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Nursing Homes (nursing + home)
Kinds of Nursing Homes Terms modified by Nursing Homes Selected AbstractsINFECTIONS IN NURSING HOMES: IS IT TIME TO REVISE THE McGEER CRITERIA?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2010Monique Rothan-Tondeur PhD No abstract is available for this article. [source] NOROVIRUS OUTBREAKS IN NURSING HOMESJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2005Paul J. Drinka MD No abstract is available for this article. [source] RACIAL DIFFERENCES IN PRESSURE ULCER PREVALENCE IN NURSING HOMESJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2005Kate L. Lapane PhD No abstract is available for this article. [source] Effect of Antibiotic Guidelines on Outcomes of Hospitalized Patients with Nursing Home,Acquired PneumoniaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2009Ali A. El Solh MD OBJECTIVES: To compare the 2003 community-acquired pneumonia (CAP) guideline and the 2005 healthcare-associated pneumonia (HCAP) guideline on time to clinical stability, length of hospital stay, and mortality in nursing home patients hospitalized for pneumonia. DESIGN: Retrospective study. SETTING: Three tertiary-care hospitals. PARTICIPANTS: Three hundred thirty-four nursing home patients. MEASUREMENTS: Patients were classified according to the antibiotic regimens they received based on the 2003 CAP guideline or the 2005 HCAP guideline. Time to clinical stability, time to switch therapy, and mortality were evaluated in an intention-to-treat analysis. A multivariate survival model using propensity analysis was used to adjust for heterogeneity between the two groups. RESULTS: Of the 334 patients, 258 (77%) were treated according to the 2003 HCAP guideline. Time to clinical stability did not differ between those treated according to the 2003 CAP or the 2005 HCAP guidelines. Only the Pneumonia Severity Index (P=.006) and multilobar involvement (P=.005) were significantly associated with delay in achieving clinical stability. Adjusted in-hospital and 30-day mortality were comparable in both cohorts (odds ratio (OR)=0.87, 95% confidence interval (CI)=0.49,1.34, and OR=0.79, 95% CI=0.42,1.31, respectively), although time to switch therapy and length of stay were longer for those treated according to the 2005 HCAP guideline. CONCLUSION: In hospitalized nursing home patients with pneumonia, treatment with an antibiotic regimen according to the 2003 CAP guideline achieved comparable time to clinical stability and in-hospital and 30-day mortality with a regimen based on the 2005 HCAP guideline. [source] Functional Trajectories in Older Persons Admitted to a Nursing Home with Disability After an Acute HospitalizationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Thomas M. Gill MD OBJECTIVES: To characterize the functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization. DESIGN: Prospective cohort study of 754 community-living persons aged 70 and older who were initially nondisabled in four essential activities of daily living (ADLs). SETTING: Greater New Haven, Connecticut. PARTICIPANTS: The analytical sample included 296 participants who were newly admitted to a nursing home with disability after an acute hospitalization. MEASUREMENTS: Information on nursing home admissions, hospitalizations, and disability in essential ADLs was ascertained during monthly telephone interviews for up to 9 years. Disability was defined as the need for personal assistance in bathing, dressing, walking inside one's home, or transferring from a chair. RESULTS: The median time to the first nursing home admission with disability after an acute hospitalization was 46 months (interquartile range 27.5,75.5), and the mean number±standard deviation of ADLs that participants were disabled in upon admission was 3.0±1.2. In the month preceding hospitalization, 189 (63.9%) participants had no disability. The most common functional trajectory was discharged home with disability (46.3%), followed by continuous disability in the nursing home (27.4%), discharged home without disability (21.6%), and noncontinuous disability in the nursing home (4.4%). Only 96 (32.4%) participants returned home at (or above) their premorbid level of function. CONCLUSION: The functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization are generally poor. Additional research is needed to identify the factors responsible for these poor outcomes. [source] Once-Daily Cefepime Versus Ceftriaxone for Nursing Home,Acquired PneumoniaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2007Joseph A. Paladino PharmD OBJECTIVES: To compare once-daily intramuscular cefepime with ceftriaxone controls. DESIGN: Double-blind study. SETTING: Six skilled nursing facilities. PARTICIPANTS: Residents aged 60 and older with nursing home,acquired pneumonia. INTERVENTION: Cultures were obtained, and patients were randomized to cefepime or ceftriaxone 1 g intramuscularly every 24 hours. MEASUREMENTS: Clinical success: cure or improvement. Cure was defined as complete resolution of all symptoms and signs of pneumonia or a return to the patient's baseline state. Improvement was defined as clear improvement but incomplete resolution of all pretherapy symptoms or signs or incomplete return to the patient's usual baseline status. Safety and pharmacoeconomics were also assessed. RESULTS: Sixty-nine patients were randomized; 61 were evaluable: (32 to cefepime, 29 ceftriaxone). Patients were predominately female (76%). They had a mean age±standard deviation of 85±6, with a mean 5.8±1.9 comorbidities; they had age-appropriate renal dysfunction, with a mean estimated creatinine clearance of 35±7 mL/min. Clinical success occurred in 78% of cefepime- and 66% of ceftriaxone-treated patients (P=.39). Fifty-seven patients (93%) were switched to oral antibiotics after 3 days. Antibiotic-related adverse events occurred in 5% of patients. Seven patients (11.5%) were hospitalized. The overall mortality rate was 8%. Mean antibiotic costs were $117±40 for cefepime- and $215±68 for ceftriaxone-treated patients (P<.001). Cost-effectiveness analysis of total costs showed that cefepime would cost $597 and ceftriaxone $1,709 per expected successfully treated patient. One- and two-way sensitivity analyses using a generic price for ceftriaxone and improving its comparative efficacy revealed that the results were robust. CONCLUSIONS: Once-daily cefepime was a cost-effective alternative to ceftriaxone for the treatment of elderly nursing home residents who developed pneumonia and did not require hospitalization. [source] A Multifaceted Intervention to Implement Guidelines Improved Treatment of Nursing Home,Acquired Pneumonia in a State Veterans HomeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2006Evelyn Hutt MD OBJECTIVES: To assess the feasibility of a multifaceted strategy to translate evidence-based guidelines for treating nursing home,acquired pneumonia (NHAP) into practice using a small intervention trial. DESIGN: Pre-posttest with untreated control group. SETTING: Two Colorado State Veterans Homes (SVHs) during two influenza seasons. PARTICIPANTS: Eighty-six residents with two or more signs of lower respiratory tract infection. INTERVENTION: Multifaceted, including a formative phase to modify the intervention, institutional-level change emphasizing immunization, and availability of appropriate antibiotics; interactive educational sessions for nurses; and academic detailing. MEASUREMENTS: Subjects' SVH medical records were reviewed for guideline compliance retrospectively for the influenza season before the intervention and prospectively during the intervention. Bivariate comparisons-of-care processes between the intervention and control facility before and after the intervention were made using the Fischer exact test. RESULTS: At the intervention facility, compliance with five of the guidelines improved: influenza vaccination, timely physician response to illness onset, x-ray for patients not being hospitalized, use of appropriate antibiotics, and timely antibiotic initiation for unstable patients. Chest x-ray and appropriate and timely antibiotics were significantly better at the intervention than at the control facility during the intervention year but not during the control year. CONCLUSION: Multifaceted, evidence-based, NHAP guideline implementation improved care processes in a SVH. Guideline implementation should be studied in a national sample of nursing homes to determine whether it improves quality of life and functional outcomes of this debilitating illness for long-term care residents. [source] Physicians "Missing in Action": Family Perspectives on Physician and Staffing Problems in End-of-Life Care in the Nursing HomeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2005Renée R. Shield PhD Objectives: To understand the roles of physicians and staff in nursing homes in relation to end-of-life care through narrative interviews with family members close to a decedent. Design: Qualitative follow-up interviews with 54 respondents who had participated in an earlier national survey of 1,578 informants. Setting: Brown University interviewers conducted telephone interviews with participants throughout the United States. Participants: The 54 participants agreed to a follow-up qualitative interview and were family members or close to the decedent. Measurements: A five-member, multidisciplinary team to identify overarching themes taped, transcribed, and then coded interviews. Results: Respondents report that healthcare professionals often insufficiently address the needs of dying patients in nursing homes and that "missing in action" physicians and insufficient staffing create extra burdens on dying nursing home residents and their families. Conclusion: Sustained efforts to increase the presence of physicians and improve staffing in nursing homes are suggested to improve end-of-life care for dying residents in nursing homes. [source] Physician Practice in the Nursing Home: Missing in Action or MisunderstoodJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2005Paul R. Katz MD No abstract is available for this article. [source] A Nursing Home in Arab-Israeli Society: Targeting Utilization in a Changing Social and Economic EnvironmentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2005Khalid Suleiman MD This article is a case study of the first 10 years of operation (1992,2002) of the Dabouriya Home for the Aged, the first publicly funded culturally adapted nursing home for Israeli citizens of Arab descent. Although 44% of Arab Israelis and 26% of Jewish Israelis aged 65 and older are disabled, in 1999, 4.3% of the Jewish population but only 0.7% of the Arab-Israeli population aged 65 or older lived in long-term care institutions; disabled Arab-Israeli elderly were mainly cared for by families. As Arab-Israeli society modernizes and traditional caregiving is reduced, alternatives must be found for this growing, disabled population. Medical and administrative records of 404 people admitted consecutively to a 136-bed facility over 10 years were analyzed. Two distinct segments of the needy population were served: people with independent activity of daily living (ADL) function but little or no family to provide help with intermediate ADLs and those dependent in ADLs and with health problems, especially dementia. Economic, demographic, and social changes in Arab-Israeli society may mean that traditional caregivers will not be able to adequately care for this highly disabled population. Administrators of the public health system in Israel should be aware of the underutilization of publicly funded long-term care by disabled Arab Israelis and the lack of care alternatives for the population that does use nursing homes, because there may be severe consequences in terms of caregiver burden and social stress when disabled elderly people remain in unsuitable environments. [source] Teaching Palliative Care in the Nursing HomeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004Eileen R. Chichin PhD No abstract is available for this article. [source] Differing Risk Factors for Falls in Nursing Home and Intermediate-Care Residents Who Can and Cannot Stand UnaidedJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2003Stephen R. Lord PhD Objectives: To determine fall risk factors in nursing home and intermediate-care residents who can and cannot stand unaided. Design: Prospective cohort study. Setting: Residential elderly care facilities in Sydney, Australia. Participants: One thousand people aged 65 to 103 (mean age ± standard deviation: 85.0 ± 7.4). Measurements: Accidental falls. Results: Fall rates were highest in those with fair standing balance, intermediate in those with the best standing balance, and lowest in those with the worst standing balance. This nonlinear pattern was even more striking when subjects were categorized according to their standing balance and ability to rise from a chair. Using this dual classification, fall rates were highest in those who could rise from a chair but could not stand unaided (81%) and lowest in those who could neither rise from a chair nor stand unaided (48%). In residents who could stand unaided, risk factors included increased age, male sex, higher care classifications, incontinence, psychoactive medication use, previous falls, and slow reaction times. In contrast, quite different risk factors were evident in residents who could not stand unaided, with a number of known fall risk factors (previous stroke, reduced ability to rise from a chair, slow reaction times) being associated with fewer falls. In this group, risk factors were intermediate versus nursing home care, poor health status, psychoactive medication use, Parkinson's disease, previous falls, and being able to get out of a chair. Conclusion: The findings indicate that there are different risk factors for falls for people living in residential aged care facilities who can and cannot stand unaided. These findings provide important information for developing fall-prevention strategies and suggest that those who can stand unaided but have multiple falls risk factors constitute the highest priority group for such interventions. [source] Consensus Statement on Improving the Quality of Mental Health Care in U.S. Nursing Homes: Management of Depression and Behavioral Symptoms Associated with DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2003American Association for Geriatric Psychiatry, American Geriatrics Society The American Geriatrics Society and American Association for Geriatric Psychiatry Expert Panel on Quality Mental Health Care in Nursing Homes developed this consensus statement. The following organizations were represented on the expert panel and have reviewed and endorsed, the consensus statement: Alzheimer's Association, American Association for Geriatric Psychiatry, American Association of Homes and Services for the Aging, American College of Health Care Administrators, American Geriatrics Society, American Health Care Association, American Medical Directors Association, American Society on Aging, American Society of Consultant Pharmacists, Gerontological Society of America, National Association of Directors of Nursing Administration in Long-Term Care, National Citizen's Coalition for Nursing Home Reform, National Conference of Gerontological Nurse Practitioners. The following organizations were also represented on the expert panel and reviewed and commented on the consensus statement: American Psychiatric Association: Council on Aging, American Psychological Association. [source] Improving Quality of Life for Elders: Resident Satisfaction with Nursing HomeNURSING & HEALTH SCIENCES, Issue 2 2000Heeyoung Lee Oh 28,29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University) [source] A comparative study of laws, rules, codes and other influences on nursing homes' disaster preparedness in the Gulf Coast statesBEHAVIORAL SCIENCES & THE LAW, Issue 5 2007Professor Lisa M. Brown Ph.D. In 2005, Hurricanes Katrina and Rita devastated several Gulf Coast states and caused many deaths. The hurricane- related deaths of 70 nursing home residents,34 believed drowned in St. Rita's Nursing Home in Louisiana and 36 from 12 other nursing homes,highlighted problems associated with poorly developed and executed disaster plans, uninformed evacuation decision-making, and generally inadequate response by providers and first responders (DHHS, 2006; Hyer, Brown, Berman, & Polivka-West, 2006). Such loss of human life perhaps could have been prevented and certainly lessened if, prior to the hurricanes, policies, regulations, and laws had been enacted, executable disaster guidelines been available, vendor contracts been honored, and sufficient planning taken place. This article discusses applicable federal and state laws and regulations that govern disaster preparedness with a particular focus on nursing homes. It highlights gaps in these laws and makes suggestions regarding future disaster planning. Copyright © 2007 John Wiley & Sons, Ltd. [source] Nursing Homes and Cancer CareHEALTH SERVICES RESEARCH, Issue 6 2009Mary L. Fennell First page of article [source] The physical environment influences neuropsychiatric symptoms and other outcomes in assisted living residentsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2010Mark C. Bicket Abstract Objective Although the number of elderly residents living in assisted living (AL) facilities is rising, few studies have examined the AL physical environment and its impact on resident well-being. We sought to quantify the relationship of AL physical environment with resident outcomes including neuropsychiatric symptoms (NPS), quality of life (QOL), and fall risk, and to compare the effects for demented and non-demented residents. Methods Prospective cohort study of a stratified random sample of 326 AL residents living in 21 AL facilities. Measures included the Therapeutic Environmental Screening Scale for Nursing Homes and Residential Care (TESS-NH/RC) to rate facilities and in-person assessment of residents for diagnosis (and assessment of treatment) of dementia, ratings on standardized clinical, cognitive, and QOL measures. Regression models compared environmental measures with outcomes. TESS-NH/RC is modified into a scale for rating the AL physical environment AL-EQS. Results The AL Environmental Quality Score (AL-EQS) was strongly negatively associated with Neuropsychiatric Inventory (NPI) total score (p,<,0.001), positively associated with Alzheimer Disease Related Quality of Life (ADRQL) score (p,=,0.010), and negatively correlated with fall risk (p,=,0.042). Factor analysis revealed an excellent two-factor solution, Dignity and Sensory. Both were strongly associated with NPI and associated with ADRQL. Conclusion The physical environment of AL facilities likely affects NPS and QOL in AL residents, and the effect may be stronger for residents without dementia than for residents with dementia. Environmental manipulations that increase resident privacy, as well as implementing call buttons and telephones, may improve resident well-being. Copyright © 2010 John Wiley & Sons, Ltd. [source] Length of Stay for Older Adults Residing in Nursing Homes at the End of LifeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2010Anne Kelly MSW OBJECTIVES: To describe lengths of stay of nursing home decedents. DESIGN: Retrospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. RESULTS: The mean age of decedents was 83.3±9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1,20) and 13.7±18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P<.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke). CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support. [source] Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic ReviewJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2010Michael A. LaMantia MD Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. A systematic review was conducted to identify and evaluate interventions to improve communication of accurate and appropriate medication lists and advance directives for elderly patients who transition between nursing homes and hospitals. MEDLINE, ISI Web, and EBSCO Host (from inception to June 2008) were searched for original, English-language research articles reporting interventions to improve communication of medication lists and advance directives. Five studies ultimately met all inclusion criteria. Two described interventions that enhanced transmission of advance directives, two described interventions that improved communication of medication lists, and one intervention addressed both goals. One study was a randomized controlled trial, whereas the remaining studies used historical or no controls. Study results indicate that a standardized patient transfer form may assist with the communication of advance directives and medication lists and that pharmacist-led review of medication lists may help identify omitted or indicated medications on transfer. Although preliminary evidence supports adoption of these methods to improve transitions between nursing home and hospital, further research is needed to define target populations and outcomes measures for high-quality transitional care. [source] Beliefs on Mandatory Influenza Vaccination of Health Care Workers in Nursing Homes: A Questionnaire Study from the NetherlandsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2009Ingrid Looijmans-van den Akker MD OBJECTIVES: To assess whether nursing homes (NHs) made organizational improvements to increase influenza vaccination rates in healthcare workers (HCWs) and to quantify the beliefs of NH administrators on the arguments used in favor of implementation of mandatory influenza vaccination of HCWs. DESIGN: Anonymous questionnaire study. SETTING: Dutch NHs. PARTICIPANTS: Dutch NH administrators. MEASUREMENTS: Influenza vaccination rates in NH residents and NH HCWs, organizational aspects of influenza vaccination of HCWs, and agreement of respondents with arguments in favor of implementation of mandatory influenza vaccination in HCWs. RESULTS: Of the 310 distributed questionnaires, 185 were returned (response rate 59.7%). The average vaccination rate in NH HCWs was 18.8% and in NH residents was 91.6%. In all, 126 (68.1%) NHs had a written policy, 161 (87.0%) actively requested that their employees be immunized, and 161 (87.0%) offered information to HCWs in any way. Despite the fact that the majority of NH administrators (>69%) agreed with all arguments in favor of implementation of mandatory influenza vaccination, only a minority (24.3%) agreed that mandatory vaccination should be implemented if voluntary vaccination fails to reach sufficient vaccination rates. CONCLUSION: Despite the low vaccination rate of NH HCWs, most NH administrators did not support mandatory influenza vaccination of NH HCWs. [source] Stage 2 Pressure Ulcer Healing in Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008Nancy Bergstrom PhD OBJECTIVES: To identify resident and wound characteristics associated with Stage 2 pressure ulcer (PrU) healing time in nursing home residents. DESIGN: Retrospective cohort study with convenience sampling. SETTING: One hundred two nursing homes participating in the National Pressure Ulcer Long-Term Care Study (NPULS) in the United States. PARTICIPANTS: Seven hundred seventy-four residents aged 21 and older with length of stay of 14 days or longer who had at least one initial Stage 2 (hereafter Stage 2) PrU. MEASUREMENTS: Data collected for each resident over a 12-week period included resident characteristics and PrU characteristics, including area when first reached Stage 2. Data were obtained from medical records and logbooks. RESULTS: There were 1,241 initial Stage 2 PrUs on 774 residents; 563 (45.4%) healed. Median time to heal was 46 days. Initial area was significantly associated with days to heal. Using Kaplan-Meier survival analyses, median days to heal was 33 for small (,1 cm2), 53 days for medium (>1 to ,4 cm2), and 73 days for large (>4 cm2) ulcers. Using Cox proportional hazard regression models to examine effects of multiple variables simultaneously, small and medium ulcers and ulcers on residents with agitation and those who had oral eating problem healed more quickly, whereas ulcers on residents who required extensive assistance with seven to eight activities of daily living (ADLs), who temporarily left the facility for the emergency department (ED) or hospital, or whose PrU was on an extremity healed more slowly. CONCLUSION: PrUs on residents with agitation or with oral eating problems were associated with faster healing time. PrUs located on extremities, on residents who went temporarily to the ED or hospital, and on residents with high ADL disabilities were associated with slower healing time. Interaction between PrU size and place of onset was also associated with healing time. For PrU onset before or after admission to the facility, smaller size was associated with faster healing time. [source] Residual Urine as a Risk Factor for Lower Urinary Tract Infection: A 1-Year Follow-Up Study in Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2008Ragnhild Omli RN OBJECTIVES: To determine whether postvoid urine is a risk factor for the development of lower urinary tract infections (UTIs) in nursing home residents. DESIGN: Prospective surveillance with a follow-up period of 1 year. SETTING: Six Norwegian nursing homes. PARTICIPANTS: One hundred fifty nursing home residents. METHODS: Postvoid residual (PVR) urine volumes were measured using a portable ultrasound. UTIs were registered prospectively for 1 year. RESULTS: Ninety-eight residents (65.3%) had a PVR less than 100 mL, and 52 (34.7%) had a PVR of 100 mL or greater. During the follow-up period, 51 residents (34.0%) developed one or more UTIs. The prevalence of UTI in women was higher than in men (40.4% vs 19.6%; P=.02). There was no significant difference in mean PVR between residents who did and did not develop a UTI (79 vs 97 mL, P=.26). PVR of 100 mL or greater was not associated with greater risk of developing a UTI (P=.59). CONCLUSION: High PVR is common in nursing home residents. No association between PVR and UTI was found. [source] Collaborative Clinical Quality Improvement for Pressure Ulcers in Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2007(See editorial comments by Dr. George Taler on pp 167, 1675) The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care. [source] Measuring Physical and Social Environments in Nursing Homes for People with Middle- to Late-Stage DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2006MSc(A), Susan Slaughter RN OBJECTIVES: To evaluate measures of dementia care environments by comparing a special care facility (SCF) with traditional institutional facilities (TIFs). DESIGN: A cross-sectional comparative study of nursing home environments conducted as part of a longitudinal study on quality of life for residents with dementia. SETTING: Twenty-four traditional nursing homes and one special care facility. PARTICIPANTS: One SCF with six distinct environments, 24 TIFs with 45 distinct environments, and 88 family members. MEASUREMENTS: Therapeutic Environment Screening Scale,2+ (TESS-2+); Special Care Unit Environmental Quality Scale (SCUEQS), a subset of the TESS-2+ items; Composite Above Average Quality Score (CAAQS), a composite score of all items on the TESS-2+; and Models of Care Instrument (MOCI). RESULTS: The SCUEQS did not detect a significant difference between the SCF and the TIFs (30.0 vs 27.2, P=.28). The CAAQS detected a significant difference between the SCF and the TIFs, whereby the SCF environments were rated as having above-average quality in 71.4% of the domains, compared with 57.3% for the TIF environments (95% confidence interval (CI) for difference=2.6,25.6%, P=.02). Using the MOCI, SCF families were 1.8 times as likely to rate the SCF as a home or resort versus a hospital as TIF families rating TIFs (95% CI for odds ratio=1.5,2.1, P<.001). CONCLUSION: The TESS-2+ CAAQS differentiated between physical environments better than the more established SCUQES. The MOCI distinguished between environments using a more holistic approach to measurement. The availability of environmental measures that are able to discriminate between specialized and traditional long-term care settings will facilitate future outcome-based research. [source] Functional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2005Joseph G. Ouslander MD Objectives: To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes. Design: Randomized, controlled, crossover trial. Setting: Four VA nursing homes. Participants: All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55). Intervention: Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial. Measurements: Timed measures of walking or wheeling a wheelchair (mobility), sit-to-stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one-repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios. Results: There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8-week crossover period. Within-person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were "responders" based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period. Conclusion: FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care. [source] Evaluation of Nationally Mandated Drug Use Reviews to Improve Patient Safety in Nursing Homes: A Natural ExperimentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2005Becky Briesacher PhD Objectives: To test whether nationally required drug use reviews reduce exposure to inappropriate medications in nursing homes. Design: Quasi-experimental, longitudinal study. Setting: Data source is the 1997,2000 Medicare Current Beneficiary Survey, a nationally representative survey of Medicare beneficiaries. Participants: Nationally representative population sample of 8 million nursing home (NH) residents (unweighted n=2,242) and a comparative group of 2 million assisted living facility (ALF) residents (unweighted n=664). Measurements: Prevalence and incident use of 38 potentially inappropriate medications compared before and after the policy: 32 restricted for all NH residents and six for residents with certain conditions. Inappropriate medications were stratified by potential for legitimate exceptions: always avoid, rarely appropriate, or some acceptable indications. Results: In July 1999, the Centers for Medicare and Medicaid Services (CMS) mandated expansions to the drug use review policy for nursing home certification. Using explicit criteria, surveyors and consultant pharmacists must evaluate resident records for potentially inappropriate medication exposures and related adverse drug reactions. Nursing homes in noncompliance may receive citations for deficient care. Before the CMS policy, 28.8% (95% confidence interval (CI)=27.3,30.3) of Medicare beneficiaries in NHs and 22.4% (95% CI=19.8,25.0) in ALFs received potentially inappropriate medications. Nearly all prepolicy use came from medications with some acceptable indications: 23.4% in NHs (95% CI=20.4,26.4) and 18.0% in ALFs (95% CI=15.6,20.4). After the policy, exposures in NHs declined to 25.6% (95% CI=24.1,27.1, P<.05), but similar declines occurred in ALFs (19.0%, 95% CI=16.7,21.3, nonsignificant). Postpolicy use of inappropriate medications with exempted indications remained high, and more than half was incident use: 20.6% of NH residents (95% CI=19.0,22.0) and 15.6% of ALF residents (95% CI=15.2,15.7). Use of drugs that are restricted with certain diseases increased 33% in NHs between 1997 and 2000 (from 9.3% to 13.2%; P<.05). Multivariate results detected no postpolicy differences in inappropriate drug use between long-term care facilities with mandatory drug use reviews and those without. Conclusion: Some postpolicy declines were noted in NH use of potentially inappropriate medications, but the decrease was uneven and could not be attributed to the national drug use reviews. This study is the first evaluation of the CMS policy, and it highlights the unclear effectiveness of drug use reviews to improve patient safety in NHs even though state and federal agencies have widely adopted this strategy. [source] National Estimates of Medication Use in Nursing Homes: Findings from the 1997 Medicare Current Beneficiary Survey and the 1996 Medical Expenditure SurveyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2005Jalpa A. Doshi PhD Objectives: To provide the first nationwide estimates of medication use in nursing homes (NHs) and to introduce a new data set for examining drug use in long-term care facilities. Design: Cross-sectional comparison. Setting: NH medication files from two nationally representative data sets, the 1997 Medicare Current Beneficiary Survey (MCBS) and the 1996 Medical Expenditure Panel Survey,Nursing Home Component (MEPS-NHC). Participants: NH residents in the MCBS (n=929, weighted n=2.0 million) and MEPS-NHC (n=5,899, weighted n=3.1 million). Measurements: Estimates include characteristics of facilities and residents, average number of drugs used per person per month, and the prevalence and duration of use by select therapeutic drug classes. Results: NH residents received, on average, seven to eight medications each month (7.6 MCBS, 7.2 MEPS-NHC). About one-third of residents had monthly drug regimens of nine or more medications (31.8% MCBS, 32.4% MEPS-NHC). The most commonly used medications in NHs, in descending order, were analgesics and antipyretics, gastrointestinal agents, electrolytic and caloric preparations, central nervous system agents, anti-infective agents, and cardiovascular agents. Conclusion: These estimates serve as examples of the first national benchmarks of prescribing patterns in NHs. This study highlights the usefulness of the MCBS as an important new resource for examining medication use in NHs. [source] End-of-Life Care in Assisted Living and Related Residential Care Settings: Comparison with Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2003Philip D. Sloane MD Objectives: To define the current state of end-of-life care in residential care/assisted living (RC/AL) facilities and nursing homes (NHs) and to compare these two types of care settings. Design: Interviews of staff and family informants about deaths that occurred during a longitudinal study. Setting: Fifty-five RC/AL facilities and 26 NHs in Florida, Maryland, New Jersey, and North Carolina. Participants: Two hundred twenty-four staff and family informants that best knew the 73 RC/AL residents and 72 NH residents who died in or within 3 days after discharge from a study facility. Measurements: Telephone interviews conducted with the facility staff member who knew the decedent best and the family member who was most involved in care during the last month of life of the decedent. Data were collected on circumstances of death, perceptions of dying process, cause of death, care during the last month of life, mood, discomfort, and family satisfaction. Results: Most decedents died in the facility where they had resided, and more than half of the subjects were alone when they died. Greater proportions of staff and family in the NHs knew that the resident's death was only days or weeks away. Both RC/AL and NH residents experienced few highly negative moods, and even on their most uncom-fortable day, the overall discomfort was low for residents in both facility types. Summary ratings of family satisfaction were significantly higher for the RC/AL (32.1) than the NH (41.2) group (P=.016). Conclusion: These data suggest that end-of-life care in RC/AL settings appears similar in process and outcomes to that provided in NHs. Thus, aging and dying-in-place can effectively occur in RC/AL. [source] Consensus Statement on Improving the Quality of Mental Health Care in U.S. Nursing Homes: Management of Depression and Behavioral Symptoms Associated with DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2003American Association for Geriatric Psychiatry, American Geriatrics Society The American Geriatrics Society and American Association for Geriatric Psychiatry Expert Panel on Quality Mental Health Care in Nursing Homes developed this consensus statement. The following organizations were represented on the expert panel and have reviewed and endorsed, the consensus statement: Alzheimer's Association, American Association for Geriatric Psychiatry, American Association of Homes and Services for the Aging, American College of Health Care Administrators, American Geriatrics Society, American Health Care Association, American Medical Directors Association, American Society on Aging, American Society of Consultant Pharmacists, Gerontological Society of America, National Association of Directors of Nursing Administration in Long-Term Care, National Citizen's Coalition for Nursing Home Reform, National Conference of Gerontological Nurse Practitioners. The following organizations were also represented on the expert panel and reviewed and commented on the consensus statement: American Psychiatric Association: Council on Aging, American Psychological Association. [source] The American Geriatrics Society and American Association for Geriatric Psychiatry Recommendations for Policies in Support of Quality Mental Health Care in U.S. Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2003American Geriatrics Society First page of article [source] | |||||||||||||||||||||||||||||||||||||