nakrem, Sigrid; Vinsnes, Anne G; Harkless, Gene E; Paulsen, Bård; Seim, Arnfinn

2013-09-01

Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live at home. Uncovering what nursing home residents' view as quality of care in nursing homes will help further understanding of how best to provide high quality, person-centred care. To describe residents' experiences of living in a nursing home related to quality of care. The study utilises a descriptive exploratory design. In-depth interviews were undertaken with 15 residents who were not cognitively impaired, aged 65 and over and living in one of four nursing homes. The interviews were transcribed verbatim and analysed by categorising of meaning. Residents perceived the nursing home as their home, but at the same time not 'a home'. This essential ambiguity created the tension from which the categories of perceptions of quality emerged. Four main categories of quality of care experience were identified: 'Being at home in a nursing home', 'Paying the price for 24-hour care', 'Personal habits and institutional routines', and 'Meaningful activities for a meaningful day'. Ambiguities concerning the nursing home as a home and place to live, a social environment in which the residents experience most of their social life and the institution where professional health service is provided were uncovered. High-quality care was when ambiguities were managed well and a home could be created within the institution. Implication for practice. Achieving quality care in nursing homes requires reconciling the ambiguities of the nursing home as a home. This implies helping residents to create a private home distinct from the professional home, allowing residents' personal habits to guide institutional routines and supporting meaningful activities. Using these resident developed quality indicators is an important step in improving nursing home services. © 2012 Blackwell Publishing Ltd.

Tai Chi and health-related quality of life in nursing home residents.

PubMed

Lee, Linda Y K; Lee, Diana T F; Woo, Jean

2009-03-01

Health-related quality of life (HRQOL) that is good is regarded as the goal of elderly residential care. However, limited evidence exists indicating a promising intervention that can achieve this goal. The aim of this study is to examine the effect of Tai Chi on HRQOL in nursing home residents. A nonequivalent pretest-posttest control-group design. A convenience sample of 139 residents from six nursing homes in Hong Kong was used. The experimental group (n=66) joined a 26-week Tai Chi program, while the control group (n=73) continued with usual daily activities. The physical and mental components of HRQOL were designated as the dependent variables. Resident satisfaction was considered as a covariate. Doubly multivariate repeated measures analysis of covariance was done to examine the intervention effect. After adjusting for the confounding effect of resident satisfaction, a statistically significant difference (p<0.05) in the physical and mental components of HRQOL between the experimental and control groups was found. Findings showed significant improvement in HRQOL after residents practiced Tai Chi. These investigators contribute additional knowledge about the health benefits of Tai Chi among nursing home residents and indicates support for its use in this population to improve HRQOL. Tai Chi has unique characteristics as a health exercise that is particularly suitable for nursing home residents. The inclusion of Tai Chi exercise in elderly residential care practice is recommended.

[Pharmacotherapy in nursing homes].

PubMed

Kersten, Hege; Ruths, Sabine; Wyller, Torgeir Bruun

2009-09-10

There is a high risk of drug-related problems in nursing homes due to polypharmacy, multi-morbidity and age-related changes. We describe the drug use and compare the pharmacotherapy in two nursing homes with different staffing of physicians. We included 48 long-term patients from two nursing homes in Oslo; i.e. nursing home A (24 patients) and nursing home B (24 patients). A pharmacist recorded information on patients' drug use, identified and classified drug-related problems, and classified the drugs used according to their anticholinergic burden. Two physicians (with experience in geriatrics and nursing home medicine) assessed the clinical importance of the drug-related problems independently from each other. The physicians were blinded with respect to which nursing home the patients came from. Patients in nursing home A used a median (interquartile range [IQR]) of 7.0 (5.3-11.0) drugs, and those in nursing home B used 9.5 (8.0-12.8); the median difference was 2.0, 95% CI 1.0-4.0, p = 0.006). Patients also had lower anticholinergic drug scores in nursing home A (1.0 [0.0-2.0]) than in nursing home B (2.0 [2.0-3.8]); median difference 1.0, 95% CI 0.0-2.0, p = 0.009). Patients in home A also had lower numbers of drug-related problems (3.0 [2.0-4.0]) than those in home B (5.5 [3.3-8.0]); median difference 1.0, 85% CI 0.0-3.0, p = 0.007. No significant differences were found between the nursing homes with regard to patients' age, co-morbidity, kidney function, or dementia state, but nursing home A had a better staffing of physicians. The number of drugs used as well as the quality indicators varied considerably between the nursing homes assessed. Differences in physician staffing might be one reasonable explanation. Our study highlights the importance of systematic multidisciplinary medication reviews for quality improvement in nursing homes.

Nursing home queues and home health users.

PubMed

Swan, J H; Benjamin, A E

1993-01-01

Home health market growth suggests the need for models explaining home health utilization. We have previously explained state-level Medicare home health visits with reference to nursing home markets. Here we introduce a model whereby state-level Medicare home health use is a function of nursing home queues and other demand and supply factors. Medicare home health users per state population is negatively related to nursing home bed stock, positively to Medicaid eligibility levels and to Medicaid nursing home recipients per population, as well as to various other demand and supply measures. This explanation of home health users explains previously-reported findings for home health visits. The findings support the argument that home health use is explained by factors affecting lengths of nursing home queues.

78 FR 15016 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

... permitted to use paid feeding assistants to supplement the services of certified nurse aides. If facilities choose this option, feeding assistants must complete a training program. Nursing home providers are... collection; Title of Information Collection: Paid Feeding Assistants in Long-Term Care Facilities and...

Development of the International Guidelines for Home Health Nursing.

PubMed

Narayan, Mary; Farris, Cindy; Harris, Marilyn D; Hiong, Fong Yoke

2017-10-01

Throughout the world, healthcare is increasingly being provided in home and community-based settings. There is a growing awareness that the most effective, least costly, patient-preferred setting is patients' home. Thus, home healthcare nursing is a growing nursing specialty, requiring a unique set of nursing knowledge and skills. Unlike many other nursing specialties, home healthcare nursing has few professional organizations to develop or support its practice. This article describes how an international network of home healthcare nurses developed international guidelines for home healthcare nurses throughout the world. It outlines how the guidelines for home healthcare nursing practice were developed, how an international panel of reviewers was recruited, and the process they used for reaching a consensus. It also describes the plan for nurses to contribute to future updates to the guidelines.

Exploring the activity profile of health care assistants and nurses in home nursing.

PubMed

De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Moons, Philip

2015-12-01

Are home nurses (also known as community nurses) ready for their changing role in primary care? A quantitative study was performed in home nursing in Flanders, Belgium, to explore the activity profile of home nurses and health care assistants, using the 24-hour recall instrument for home nursing. Seven dates were determined, covering each day of the week and the weekend, on which data collection would take place. All the home nurses and health care assistants from the participating organisations across Flanders were invited to participate in the study. All data were measured at nominal level. A total of 2478 home nurses and 277 health care assistants registered 336 128 (47 977 patients) and 36 905 (4558 patients) activities, respectively. Home nurses and health care assistants mainly perform 'self-care facilitation' activities in combination with 'psychosocial care' activities. Health care assistants also support home nurses in the 'selfcare facilitation' of patients who do not have a specific nursing indication.

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

PubMed Central

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

1985-01-01

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. PMID:3932258

Is There a Trade-off Between Quality and Profitability in United States Nursing Homes?

PubMed

Godby, Tyler; Saldanha, Sarah; Valle, Jazmine; Paul, David P; Coustasse, Alberto

Nursing home residents across the United States rely on quality care and effective services. Nursing homes provide skilled nurses and nursing aides who can provide services 24 hours a day for individuals who could not perform these tasks for themselves. Not-for-profit (NFP) versus for-profit (FP) nursing homes have been examined for utilization and efficacy; however, it has been shown that NFP nursing homes generally offer higher quality care and generate greater profit margins compared with FP nursing homes. The purpose of this research was to determine if NFP nursing homes provide enhanced quality care and a larger profit margin compared with FP nursing homes. Benefits and barriers in regard to financial stability and quality of care exist for both FP and NFP homes. Based on the findings of this review, it is suggested that NFP nursing homes have achieved higher quality of care because of a more effective balance of business aspects, as well as prioritizing resident well-being, and care quality over profit maximization in NFP homes.

Leadership education, certification and resident outcomes in US nursing homes: cross-sectional secondary data analysis.

PubMed

Trinkoff, Alison M; Lerner, Nancy B; Storr, Carla L; Han, Kihye; Johantgen, Mary E; Gartrell, Kyungsook

2015-01-01

Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. To examine associations of education and certification among NHAs and DONs with resident outcomes. Cross-sectional secondary data analysis. This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). 1142 nursing homes in the survey which represented 16628 nursing homes in the US. Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. Nursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships. Copyright © 2014 Elsevier Ltd. All rights reserved.

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 following...

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 following...

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 following...

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 following...

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 following...

Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes: "While it's tough, it's useful"

PubMed Central

Lundin-Olsson, Lillemor; Skelton, Dawn A.; Lundman, Berit; Rosendahl, Erik

2017-01-01

The objective of the study was to describe the views and experiences of participation in a high-intensity functional exercise (HIFE) program among older people with dementia in nursing homes. The study design was a qualitative interview study with 21 participants (15 women), aged 74–96, and with a Mini-Mental State Examination score of 10–23 at study start. The HIFE-program comprises exercises performed in functional weight-bearing positions and including movements used in everyday tasks. The exercise was individually designed, supervised in small groups in the nursing homes and performed during four months. Interviews were performed directly after exercise sessions and field notes about the sessions were recorded. Qualitative content analysis was used for analyses. The analysis revealed four themes: Exercise is challenging but achievable; Exercise gives pleasure and strength; Exercise evokes body memories; and Togetherness gives comfort, joy, and encouragement. The intense and tailored exercise, adapted to each participant, was perceived as challenging but achievable, and gave pleasure and improvements in mental and bodily strength. Memories of previous physical activities aroused and participants rediscovered bodily capabilities. Importance of individualized and supervised exercise in small groups was emphasized and created feelings of encouragement, safety, and coherence. The findings from the interviews reinforces the positive meaning of intense exercise to older people with moderate to severe dementia in nursing homes. The participants were able to safely adhere to and understand the necessity of the exercise. Providers of exercise should consider the aspects valued by participants, e.g. supervision, individualization, small groups, encouragement, and that exercise involved joy and rediscovery of body competencies. PMID:29149198

Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes: "While it's tough, it's useful".

PubMed

Lindelöf, Nina; Lundin-Olsson, Lillemor; Skelton, Dawn A; Lundman, Berit; Rosendahl, Erik

2017-01-01

The objective of the study was to describe the views and experiences of participation in a high-intensity functional exercise (HIFE) program among older people with dementia in nursing homes. The study design was a qualitative interview study with 21 participants (15 women), aged 74-96, and with a Mini-Mental State Examination score of 10-23 at study start. The HIFE-program comprises exercises performed in functional weight-bearing positions and including movements used in everyday tasks. The exercise was individually designed, supervised in small groups in the nursing homes and performed during four months. Interviews were performed directly after exercise sessions and field notes about the sessions were recorded. Qualitative content analysis was used for analyses. The analysis revealed four themes: Exercise is challenging but achievable; Exercise gives pleasure and strength; Exercise evokes body memories; and Togetherness gives comfort, joy, and encouragement. The intense and tailored exercise, adapted to each participant, was perceived as challenging but achievable, and gave pleasure and improvements in mental and bodily strength. Memories of previous physical activities aroused and participants rediscovered bodily capabilities. Importance of individualized and supervised exercise in small groups was emphasized and created feelings of encouragement, safety, and coherence. The findings from the interviews reinforces the positive meaning of intense exercise to older people with moderate to severe dementia in nursing homes. The participants were able to safely adhere to and understand the necessity of the exercise. Providers of exercise should consider the aspects valued by participants, e.g. supervision, individualization, small groups, encouragement, and that exercise involved joy and rediscovery of body competencies.

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,…

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…

The Role of Hospice Care in the Nursing Home Setting

PubMed Central

Miller, Susan C.; Mor, Vince N.T.

2013-01-01

The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing homes may be excessive, has perhaps slowed the adoption of hospice services into the nursing home setting. Currently, access to hospice care in nursing homes is inequitable across facilities, and across geographic areas. In nursing homes where hospice is available and present, however, recent research documents superior outcomes for residents enrolled in hospice, and perhaps for nonhospice residents. Still, more research is needed, particularly research focusing on the government costs associated with the provision of hospice care in nursing homes. If subsequent research continues to support the “added value” of hospice care in nursing homes and at the same or less total costs, the issue of foremost concern becomes how equitable access to Medicare hospice care in nursing homes can be achieved. Access may be increased to some extent by changing government policies, and conflicting regulations and interpretive guidelines, so they support and encourage the nursing home/hospice collaboration. PMID:12006229

Hospice and nursing homes.

PubMed

Castle, N G

1999-01-01

In this article a descriptive analysis of nursing homes with special care hospice units is provided. These are compared to nursing homes with other special care units and to nursing homes without any special care units. An analysis of the determinants of nursing homes with special care hospice units is also provided. Factors such as ownership, staffing levels, having other special care units, case-mix intensity, competitiveness of the nursing home market, and the state Medicaid reimbursement rate structure are examined. Finally, the influence of policies on hospice care in nursing homes is discussed.

Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative.

PubMed

Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Crecelius, Charles; Ge, Bin; Petroski, Gregory

2017-11-01

The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Health Behaviors and Overweight in Nursing Home Employees: Contribution of Workplace Stressors and Implications for Worksite Health Promotion.

PubMed

Miranda, Helena; Gore, Rebecca J; Boyer, Jon; Nobrega, Suzanne; Punnett, Laura

2015-01-01

Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.

Health Behaviors and Overweight in Nursing Home Employees: Contribution of Workplace Stressors and Implications for Worksite Health Promotion

PubMed Central

Miranda, Helena; Gore, Rebecca J.; Boyer, Jon; Nobrega, Suzanne; Punnett, Laura

2015-01-01

Background. Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. Methods. A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. Results. Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. Conclusions. Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health. PMID:26380373

Priorities for the professional development of registered nurses in nursing homes: a Delphi study.

PubMed

Cooper, Emily; Spilsbury, Karen; McCaughan, Dorothy; Thompson, Carl; Butterworth, Tony; Hanratty, Barbara

2017-01-08

To establish a consensus on the care and professional development needs of registered nurses (RNs) employed by UK care homes. Two-stage, online modified Delphi study. A panel (n = 352) of individuals with experience, expertise or interest in care home nursing: (i) care home nurses and managers; (ii) community healthcare professionals (including general practitioners, geriatricians, specialist and district nurses); and (iii) nurse educators in higher education. RNs employed by nursing homes require particular skills, knowledge, competence and experience to provide high-quality care for older residents. The most important responsibilities for the nursing home nurse were: promoting dignity, personhood and wellbeing, ensuring resident safety and enhancing quality of life. Continuing professional development priorities included personal care, dementia care and managing long-term conditions. The main barrier to professional development was staff shortages. Nursing degree programmes were perceived as inadequately preparing nurses for a nursing home role. Nursing homes could improve by providing supportive learning opportunities for students and fostering challenging and rewarding careers for newly RNs. If nurses employed by nursing homes are not fit for purpose, the consequences for the wider health and social-care system are significant. Nursing homes, the NHS, educational and local authorities need to work together to provide challenging and rewarding career paths for RNs and evaluate them. Without well-trained, motivated staff, a high-quality care sector will remain merely an aspiration.

Nursing home quality: a comparative analysis using CMS Nursing Home Compare data to examine differences between rural and nonrural facilities.

PubMed

Lutfiyya, May Nawal; Gessert, Charles E; Lipsky, Martin S

2013-08-01

Advances in medicine and an aging US population suggest that there will be an increasing demand for nursing home services. Although nursing homes are highly regulated and scrutinized, their quality remains a concern and may be a greater issue to those living in rural communities. Despite this, few studies have investigated differences in the quality of nursing home care across the rural-urban continuum. The purpose of this study was to compare the quality of rural and nonrural nursing homes by using aggregated rankings on multiple quality measures calculated by the Centers for Medicare and Medicaid Services and reported on their Nursing Home Compare Web site. Independent-sample t tests were performed to compare the mean ratings on the reported quality measures of rural and nonrural nursing homes. A linear mixed binary logistic regression model controlling for state was performed to determine if the covariates of ownership, number of beds, and geographic locale were associated with a higher overall quality rating. Of the 15,177 nursing homes included in the study sample, 69.2% were located in nonrural areas and 30.8% in rural areas. The t test analysis comparing the overall, health inspection, staffing, and quality measure ratings of rural and nonrural nursing homes yielded statistically significant results for 3 measures, 2 of which (overall ratings and health inspections) favored rural nursing homes. Although a higher percentage of nursing homes (44.8%-42.2%) received a 4-star or higher rating, regression analysis using an overall rating of 4 stars or higher as the dependent variable revealed that when controlling for state and adjusting for size and ownership, rural nursing homes were less likely to have a 4-star or higher rating when compared with nonrural nursing homes (OR = .901, 95% CI 0.824-0.986). Mixed model logistic regression analysis suggested that rural nursing home quality was not comparable to that of nonrural nursing homes. When controlling for state and adjusting for nursing home size and ownership, rural nursing homes were not as likely to earn a 4-or higher star quality rating as nonrural nursing homes. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

[Results of a physical therapy program in nursing home residents: A randomized clinical trial].

PubMed

Casilda-López, Jesús; Torres-Sánchez, Irene; Garzón-Moreno, Victor Manuel; Cabrera-Martos, Irene; Valenza, Marie Carmen

2015-01-01

The maintenance of the physical functionality is a key factor in the care of the elderly. Inactive people have a higher risk of death due to diseases associated with inactivity. In addition, the maintenance of optimal levels of physical and mental activity has been suggested as a protective factor against the development and progression of chronic illnesses and disability. The objective of this study is to assess the effectiveness of an 8-week exercise program with elastic bands, on exercise capacity, walking and balance in nursing home residents. A nursing home sample was divided into two groups, intervention group (n=26) and control group (n=25). The intervention group was included in an 8-week physical activity program using elastic bands, twice a week, while the control group was took part in a walking programme. Outcome measurements were descriptive variables (anthropometric characteristics, quality of life, fatigue, fear of movement) and fundamental variables (exercise capacity, walking and balance). A significant improvement in balance and walking speed was observed after the programme. Additionally, exercise capacity improved significantly (P≤.001), and the patients showed an improvement in perceived dyspnea after the physical activity programme in the intervention group. The exercise program was safe and effective in improving dyspnea, exercise capacity, walking, and balance in elderly. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

77 FR 4038 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-26

... proposed information collection project: ``Nursing Home Survey on Patient Safety Culture Comparative...: Proposed Project Nursing Home Survey on Patient Safety Culture Comparative Database The Agency for... Nursing Home Survey on Patient Safety Culture (Nursing Home SOPS) Comparative Database. The Nursing Home...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-06

... State Home Nursing Home Care AGENCY: Department of Veterans Affairs. ACTION: Interim final rule. SUMMARY... into contracts or provider agreements with State homes for the nursing home care of certain disabled... submitted in response to ``RIN 2900-AO57--Contracts and Provider Agreements for State Home Nursing Home Care...

Dementia-Related Work Activities of Home Care Nurses and Aides: Frequency, Perceived Competence, and Continuing Education Priorities

ERIC Educational Resources Information Center

Morgan, Debra G.; Kosteniuk, Julie G.; O'Connell, Megan E.; Dal Bello-Haas, Vanina; Stewart, Norma J.; Karunanayake, Chandima

2016-01-01

An understanding of the specific dementia learning needs of home care staff is needed to plan relevant continuing education (CE) programs and supports. The study's objective was to examine frequency and perceived competence in performing 20 dementia-related work activities, and identify CE priorities among home care staff. A cross-sectional survey…

Around-the-clock nursing care for the elderly in Japan.

PubMed

Murashima, S; Zerwekh, J V; Yamada, M; Tagami, Y

1998-01-01

To describe the first phase of creating a Japanese model of community-based long-term care, called around-the-clock care (ACC), by operationally defining the components of ACC, identifying those eligible for the program, clarifying methods of planning and organization, and exploring outcomes. Exploratory evaluation for the population of frail elderly Japanese citizens living at home. A convenience sample of 44 patients receiving care from four visiting-nurse-service stations during 3 months in 1994 was used. Needs assessments; record reviews of patient encounters; evaluations by patients, families, and visiting nurses; and reviews of administrative data. Nurses perceived that ACC stabilized medical status, reduced the emotional and physical burden of treatment, and improved hygiene. It also reduced family caregiving burdens and the stress of family caregivers' employment responsibilities. The highest rating of ACC by patient and families was for those with the most complex physical needs. Skilled nursing at home permitted early identification and treatment of problems before they became crises or required hospitalization. Early findings suggest 24-hour nurse-home helper teamwork may be an effective system of community-based long-term care and should be considered a key element of future Japanese health policy.

Person-Centered Care in the Home Setting for Parkinson's Disease: Operation House Call Quality of Care Pilot Study.

PubMed

Hack, Nawaz; Akbar, Umer; Monari, Erin H; Eilers, Amanda; Thompson-Avila, Amanda; Hwynn, Nelson H; Sriram, Ashok; Haq, Ihtsham; Hardwick, Angela; Malaty, Irene A; Okun, Michael S

2015-01-01

Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.

Person-Centered Care in the Home Setting for Parkinson's Disease: Operation House Call Quality of Care Pilot Study

PubMed Central

Akbar, Umer; Eilers, Amanda; Thompson-Avila, Amanda; Malaty, Irene A.; Okun, Michael S.

2015-01-01

Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program. PMID:26078912

Staff exchange within and between nursing homes in The Netherlands and potential implications for MRSA transmission.

PubMed

VAN Gaalen, R D; Hopman, H A; Haenen, A; VAN DEN Dool, C

2017-03-01

A recent countrywide MRSA spa-type 1081 outbreak in The Netherlands predominantly affected nursing homes, generating questions on how infection spreads within and between nursing homes despite a low national prevalence. Since the transfer of residents between nursing homes is uncommon in The Netherlands, we hypothesized that staff exchange plays an important role in transmission. This exploratory study investigated the extent of former (last 2 years) and current staff exchange within and between nursing homes in The Netherlands. We relied on a questionnaire that was targeted towards nursing-home staff members who had contact with residents. We found that 17·9% and 12·4% of the nursing-home staff formerly (last 2 years) or currently worked in other healthcare institutes besides their job in the nursing home through which they were selected to participate in this study. Moreover, 39·7% of study participants worked on more than one ward. Our study shows that, in The Netherlands, nursing-home staff form a substantial number of links between wards within nursing homes and nursing homes are linked to a large network of healthcare institutes through their staff members potentially providing a pathway for MRSA transmission between nursing homes and throughout the country.

Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

PubMed

Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook

2013-12-01

The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

Nursing home nurses' experiences of resident transfers to the emergency department: no empathy for our work environment difficulties.

PubMed

Tsai, Hsiu-Hsin; Tsai, Yun-Fang; Huang, Hsiu-Li

2016-03-01

To explore the experiences of nursing home nurses when they transfer residents from nursing homes to the emergency department in Taiwan. The transfer of residents between nursing homes and emergency departments challenges continuity of care. Understanding nursing home nurses' experiences during these transfers may help to improve residents' continuity of care. However, few empirical data are available on these nurses' transfer experiences worldwide, and none could be found in Asian countries. Qualitative descriptive study. Data were collected from August 2012-June 2013 in audiotaped, individual, in-depth interviews with 25 nurses at five nursing homes in Taiwan. Interview transcripts were analysed by constant comparative analysis. Analysis of interview transcripts revealed that the core theme of nursing home nurses' transfer experience was discontinuity in nursing home to emergency department transitions. This core theme comprised three themes: discontinuity in family involvement, discontinuity in medical resources and expectations, and discontinuity in nurses' professional role. Nursing home nurses need a working environment that is better connected to residents' family members and more immediate and/or easier access to acute care for residents. Communication between nurses and residents' family could be improved by using text messages or social media by mobile phones, which are widely used in Taiwan and worldwide. To improve access to acute care, we suggest developing a real-time telehealth transfer system tailored to the medical culture and policies of each country. This system should facilitate communication among nursing home staff, family members and hospital staff. Our findings on nurses' experiences during transfer of nursing home residents to the emergency department can be used to design more effective transfer policies such as telemedicine systems in Taiwan and other Asian countries or in those with large populations of Chinese immigrants. © 2016 John Wiley & Sons Ltd.

Manual for monitoring the quality of nursing home care records.

PubMed

Barbosa, Silvia Freitas; Tronchin, Daisy Maria Rizatto

2015-01-01

to build and validate an instrument aimed at monitoring the quality of nursing records in the Home Care Program (HCP) of a university hospital. methodological study involving the elaboration of a manual, whose content was later submitted to six experts for validation, reaching a ≥ 80% consensus. The data collection process was carried out in 2012 by means of a questionnaire comprised of the following issues: nursing evolution, nursing diagnosis, and nursing prescription, and standards for the nursing team recommended by the Regional Nursing Council of São Paulo and by the assessed institution. Manual items were judged according to the following variables: relevance, pertinence, clarity and simplicity. of the 39 propositions, 100% achieved ≥ 80% agreement in the relevance, pertinence and clarity variables; 92.3% in the simplicity variable. Sleep/rest, Mobility and Check-out variables did not reach a favorable minimum consensus in the prescribed activities and were improved following suggestions from the experts. we believe that the instrument will enable the improvement of the HCP's work process.

24 CFR 252.1 - Termination of program.

Code of Federal Regulations, 2010 CFR

2010-04-01

... COINSURANCE OF MORTGAGES COVERING NURSING HOMES, INTERMEDIATE CARE FACILITIES, AND BOARD AND CARE HOMES § 252... preliminary as well as full approval to process coinsurance applications and without regard to whether the... subject to the precommitment review process described in paragraph (b) of this section. (d) Reopened...

The Association Between Psychosocial Work Environment and Satisfaction With Old Age Care Among Care Recipients.

PubMed

Lundgren, Dan; Ernsth Bravell, Marie; Börjesson, Ulrika; Kåreholt, Ingemar

2018-06-01

This study examines the association between nursing assistants' perceptions of their psychosocial work environment and satisfaction among older people receiving care in nursing homes and home care. Cross-sectional surveys were conducted among people receiving care ( N = 1,535) and nursing assistants ( N = 1,132) in 45 nursing homes and 21 home care units within municipal old-age care. Better psychosocial work environment was related to higher satisfaction in old-age care among the recipients. Significant and stronger associations were more common in nursing homes than in home care. Perception of mastery and positive challenges at work were associated with higher recipient satisfaction both in home care and in nursing homes: social climate, perception of group work, perception of mastery, and positive challenges at work only in nursing homes. Findings suggest that recipient satisfaction may be increased by improving the psychosocial work environment for nursing assistants, both in nursing homes and in home care.

Nurses Aide and Hospital Orderly, Course Description.

ERIC Educational Resources Information Center

Stroup, Katherine L.; Anderson, Floyd L.

Prepared by an instructor and curriculum development specialist of the Minnesota Work Opportunity Center, this course is designed to train dropout and/or hard-core unemployed youth for occupations as aides or orderlies in hospitals and nursing homes. Each student enrolled in the program receives a personal orientation, and after demonstrating the…

Is compromised oral health associated with a greater risk of mortality among nursing home residents? A controlled clinical study.

PubMed

Klotz, Anna-Luisa; Hassel, Alexander Jochen; Schröder, Johannes; Rammelsberg, Peter; Zenthöfer, Andreas

2017-08-30

The objective of this controlled clinical study was to evaluate the association between oral health and 1-year mortality among nursing home residents with or without oral health intervention. This research was part of a multidisciplinary intervention study (EVI-P) performed in 14 nursing homes in Germany. Two-hundred and nineteen nursing home residents were included in the study and assigned to an intervention group, for which dental health education was offered and ultrasonic baths were used for denture cleaning (n = 144), or to a control group (n = 75). Before the intervention, each participant was examined, and dental status, plaque control record (PCR), Denture Hygiene Index, and results from the Revised Oral Assessment Guide were recorded. Amount of care needed and dementia were also assessed, by use of the Barthel Index and the Mini Mental State Examination, respectively. Participant mortality was determined after 12 months, and bivariate analysis and logistic regression models were used to evaluate possible factors affecting mortality. Bivariate analysis detected a direct association between greater mortality and being in the control group (p = .038). Participants with higher PCR were also more likely to die during the study period (p = .049). For dentate participants, the protective effect of being in the intervention group was confirmed by multivariate analysis in which covariates such as age and gender were considered. Oral hygiene and oral health seem to affect the risk of mortality of nursing home residents. Dental intervention programs seem to reduce the risk of 1-year mortality among nursing home residents having remaining natural teeth. Further studies, with larger sample sizes and evaluation of the causes of death, are necessary to investigate the reasons for these associations.

Administrative and policy issues in reimbursement for nursing home capital investment.

PubMed

Boerstler, H; Carlough, T; Schlenker, R E

1991-01-01

The way in which states reimburse for nursing home capital costs can create incentives for nursing home owners to use the home primarily as a vehicle for real estate speculation, with potentially adverse consequences for patient care. In order to help promote and control the stability, adequacy, and quality of capital investment in long-term care, an increasing number of states are using a fair-rental approach for calculating capital reimbursement. In this article we compare the fair-rental approach with traditional cost-based capital reimbursement in terms of administration and policy. We discuss issues of concern to the state (cost and reimbursement design options) and the investor (after-tax cash flows, rate of return, etc.). Our analysis suggests that fair-rental systems may be superior to traditional cost-based reimbursement in promoting and controlling industry stability, while at the same time providing an adequate return to investors, without incurring long-term increases in the costs of administering programs.

Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study.

PubMed

Meesterberends, Esther; Halfens, Ruud J G; Spreeuwenberg, Marieke D; Ambergen, Ton A W; Lohrmann, Christa; Neyens, Jacques C L; Schols, Jos M G A

2013-08-01

To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents. A prospective multicenter cohort study. Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg). A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer. Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants. A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home. The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular internal quality controls. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Advancing nursing leadership in long-term care.

PubMed

O'Brien, Jennifer; Ringland, Margaret; Wilson, Susan

2010-05-01

Nurses working in the long-term care (LTC) sector face unique workplace stresses, demands and circumstances. Designing approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues. Through the St. Joseph's Health Centre Guelph demonstration site project, funded by the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care, the Excelling as a Nurse Leader in Long Term Care training program and the Mentor Team program were developed to address these needs. Evaluation results show that not only have individual nurses benefitted from taking part in these programs, but also that the positive effects were felt in other parts of the LTC home (as reported by Directors of Care). By creating a generally healthier work environment, it is anticipated that these programs will also have a positive effect on recruitment and retention.

Effects of home visits by paraprofessionals and by nurses: age 4 follow-up results of a randomized trial.

PubMed

Olds, David L; Robinson, JoAnn; Pettitt, Lisa; Luckey, Dennis W; Holmberg, John; Ng, Rosanna K; Isacks, Kathy; Sheff, Karen; Henderson, Charles R

2004-12-01

To examine the effects of prenatal and infancy home visiting by paraprofessionals and by nurses from child age 2 through age 4 years. We conducted, in public and private care settings in Denver, Colorado, a randomized, controlled trial with 3 arms, ie, control, paraprofessional visits, and nurse visits. Home visits were provided from pregnancy through child age 2 years. We invited 1178 consecutive, low-income, pregnant women with no previous live births to participate, and we randomized 735; 85% were unmarried, 47% Mexican American, 35% white non-Mexican American, 15% black, and 3% American Indian/Asian. Outcomes consisted of maternal reports of subsequent pregnancies, participation in education and work, use of welfare, marriage, cohabitation, experience of domestic violence, mental health, substance use, and sense of mastery; observations of mother-child interaction and the home environment; tests of children's language and executive functioning; and mothers' reports of children's externalizing behavior problems. Two years after the program ended, women who were visited by paraprofessionals, compared with control subjects, were less likely to be married (32.2% vs 44.0%) and to live with the biological father of the child (32.7% vs 43.1%) but worked more (15.13 months vs 13.38 months) and reported a greater sense of mastery and better mental health (standardized scores [mean = 100, SD = 10] of 101.25 vs 99.31 and 101.21 vs 99.16, respectively). Paraprofessional-visited women had fewer subsequent miscarriages (6.6% vs 12.3%) and low birth weight newborns (2.8% vs 7.7%). Mothers and children who were visited by paraprofessionals, compared with control subjects, displayed greater sensitivity and responsiveness toward one another (standardized score [mean = 100, SD = 10] of 100.92 vs 98.66) and, in cases in which the mothers had low levels of psychologic resources at registration, had home environments that were more supportive of children's early learning (score of 24.63 vs 23.35). Nurse-visited women reported greater intervals between the births of their first and second children (24.51 months vs 20.39 months) and less domestic violence (6.9% vs 13.6%) and enrolled their children less frequently in preschool, Head Start, or licensed day care than did control subjects. Nurse-visited children whose mothers had low levels of psychologic resources at registration, compared with control group counterparts, demonstrated home environments that were more supportive of children's early learning (score of 24.61 vs 23.35), more advanced language (score of 91.39 vs 86.73), superior executive functioning (score of 100.16 vs 95.48), and better behavioral adaptation during testing (score of 100.41 vs 96.66). There were no statistically significant effects of either nurse or paraprofessional visits on the number of subsequent pregnancies, women's educational achievement, use of substances, use of welfare, or children's externalizing behavior problems. Paraprofessional-visited mothers began to experience benefits from the program 2 years after the program ended at child age 2 years, but their first-born children were not statistically distinguishable from their control group counterparts. Nurse-visited mothers and children continued to benefit from the program 2 years after it ended. The impact of the nurse-delivered program on children was concentrated on children born to mothers with low levels of psychologic resources.

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.

Research supporting the congruence between rehabilitation principles and home health nursing practice.

PubMed

Neal, L J

1999-01-01

A grounded-theory study of 30 home health nurses conducted in the Washington, DC, metropolitan area used unstructured audiotaped interviews to elicit data as to how home health nurses define their practice. The purpose of the study was to develop a beginning substantive research-based theory of home health nursing practice. The model that emerged consists of three stages by which nurses attain autonomy in their practice. Adaptation was found to be the core category, in that nurses cannot function effectively or successfully in the home health arena unless they are or learn to be adaptable. Data also revealed that home health nurses either knowingly or unknowingly use rehabilitation nursing principles in their practice, thereby lending credence to the supposition that home health nursing practice is congruent with rehabilitation nursing principles.

Sustained health home visiting can improve families' social support and community connectedness.

PubMed

Stubbs, Joanne M; Achat, Helen M

2016-01-01

Home visiting (HV) is a strategy used internationally to address the multiple needs of infants and families at risk of suboptimal health and developmental outcomes. Describe nursing interventions and program achievements of a pilot HV program for families living in a highly disadvantaged outer suburb of Sydney, New South Wales, Australia. A family partnership model was adopted. Follow-up is reported for 65 of the 75 clients remaining in the program for at least 6 months. Nurses most commonly provided clients with emotional support, information about health and well-being and information on infant development. Clients experienced noteworthy improvements consistent with key objectives - greater access to support services, and increased self-efficacy and social networks. Consistent with the growing body of international literature on the achievements of HV, HV programs can empower vulnerable families to better cope with daily life demands and their family.

The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

PubMed Central

Rabiner, D J; Stearns, S C; Mutran, E

1994-01-01

OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the National Long-Term Care Data Set. PRINCIPAL FINDINGS. The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found. CONCLUSIONS. This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use. PMID:8002352

Listening with care: Using narrative methods to cultivate nurses’ responsive relationships in a home visiting intervention with teen mothers

PubMed Central

SmithBattle, Lee; Lorenz, Rebecca; Leander, Sheila

2012-01-01

Effective public health nursing relies on the development of responsive and collaborative relationships with families. While nurse-family relationships are endorsed by home visitation programs, training nurses to follow visit-to-visit protocols may unintentionally undermine these relationships and may also obscure nurses’ clinical understanding and situated knowledge. With these issues in mind, we designed a home visiting intervention, titled Listening with Care, to cultivate nurses’ relationships with teen mothers and nurses’ clinical judgment and reasoning. Rather than using protocols, the training for the intervention introduced nurses to narrative methods and therapeutic tools. This mixed-method pilot study included a quasi-experimental design to examine the effect of the intervention on teen mothers’ depressive symptoms, self-silencing, repeat pregnancy, and educational progress compared to teens who received usual care. Qualitative data was collected from the nurses to evaluate the feasibility and acceptability of the intervention and therapeutic tools. The nurses endorsed the therapeutic tools and expected to continue using them in their practice. Despite the lack of statistically significant differences in outcomes between groups, findings suggest that further study of the intervention is warranted. Future studies may have implications for strengthening hidden aspects of nursing that make a difference in the lives of teen mothers. PMID:22713121

Easing the transition: sSupport for the new graduate nurse in long-term care.

PubMed

Burgess, Jennifer; D'Hondt, Allison

2007-01-01

As our population continues to age, more nurses will be needed to enter the specialty of LTC nursing to meet the needs of our senior population. To promote this area of nursing and retain new graduate nurses in LTC, more research is required to support the specific challenges faced by LTC nurses compared with those of other areas of nursing. The authors suggest implementation of support strategies that may include a formal preceptorship program of at least one month in duration, additional clinical support on night shifts, coaching and mentoring models, learning opportunities based on a learning needs assessment, and orientation to the overall culture and environment of the home including time spent with all departments. LTC homes need to examine their approaches to leadership, providing comprehensive orientation and resource support for new graduates and developing strategies specific to their organization's mission and vision that will empower and provide support to ease the unique transition to LTC. These strategies lead to promoting positive relationships, professional development and overall positive outcomes with workplace satisfaction in the LTC setting. The authors encourage federal and provincial government officials to examine this more closely and to better support this effort with the financial resources that are greatly needed in LTC homes to provide the exemplary care that our seniors deserve.

Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial.

PubMed

Telenius, Elisabeth Wiken; Engedal, Knut; Bergland, Astrid

2015-12-03

Research indicates that exercise can have a positive effect on both physical and mental health in nursing home patients with dementia, however the lasting effect is rarely studied. In a previously published article we investigated the immediate effect of a 12 weeks functional exercise program on physical function and mental health in nursing home residents with dementia. In this paper we studied the long-term effect of this exercise program. We explored the differences between the exercise and control group from baseline to 6 months follow-up and during the detraining period from month 3 to 6. A single blind, randomized controlled trial was conducted and a total of 170 nursing home residents with dementia were included. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities. Thirty participants were lost between baseline and six-month follow-up. Linear mixed model analyses for repeated measurements were used to investigate the effect of exercise after detraining period. The exercise group improved their scores on Berg Balance Scale from baseline to 6 months follow-up by 2.7 points in average. The control group deteriorated in the same period and the difference between groups was statistically significant (p = 0.031). The exercise group also scored better on NPI agitation sub-score after 6 months (p = 0.045). The results demonstrate long-time positive effects of a high intensity functional exercise program on balance and indicate a positive effect on agitation, after an intervention period of 12 weeks followed by a detraining period of 12 weeks. Identifier at ClinicalTrials.gov: NCT02262104.

Nursing students' attitudes about home health nursing.

PubMed

Prestia, Mindy; Murphy, Susan; Yoder, Marian

2008-09-01

In an effort to address the home care nursing shortage, this pilot study was designed to measure nursing students' attitudes toward home health nursing and to test the Home Health Attitude Questionnaire developed specifically for this study based on the Theory of Planned Behavior. Senior undergraduate nursing students and registered nursing to bachelor of science in nursing students completed the questionnaire.

38 CFR 51.40 - Basic per diem.

Code of Federal Regulations, 2010 CFR

2010-07-01

... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Per Diem Payments § 51.40 Basic per diem. Except as... home for nursing home care the lesser of the following for nursing home care provided to an eligible... each subsequent Fiscal Year, VA will pay a facility recognized as a State home for nursing home care...

38 CFR 51.40 - Basic per diem.

Code of Federal Regulations, 2012 CFR

2012-07-01

... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Per Diem Payments § 51.40 Basic per diem. Except as... home for nursing home care the lesser of the following for nursing home care provided to an eligible... each subsequent Fiscal Year, VA will pay a facility recognized as a State home for nursing home care...

38 CFR 51.31 - Automatic recognition.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will be...

38 CFR 51.31 - Automatic recognition.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will be...

38 CFR 51.31 - Automatic recognition.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will be...

38 CFR 51.31 - Automatic recognition.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will be...

38 CFR 51.31 - Automatic recognition.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Obtaining Per Diem for Nursing Home Care in... that already is recognized by VA as a State home for nursing home care at the time this part becomes effective, automatically will continue to be recognized as a State home for nursing home care but will be...

Factors associated with resident aggression toward caregivers in nursing homes.

PubMed

Zeller, Adelheid; Dassen, Theo; Kok, Gerjo; Needham, Ian; Halfens, Ruud J G

2012-09-01

Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers' experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes. A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study. Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied. The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age (< 30 years vs. 30-45 years: OR = 1.46; < 30 years vs. > 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age (< 30 years vs. 30-45 years: OR = 2.00; < 30 years vs. > 45 years: OR = 2.04). Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed. The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and aim on present programs for management of aggressive behavior. Caregivers in nursing homes should be qualified in understanding resident aggression in a comprehensive way. A critical point in this topic seems to be the interaction between caregiver and resident during basic care activities. This topic should be investigated in further research projects. © 2012 Sigma Theta Tau International.

Robert Wood Johnson Foundation Nurse Faculty Scholars program leadership training.

PubMed

Campbell, Jacquelyn C; McBride, Angela Barron; Etcher, LuAnn; Deming, Katie

The Robert Wood Johnson Foundation Nurse Faculty Scholars program was created to address the nursing shortage via development of the next generation of national leaders in academic nursing. The leadership training combined development at the scholar's home institution with in-person didactic and interactive sessions with notable leaders in nursing and other disciplines. A curriculum matrix, organized by six domains, was evaluated quantitatively and qualitatively. What set this program apart is that it immersed junior faculty in concerted leadership development with regard to all aspects of the faculty role so that teaching interactively, making use of the latest in information technology, giving testimony before a policy-making group, participating in strategic planning, and figuring out how to reduce the budget without jeopardizing quality were all envisioned as part of the faculty role. The domains covered by this program could easily be used as the framework to plan other leadership-development programs for the next generation of academic leaders. Copyright © 2017 Elsevier Inc. All rights reserved.

Self-study program on HTML browser--application to Clinical Nursing General Remarks Course.

PubMed

Ochiai, N; Sota, Y; Ezumi, H

1997-01-01

We created a self-study program using HTML browser on the Clinical Nursing General Remarks Course, Eighty-three students each selected a published book on a personal history (written personal reflections from individuals who had undergone medical treatment and hospitalization), read it and submitted reports of their impressions of the histories. Their reports were arranged from a nursing perspective and entered on the home page of our college using HTML browser. We intended that the students would become more interested in reading of the personal histories, and that they would acquire new self-study skills and increase their interest in Internet through use of our program. In addition, we hoped that this program would encourage positive communication and mutual sharing of information. The students were able to easily refer to a personal history according to their interest from a nursing perspective. Therefore this program realized the mutual learning among students and other users.

A physical exercise program using music-supported video-based training in older adults in nursing homes suffering from dementia: a feasibility study.

PubMed

Spildooren, Joke; Speetjens, Ite; Abrahams, Johan; Feys, Peter; Timmermans, Annick

2018-04-28

Motivation towards an exercise program is higher in a small group setting in comparison to individual therapy. Due to attentional problems, group exercises are difficult for people with Alzheimer disease (AD). This study evaluates the feasibility of a music-supported video-based group exercise program in older adults suffering from AD. Five participants with moderate AD were recruited from a nursing home. A progressive physical exercise program using a video-based training with musical accompaniment was performed and digitally recorded to investigate the adherence and performed accuracy of the exercises. The overall participation during the exercises was 84.1%. The quality of the performance was for all exercises above the cut-off scores. A music-supported video-based group exercise program is feasible in persons with AD. The participants were motivated and the expectations towards the program increased over time. Music seemed an important factor for attention in participants with AD.

Relationships among person-centered care, nursing home adjustment, and life satisfaction: a cross-sectional survey study.

PubMed

Yoon, Ju Young

2018-04-02

ABSTRACTBackground:The purpose of this study was to examine whether a perceived person-centered nursing home environment has a direct relationship with nursing home adjustment and life satisfaction, and whether a perceived person-centered nursing home environment has an indirect relationship with life satisfaction through improved nursing home adjustment. 203 nursing home residents who were able to read and speak English and were physically and cognitively able to respond to questionnaires were included in this study. Data were collected from six nursing homes in the Midwestern US. Higher levels of a perceived person-centered nursing home environment had a significantly direct relationship with increased life satisfaction of residents (β = 0.35), and this relationship was mediated by residents' improved nursing home adjustment (β = 0.10). In-depth exploration using sub-domains of the main variables demonstrated that "safety" and "everydayness" of a person-centered nursing home environment were directly related to higher levels of life satisfaction (β = 0.15 and β = 0.16, respectively); and "everydayness" was related to three sub-domains of nursing home adjustment: better "relationship development," "acceptance of the new residence" (β = 0.32 and β = 0.24, respectively), and lower "depressed mood" (β = 0.05). The positive relationship between "everydayness" and life satisfaction was partially mediated by the "relationship development" sub-domain of nursing home adjustment (β = 0.07). The findings provide new evidence for the positive association between person-centered care and nursing home adjustment. The findings also provide insights into the mechanism through which the specific sub-domains of person-centered care and nursing home adjustment operate in the path model.

38 CFR 52.80 - Enrollment, transfer and discharge rights.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.80 Enrollment, transfer and discharge rights. (a) Participants in the adult day health care program must meet the...) Diagnosis of clinical depression. (vi) Recent discharge from nursing home or hospital. (vii) Significant...

38 CFR 51.190 - Infection control.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Infection control. 51.190... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The facility management must establish and maintain an infection control program designed to provide a safe, sanitary, and...

38 CFR 51.190 - Infection control.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Infection control. 51.190... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The facility management must establish and maintain an infection control program designed to provide a safe, sanitary, and...

38 CFR 51.190 - Infection control.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Infection control. 51.190... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The facility management must establish and maintain an infection control program designed to provide a safe, sanitary, and...

38 CFR 51.190 - Infection control.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Infection control. 51.190... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The facility management must establish and maintain an infection control program designed to provide a safe, sanitary, and...

38 CFR 51.190 - Infection control.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Infection control. 51.190... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The facility management must establish and maintain an infection control program designed to provide a safe, sanitary, and...

Enduring effects of prenatal and infancy home visiting by nurses on children: follow-up of a randomized trial among children at age 12 years.

PubMed

Kitzman, Harriet J; Olds, David L; Cole, Robert E; Hanks, Carole A; Anson, Elizabeth A; Arcoleo, Kimberly J; Luckey, Dennis W; Knudtson, Michael D; Henderson, Charles R; Holmberg, John R

2010-05-01

To test the effect of prenatal and infancy home visits by nurses on 12-year-old, firstborn children's use of substances, behavioral adjustment, and academic achievement. Randomized controlled trial. Public system of obstetric and pediatric care in Memphis, Tennessee. We studied 12-year-old, firstborn children (n = 613) of primarily African American, economically disadvantaged women (743 randomized during pregnancy). Program of prenatal and infancy home visits by nurses. Use of cigarettes, alcohol, and marijuana; internalizing, externalizing, and total behavioral problems; and academic achievement. By the time the firstborn child was 12 years of age, those visited by nurses, compared with those in the control group, reported fewer days of having used cigarettes, alcohol, and marijuana during the 30-day period before the 12-year interview (0.03 vs 0.18, P = .02) and were less likely to report having internalizing disorders that met the borderline or clinical threshold (22.1% vs 30.9%, P = .04). Nurse-visited children born to mothers with low psychological resources, compared with their control group counterparts, scored higher on the Peabody Individual Achievement Tests in reading and math (88.78 vs 85.70, P = .009) and, during their first 6 years of education, scored higher on group-administered standardized tests of math and reading achievement (40.52 vs 34.85, P = .02). No statistically significant program effects were found on children's externalizing or total behavioral problems. Through age 12, the program reduced children's use of substances and internalizing mental health problems and improved the academic achievement of children born to mothers with low psychological resources.

"Wish we would have known that!" Communication Breakdown Impedes Person-Centered Care.

PubMed

Kolanowski, Ann; Van Haitsma, Kimberly; Penrod, Janice; Hill, Nikki; Yevchak, Andrea

2015-06-01

To understand how nursing home staff obtain information needed for implementing person-centered care (PCC) to residents with dementia who exhibit behavioral and psychological symptoms of dementia (BPSD), and how they communicate this information to other staff. Barriers to PCC and information exchange were also explored. Participants were 59 staff from two nursing homes. Focus group methodology captured discussions in eight 1-hr sessions. Sessions were audiotaped and transcribed. Data were analyzed using qualitative content analysis to provide a comprehensive summary of real world context of implementing PCC. To deliver PCC staff identified a need for access to psychosocial/medical history of the resident and knowledge of strategies families used for managing BPSD in the past. However, resident information is not routinely shared with all staff and written documentation systems for communicating resident-specific information do not support the time-pressured work pattern of certified nursing assistants (CNAs). Word-of-mouth was considered more reliable and expedient than educational sessions. CNAs described themselves as visual learners who prefer educational programs addressing individual resident emergent behaviors and programs that are scheduled at dedicated times. To improve PCC the flow of information exchange requires: inclusion of all staff, particularly CNAs; systems of communication that consider the time and resource constraints of nursing homes; development of educational programs for BPSD that are responsive to staff learning styles; administrative investment in nursing leadership to effect these changes; and reimbursement approaches to encourage culture change investments. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

38 CFR 17.58 - Evacuation of community nursing homes.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 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. When veterans are evacuated from a community nursing home as the result of an emergency, they may be relocated...

38 CFR 17.58 - Evacuation of community nursing homes.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 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. When veterans are evacuated from a community nursing home as the result of an emergency, they may be relocated...

38 CFR 17.58 - Evacuation of community nursing homes.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 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. When veterans are evacuated from a community nursing home as the result of an emergency, they may be relocated...

Prior Work and Educational Experience Are Not Associated With Successful Completion of a Master's-Level, Distance Education Midwifery Program.

PubMed

Niemczyk, Nancy A; Cutts, Alison; Perlman, Dana B

2018-03-01

In order to increase and diversify the midwifery workforce, admissions criteria for midwifery education programs must not contain unnecessary barriers to entry. Once accepted, students need to successfully complete the program. Many admissions criteria commonly used in midwifery education programs in the United States are not evidence based and could be unnecessary barriers to education. The primary objective of this study was to identify factors known during the admission process that were related to successful completion or failure to complete a midwifery program educating both student nurse-midwives (SNMs) and student midwives (SMs); a secondary objective was to quantify reasons for program noncompletion. This master's-level, distance education program educates a diverse group of both SNMs and SMs. A pilot, retrospective cohort study examined all students matriculating at the program from fall 2012 on and scheduled to graduate by summer 2016 (N = 58). Demographic information, admissions information, academic records, and advising notes were reviewed. Reasons for noncompletion were identified, and characteristics were compared between students who did and did not complete the program. Program completion was not significantly associated with students' status as nurses prior to admission, labor and delivery nursing experience, length of nursing experience, nursing degree held, presence of children at home, working while in school, or undergraduate grade point average. Being a nurse, years of nursing experience, type of nursing degree, or labor and delivery nursing experience were not associated with completion of this midwifery program. © 2018 by the American College of Nurse-Midwives.

Enabling at-homeness for residents living in a nursing home: Reflected experience of nursing home staff.

PubMed

Saarnio, Lotta; Boström, Anne-Marie; Hedman, Ragnhild; Gustavsson, Petter; Öhlén, Joakim

2017-12-01

Older people are often living the last period of their lives in institutions such as nursing homes. Knowledge of this period, specifically related to at-homeness which can be described as wellbeing in spite of illness and has been regarded as one of the goals in palliative care, has been very little researched in the context of nursing homes and the experience of nursing home staff. The aim of this study was to explore the experiences of nursing home staff of how to enable at-homeness for residents. Qualitative interpretive description methodology guided the design. The data generation was conducted in winter 2014-2015, when seven repetitive reflective group discussions with staff in a nursing home were held. The results show five patterns for how healthcare staff enabled at-homeness for the residents: Striving to know the resident, Showing respect for the resident's integrity, Creating and working in family-like relationships, Helping to find a new ordinariness and Preparing and making plans to ensure continuity. Nursing home staff seem to have collegial knowledge of how to enable at-homeness for the residents in a nursing home. Close relationships with respect for the resident's integrity stand out as enabling at-homeness. Copyright © 2017 Elsevier Inc. All rights reserved.

Leadership and the psychosocial work environment in old age care.

PubMed

Lundgren, Dan; Ernsth-Bravell, Marie; Kåreholt, Ingemar

2016-03-01

To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services. Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services. Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed. The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2. Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services. Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services. Due to the differences in organisational settings, it is important to consider the differences in prerequisites in conducting leadership. To influence nursing assistants' performance and to increase quality in old age care in the long term, appropriate leadership is necessary. © 2015 The Authors. International Journal of Older People Nursing Published by John Wiley & Sons Ltd.

Nursing Homes and Hostels Legislation Amendment Act 1987 (No. 72 of 1987), 5 June 1987.

PubMed

1988-01-01

Among other things, this Act amends the Australia National Health Act 1953 to include within its coverage nursing homes for disabled people, to authorize the competent minister to declare that a nursing home patient is no longer an approved patient, to authorize the minister to determine a standard ordinary care fee for each approved nursing home and set a formula for making this determination, to authorize the minister to determine standards to be observed for the provision of services in approved nursing homes and to withhold funds from nursing homes not meeting these standards, to authorize the minister to make advance payments of benefits to nursing homes, and to increase certain penalties relating to the provision of information by nursing homes. full text

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration.

PubMed

Kristof, Lorand; Fortinsky, Richard H; Kellett, Kathy; Porter, Martha; Robison, Julie

2017-01-01

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver's perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.

[Treatment of residents in 74 nursing homes: the opinion of caregivers].

PubMed

van den Elzen, A J

2005-07-01

This study is based on the outcomes of the program "Privacy In Nursing Homes" that has been initiated by the Dutch Department of Health in the late 90's. In this study, personnel of 74 nursing homes were asked to reflect on the way they treat residents. The attitudes of personnel were measured with a questionnaire that contains 80 propositions about their behaviour towards residents. The propositions can be reduced to five factors: kindness, structural environment, control, freedom to choose, and respect. First, we give the general results on these five factors. After that we give insight in the correlations between the five different aspects of treatment and the results of regression analysis. The general conclusion is that the behaviour towards residents in nursing homes at the beginning of the 21st Century is far from optimal. Residents most notably lack personal freedom and control over their received care and their way of living. This result is especially worrying because client conformed care has been an important point of attention for some time now. Another important conclusion is that the care for residents has a positive relation with the mangement policy of an organization and so, it is possible to improve the care.

Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

PubMed Central

Kissam, Stephanie; Gifford, David; Parks, Peggy; Patry, Gail; Palmer, Laura; Wilkes, Linda; Fitzgerald, Matthew; Petrulis, Alice Stollenwerk; Barnette, Leslie

2003-01-01

Background In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) that led quality improvement efforts in nursing homes from the six pilot states. Results QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. Conclusion The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting. PMID:12753699

Evaluation of the Cincinnati Veterans Affairs Medical Center Hospital-in-Home Program.

PubMed

Cai, Shubing; Grubbs, Andrew; Makineni, Rajesh; Kinosian, Bruce; Phibbs, Ciaran S; Intrator, Orna

2018-04-20

To examine hospital readmissions, costs, mortality, and nursing home admissions of veterans who received Hospital-in-Home (HIH) services. Retrospective cohort study. Cincinnati Veterans Affairs Medical Center (VAMC). Study cohort included veterans who received HIH services as an alternative to inpatient care between October 1, 2012, and November 30, 2015, and non-HIH veterans who were hospitalized for similar conditions in the Cincinnati VAMC during the same period. We identified 138 veterans who used HIH services and 694 non-HIH veterans. HIH veterans received hospital-equivalent care at home. Non-HIH veterans received traditional inpatient services in the Cincinnati VAMC. Total costs of care for treating an acute episode (HIH services vs inpatient) and likelihood of hospital readmission, death, or nursing home admission within 30 days of discharge from HIH services or hospitalization. Average per person costs were $7,792 for HIH services and $10,960 for traditional inpatient care (P<0.001). HIH veterans were less likely to use a nursing home within 30 days of discharge (3.1%) than non-HIH veterans (12.6%) (P<0.001). Thirty-day readmission rates and mortality were not statistically different between HIH and non-HIH veterans. The substitutive HIH model implemented in the Cincinnati VAMC delivered acute services in veterans' homes at lower cost and with lower likelihood of postdischarge nursing home use. Broader implementation of this innovative delivery model may benefit older adults in need of care while reducing healthcare system costs. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

The effect of nurse-patient interaction on anxiety and depression in cognitively intact nursing home patients.

PubMed

Haugan, Gørill; Innstrand, Siw T; Moksnes, Unni K

2013-08-01

To test the effects of nurse-patient interaction on anxiety and depression among cognitively intact nursing home patients. Depression is considered the most frequent mental disorder among the older population. Specifically, the depression rate among nursing home patients is three to four times higher than among community-dwelling older people, and a large overlap of anxiety is found. Therefore, identifying nursing strategies to prevent and decrease anxiety and depression is of great importance for nursing home patients' well-being. Nurse-patient interaction is described as a fundamental resource for meaning in life, dignity and thriving among nursing home patients. The study employed a cross-sectional design. The data were collected in 2008 and 2009 in 44 different nursing homes from 250 nursing home patients who met the inclusion criteria. A sample of 202 cognitively intact nursing home patients responded to the Nurse-Patient Interaction Scale and the Hospital Anxiety and Depression Scale. A structural equation model of the hypothesised relationships was tested by means of Lisrel 8.8 (Scientific Software International Inc., Lincolnwood, IL, USA). The SEM model tested demonstrated significant direct relationships and total effects of nurse-patient interaction on depression and a mediated influence on anxiety. Nurse-patient interaction influences depression, as well as anxiety, mediated by depression. Hence, nurse-patient interaction might be an important resource in relation to patients' mental health. Nurse-patient interaction is an essential factor of quality of care, perceived by long-term nursing home patients. Facilitating nurses' communicating and interactive skills and competence might prevent and decrease depression and anxiety among cognitively intact nursing home patients. © 2013 Blackwell Publishing Ltd.

The effect of laughter therapy on the quality of life of nursing home residents.

PubMed

Kuru, Nilgun; Kublay, Gulumser

2017-11-01

To evaluate the effect of Laughter therapy on the quality of life of nursing home residents. By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance. Quasi-experimental design. The study was conducted between 2 March - 25 May 2015. The experimental group was composed of 32 nursing home residents from one nursing home, while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection. After the laughter therapy intervention, general and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and spiritual health) quality-of-life scores of residents in the experimental group significantly increased in comparison with the pretest. Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention. The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents. © 2016 John Wiley & Sons Ltd.

75 FR 49215 - Medicare Program; End-Stage Renal Disease Quality Incentive Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

... new feature on http://www.medicare.gov that was modeled after Nursing Home Compare and continues to be... for the three finalized measures. We believe that this is the performance period that best balances...

Nursing home administrators' opinions of pay for performance.

PubMed

Castle, Nicholas G; Engberg, John; Ferguson-Rome, Jamie C; Sonon, Kristen

2014-01-01

The research presented here provides some descriptive information of nursing home pay for performance (P4P) initiatives and an examination of the opinions of nursing home administrators (NHAs) about P4P. Opinions on three common elements of P4P were examined: the incentive format, program format, and quality format. Information came from a mail survey of 2,426 NHAs. Most of the summary scores show that few NHAs gave positive responses to P4P. Very few NHAs believed that P4P would increase their revenues. NHAs were skeptical that P4P systems were for quality improvement and instead believed they were developed for purposes of cost reduction. Relatively few NHAs believed that P4P would improve quality of care. Given that we have limited experience with setting performance goals and incentive formats for NHAs, the findings presented may prove useful in modeling future P4P systems.

Does investor-ownership of nursing homes compromise the quality of care?

PubMed

Harrington, Charlene; Woolhandler, Steffie; Mullan, Joseph; Carrillo, Helen; Himmelstein, David U

2002-01-01

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

Interprofessional collaboration in nursing homes (interprof): a grounded theory study of general practitioner experiences and strategies to perform nursing home visits.

PubMed

Fleischmann, Nina; Tetzlaff, Britta; Werle, Jochen; Geister, Christina; Scherer, Martin; Weyerer, Siegfried; Hummers-Pradier, Eva; Mueller, Christiane A

2016-08-30

Interprofessionalism, considered as collaboration between medical professionals, has gained prominence over recent decades and evidence for its impact has grown. The steadily increasing number of residents in nursing homes will challenge medical care and the interaction across professions, especially nurses and general practitioners (GPs). The nursing home visit, a key element of medical care, has been underrepresented in research. This study explores GP perspectives on interprofessional collaboration with a focus on their visits to nursing homes in order to understand their experiences and expectations. This research represents an aspect of the interprof study, which explores medical care needs as well as the perceived collaboration and communication by nursing home residents, their families, GPs and nurses. This paper focusses on GPs' views, investigating in particular their visits to nursing homes in order to understand their experiences. Open guideline-interviews covering interprofessional collaboration and the visit process were conducted with 30 GPs in three study centers and analyzed with grounded theory methodology. GPs were recruited via postal request and existing networks of the research partners. Four different types of nursing home visits were found: visits on demand, periodical visits, nursing home rounds and ad-hoc-decision based visits. We identified the core category "productive performance" of home visits in nursing homes which stands for the balance of GPs´ individual efforts and rewards. GPs used different strategies to perform a productive home visit: preparing strategies, on-site strategies and investing strategies. We compiled a theory of GPs home visits in nursing homes in Germany. The findings will be useful for research, and scientific and management purposes to generate a deeper understanding of GP perspectives and thereby improve interprofessional collaboration to ensure a high quality of care.

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…

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…

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

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 Contract...

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 Contract...

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 Contract...

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 Contract...

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 Contract...

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...

Impact of the Medicare Catastrophic Coverage Act on nursing homes.

PubMed

Laliberte, L; Mor, V; Berg, K; Intrator, O; Calore, K; Hiris, J

1997-01-01

The Medicare Catastrophic Coverage Act (MCCA) of 1988 altered eligibility and coverage for skilled nursing facility (SNF) care and changed Medicaid eligibility rules for nursing-home residents. Detailed data on the residents of a for-profit nursing-home chain and Medicare claims for a 1 percent sample of beneficiaries were used to examine the impact of the MCCA on nursing homes. The case mix of nursing-home admissions was scrutinized, specifically for length of stay, discharge disposition, rate of hospitalization, and changes in payer source. Findings revealed that, although the proportion of Medicare-financed nursing-home care increased, as did the case-mix severity of residents during the MCCA period, there was no corollary reduction in hospital use by nursing-home residents.

Do Safety Culture Scores in Nursing Homes Depend on Job Role and Ownership? Results from a National Survey.

PubMed

Banaszak-Holl, Jane; Reichert, Heidi; Todd Greene, M; Mody, Lona; Wald, Heidi L; Crnich, Christopher; McNamara, Sara E; Meddings, Jennifer

2017-10-01

To identify facility- and individual-level predictors of nursing home safety culture. Cross-sectional survey of individuals within facilities. Nursing homes participating in the national Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infections Project. Responding nursing home staff (N = 14,177) from 170 (81%) of 210 participating facilities. Staff responses to the Nursing Home Survey on Patient Safety Culture (NHSOPS), focused on five domains (teamwork, training and skills, communication openness, supervisor expectations, organizational learning) and individual respondent characteristics (occupation, tenure, hours worked), were merged with data on facility characteristics (from the Certification and Survey Provider Enhanced Reporting): ownership, chain membership, percentage residents on Medicare, bed size. Data were analyzed using multivariate hierarchical models. Nursing assistants rated all domains worse than administrators did (P < .001), with the largest differences for communication openness (24.3 points), teamwork (17.4 points), and supervisor expectations (16.1 points). Clinical staff rated all domains worse than administrators. Nonprofit ownership was associated with worse training and skills (by 6.0 points, P =.04) and communication openness (7.3 points, P =.004), and nonprofit and chain ownership were associated with worse supervisor expectations (5.2 points, P =.001 and 3.2 points, P =.03, respectively) and organizational learning (5.6 points, P =.009 and 4.2 points, P = .03). The percentage of variation in safety culture attributable to facility characteristics was less than 22%, with ownership having the strongest effect. Perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents. Reporting safety culture scores according to occupation may be more important than facility-level scores alone to describe and assess barriers, facilitators, and changes in safety culture. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

76 FR 75509 - Autopsies at VA Expense

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-02

... Administrative practice and procedure; Alcohol abuse; Alcoholism; Claims; Day care; Dental health; Drug abuse...; Health professions; Health records; Homeless; Mental health programs; Nursing homes; Philippines...

Malpractice paid losses and financial performance of nursing homes.

PubMed

Zhao, Mei; Haley, D Rob; Oetjen, Reid M; Carretta, Henry J

2011-01-01

Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

Trade-off Between Quality, Price, and Profit Orientation in Germany's Nursing Homes.

PubMed

Geraedts, Max; Harrington, Charlene; Schumacher, Daniel; Kraska, Rike

International data suggest that for-profit nursing homes tend to provide lower quality than not-for-profit nursing homes. In Germany, the relationships between profit orientation, price and quality of nursing homes have not been investigated. We performed an observational study using secondary data from statutory quality audits of all nursing homes in Germany. The relationships were analyzed bivariately via Mann-Whitney U -Test and Kruskal-Wallis Test respectively, followed by a multivariate variance analysis which also covered the interaction effect between quality, price and type of ownership. 41 % of 10,168 German nursing homes were for-profit charging on average about 10 % less than not-for-profit homes. In five out of six quality categories under study, for-profit nursing homes provided lower quality than not-for-profit homes. Quality of care in all quality categories improved with increasing prices per day. However, for four out of six quality categories examined, the quality difference between for-profit and non-profit nursing homes existed independent of the price charged. When selecting a nursing home it is therefore advisable to consider the profit orientation of the institution. German legislation should require that statutory public quality reports contain details on the profit orientation of nursing homes.

Time to and predictors of dual incontinence in older nursing home admissions.

PubMed

Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E; Harms, Susan

2018-01-01

There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents. Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used. At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care. The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents. © 2017 Wiley Periodicals, Inc.

Disparities in Nursing Home Use and Quality Among African American, Hispanic, and White Medicare Residents With Alzheimer's Disease and Related Dementias.

PubMed

Rivera-Hernandez, Maricruz; Kumar, Amit; Epstein-Lubow, Gary; Thomas, Kali S

2018-04-01

This article examines differences in nursing home use and quality among Medicare beneficiaries, in both Medicare Advantage and fee-for-service, newly admitted to nursing homes with Alzheimer's disease and related dementias (ADRD). Retrospective, national, population-based study of Medicare residents newly admitted to nursing homes with ADRD by race and ethnic group. Our analytic sample included 1,302,099 nursing home residents-268,181 with a diagnosis of ADRD-in 13,532 nursing homes from 2014. We found that a larger share of Hispanic Medicare residents that are admitted to nursing homes have ADRD compared with African American and White beneficiaries. Both Hispanics and African Americans with ADRD received care in segregated nursing homes with fewer resources and lower quality of care compared with White residents. These results have implications for targeted efforts to achieve health care equity and quality improvement efforts among nursing homes that serve minority patients.

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.

Something Old Something New

ERIC Educational Resources Information Center

Pierce, Dennis

2018-01-01

To help meet the surging demand for medical care as veterans returned home from World War II, Mississippi Gulf Coast Community College (MGCCC) created its first nursing program back in 1944. Since that time, the college has become a leader in local health care education--and a brand-new Nursing and Simulation Center will help further this legacy.…

78 FR 16632 - Medicare Program; Part B Inpatient Billing in Hospitals

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-18

...-hospital Skilled Nursing Facility (SNF) care, because section 1861(i) of the Act requires a prior 3-day... outpatients rather than inpatients or expanding the number of payable Part B inpatient services could impact... an inpatient in a hospital, SNF, hospice, or nursing home.'' Therefore, under our proposal these...

A Community College and Employer Partnership. Promising Practice

ERIC Educational Resources Information Center

Office of Community College Research and Leadership, 2010

2010-01-01

As a pilot site selected to participate in Illinois' Shifting Gears (SG) initiative in 2007, Oakton Community College (OCC) partnered with Presbyterian Homes to develop a bridge course to prepare a cadre of their employed Certified Nurse Assistants (CNAs) to enter college-credit level prerequisite courses to a Practical Nursing program. Oakton…

Innovative Contextualized Curriculum for a CNA to LPN Bridge Course. Promising Practice

ERIC Educational Resources Information Center

Office of Community College Research and Leadership, 2010

2010-01-01

As a pilot site selected to participate in Illinois' Shifting Gears (SG) initiative in 2007, Oakton Community College (OCC) partnered with Presbyterian Homes to develop a bridge course to prepare a cadre of their employed Certified Nursing Assistants (CNAs) to enter college-credit prerequisite courses to a Practical Nursing program. Oakton…

Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services.

PubMed

Garrido, Melissa M; Allman, Richard M; Pizer, Steven D; Rudolph, James L; Thomas, Kali S; Sperber, Nina R; Van Houtven, Courtney H; Frakt, Austin B

2017-11-01

A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's (VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD-HCBS to veterans at risk of nursing home placement. Services will be provided to community-dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence-based Policy Resource Center (PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long-Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD-HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD-HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHA's randomized rollout of VD-HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReC's experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large-scale evaluations of delivery system innovations targeted to older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

PubMed

Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

2017-12-01

To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. Medicare-certified nursing homes and acute care hospitals. 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. Community-specific nursing home performance is associated with community-specific hospital 30-day readmission rates for Medicare fee-for-service patients for acute myocardial infarction, heart failure or pneumonia. Coordinated care between hospitals and nursing homes is essential to reduce readmissions. Nursing homes can improve performance and reduce readmissions by increasing registered nursing homes. Further, communities can work together to create cross-continuum care teams comprised of hospitals, nursing homes, patients and their families, and other community-based service providers to reduce unplanned readmissions. © 2017 John Wiley & Sons Ltd.

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

... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality... State homes providing nursing home and adult day health services care to Veterans. VA requires...

An investigation of the effects of a nonprofit agency's investigations on quality of care in nursing homes.

PubMed

Lorentz, Madeline; Finnegan, Brittany

2013-01-01

This study examined whether an agency's investigation of complaints in 40 nursing homes is positively correlated with the quality of nursing home care. A quantitative methodology design using quantitative and qualitative data was used to assess the relationship between Agency X's investigation of consumers' nursing home complaints and the quality of nursing home care. Results showed fewer violations after the agency's interventions, indicating improvement in the nursing care. Analysis showed on average 0.14 fewer violations. This decrease is statistically significant (p = .015), indicating that this agency's intervention improved nursing home care. Additional studies are needed to further explore the quality of care given in nursing homes. Nurses may propose to the Centers for Medicare & Medicaid Services to establish a new innovative system for ensuring high quality nursing home care by requiring the establishment of outside agencies, such as Agency X, to monitor care in addition to the annual surveys conducted by the Department of Health and Human Services. © 2013 Wiley Periodicals, Inc.

Nursing home consumer complaints and quality of care: a national view.

PubMed

Stevenson, David G

2006-06-01

This study uses 5 years of national data on investigated nursing home complaints (1998-2002) to evaluate whether complaints might be used to assess nursing home quality of care. On-Line Survey Certification and Reporting (OSCAR) data are used to evaluate the association between consumer complaints, facility and resident characteristics, and other nursing home quality measures. The analyses are undertaken in the context of considerable cross-state variation in nursing home complaint processes and rates. Complaints varied across facility characteristics in ways consistent with the nursing home quality literature. Complaints were significantly positively associated with survey deficiencies and the presence of serious survey deficiencies, and significantly negatively associated with nurse and nurse aide staffing. Complaints performance was significantly predictive of survey deficiencies at subsequent inspections. This study presents the first national evidence for using consumer complaints to assess nursing home quality of care. Despite limitations, nursing home complaints appear to offer a real-time signal of quality concerns.

Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes.

PubMed

Hasson, Henna; Arnetz, Judith E

2008-02-01

The aims of this study were to: (1) compare older people care nursing staff's perceptions of their competence, work strain and work satisfaction in nursing homes and home-based care; and (2) to examine determinants of work satisfaction in both care settings. The shift in older people care from hospitals to community-based facilities and home care has had implications for nursing practice. Lack of competence development, high levels of work strain and low levels of work satisfaction among nursing staff in both care settings have been associated with high turnover. Few studies have compared staff perceptions of their competence and work in nursing homes as opposed to home-based care. A cross-sectional questionnaire survey. Nursing staff perceptions of their competence, work strain, stress and satisfaction were measured by questionnaire in 2003 in two older people care organizations in Sweden. Comparisons of all outcome variables were made between care settings both within and between the two organizations. Multiple regression analysis was used to determine predictors of work satisfaction in home care and nursing homes respectively. In general, staff in home-based care reported significantly less sufficient knowledge compared with staff in nursing homes. However, home care staff experienced significantly less physical and emotional strain compared with staff in nursing homes. Ratings of work-related exhaustion, mental energy and overall work satisfaction did not differ significantly between care settings. In both care settings, work-related exhaustion was the strongest (inverse) predictor of work satisfaction. Future interventions should focus on counteracting work-related exhaustion and improving competence development to improve work satisfaction among older people care nursing staff in both care settings. Relevance to clinical practice. Work-related exhaustion and lack of competence development may have significant negative implications for work satisfaction among older people care nursing staff in both home care and nursing homes.

Private investment purchase and nursing home financial health.

PubMed

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

2015-02-01

To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998-2010. Regression specification incorporating facility and time fixed effects. 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. 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. © Health Research and Educational Trust.

Impact of the nursing home scale on residents' social engagement in South Korea.

PubMed

Yoon, Ju Young; Kim, Hongsoo; Jung, Young-Il; Ha, Jung-Hwa

2016-12-01

This study aimed to describe the levels of social engagement and to examine the relationship between the nursing home scale groups and social engagement in nursing homes in South Korea. A total of 314 residents were randomly selected from rosters provided by 10 nursing homes located in three metropolitan areas in South Korea. The outcome variable was social engagement measured by the Revised Index of Social Engagement (RISE), and the key independent variable was the nursing home scale (small, medium, and large). Individual factors (age, gender, activities of daily living and cognitive function, and depressive symptoms) and organizational factors (location, ownership, and staffing levels) were controlled in the model as covariates. Multilevel logistic regression was used in this study. About half of the residents (46%) in this study were not socially engaged in the nursing home (RISE=0) where they resided. Controlling for individual- and organizational-level factors, the nursing home facility size was a significant factor to predict the likelihood of residents' social engagement, with that the residents in large-scale nursing homes being less likely to be socially engaged than those in medium-scale nursing homes (odds ratio = 0.457; p-value = 0.005). This study supports evidence from previous studies that smaller-scale nursing homes are likely to provide more person-centered care compared to larger-scale nursing homes. Subsequent quality studies are needed to examine how the mechanisms for how smaller-scale nursing homes can enhance residents' social engagement in terms of care delivery processes.

Exploring the relationship between nursing home financial performance and management entrepreneurial attributes.

PubMed

Davis, Jullet A; Marino, Louis D; Vecchiarini, Mariangela

2013-01-01

This paper explores the relationship between entrepreneurial orientation (EO) (i.e., their innovativeness, proactiveness and risk-taking) and financial performance in nursing homes. We hypothesize that nursing homes that are more proactive will report better short-term financial performance, while when firms with higher propensities for innovativeness and risk-taking will experience poorer financial performance in the short period due to the high costs associated with the initial adoption of innovation and with pursuing high-risks ventures. In 2004, a survey was developed and mailed to a population of 670 nursing homes in the state of Florida who were listed in the Florida Nursing Home Guide of the Agency for Health Care Administration. The final sample for this study included 104 respondents. The data from these surveys were merged with additional variables gathered from the 2004 Online Survey Certification and Reporting (OSCAR) system and the 2004/2005 Medicare Cost Reports (MCR). EO was operationalized using a nine-item scale adapted from Covin and Slevin (1989), and financial performance was assessed using total profit margin. The overall findings suggest partial support for the hypotheses. Support was found for the negative relationship between innovativeness and short-term financial performance, but only partial support was found for the relationship between performance and risk-taking. Our results demonstrated that the various aspects of entrepreneurial behaviors have a differential effect on firm performance. From a managerial perspective, nursing home administrators may continue to seek ways to be entrepreneurial while understanding that some activities may only lead to short-term profitability. These findings should not dissuade administrators from innovative behaviors. They do suggest, however, that innovative administrators should prepare for some initial decrease in profitability following new service implementation. Findings suggest that to varying degrees, nursing home administrators may view themselves as being entrepreneurial despite the intense pressures from governments, poor public perceptions, decreasing reimbursement, more impaired residents, and increasing competition from substitute providers. Further administrators may need to manage the expectations of key stakeholders when they undertake innovative programs that will support social outcomes but which may not enhance short term financial performance. This paper demonstrates the complex relationship between entrepreneurial activities and firm performance in nursing homes and has implications for the broader health care setting.

Predictors of home healthcare nurse retention.

PubMed

Ellenbecker, Carol Hall; Porell, Frank W; Samia, Linda; Byleckie, James J; Milburn, Michael

2008-01-01

To examine the level of job satisfaction and test a theoretical model of the direct and indirect effects of job satisfaction, and individual nurse and agency characteristics, on intent to stay and retention for home healthcare nurses. A descriptive correlation study of home healthcare nurses in six New England states. Home healthcare nurse job satisfaction self-report data was collected with the HHNJS survey questionnaire & Retention Survey Questionnaire. Based on a structural equation model, job tenure and job satisfaction were the strongest predictors of nurse retention. Understanding the variables associated with home healthcare nurse retention can help agencies retain nurses in a time of severe nurse shortages and increased patient demand. Predicted nursing shortages and increasing demand have made the retention of experienced, qualified nursing staff essential to assure access to high-quality home healthcare services in the future.

Does investor ownership of nursing homes compromise the quality of care?

PubMed

Harrington, C; Woolhandler, S; Mullan, J; Carrillo, H; Himmelstein, D U

2001-09-01

Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. We analyzed 1998 data from state inspections of 13,693 nursing facilities. We used a multivariate model and controlled for case mix, facility characteristics, and location. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.

The Effects of the Green House Nursing Home Model on ADL Function Trajectory: A Retrospective Longitudinal Study

PubMed Central

YOON, Ju Young; BROWN, Roger L.; BOWERS, Barbara J.; SHARKEY, Siobhan S.; HORN, Susan D.

2015-01-01

Background Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House (GH) nursing home model, has shown positive psychological outcomes. However, little is known about whether the GH nursing home model has positive effects on physical function compared to traditional nursing homes. Objectives To examine the longitudinal effects of the GH nursing home model by comparing change patterns of ADL function over time between GH home residents and traditional nursing home residents. Design A retrospective longitudinal study. Settings Four GH organizations (nine GH units and four traditional units). Participants A total of 242 residents (93 GH residents and 149 traditional home residents) who had stayed in the nursing home at least six months from admission. Methods The outcome was ADL function, and the main independent variable was the facility type in which the resident stayed: a GH or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses. Results The mean ADL function showed deterioration over time, and the rates of deterioration between GH and traditional home residents were not different over time. Four different ADL function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups. Conclusions Although GH nursing homes are considered to represent an innovative model changing the nursing home environment into more person-centered, this study did not demonstrate significant differences in ADL function changes for residents in the GH nursing homes compared to traditional nursing homes. Given that the GH model continues to evolve as it is being implemented and variations within and across GH homes are identified, large-scale longitudinal studies are needed to provide further relevant information on the effects of the GH model. PMID:26260709

Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study.

PubMed

Ju, Yeong Jun; Lee, Hyo Jung; Kim, Woorim; Lee, Sang Ah; Han, Kyu-Tae; Park, Eun-Cheol

2017-10-01

Ensuring and improving long-term care services that use limited healthcare resources more efficiently is a major concern for many aging societies. The aim of this study was to investigate the relationship between use of home-visit nursing services and all-cause hospitalization in a home-visit nursing-recommended group. A retrospective cohort study. Population-based sample of long-term care insurance beneficiaries from the long-term care insurance 2002-2013 claims database in South Korea. Long-term care insurance beneficiaries who need one or more types of nursing care were defined as the home-visit nursing -recommended group (n=4173). The dependent variable in this study was all-cause hospitalization in the home-visit nursing-recommended population. Multivariate Cox proportional hazards regression analysis was used to identify the association between home-visit nursing service use and all-cause hospitalization. A total of 3.8% of the subjects used home-visit nursing services. When participants who used home-visit nursing services were set as the reference group, participants who did not use home-visit nursing services had a higher risk of hospitalization (hazard ratio [HR]=1.25, 95% confidence interval [CI]=1.07-1.47). Additionally, participants who did not use home-visit nursing services and who did not have a caregiver showed a marked increase in the risk of hospitalization (HR=6.81, 95% CI=1.17-39.66). Participants who did not use home-visit nursing services with greater comorbidity showed a considerable increase in risk of hospitalization (HR=1.36, 95% CI=1.09-1.70). Non-use of home-visit nursing services was associated with an increased risk of all-cause hospitalization in the home-visit nursing-recommended population. The present results suggest that the use of home-visit nursing services reduced the risk of hospitalization. Moreover, home-visit nursing may play an essential role in reducing hospitalization risk in the absence of caregiver support. Copyright © 2017 Elsevier Ltd. All rights reserved.

Disease management to promote blood pressure control among African Americans.

PubMed

Brennan, Troyen; Spettell, Claire; Villagra, Victor; Ofili, Elizabeth; McMahill-Walraven, Cheryl; Lowy, Elizabeth J; Daniels, Pamela; Quarshie, Alexander; Mayberry, Robert

2010-04-01

African Americans have a higher prevalence of hypertension and poorer cardiovascular and renal outcomes than white Americans. The objective of this study was to determine whether a telephonic nurse disease management (DM) program designed for African Americans is more effective than a home monitoring program alone to increase blood pressure (BP) control among African Americans enrolled in a national health plan. A prospective randomized controlled study (March 2006-December 2007) was conducted, with 12 months of follow-up on each subject. A total of 5932 health plan members were randomly selected from the population of self-identified African Americans, age 23 and older, in health maintenance organization plans, with hypertension; 954 accepted, 638 completed initial assessment, and 485 completed follow-up assessment. The intervention consisted of telephonic nurse DM (intervention group) including educational materials, lifestyle and diet counseling, and home BP monitor vs. home BP monitor alone (control group). Measurements included proportion with BP < 120/80, mean systolic BP, mean diastolic BP, and frequency of BP self-monitoring. Results revealed that systolic BP was lower in the intervention group (adjusted means 123.6 vs. 126.7 mm Hg, P = 0.03); there was no difference for diastolic BP. The intervention group was 50% more likely to have BP in control (odds ratio [OR] = 1.50, 95% confidence interval [CI] 0.997-2.27, P = 0.052) and 46% more likely to monitor BP at least weekly (OR 1.46, 95% CI 1.07-2.00, P = 0.02) than the control group. A nurse DM program tailored for African Americans was effective at decreasing systolic BP and increasing the frequency of self-monitoring of BP to a greater extent than home monitoring alone. Recruitment and program completion rates could be improved for maximal impact.

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…

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,…

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…

Structure, environment and strategic outcome: a study of Pennsylvania nursing homes.

PubMed

Aaronson, W E; Zinn, J S; Rosko, M D

1995-02-01

This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.

Differences among nursing homes in outcomes of a safe resident handling program

PubMed Central

Kurotvski, Alicia; Gore, Rebecca; Buchholz, Bryan; Punnett, Laura

2018-01-01

A large nursing home corporation implemented a safe resident handling program (SRHP) in 2004–2007. We evaluated its efficacy over a 2-year period by examining differences among 5 centers in program outcomes and potential predictors of those differences. We observed nursing assistants (NAs), recording activities and body postures at 60-second intervals on personal digital assistants at baseline and at 3-month, 12-month, and 24-month follow-ups. The two outcomes computed were change in equipment use during resident handling and change in a physical workload index that estimated spinal loading due to body postures and handled loads. Potential explanatory factors were extracted from post-observation interviews, investigator surveys of the workforce, from administrative data, and employee satisfaction surveys. The facility with the most positive outcome measures was associated with many positive changes in explanatory factors and the facility with the fewest positive outcome measures experienced negative changes in the same factors. These findings suggest greater SRHP benefits where there was lower NA turnover and agency staffing; less time pressure; and better teamwork, staff communication, and supervisory support. PMID:22833329

Attractiveness of working in home care: An online focus group study among nurses.

PubMed

De Groot, Kim; Maurits, Erica E M; Francke, Anneke L

2018-01-01

Many western countries are experiencing a substantial shortage of home-care nurses due to the increasing numbers of care-dependent people living at home. In-depth knowledge is needed about what home-care nurses find attractive about their work in order to make recommendations for the recruitment and retention of home-care nursing staff. The aims of this explorative, qualitative study were to gain in-depth knowledge about which aspects home-care nurses find attractive about their work and to explore whether these aspects vary for home-care nurses with different levels of education. Discussions were conducted with six online focus groups in 2016 with a total of 38 Dutch home-care nurses. The transcripts were analysed using the principles of thematic analysis. The findings showed that home-care nurses find it attractive that they are a "linchpin", in the sense of being the leading professional and with the patient as the centre of care. Home-care nurses also find having autonomy attractive: autonomy over decision-making about care, freedom in work scheduling and working in a self-directed team. Variety in patient situations and activities also makes their work attractive. Home-care nurses with a bachelor's degree did not differ much in what they found attractive aspects from those with an associate degree (a nursing qualification after completing senior secondary vocational education). It is concluded that autonomy, variety and being a "linchpin" are the attractive aspects of working in home care. To help recruit and retain home-care nursing staff, these attractive aspects should be emphasised in nursing education and practice, in recruitment programmes and in publicity material. © 2017 John Wiley & Sons Ltd.

Ensuring Quality Nursing Home Care

MedlinePlus

Ensuring Quality Nursing Home Care Before you choose a nursing home Expert information from Healthcare Professionals Who Specialize in the Care ... Nearly 1.6 million older Americans live in nursing homes in the United States. The move to ...

Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial.

PubMed

Rolland, Yves; Pillard, Fabien; Klapouszczak, Adrian; Reynish, Emma; Thomas, David; Andrieu, Sandrine; Rivière, Daniel; Vellas, Bruno

2007-02-01

To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD). Randomized, controlled trial. Five nursing homes. One hundred thirty-four ambulatory patients with mild to severe AD. Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months. ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis. ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred. A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.

Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses.

PubMed

Maurits, Erica E M; de Veer, Anke J E; Groenewegen, Peter P; Francke, Anneke L

2018-07-01

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people-centred and integrated health services. This includes providing integrated care around people's needs that is effectively co-ordinated across providers and co-produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home-care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people-centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home-care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people-centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home-care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people-centred, integrated home care as attractive. Specific aspects that home-care nurses find attractive are promoting the patient's self-reliance and having a network in the community. Hospital nurses are mainly attracted to health-related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home-care nurses and a minority of hospital nurses feel attracted to people-centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home-care organisations who aim to expand the home-care nursing workforce. © 2018 John Wiley & Sons Ltd.

Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia

PubMed Central

Lee, Michelle M; Camp, Cameron J; Malone, Megan L

2007-01-01

Fourteen nursing home residents on a dementia special care unit at a skilled nursing facility took part in one-to-one intergenerational programming (IGP) with 15 preschool children from the facility’s on-site child care center. Montessori-based activities served as the interface for interactions between dyads. The amount of time residents demonstrated positive and negative forms of engagement during IGP and standard activities programming was assessed through direct observation using a tool developed for this purpose – the Myers Research Institute Engagement Scale (MRI-ES). These residents with dementia displayed the ability to successfully take part in IGP. Most successfully presented “lessons” to the children in their dyads, similar to the way that Montessori teachers present lessons to children, while persons with more severe cognitive impairment took part in IGP through other methods such as parallel play. Taking part in IGP was consistently related with higher levels of positive engagement and lower levels of negative forms of engagement in these residents with dementia than levels seen in standard activities programming on the unit. Implications of using this form of IGP, and directions for future research, are discussed. PMID:18044197

Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia.

PubMed

Lee, Michelle M; Camp, Cameron J; Malone, Megan L

2007-01-01

Fourteen nursing home residents on a dementia special care unit at a skilled nursing facility took part in one-to-one intergenerational programming (IGP) with 15 preschool children from the facility's on-site child care center. Montessori-based activities served as the interface for interactions between dyads. The amount of time residents demonstrated positive and negative forms of engagement during IGP and standard activities programming was assessed through direct observation using a tool developed for this purpose--the Myers Research Institute Engagement Scale (MRI-ES). These residents with dementia displayed the ability to successfully take part in IGP. Most successfully presented "lessons" to the children in their dyads, similar to the way that Montessori teachers present lessons to children, while persons with more severe cognitive impairment took part in IGP through other methods such as parallel play. Taking part in IGP was consistently related with higher levels of positive engagement and lower levels of negative forms of engagement in these residents with dementia than levels seen in standard activities programming on the unit. Implications of using this form of IGP, and directions for future research, are discussed.

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

... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality... per diem to State homes providing nursing home and adult day health services care to Veterans. VA...

Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries.

PubMed

Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

2017-10-01

To examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. We identified Medicare beneficiaries without full Medicaid or use of hospital or nursing home services in 2008 (N = 2,163,387). A discrete survival analysis estimated beneficiaries' monthly likelihood of entry into the full Medicaid program between January 2009 and June 2010. During the 18-month study period, Medicaid entry occurred for 1.1% and 3.7% of beneficiaries who aged into Medicare or originally qualified for Medicare due to disability, respectively. Among beneficiaries who aged into Medicare, 49% of new Medicaid participants had no use of inpatient, skilled nursing facility, or nursing home services during the study period. Individuals who recently used inpatient, skilled nursing facility or nursing home services had monthly rates of 1.9, 14.0, and 38.1 new Medicaid participants per 1,000 beneficiaries, respectively, compared with 0.4 new Medicaid participants per 1,000 beneficiaries with no recent use of these services. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period. These patterns should be considered when designing and evaluating interventions to reform health care delivery for dual-eligible beneficiaries. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Prevention of falls in nursing homes: subgroup analyses of a randomized fall prevention trial.

PubMed

Rapp, Kilian; Lamb, Sarah E; Büchele, Gisela; Lall, Ranjit; Lindemann, Ulrich; Becker, Clemens

2008-06-01

To evaluate the effectiveness of a multifactorial fall prevention program in prespecified subgroups of nursing home residents. Secondary analysis of a cluster-randomized, controlled trial. Six nursing homes in Germany. Seven hundred twenty-five long-stay residents; median age 86; 80% female. Staff and resident education on fall prevention, advice on environmental adaptations, recommendation to wear hip protectors, and progressive balance and resistance training. Time to first fall and the number of falls. Falls were assessed during the 12-month intervention period. Univariate regression analyses were performed, including a confirmatory test of interaction. The intervention was more effective in people with cognitive impairment (hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35-0.69) than in those who were cognitively intact (HR=0.91, 95% CI=0.68-1.22), in people with a prior history of falls (HR=0.47, 95% CI=0.33-0.67) than in those with no prior fall history (HR=0.77, 95% CI=0.58-1.01), in people with urinary incontinence (HR=0.59, 95% CI=0.45-0.77) than in those with no urinary incontinence (HR=0.98, 95% CI=0.68-1.42), and in people with no mood problems (incidence rate ratio (IRR)=0.41, 95% CI=0.27-0.61) than in those with mood problems (IRR=0.74, 95% CI=0.51-1.09). The effectiveness of a multifactorial fall prevention program differed between subgroups of nursing home residents. Cognitive impairment, a history of falls, urinary incontinence, and depressed mood were important in determining response.

Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home Visiting

PubMed Central

Goodman, W. Benjamin; Murphy, Robert A.; O’Donnell, Karen; Sato, Jeannine; Guptill, Susan

2014-01-01

Objectives. We evaluated whether a brief, universal, postnatal nurse home-visiting intervention can be implemented with high penetration and fidelity, prevent emergency health care services, and promote positive parenting by infant age 6 months. Methods. Durham Connects is a manualized 4- to 7-session program to assess family needs and connect parents with community resources to improve infant health and well-being. All 4777 resident births in Durham, North Carolina, between July 1, 2009, and December 31, 2010, were randomly assigned to intervention and control conditions. A random, representative subset of 549 families received blinded interviews for impact evaluation. Results. Of all families, 80% initiated participation; adherence was 84%. Hospital records indicated that Durham Connects infants had 59% fewer infant emergency medical care episodes than did control infants. Durham Connects mothers reported fewer infant emergency care episodes and more community connections, more positive parenting behaviors, participation in higher quality out-of-home child care, and lower rates of anxiety than control mothers. Blinded observers reported higher quality home environments for Durham Connects than for control families. Conclusions. A brief universal home-visiting program implemented with high penetration and fidelity can lower costly emergency medical care and improve family outcomes. PMID:24354833

Comparing Public Quality Ratings for Accredited and Nonaccredited Nursing Homes.

PubMed

Williams, Scott C; Morton, David J; Braun, Barbara I; Longo, Beth Ann; Baker, David W

2017-01-01

Compare quality ratings of accredited and nonaccredited nursing homes using the publicly available Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data set. This cross-sectional study compared the performance of 711 Joint Commission-accredited (TJC-accredited) nursing homes (81 of which also had Post-Acute Care Certification) to 14,926 non-Joint Commission-accredited (non-TJC-accredited) facilities using the Nursing Home Compare data set (as downloaded on April 2015). Measures included the overall Five-Star Quality Rating and its 4 components (health inspection, quality measures, staffing, and RN staffing), the 18 Nursing Home Compare quality measures (5 short-stay measures, 13 long-stay measures), as well as inspection deficiencies, fines, and payment denials. t tests were used to assess differences in rates for TJC-accredited nursing homes versus non-TJC-accredited nursing homes for quality measures, ratings, and fine amounts. Analysis of variance models were used to determine differences in rates using Joint Commission accreditation status, nursing home size based on number of beds, and ownership type. An additional model with an interaction term using Joint Commission accreditation status and Joint Commission Post-Acute Care Certification status was used to determine differences in rates for Post-Acute Care Certified nursing homes. Binary variables (eg, deficiency type, fines, and payment denials) were evaluated using a logistic regression model with the same covariates. After controlling for the influences of facility size and ownership type, TJC-accredited nursing homes had significantly higher star ratings than non-TJC-accredited nursing homes on each of the star rating component subscales (P < .05) (but not on the overall star rating), and TJC-accredited nursing homes with Post-Acute Care Certification performed statistically better on the overall star rating, as well as 3 of the 4 subscales (P < .05). TJC-accredited nursing homes had statistically fewer deficiencies than non-TJC-accredited nursing homes (P < .001), were less likely to have immediate jeopardy or widespread deficiencies (P < .001), and had fewer payment denials (P < .001) and lower fines (P < .001). Despite recent changes made to the CMS NHC star-rating methodology, results confirm previous findings that demonstrate a consistent pattern of superior performance among nursing homes accredited by The Joint Commission when compared to non-TJC-accredited facilities across a broad range of indicators in the Nursing Home Compare data set. It is important to note, however, that a cross-sectional study cannot determine causation, so it is unclear if accreditation assists nursing homes in achieving better care, or if higher-performing nursing homes are more likely to pursue accreditation. Accreditation status remains a significant predictor of nursing home quality across multiple dimensions, independent of facility size and ownership type. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Washington State Nursing Home Administrator Model Curriculum. Final Report.

ERIC Educational Resources Information Center

Cowan, Florence Kelly

The course outlines presented in this final report comprise a proposed Fort Steilacoom Community College curriculum to be used as a statewide model two-year associate degree curriculum for nursing home administrators. The eight courses described are introduction to nursing, home administration, financial management of nursing homes, nursing home…

Hospice use among nursing home and non-nursing home patients.

PubMed

Unroe, Kathleen T; Sachs, Greg A; Dennis, M E; Hickman, Susan E; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M

2015-02-01

For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform. Our aim was to describe characteristics and utilization of hospice among nursing home and non-nursing home patients. Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay. Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics. Nursing home hospice patients were older, and more likely to be women and to have dementia (p < 0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of non-nursing home hospice and 7.6 % of those with near transitions) (p < 0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p < 0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p < 0.05). Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.

Variations in levels of care between nursing home patients in a public health care system

PubMed Central

2014-01-01

Background Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. Methods The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. Results There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. Conclusion In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients’ own needs, but also on the needs of all the other residents. PMID:24597468

Variations in levels of care between nursing home patients in a public health care system.

PubMed

Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

2014-03-05

Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients' own needs, but also on the needs of all the other residents.

Memory Recall and Participation Levels in the Elderly: A Study of Golden Age Radio.

ERIC Educational Resources Information Center

Durham, Pamela R.; Whittemore, Margaret P.

1993-01-01

Twelve women (mean age 90) in a nursing home listened to Golden Age radio programs and answered trivia questions. Reactions to musical programs showed they encouraged reminiscence; trivia stimulated recall of historical and life events. In contrast, comedy programs evoked little response. (SK)

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

Ownership conversions and nursing home performance.

PubMed

Grabowski, David C; Stevenson, David G

2008-08-01

To examine the effects of ownership conversions on nursing home performance. Online Survey, Certification, and Reporting system data from 1993 to 2004, and the Minimum Data Set (MDS) facility reports from 1998 to 2004. Regression specification incorporating facility fixed effects, with terms to identify trends in the pre- and postconversion periods. The annual rate of nursing home conversions almost tripled between 1994 and 2004. Our regression results indicate converting facilities are generally different throughout the pre/postconversion years, suggesting little causal effect of ownership conversions on nursing home performance. Before and after conversion, nursing homes converting from nonprofit to for-profit status generally exhibit deterioration in their performance, while nursing homes converting from for-profit to nonprofit status generally exhibit improvement. Policy makers have expressed concern regarding the implications of ownership conversions for nursing home performance. Our results imply that regulators and policy makers should not only monitor the outcomes of nursing home conversions, but also the targets of these conversions.

Facilitators and barriers to self-management of nursing home residents: perspectives of health-care professionals in Korean nursing homes.

PubMed

Park, Yeon-Hwan; Bang, Hwal Lan; Kim, Ga Hye; Ha, Ji Yeon

2015-01-01

To explore facilitators and barriers to self-management from the viewpoint of staff taking care of nursing home (NH) residents with chronic diseases in South Korea. A qualitative content analysis was done using the focus group interview method. A total of 23 health-care professionals (16 registered nurses and 7 social workers) were interviewed from three urban NHs, each with more than 100 beds. Five facilitators were identified: grouping the residents; the resident's awareness of his/her current health status; the willingness of residents to engage in self-management; residence in the facility; and support from the staff. Additionally, seven barriers were identified: deterioration of the resident's health; the dependency expectations of the resident; hesitation in asking for help; difference in expectations between the staff and the resident's family; insufficient staffing and time; lack of standardized guidelines; and conservative tendencies of the staff due to rigid policies. The findings of this study can help health-care professionals recognize the factors that influence self-management and provide direction for registered nurses and other health professionals involved in supporting self-management programs for NH residents.

Facilitators and barriers to self-management of nursing home residents: perspectives of health-care professionals in Korean nursing homes

PubMed Central

Park, Yeon-Hwan; Bang, Hwal Lan; Kim, Ga Hye; Ha, Ji Yeon

2015-01-01

Purpose To explore facilitators and barriers to self-management from the viewpoint of staff taking care of nursing home (NH) residents with chronic diseases in South Korea. Patients and methods A qualitative content analysis was done using the focus group interview method. A total of 23 health-care professionals (16 registered nurses and 7 social workers) were interviewed from three urban NHs, each with more than 100 beds. Results Five facilitators were identified: grouping the residents; the resident’s awareness of his/her current health status; the willingness of residents to engage in self-management; residence in the facility; and support from the staff. Additionally, seven barriers were identified: deterioration of the resident’s health; the dependency expectations of the resident; hesitation in asking for help; difference in expectations between the staff and the resident’s family; insufficient staffing and time; lack of standardized guidelines; and conservative tendencies of the staff due to rigid policies. Conclusion The findings of this study can help health-care professionals recognize the factors that influence self-management and provide direction for registered nurses and other health professionals involved in supporting self-management programs for NH residents. PMID:26491277

The Natural History of Nursing Home Patients.

ERIC Educational Resources Information Center

Lewis, Mary Ann; And Others

1985-01-01

Former nursing home residents (N=197) were followed for 2 years after discharge. Four subgroups of patients were identified on the basis of different patterns of survival and use of health care resources: those who returned home, died in nursing homes, transferred to hospitals, or transferred to other nursing homes. (NRB)

Bases for Vocational Education for Food Service Industry Employees.

ERIC Educational Resources Information Center

Iowa State Univ. of Science and Technology, Ames.

As a preliminary step in establishing bases for food service training programs, data were collected from a sample of institutions including 4,496 restaurants, 158 hospitals, 436 nursing homes, and 343 custodial homes. A second phase involved developing inventories of attitudes toward food service employment and administering them to high school…

Home Healthcare Nurses' Job Satisfaction Scale: refinement and psychometric testing.

PubMed

Ellenbecker, Carol H; Byleckie, James J

2005-10-01

This paper describes a study to further develop and test the psychometric properties of the Home Healthcare Nurses' Job Satisfaction Scale, including reliability and construct and criterion validity. Numerous scales have been developed to measure nurses' job satisfaction. Only one, the Home Healthcare Nurses' Job Satisfaction Scale, has been designed specifically to measure job satisfaction of home healthcare nurses. The Home Healthcare Nurses' Job Satisfaction Scale is based on a theoretical model that integrates the findings of empirical research related to job satisfaction. A convenience sample of 340 home healthcare nurses completed the Home Healthcare Nurses' Job Satisfaction Scale and the Mueller and McCloskey Satisfaction Scale, which was used to test criterion validity. Factor analysis was used for testing and refinement of the theory-based assignment of items to constructs. Reliability was assessed by Cronbach's alpha internal consistency reliability coefficients. The data were collected in 2003. Nine factors contributing to home healthcare nurses' job satisfaction emerged from the factor analysis and were strongly supported by the underlying theory. Factor loadings were all above 0.4. Cronbach's alpha coefficients for each of the nine subscales ranged from 0.64 to 0.83; the alpha for the global scale was 0.89. The correlations between the Home Healthcare Nurses' Job Satisfaction Scale and Mueller and McCloskey Satisfaction Scale was 0.79, indicating good criterion-related validity. The Home Healthcare Nurses' Job Satisfaction Scale has potential as a reliable and valid scale for measurement of job satisfaction of home healthcare nurses.

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.

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,…

A physical workload index to evaluate a safe resident handling program for nursing home personnel.

PubMed

Kurowski, Alicia; Buchholz, Bryan; Punnett, Laura

2014-06-01

The aim of this study was to obtain a comprehensive analysis of the physical workload of clinical staff in long-term care facilities, before and after a safe resident handling program (SRHP). Ergonomic exposures of health care workers include manual handling of patients and many non-neutral postures. A comprehensive assessment requires the integration of loads from these varied exposures into a single metric. The Postures, Activities, Tools, and Handling observational protocol, customized for health care, was used for direct observations of ergonomic exposures in clinical jobs at 12 nursing homes before the SRHP and 3, 12, 24, and 36 months afterward. Average compressive forces on the spine were estimated for observed combinations of body postures and manual handling and then weighted by frequencies of observed time for the combination. These values were summed to obtain a biomechanical index for nursing assistants and nurses across observation periods. The physical workload index (PWI) was much higher for nursing assistants than for nurses and decreased more after 3 years (-24% versus -2.5%). Specifically during resident handling, the PWI for nursing assistants decreased by 41% of baseline value. Spinal loading was higher for nursing assistants than for nurses in long-term care centers. Both job groups experienced reductions in physical loading from the SRHP, especially the nursing assistants and especially while resident handling. The PWI facilitates a comprehensive investigation of physical loading from both manual handling and non-neutral postures. It can be used in any work setting to identify high-risk tasks and determine whether reductions in one exposure are offset by increases in another.

Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care.

PubMed

Weaver, Meaghann S; Wichman, Brittany; Bace, Sue; Schroeder, Denice; Vail, Catherine; Wichman, Chris; Macfadyen, Andrew

2018-06-01

The national nursing shortage translates into a gap in home nursing care available to children with complex, chronic medical conditions and their family caregivers receiving palliative care consultations. A total of 38 home health nursing surveys were completed by families receiving pediatric palliative care consultation services at a freestanding children's hospital in the Midwest. The gap in the average number of nursing hours allotted versus received was 40 h/wk per family, primarily during evening hours. Parents missed an average of 23 hours of employment per week to provide hands-on nursing care at home, ranking stress regarding personal employment due to nursing shortage at 6.2/10. Families invested an average of 10 h/mo searching for additional nursing coverage and often resorted to utilizing more than 6 different home nurse coverage personnel per month. Families reported multiple delays to hospital discharges (mean, 15 days per delay) due to inability to find home nursing coverage. Respiratory technology and lack of Medicaid coverage ( P < .02) correlated with the gap in home nursing access. This study examines how the pediatric home nursing shortage translates into a lived experience for families with children with complex medical conditions receiving palliative care.

Development, validation and testing of a nursing home to emergency room transfer checklist.

PubMed

Tsai, Hsiu-Hsin; Tsai, Yun-Fang

2018-01-01

To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults between facilities such as nursing homes and hospitals. © 2017 John Wiley & Sons Ltd.

Hospice family members' perceptions of and experiences with end-of-life care in the nursing home.

PubMed

Oliver, Debra Parker; Washington, Karla; Kruse, Robin L; Albright, David L; Lewis, Alexandria; Demiris, George

2014-10-01

Even though 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 2 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 with 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? 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 members of hospice patients residing in the community. 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. 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 residents. This study suggests that nursing homes should embrace the opportunity to demonstrate the value of family participation in the care-planning process. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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 residents. This study suggests that nursing homes should embrace the opportunity to demonstrate the value of family participation in the care planning process. PMID:25017391

"I'm not sure I'm a nurse": A hermeneutic phenomenological study of nursing home nurses' work identity.

PubMed

Thompson, Juliana; Cook, Glenda; Duschinsky, Robbie

2018-03-01

To explore nursing home nurses' experiences and views of work identity. Nursing home nurses are in a unique position as they work at the interface of health and social care. Little is known about nursing home nurses' perceptions and experiences of working within this context. Evidence suggests that using the concept of work identity can support understanding of how workers make sense of their work. Hermeneutic phenomenological study. The study was carried out in seven nursing homes in North East England. Findings are based upon literary analysis of multiple episodic interviews with 13 nursing home nurses. Participants' responses suggested that nursing "residents" is different to nursing "patients," and nursing home nurses are required to modify their care activities to account for these differences. Participants also proposed that they are isolated and excluded from the rest of the healthcare workforce group. These issues led participants to feel uncertain about work identity. Many participants attempted to strengthen their work identity by aligning their role with what they perceived the "nurse identity" to be. Nurses' work activities and professional group identity influence their work identity. When work activities and professional group identity do not align with role expectations, as can be the case for nursing home nurses, work identity may be compromised. These nurses may attempt to change work practices to strengthen their work identity. Health- and social care providers need to account for work identity factors in the organisation of care, and planning and implementation of integrated health- and social care initiatives. © 2017 John Wiley & Sons Ltd.

Changes in nursing home staffing levels, 1997 to 2007.

PubMed

Seblega, Binyam K; Zhang, Ning Jackie; Unruh, Lynn Y; Breen, Gerald-Mark; Seung Chun Paek; Wan, Thomas T H

2010-04-01

A positive relationship has been demonstrated between the quality of care delivered in nursing homes and the quality of nursing staff providing the care. The general perception, however, is that there is a decline in registered nurses' staff hours in nursing homes. The primary objective of this study is to investigate whether the levels of registered nurses (RNs), licensed practical nurses (LPNs), and nursing assistants (NAs) as well as skill mix has changed in nursing homes between the years 1997 and 2007. A descriptive research design was employed on data derived from Online Survey Certification and Reporting System database. After accounting for facility size and ownership, it was found that more nursing homes have increased-rather than decreased-LPN and NA hours per resident day between 1997 and 2007. On the other hand, more nursing homes have decreased-rather than increased-RN hours per resident day and skill mix during the same time period.

Staffing and Worker Injury in Nursing Homes

PubMed Central

Trinkoff, Alison M.; Johantgen, Meg; Muntaner, Carles; Le, Rong

2005-01-01

Objectives. We examined the relationship between nursing home staffing levels and worker injury rates in 445 nursing homes in 3 states. Methods. We obtained First Reports of Injury and workers’ compensation data from 3 states (Ohio, West Virginia, and Maryland) for the year 2000. We then linked these data to Medicare’s Online Survey, Certification and Reporting system to obtain nursing home staffing details and organizational descriptors. We used ordinary least squares and log-transformed regression models to examine the association between worker injury rate and nursing home staffing and organizational characteristics. Results. Total nursing hours per resident day were significantly associated with worker injury rates in nursing homes after we adjusted for organizational characteristics and state dummy variables (P=.0004). Conclusions. Our findings suggest that nursing home staffing levels have an important impact on worker health. These findings were supported for multiple facilities across different states; therefore, policies and resources that increase staffing levels in nursing homes are warranted. PMID:15983274

Introduction of assistive devices: home nurses' practices and beliefs.

PubMed

Roelands, Marc; Van Oost, Paulette; Depoorter, Anne Marie; Buysse, Ann; Stevens, Veerle

2006-04-01

This paper reports a study describing home nurses' intention and current practices regarding introducing assistive devices, and investigating whether their practice is related to social cognitive factors (attitudes, subjective norms and self-efficacy). Home nurses not only care for patients in particular medical domains, but also educate and guide them towards more independence. Patients with age-related disabilities in mobility and self-care might benefit from the use of assistive devices. A home nurse might be the first and only person to discuss the disability and use of an assistive device. Therefore, home nurses' beliefs about the introduction of assistive devices could affect their daily practices. A cross-sectional study was conducted with a convenience sample of 64 home nurses chosen from a random sample of home nursing departments. The home nurses completed a self-administered questionnaire. The Theory of Planned Behaviour framework was used to develop the social cognitive measures regarding each of the six steps distinguished in the introduction of assistive devices. Home nurses had positive attitudes and high levels of intention, subjective norm and self-efficacy towards most steps of the decision process to introduce assistive devices. In a multiple linear regression analysis, attitude and self-efficacy predicted intention to introduce assistive devices to older clients with disabilities. Intention was correlated to home nurses' current practices. The findings suggest that conditions are present to involve home nurses more explicitly in the introduction of assistive devices to their patients. Social cognitive factors should be taken into account when developing interventions that aim to support home nurses to do this.

Is a public reporting approach appropriate for nursing home care?

PubMed

Stevenson, David G

2006-08-01

Publicizing quality information has been used as a quality improvement strategy in the acute care sector for more than a decade. Despite research showing mixed results of these efforts, publicly reporting quality measures is currently being pursued as a quality improvement strategy for nursing homes. Designed to empower consumers to make informed choices and to stimulate provider competition on quality, nursing home public reporting began in 1998 with the Nursing Home Compare Web site and has received greater emphasis in the 2002 Nursing Home Quality Initiative, both directed by the federal government. Focusing on the response of three key stakeholder groups across settings of care-consumers, providers, and purchasers-I identify several challenges that nursing home reporting must overcome to be successful. I conclude that publicly reporting quality measures for nursing homes will have a harder time promoting quality improvement than for acute care settings, where results have been disappointing thus far. In addition to the conceptual analysis, I evaluate whether the quality information reported on Nursing Home Compare had any impact on nursing home occupancy rates following its release. Using a pre/post-release design, I find that the effect of public reporting on nursing home occupancy rates has been minimal thus far. Although some estimates of effect are statistically significant and in the hypothesized direction, they all suggest very small effect sizes. It is unclear whether the absence of a larger reporting effect to date is specific to Nursing Home Compare or whether it inheres to the broader task of using quality information to promote change in the nursing home care sector.

Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

PubMed

Park, Claire Su-Yeon

2017-08-01

To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.

Does Investor Ownership of Nursing Homes Compromise the Quality of Care?

PubMed Central

Harrington, Charlene; Woolhandler, Steffie; Mullan, Joseph; Carrillo, Helen; Himmelstein, David U.

2001-01-01

Objectives. Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. Methods. We analyzed 1998 data from state inspections of 13 693 nursing facilities. We used a multivariate model and controlled for case mix, facility characteristics, and location. Results. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. Conclusions. Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes. PMID:11527781

High-Risk Medication Use by Nursing Home Residents Before and After Hospitalization

PubMed Central

Stevenson, David G.; Dusetzina, Stacie B.; O’Malley, A. James; Mitchell, Susan L.; Zarowitz, Barbara J.; Chernew, Michael E.; Newhouse, Joseph P.; Huskamp, Haiden A.

2014-01-01

Background Two prominent challenges in nursing home care are ensuring appropriate medication use and achieving high quality care as residents transition from the hospital to the nursing home and back. Research about prescribing practices at this important clinical juncture is limited. Objective To analyze the use of high-risk medications by nursing home residents before and after being hospitalized. We define high-risk medications using the Beers criteria for potentially inappropriate medication use. Research Design, Subjects, Measures Using a dataset with Medicare claims for inpatient and skilled nursing facility stays, and pharmacy claims for all medications dispensed in the nursing home setting, we examine high-risk medication use for hospitalized nursing home residents before and after being hospitalized. Our study population includes 52,559 dual-eligible nursing home residents aged 65 and older who are hospitalized and then readmitted to the same nursing home in 2008. Our primary outcome of interest is the use of high-risk medications in the 30 days before hospitalization and the 30 days following readmission to the same nursing home. We define high-risk medications using the Beers criteria for potentially inappropriate medication use. Results Around one in five hospitalized nursing home residents (21%) used at least one high-risk medication the day before hospitalization. Among individuals with high-risk medication use at hospitalization, the proportion using these medications dropped to 45% after nursing home readmission but increased thereafter, to 59% by the end of the 30-day period. Conclusion We found moderate levels of high-risk medication use by hospitalized nursing home residents before and after their hospital stays, constituting an important clinical and policy challenge. PMID:25185637

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

... Activities (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of.... 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 day health care to furnish an application...

Medicaid Issues in Family Welfare and Nursing Home Reform. Including H.R. 2270, a Bill To Amend Title XIX of the Social Security Act To Change the Medicaid Requirements for Nursing Facilities Based on Recommendations of the Institute of Medicine of the National Academy of Sciences. Hearings before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives, One Hundredth Congress, First Session (April 24 and May 12, 1987).

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Energy and Commerce.

Two hearings held a month apart examine major issues concerning Medicaid benefits in family welfare and nursing home reform. The first set of hearings discusses the proposed Family Welfare Reform Act of 1987 (H.R. 1720), which is intended to replace the Aid to Families with Dependent Children (AFDC) program of the Social Security Act Title IV.…

Development and Pilot Evaluation of a Novel Dignity-Conserving End-of-Life (EoL) Care Model for Nursing Homes in Chinese Societies.

PubMed

Ho, Andy H Y; Dai, Annie A N; Lam, Shu-Hang; Wong, Sandy W P; Tsui, Amy L M; Tang, Jervis C S; Lou, Vivian W Q

2016-06-01

The provision of end-of-life (EoL) care in long-term-care settings remains largely underdeveloped in most Chinese societies, and nursing home residents often fail to obtain good care as they approach death. This paper systematically describes the development and implementation mechanisms of a novel Dignity-Conserving EoL Care model that has been successfully adopted by three nursing homes in Hong Kong and presents preliminary evidence of its effectiveness on enhancing dignity and quality of life (QoL) of terminally ill residents. Nine terminally ill nursing home residents completed the McGill Quality of Life Questionnaire and the Nursing Facilities Quality of Life Questionnaire at baseline and 6 months post-EoL program enrollment. Wilcoxon signed rank test was used to detect significance changes in each QoL domains across time. Although significant deterioration was recorded for physical QoL, significant improvement was observed for social QoL. Moreover, a clear trend toward significant improvements was identified for the QoL domains of individuality and relationships. A holistic and compassionate caring environment, together with the core principles of family-centered care, interagency and interdisciplinary teamwork, as well as cultural-specific psycho-socio-spiritual support, are all essential elements for optimizing QoL and promoting death with dignity for nursing home residents facing morality. This study provides a useful framework to facilitate the future development of EoL care in long-term-care settings in the Chinese context. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Project (inverted exclamation mark)EXITO!: success through diversity and universality for outcomes improvement among Hispanic home care patients.

PubMed

Woerner, Louise; Espinosa, Javier; Bourne, Susan; O'Toole, Marie; Ingersoll, Gail L

2009-01-01

The National Health Disparities Report notes that Hispanics have poorer quality of care in 23 of 38 core measures. The result of this disparity is great personal and health system costs, which could be reduced. Prior studies have focused on access and language. We studied outcomes improvement. The purpose of this project was to develop a replicable theory-based outcomes improvement model for delivery of nursing care to Hispanic patients. The Leininger Sunrise Enabler approach was used to design a program specific to the cultural needs of a home care population. Outcome and Assessment Information Set (OASIS) data from 125 unduplicated home care patients were tracked. Nursing care delivery was analyzed using ethnographic research techniques. Delivery of nursing care using a culturally congruent approach reduced acute hospitalization and emergent care visits. Medication management and customer and nursing satisfaction also improved. National standards for culturally and linguistically appropriate services in health care help reduce healthcare disparities, but improving Hispanic outcomes requires moving beyond symptoms and symptom management to transcultural care. The estimated savings to the health care system are significant.

High Job Demands and Low Job Control Increase Nurses' Professional Leaving Intentions: The Role of Care Setting and Profit Orientation.

PubMed

Wendsche, Johannes; Hacker, Winfried; Wegge, Jürgen; Rudolf, Matthias

2016-10-01

We investigated how two types of care setting (home care and nursing home) and type of ownership (for-profit vs. public/non-profit) of geriatric care services interacted in influencing registered nurses' intention to give up their profession. In prior research, employment in for-profit-organizations, high job demands, and low job control were important antecedents of nurses' intent to leave. However, the impact of care setting on these associations was inconclusive. Therefore, we tested a mediated moderation model predicting that adverse work characteristics would drive professional leaving intentions, particularly in for-profit services and in nursing homes. A representative German sample of 304 registered nurses working in 78 different teams participated in our cross-sectional study. As predicted, lower job control and higher job demands were associated with higher professional leaving intentions, and nurses reported higher job demands in public/non-profit care than in for-profit care, and in nursing homes compared to home care. Overall, RNs in nursing homes and home care reported similar intent to leave, but in for-profit settings only, nurses working in nursing homes reported higher professional leaving intentions than did nurses in home care, which was linked to lower job control in the for-profit nursing home setting, supporting mediated moderation. Taken together, our results indicate that the interplay of care setting and type of ownership is important when explaining nurses' intentions to give up their profession. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

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.

Evaluation of a long-term home care program.

PubMed

Hughes, S L; Cordray, D S; Spiker, V A

1984-05-01

This article reports the outcomes of a 9-month evaluation of the Five Hospital Homebound Elderly Program ( FHHEP ), a model long-term, comprehensive, coordinated home care program in Chicago. Outcomes assessed include the mortality, comprehensive functional status, and rates of hospitalization and of institutionalization of the elderly (mean age, 80.4 years), chronically impaired population served by the FHHEP . The evaluation utilized a quasi-experimental, preposttest design with a nonequivalent control group consisting of similarly elderly and impaired subjects who received OAA Title III-c home-delivered meals. Consecutively accepted experimental (n = 122) and control group clients (n = 123) were interviewed using the Duke/ OARS Multi-dimensional Functional Assessment Questionnaire at the time of acceptance to service and 9 months later. Service utilization data were also obtained for both groups to correlate client outcomes and characteristics with level and type of services used. Data collection took place over a 31-month period. Posttest functional status measures were obtained for 83% of experimental and 81% of control subjects. Multivariate analysis was used to control measured pretest differences. Major findings include a significant reduction in the nursing home admissions (16 vs. 28) and nursing home days (including sheltered care) of experimental group clients. The reported analyses also show an increase in experimental clients' sense of physical health well-being and a decrease in their number of previously unmet needs for community services. Somewhat paradoxically, the experimental sample also demonstrated a decrease in physical activities of daily living ( PADL ) functioning. The mortality and hospitalization rate were equal for both groups. Despite savings in nursing home days of care, average per-capita costs for experimental group clients were 19% higher than for controls. However, this additional cost was accompanied by an increase in quality of life. Longer-range cost and outcomes are being assessed through a 4-year follow-up study currently in progress.

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.

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 part...

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 part...

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 part...

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 part...