The care unit in nursing home research: Evidence in support of a definition

Abstract Background Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. Methods An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η2, and ω2), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. Results In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A significantly higher percentage of variance was explained in the ACT concepts at the unit level compared to the individual and/or nursing home levels. Conclusions The statistical results support the use of our definition of care unit in nursing home research in the Canadian prairie provinces. Beyond research convenience however, the results also support the resident unit as an important Clinical Microsystem to which future interventions designed to improve resident quality of care and staff (healthcare aide) worklife should be targeted

Effect of Dementia on the Use of Drugs for Secondary Prevention of Ischemic Heart Disease

Background. Dementia and cardiovascular disease (CVD) are frequently comorbid. The presence of dementia may have an effect on how CVD is treated. Objective. To examine the effect of dementia on the use of four medications recommended for secondary prevention of ischemic heart disease (IHD): angiotensin-converting enzyme inhibitors, beta-blockers, lipid-lowering medications, and antiplatelet medications. Design. Retrospective analysis of data from the Cardiovascular Health Study: Cognition Study. Setting and Subjects. 1,087 older adults in four US states who had or developed IHD between 1989 and 1998. Methods. Generalized estimating equations to explore the association between dementia and the use of guideline-recommended medications for the secondary prevention of IHD. Results. The length of follow-up for the cohort was 8.7 years and 265 (24%) had or developed dementia during the study. Use of medications for the secondary prevention of IHD for patients with and without dementia increased during the study period. In models, subjects with dementia were not less likely to use any one particular class of medication but were less likely to use two or more classes of medications as a group (OR, 0.60; 95% CI, 0.36–0.99). Conclusions. Subjects with dementia used fewer guideline-recommended medications for the secondary prevention of IHD than those without dementia

The Gerontologist Using Resident Reports of Quality of Life to Distinguish Among Nursing Homes

Purpose: We used measures created to assess the quality of life (QOL) of nursing home residents to distinguish among nursing facilities. Design and Methods: We statistically adjusted scores for 10 QOL domains derived from standardized interviews with nursing home residents for age, gender, activities of daily living functioning, cognitive functioning, and length of stay, and then we aggregated them to the facility level. We compared the patterns across a sample of 40 facilities. We correlated facility characteristics with QOL scores. Results: The pattern of QOL scores for each of the 10 domains was generally consistent within a given facility. Although resident characteristics played a major role in explaining variance, there were significant effects of facilities as well. Some modest relationships were found between facility characteristics such as ownership, percentage of private rooms, and rural-urban location and facility QOL scores. No effect of facility size was detected. Implications: This article shows that it is possible to differentiate among facilities on the basis of resident self-reported QOL. On the basis of our analysis, we find that a sample of 28 residents per facility is sufficient to generate a reliable QOL score for each of the domains studied

The Mental Cacpacity Act 2005 and its influences on social work practice: debate and synthesis

The newly implemented Mental Capacity Act 2005 in England and Wales enshrines much of the practice established under case law to safeguard people who lack ability to make specific decisions, enhances personal autonomy and enables people to make advance decisions to refuse treatment. It introduces new proxy-decision-making roles to address health, welfare and financial matters and specialist advocacy for people who do not have family or friends where major health and welfare decisions are to be made. This article outlines the scope of the Mental Capacity Act 2005, considers some of the implications of the Act for social work practitioners around the areas of planning and working with others in new roles, and clarifies some of their responsibilities. The article concludes that the potential for good practice will need to be supported by professional reflection and service monitoring