Fidelity to a behavioral intervention to improve goals of care decisions for nursing home residents with advanced dementia

Ensuring fidelity to a behavioral intervention implemented in nursing homes requires awareness of the unique considerations of this setting for research. The purpose of this manuscript is to describe the Goals of Care (GOC) cluster-randomized trial and the methods used to monitor and promote fidelity to a GOC decision aid intervention delivered in nursing homes

Challenges of Antibiotic Prescribing for Assisted Living Residents: Perspectives of Providers, Staff, Residents, and Family Members

To better understand the antibiotic prescribing process in assisted living (AL) communities given the growing rates of antibiotic resistance

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

Adverse Events Among Patients With Diabetes And Ambulatory Practice Characteristics: Evidence From A Nationally Representative Survey

Medications are the most common treatment modality for diabetes; however, medications may lead to inadvertent injury. Reducing adverse events in patients with diabetes is an important health care goal. Using pooled data from the 2011-2013 National Ambulatory Medical Care Survey, this cross-sectional, observational study explored univariate associations between patient safety for patients with diabetes as measured by adverse events and practice characteristics, including health information technology capabilities. This study found that the overall rate of adverse events among adults with diabetes is 7%, inclusive of injury, poisoning, or adverse effect of medical/surgical care or medicinal drug. We find evidence that e-prescribing, seeing a primary care provider, and being an established patient are associated with less adverse events

Nursing Home Staff Perspectives On Adoption Of An Innovation In Goals Of Care Communication

Nursing homes (NH) are important settings for end-of-life care, but limited implementation may impede goals of care discussions. The purpose of this study was to understand NH staff perceptions of adoption and sustainability of the Goals of Care video decision aid for families of residents with advanced dementia. Study design was a cross-sectional survey of staff at 11 NHs in North Carolina who participated in the Goals of Care (GOC) cluster randomized clinical trial. Staff perceived the GOC decision aid intervention as a positive innovation; it was perceived as more compatible with current practices by male staff, nurses, and more experienced NH staff. Perceptions were correlated with experience, implying that experience with an innovative approach may help to promote improved GOC communication in nursing homes. Nurses and social work staff could be effective champions for implementing a communication technique, like the GOC intervention

The Presence Of Hospital-Based Palliative Care Programs: A Resource Dependence Perspective

Background: The presence of hospital-based palliative care programs has risen over time in the United States. Nevertheless, organizational and environmental factors that contribute to the presence of hospital-based palliative care programs are unclear. Purpose: The aim of this study was to examine the role of organizational and environmental factors associated with the presence of hospital-based palliative care programs using resource dependence theory. Methodology: Panel data from 2000 to 2009 American Hospital Association Annual Survey and the Area Resource File were used in this study. A random-effect logistic regression was used to analyze the relationship between organizational and environmental factors and the presence of hospital-based palliative care programs. Findings: Hospitals with higher Medicare inpatient days, located in counties with higher Medicare managed penetration, and larger hospitals had greater odds of having a hospital-based palliative care program. Although hospitals in counties that have a higher percentage of individuals 65 years and older, for-profit and government hospitals were less likely to have a hospital-based palliative care program. Practice Implications: Hospitals will vary in the organizational resources available to them, as such, administrators\u27 awareness of the relationship between resources and palliative care programs can help determine the relevance of a program in their hospital

Nursing Home Quality And Financial Performance: Does The Racial Composition Of Residents Matter?

Objective To examine the effects of the racial composition of residents on nursing homes\u27 financial and quality performance. The study examined Medicare and Medicaid-certified nursing homes across the United States that submitted Medicare cost reports between the years 1999 and 2004 (11,472 average per year). Data Source Data were obtained from the Minimum Data Set, the On-Line Survey Certification and Reporting, Medicare Cost Reports, and the Area Resource File. Study Design Panel data regression with random intercepts and negative binomial regression were conducted with state and year fixed effects. Principal Findings Financial and quality performance differed between nursing homes with high proportions of black residents and nursing homes with no or medium proportions of black residents. Nursing homes with no black residents had higher revenues and higher operating margins and total profit margins and they exhibited better processes and outcomes than nursing homes with high proportions of black residents. Conclusion Nursing homes\u27 financial viability and quality of care are influenced by the racial composition of residents. Policy makers should consider initiatives to improve both the financial and quality performance of nursing homes serving predominantly black residents. © Health Research and Educational Trust

Culture Change In Nursing Homes: What Is The Role Of Nursing Home Resources?

Quality of care has been a long-standing issue in US nursing homes. The culture change movement attempts to transition nursing homes from health care institutions to person-centered homes. While the adoption of culture change has been spreading across nursing homes, barriers to adoption persist. Nursing homes that disproportionately serve minority residents may have additional challenges implementing culture change compared with other facilities due to limited financial and staffing resources. The objective of this study was to examine how nursing home characteristics are associated with culture change adoption in Central Florida nursing homes. This cross-sectional study included 81 directors of nursing (DONs) who completed the Artifacts of Culture Change survey. In addition, nursing home organizational data were obtained from the Certification and Survey Provider Enhanced Reports (CASPER). A logistic regression was conducted to examine the relationship between high culture change adoption and nursing home characteristics. The overall adoption of culture change scores in Central Florida nursing homes was low. Nevertheless, there was variability across nursing homes in the adoption of culture change. High culture change adoption was associated with nursing homes having lower proportions of Medicaid residents

Nursing Home Quality and Financial Performance: Does the Racial Composition of Residents Matter?

Objective: To examine the effects of the racial composition of residents on nursing homes’ financial and quality performance. The study examined Medicare and Medicaid-certified nursing homes across the United States that submitted Medicare cost reports between the years 1999 and 2004 (11,472 average per year). Data Source: Data were obtained from the Minimum Data Set, the On-Line Survey Certification and Reporting, Medicare Cost Reports, and the Area Resource File. Study Design: Panel data regression with random intercepts and negative binomial regression were conducted with state and year fixed effects. Principal Findings: Financial and quality performance differed between nursing homes with high proportions of black residents and nursing homes with no or medium proportions of black residents. Nursing homes with no black residents had higher revenues and higher operating margins and total profit margins and they exhibited better processes and outcomes than nursing homes with high proportions of black residents. Conclusion: Nursing homes’ financial viability and quality of care are influenced by the racial composition of residents. Policy makers should consider initiatives to improve both the financial and quality performance of nursing homes serving predominantly black residents

Prevalence Of Moderate To Severe Obesity Among U.S. Nursing Home Residents, 2000-2010

Obesity rates are high among all age groups, including older adults. Obesity negatively affects health and functional ability, increasing the risk for nursing home (NH) admission. The current study examines trends over 11 years in moderate to severe obesity rates among NH residents. A generalized least squares regression model for panel data was used to test the effect of time (years) on the rates. A significant increase in rates and significant variation in rates were observed. Little research has focused on the issue of obesity in NHs. High and increasing rates and variation in rates raise questions on demand and access to NH care for obese older adults. Additional research is needed to consider factors other than time that may affect NHs’ ability to admit moderate to severely obese individuals. Understanding these trends will help NHs prepare for future demand, ensure equal access, quality care, and financing of services