Assessment of Multiple Constructs of Social Integration for Older Adults Living in Nursing Homes

A variety of terms and measures have been used in the literature to denote being socially integrated, and many studies of older adults focus on only social networks or social support and often only include those living in the community. The purpose of this study was to assess multiple constructs of social integration (i.e., social networks, social capital, social support, and social engagement) for older adults in nursing homes. Data were collected from 140 older adults at 30 nursing homes in Kansas. We interviewed older adults\u27 in-person using a survey questionnaire, and used multilevel confirmatory factor analysis to analyze the data. The final model that included the four constructs had acceptable fit (χ2 = 174.71; df = 112; p \u3c .01; CFI = .93; RMSEA = .06; SRMR-W = .06; SRMR-B = .12). The results showed that the proposed model was supported at the individual level. At the between-level, social networks and social support were supported. Study results have methodological and practice/policy implications for the study of older adults in long term care settings. In particular, this study contributes to understanding how to operationally define and differentiate social integration variables in studies of older adults, particularly when study data are hierarchical

Successful Strategies for Discharging Medicaid Nursing Home Residents with Mental Health Diagnoses to the Community

The state and federal push to transition Medicaid residents from nursing homes to the community calls for effective discharge strategies targeted to residents’ diverse needs. This exploratory, mixed-methods study utilized the Minimum Data Set to describe demographics, health characteristics, and transition patterns of Kansas Medicaid residents with mental health diagnoses who were discharged from nursing homes from 2005 to 2008. Discharged residents (n = 720) had multiple comorbidities, and more than half remained in the community following their first nursing home event. In-depth interviews with nursing home staff (n = 11) explored successful discharge strategies. Successful strategies support an ecological approach to meeting individual, family, organizational, and community needs. This includes creating/sustaining a culture of discharge, encompassing informal and formal community supports in the discharge process, proactively addressing physical environment needs, and assisting individuals and their family members in managing physical and mental health conditions. Findings suggest that policies in the areas of preadmission screening, caregiver support, and revised Medicaid reimbursement are needed to better support continuity of care and promote discharge for nursing home residents with complex care needs. Future research could examine individual and family perspectives on the discharge process and track outcomes when transitioning between settings

The Service Use Index: A Tool for Examining Rural/Urban Differences

Development of tools for identifying and tracking differences in older adult service utilization by race, ethnicity, income, and geographic area is vital in the face of current demographic and economic changes in rural areas, particularly in areas experiencing rapid demographic changes. In this conceptual article, we explain how to calculate a service use index that compares service utilization of a specific group of older adults to that of the entire older adult population. We then illustrate its usefulness with a case example using geographic information systems (GIS). This unique approach can be utilized to understand differences across fields of practice, enhance planning to address differences, and monitor changes over time

Engaging Nursing Home Residents in Formal Volunteer Activities: a Focus on Strengths

Nursing homes around the world are seeking new strategies to improve the quality of life for older adults living in their facilities. Involvement of older adults in formal volunteer opportunities is a strategy that can provide social interaction and meaningful experiences and has been associated with physical and emotional health benefits. Although engaging older adults in volunteering has shown promise as a method for improving quality of life, community volunteer opportunities have often been made available only to non-institutionalized older adults. This may be due to negative views of both nursing homes and their residents. In addition, nursing home residents are often isolated both physically and socially from their surrounding community. However, using the strengths perspective as a framework, human service professionals in the United States and around the world can help to address these barriers. Specifically, human service professionals can help reframe negative views of nursing homes, identify strengths of nursing homes and their residents, and create and implement a strengths-based agenda for extending formal volunteer opportunities into nursing homes