Old, alone, and neglected: care of the aged in the United States and Scotland

As the median age of the population increases, the care and housing of the elderly in the U.S. are of increasing concern. Jeanie Kayser-Jones compares a typical private institution in the U.S. with a government-owned home in Scotland.Her analysis compels attention to the systematic abuse of the institutionalized elderly in the U.S

Distributive justice and the treatment of acute illness in nursing homes

Using participant observation and interviews, this research investigated the social-cultural factors that influence decision making in the evaluation and treatment of acute illness in nursing homes. Mental status and cost of care emerged as the predominant factors that influence physicians in the decision-making process. Drawing on some of the principles of distributive justice, it is argued that it is unjust to deny health care to the elderly because of their impaired mental status or a lack of financial resources. Quality of life from the patient's perspective, the patient's and their family's wishes and cultural and individual values must be considered in the decision-making process.nursing homes acute care justice

A model long-term care hospice unit: care, community, and compassion

The purpose of this study was to investigate the factors that influenced the quality of care of terminally ill nursing home residents on a hospice unit in a city and county long-term care facility. The findings disclosed that the hospice team had created a cultural environment in which care, community, and compassion were the predominant components of their philosophy of palliative care. Communication at all levels-among staff, family, friends, and residents-was found to be a core hospice value, essential to community development. The results of this study illustrate that exemplary palliative care can be provided when an interdisciplinary team is dedicated to creating an environment where the principles of palliative care can be fully implemented. The authors conclude that there is a developing role for geriatric nurses to participate in further defining and providing palliative care for older people in their homes, hospitals, nursing homes, and residential care

Hospice Care in Nursing Homes: Does It Contribute to Higher Quality Pain Management?

Purpose:The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods:In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication Quantification Scale was used in order to account for the prescription and administration of all analgesic medications. Results:Although 72% of residents experienced pain, we found no statistically significant differences in the proportion of hospice versus non-hospice residents (a) who had been prescribed opioids and co-analgesics, and (b) whose medication was administered around the clock or as needed. Limited physician availability, lack of pharmacologic knowledge, and limitations of nursing staff hindered pain management of both groups of residents. Implications:Although hospice care is of some benefit, pain management and high-quality end-of-life care is dependent upon the context in which it is provided. Given that between 1991 and 2001 Medicare expenditures for nursing home-based hospice care increased from $8.6 million to$21.8 million, the effectiveness of hospice-care programs in nursing homes warrants further study

Factors that influence end-of-life care in nursing homes: the physical environment, inadequate staffing, and lack of supervision

This study investigated the physical environment and organizational factors that influenced the process of providing care to terminally ill nursing home residents.Design and Methods:Participant observation, interviews, and event analysis were used to obtain data in two proprietary facilities.Results:The physical environment was not conducive to end-of-life care. The rooms were crowded, there was little privacy, and the facilities were noisy. Inadequate staffing and lack of supervision were among the most significant organizational factors that influenced care. Often, residents did not receive basic care, such as bathing, oral hygiene, adequate food and fluids, and repositioning. A consequence of inadequate staffing was the development of pressure ulcers; 54% of the residents had pressure ulcers; 82% of these residents died with pressure ulcers.Implications:Findings suggest that the nursing home environment in these two facilities, as now structured, is an inappropriate setting for end-of-life care

Pressure ulcers among terminally ill nursing home residents.

The purpose of this prospective, anthropological study was to describe and analyze the experiences and care of terminally ill nursing home residents who were admitted with or acquired pressure ulcers (PUs) after admission. Data were collected in two proprietary nursing homes. Participant observation, in-depth interviews, event analysis, and chart review were used to obtain data. A total of 64 (54.7%) of the 117 terminally ill residents in the study had PUs; 52 (81.3%) of whom died with PUs. The findings disclosed that the absence of family advocacy, inability to speak English, and inadequate staffing and lack of supervision, along with other previously reported risk factors, contributed to the development of PUs. Specifically, inadequate staffing and lack of supervision led to inadequate assistance at mealtime, infrequent repositioning, and inadequate continence care, which in turn led to weight loss, unrelieved pressure on bony prominences, and moist, irritated skin. The outcome was a high rate of residents dying with PUs. Knowledge of and attention to these risk factors can guide nurses in the prevention and management of PUs