The Use of Physical Restraints Among Nursing Home Residents: Do Disparities Exist?

Introduction: The purpose of this study is to examine how nursing home (NH) characteristics, specifically racial composition of nursing homes residents, influences the use of physical restraints. As the population ages and becomes more diverse, it is essential to mitigate/eliminate racial/ethnic disparities in quality care. Methods: This is cross-sectional study using a 2010 national data set from Brown University Center for Gerontology and Healthcare Research. This study employs Donabedian\u27s Structure-Process-Outcome (SPO) conceptual framework. Statistical analysis includes univariate, bivariate, and a logistic regression model. It is hypothesized that nursing homes with higher proportions of black residents, more Medicaid residents, and for-profit ownership status will be associated with higher prevalence of physical restraint use. Results: Findings show that nursing homes with high proportions of blacks have a lower likelihood of high physical restraint use. Nursing homes with a higher proportion of Medicaid-reliant residents have a higher likelihood of restraint use, as does for-profit nursing homes. Discussion: The findings indicate that there are no racial/ethnic disparities present in the use of physical restraints in nursing homes. There is indication of socio-economic disparities, since nursing homes with higher Medicaid-reliant residents are associated with greater restraint. There are policy implications associated with these findings, including raising Medicaid per diem or implementing a quality performance payment incentive. Further research will be needed to determine ways to reduce racial/ethnic disparities in nursing homes. This research, adds to the nursing home literature focused on socio-economic disparities

To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors

Compared with young White women, young Black women are more likely to present with aggressive breast cancer (BC) subtypes that are potentially linked to worse health-related quality of life (HRQOL); however, there is limited consensus regarding HRQOL needs among young Black BC survivors. Employing Ferrell's framework on QOL in BC (i.e., physical, psychological, social, and spiritual well-being), we conducted a systematic review on HRQOL among Black BC survivors aged <50 years and proposed recommendations for advancing HRQOL research and care for this population

State Policy Responses to COVID-19 in Nursing Homes

Context: COVID-19 has a high case fatality rate in high-risk populations and can cause severe morbidity and high healthcare resource use. Nursing home residents are a high-risk population; they live in congregate settings, often with shared rooms, and require hands-on care. Objectives: To assess state responses to the coronavirus pandemic related to nursing homes in the first half of 2020. Methods: An in-depth examination of 12 states’ responses to the COVID-19 pandemic in nursing homes through June 2020, using publicly reported information such as government decrees, health department guidance, and news reports. Findings: No state emerged as a model of care. All states faced difficulty with limited availability of testing and Personal Protective Equipment (PPE). State-level efforts to increase pay and benefits as a strategy to enable infected staff to quickly physically separate from residents were minimal, and other separation strategies depended on the ability to obtain test results rapidly and on state rules regarding accepting discharged COVID-19 patients into nursing homes. Visitor restrictions to reduce risk were ubiquitous, though based on a slim evidence-base. Limitations: The information used was limited to that which was publicly available. Implications: Overall, the results suggest that the states that handle the ongoing pandemic in nursing homes best will be those that find ways to make sure nursing homes have the resources to follow best practices for testing, PPE, separation, and staffing. Evidence is needed on visitor restrictions and transmission, as states and their citizens would benefit from finding safe ways to relax visitor restrictions

Shekinah Fashaw, \u2715

Shekinah is pursuing an interdisciplinary studies degree, focusing on biomedical sciences and public affairs in Undergraduate Studies, and minoring in health services administration. Her academic achievements include the President\u27s Honor Roll and dean\u27s list every semester. As a McNair Scholar and a member of The Burnett Honors College, she is conducting independent health services research and looking forward to presenting at future conferences. She has also worked as a research assistant in the College of Nursing through the LEAD Scholars Assistantship program. She is a proud member of Alpha Kappa Psi professional business fraternity, as well as the President\u27s Leadership Council. As a founding member of two student organizations, she values servant leadership and creating opportunities for others. She served in Student Government Association during her entire academic career; most recently, as the director of Student Affairs and as the Outreach chair on the Golden Rule Review Committee. Her passion for continuously investing in others is what drives her. She served as a student representative on the Capital Improvement Trust Fund Fee Committee as well as the Student Activities Committee leader for SDES PROGRESS initiative. For all of her achievements Shekinah has also been recognized with UCF\u27s highest honor, the Order of Pegasus. She plans to obtain her Ph.D. in Public Health and work in a government or research organization that focuses on health policy.https://stars.library.ucf.edu/mcnair_gallery/1096/thumbnail.jp

Developments in the Market for Assisted Living: Residential Care Availability in 2017

Objectives Describe how the availability of assisted living (AL) and dementia-specific AL vary across counties and correlate with demographic and socioeconomic characteristics. Design Maps, univariate statistics, and standardized mean differences show the differences between counties with high and low levels of AL market penetration, and between counties with and without dementia-specific AL. Setting and Participants Data collected from state agencies on licensed AL communities, capacity, and geographic location, and population characteristics from the Area Health Resource file. We include novel and previously undescribed data on dementia-specific AL licenses in 21 states. Measures AL market penetration is reported as the number of AL units or beds per 1000 persons over age 65 years in a county. Results In comparison to counties with the lowest AL penetration, high-penetration counties had higher high school and college education attainment (mean 25.3% vs 18.5%) and median annual income ($56,000 vs$46,800), and lower poverty (12.8% vs 17.3%) and unemployment rates (3.9% vs 5.1%). Compared to counties with AL but no dementia-specific care, counties with dementia care had substantially higher college attainment (24.6% vs 17.7%) and had higher urbanity index (3.8 vs 5.6 on a 1-9 scale, 1 most urban). Counties with dementia care also had, on average, 16% more in median household income ($54,200 vs$46,400) and 40% greater home value ($159,800 vs.$113,600). Conclusions and Implications Large socioeconomic disparities persist among counties without any AL or low penetration of AL in their borders in comparison to those with high AL penetration, as well as between counties with and without dementia-specific AL communities. There may be a mismatch in need and availability of residential care options for older adults with Alzheimer\u27s disease and related dementias that contributes to the disproportionate share of racial/ethnic minorities with dementia in nursing homes. Lack of available AL beds in the communities where Medicaid individuals reside could make rebalancing efforts doubly difficult, in that Medicaid enrollees may be reluctant to move out of their neighborhoods

Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD

BackgroundPrevious research demonstrated an increase in the reporting of schizophrenia diagnoses among nursing home (NH) residents after the Centers for Medicare & Medicaid Services National Partnership to Improve Dementia Care. Given known health and healthcare disparities among Black NH residents, we examined how race and Alzheimer’s and related dementia (ADRD) status influenced the rate of schizophrenia diagnoses among NH residents following the partnership.MethodsWe used a quasi- experimental difference- in- differences design to study the quarterly prevalence of schizophrenia among US long- stay NH residents aged 65- years and older, by Black race and ADRD status. Using 2011- 2015 Minimum Data Set 3.0 assessments, our analysis controlled for age, sex, measures of function and frailty (activities of daily living [ADL] and Changes in Health, End- stage disease and Symptoms and Signs scores) and behavioral expressions.ResultsThere were over 1.2 million older long- stay NH residents, annually. Schizophrenia diagnoses were highest among residents with ADRD. Among residents without ADRD, Black residents had higher rates of schizophrenia diagnoses compared to their nonblack counterparts prior to the partnership. Following the partnership, Black residents with ADRD had a significant increase of 1.7% in schizophrenia as compared to nonblack residents with ADRD who had a decrease of 1.7% (p = 0.007).ConclusionsFollowing the partnership, Black NH residents with ADRD were more likely to have a schizophrenia diagnosis documented on their MDS assessments, and schizophrenia rates increased for Black NH residents with ADRD only. Further work is needed to examine the impact of - colorblind- policies such as the partnership and to determine if schizophrenia diagnoses are appropriately applied in NH practice, particularly for black Americans with ADRD.See related editorial by Rhodes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171195/1/jgs17464.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171195/2/jgs17464_am.pd

Lessons learned from frontline skilled nursing facility staff regarding COVID‐19 vaccine hesitancy

BackgroundPresently a median of 37.5% of the U.S. skilled nursing facility (SNF) workforce has been vaccinated for COVID‐19. It is essential to understand vaccine hesitancy among SNF workers to inform vaccine campaigns going forward.ObjectiveTo describe the concerns raised among healthcare workers and staff from SNFs during town hall meetings.DesignSixty‐three SNFs from four corporations were invited to send Opinion Leaders, outspoken staff from nursing, nurse aid, dietary, housekeeping or recreational therapy, to attend a 1‐h virtual town hall meeting. Meetings used a similar format where the moderator solicited concerns that the attendees themselves had or had heard from others in the facility about the COVID‐19 vaccine. Physicians and moderators used personal stories to address concerns and reaffirmed positive emotions.SettingTwenty‐six video town hall meetings with SNF staff.ParticipantsHealthcare workers and staff, with physicians serving as content experts.MeasurementQuestions and comments about the COVID‐19 vaccines noted by physicians.ResultsOne hundred and ninety three staff from 50 facilities participated in 26 meetings between December 30, 2020 and January 15, 2021. Most staff reported getting information about the vaccine from friends or social media. Concerns about how rapidly the vaccines were developed and side effects, including infertility or pregnancy related concerns, were frequently raised. There were no differences in concerns raised by discipline. Questions about returning to prior activities after being vaccinated were common and offered the opportunity to build on positive emotions to reduce vaccine hesitancy.ConclusionsMisinformation about the COVID‐19 vaccine was widespread among SNF staff. Sharing positive emotions and stories may be more effective than sharing data when attempting to reduce vaccine hesitancy in SNF staff.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167807/1/jgs17136.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167807/2/jgs17136_am.pd

Trends in antipsychotic prescribing among long‐term care residents receiving hospice care

ImportanceThe Centers for Medicare & Medicaid Services’ (CMS) National Partnership to Improve Dementia Care in Nursing Homes (“CMS National Partnership”) focuses on reducing antipsychotic prescribing to long‐term care residents. Hospice enrollment is not an exclusionary condition for the antipsychotic quality measure reported by CMS. It is unclear how prescribing in hospice may have been impacted by the initiative.ObjectiveEstimate the association of the CMS National Partnership with trends in antipsychotic prescribing among long‐term care residents in hospice.DesignInterrupted time‐series analysis of a 100% Minimum Data Set sample with linked hospice claims from 2011 to 2017.SettingLong‐term care nursing facilities.ParticipantsOlder adults ≥65 residing in long‐term care (n = 3,741,379) and limited to those enrolled in hospice (n = 821,610).Main outcomeQuarterly prevalence of antipsychotic and other psychotropic (antianxiety, hypnotic, antidepressant) use among long‐term care residents; overall and among residents with dementia, stratified by hospice enrollment.ResultsFrom 2011 to 2017, parallel declines in antipsychotic prescribing were observed among long‐term care residents enrolled and not enrolled in hospice (hospice: decline from 26.8% to 18.7%; non‐hospice: decline from 23.0% to 14.4%). Following the 2012 CMS National Partnership, quarterly rates of antipsychotic prescribing declined significantly for both residents enrolled and not enrolled in hospice care. Declines in antipsychotic prescribing were greater for residents with dementia, with similar rates among residents enrolled and not enrolled in hospice. Among residents with dementia enrolled in hospice, use of other psychotropic medication classes including antianxiety, antidepressant, and hypnotic use remained relatively stable over time.Conclusions and relevanceDeclines in antipsychotic prescribing during the CMS National Partnership occurred among long‐term care residents in hospice, where use may be deemed clinically appropriate. Nursing homes are an important location for the provision of dementia end‐of‐life care and the drivers of potentially unintended reductions in antipsychotic use merits further investigation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169272/1/jgs17172_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169272/2/jgs17172.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169272/3/jgs17172-sup-0001-supinfo.pd

To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors

PURPOSE: Compared with young White women, young Black women are more likely to present with aggressive breast cancer (BC) subtypes that are potentially linked to worse health-related quality of life (HRQOL); however, there is limited consensus regarding HRQOL needs among young Black BC survivors. Employing Ferrell's framework on QOL in BC (i.e., physical, psychological, social, and spiritual well-being), we conducted a systematic review on HRQOL among Black BC survivors aged <50 years and proposed recommendations for advancing HRQOL research and care for this population. METHODS: Literature searches were conducted in MED-LINE/PubMed, EMBASE, CINAHL, and PsycINFO to identify relevant articles published from 1995 to 2015. Abstracts and full-text articles were screened using predetermined inclusion/exclusion criteria and evaluated for quality. RESULTS: A total of 2533 articles were identified, but six met eligibility criteria. Most studies examined multiple HRQOL domains, with the psychological domain most represented. Compared with their older, White, and BC-free counterparts, young Black BC survivors reported greater fear of dying, unmet supportive care needs, financial distress, and lower physical/functional well-being. However, spiritual well-being appeared favorable for young Black survivors. Research gaps include the absence of longitudinal studies and under-representation of studies examining physical, social, and particularly, spiritual HRQOL in young Black BC survivors. CONCLUSIONS: Young Black BC survivors generally experience suboptimal HRQOL after BC diagnosis. As few studies have reported on HRQOL among this group, future research and oncology care should prioritize young Black women in ways that recognize their unique concerns, in order to ensure better HRQOL outcomes both during and after treatment