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Dunbar P, Keyes LM, Browne JP. Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research. PLoS One 2023; 18:e0278007. [PMID: 37053186 PMCID: PMC10101495 DOI: 10.1371/journal.pone.0278007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of services by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. METHODS Searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two reviewers independently. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. RESULTS The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. Determinants were largely structural in nature and allocated most frequently to the inner and outer setting domains of the CFIR. The following structural characteristics and compliance were found to be positively associated: smaller facilities (measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility's geographic location and compliance was also associated. It was difficult to make findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. CONCLUSION The literature in this field has focused to date on structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work, are evident in the literature and further research in this area is needed to provide a clearer picture.
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Affiliation(s)
- Paul Dunbar
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - John P Browne
- School of Public Health, University College Cork, Cork, Ireland
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2
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Hirt J, Adlbrecht L, Heinrich S, Zeller A. Staff-to-resident abuse in nursing homes: a scoping review. BMC Geriatr 2022; 22:563. [PMID: 35794542 PMCID: PMC9261065 DOI: 10.1186/s12877-022-03243-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elder abuse in long-term care is an important public health concern with social, health-related, and economic implications. Staff-to-resident abuse is of particular interest since institutions should protect residents' rights and prevent harm. To provide an up-to date comprehensive overview of staff-to-resident abuse in nursing homes, we performed a scoping review considering types of abuse, their prevalence and associated factors, descriptions, experiences, and preventive interventions. METHODS We performed a scoping review following the framework provided by Arksey and O'Malley. We searched MEDLINE (via PubMed), CINAHL, PsycINFO via Ovid, and Cochrane Library. Additionally, we performed free web searching using Google Scholar and checked relevant reviews. Two reviewers independently selected studies. We narratively synthesised the results. RESULTS Out of 3876 references retrieved by our search, we included 46 studies in 47 reports. The prevalence rates of abuse varied widely, ranging from 0 to 93% depending on the type of abuse. Associated factors of abuse at the staff, resident, and nursing home level were evaluated inconsistently. Abuse was perceived ambiguous: even though it was considered unacceptable, it was underreported. We found only four studies addressing preventive interventions. Of these, four made recommendations for intervention development. Only one study with an experimental design examined a multi-component intervention including education and mutual support. CONCLUSIONS The review yielded heterogenous evidence not allowing a concrete conclusion on prevalence and associated factors. However, the results show the significance of the problem and indicate that there are associate factors of abuse that can be influenced by appropriate interventions. These are amongst other staff education, organisational culture, and conditions. Further research should investigate the composition and content of preventive interventions and their potential to reduce abusive behaviours.
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Affiliation(s)
- Julian Hirt
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
- International Graduate Academy, Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle (Saale), Germany
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Adlbrecht
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Steffen Heinrich
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Adelheid Zeller
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
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Botngård A, Eide AH, Mosqueda L, Blekken L, Malmedal W. Factors associated with staff-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study. BMC Health Serv Res 2021; 21:244. [PMID: 33740965 PMCID: PMC7977325 DOI: 10.1186/s12913-021-06227-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Elder abuse is a public health problem that is gaining attention due to its serious impacts on people's health and well-being, and it is predicted to increase along with the world's rapidly ageing population. Staff-to-resident abuse in nursing homes is a complex and multifaceted phenomenon associated with multiple factors on different levels of the ecological model. This study aimed to explore individual, relational, and institutional characteristics associated with perpetrated staff-to-resident abuse in nursing homes, using a multilevel hierarchical approach. METHODS This was a cross-sectional exploratory study of 3693 nursing staff (response rate 60.1%) in 100 randomly selected nursing homes in Norway. We explored the characteristics of nursing staff, their relationship with residents, and institutional features associated with three types of abuse: psychological abuse, physical abuse, and neglect. These were modelled using multilevel mixed-effects logistic regression analyses. RESULTS Individual staff factors found to be associated with all three types of abuse were 1) being a registered nurse/social educator (OR 1.77-2.49) or licensed practical nurse (OR 1.64-1.92), 2) reporting symptoms of psychological distress (OR 1.44-1.46), 3) intention to leave the job (OR 1.35-1.40), and 4) reporting poor attitudes towards people with dementia (OR 1.02-1.15). Also, staff who reported poorer quality of childhood were more likely to perpetrate neglect (OR 1.14). Relational factors such as care-related conflicts (OR 1.97-2.33) and resident aggression (OR 1.36-2.09) were associated with all three types of abuse. Of institutional factors, lack of support from a manager was associated with perpetrating psychological abuse (OR 1.56). CONCLUSIONS We found several predictors of staff-to-resident abuse on different levels of the ecological model, which underlines the importance of using a multifaceted approach to identify risk factors of elder abuse in nursing homes. However, future studies should explore the underlying mechanism and causes with a prospective or qualitative design and target the multifaceted nature of risk factors when designing preventive interventions.
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Affiliation(s)
- Anja Botngård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Henning Eide
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Research, SINTEF Digital, Oslo, Norway
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Lene Blekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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4
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Magruder KJ, Fields NL, Xu L. Sizing up assisted living: an examination of long-term care ombudsman complaint data. Home Health Care Serv Q 2018; 37:158-176. [PMID: 29856271 DOI: 10.1080/01621424.2018.1474830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Long-term care ombudsmen are resident advocates who receive, investigate, and resolve complaints relating to quality of care and violations of resident rights in assisted living (AL). More research is needed to understand systemic differences in source, type, and number of ombudsman complaints in AL. Ombudsman complaint data (n = 5,705 complaints) in small, medium, and large ALs in Dallas, Texas were analyzed using proportion Z tests. Findings suggest that all facilities had a high number of environmental complaints. Compared to larger facilities, small ALs have a disproportionately high number of complaints, a significantly higher number of complaints related to access to information, visitors, and ombudsmen, lower number of complaints related to care and staffing, family are less likely to complain, and residents are least likely to voice concerns. We recommend strategies for ombudsmen and AL providers to better meet residents' needs. We conclude with a call to action underscoring the increasing importance of the role of the ombudsman in AL.
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Affiliation(s)
| | - Noelle L Fields
- b The University of Texas at Arlington , Arlington , Texas , USA
| | - Ling Xu
- b The University of Texas at Arlington , Arlington , Texas , USA
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5
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Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality. Health Care Manage Rev 2017; 42:315-327. [DOI: 10.1097/hmr.0000000000000116] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Pickering CEZ, Nurenberg K, Schiamberg L. Recognizing and Responding to the "Toxic" Work Environment: Worker Safety, Patient Safety, and Abuse/Neglect in Nursing Homes. QUALITATIVE HEALTH RESEARCH 2017; 27:1870-1881. [PMID: 28805151 DOI: 10.1177/1049732317723889] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This grounded theory study examined how the certified nursing assistant (CNA) understands and responds to bullying in the workplace. Constant comparative analysis was used to analyze data from in-depth telephone interviews with CNAs ( N = 22) who experienced bullying while employed in a nursing home. The result of the analysis is a multistep model describing CNA perceptions of how, over time, they recognized and responded to the "toxic" work environment. The strategies used in responding to the "toxic" environment affected their care provision and were attributed to the development of several resident and worker safety outcomes. The data suggest that the etiology of abuse and neglect in nursing homes may be better explained by institutional cultures rather than individual traits of CNAs. Findings highlight the relationship between worker and patient safety, and suggest worker safety outcomes may be an indicator of quality in nursing homes.
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7
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Heckman GA, Boscart VM, D'Elia T, Kaasalainen S, McAiney C, Kelley ML, Stolee P, Strachan P, McKelvie RS. The role of unregulated care providers in managing heart failure patients in long-term care facilities. J Clin Nurs 2017; 26:849-861. [DOI: 10.1111/jocn.13413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- George A Heckman
- Schlegel - University of Waterloo -Research Institute for Aging; University of Waterloo; Waterloo ON Canada
| | - Veronique M Boscart
- Conestoga College Institute of Technology & Advanced Learning and Schlegel Villages; School for Health Sciences and Community Services; Kitchener ON Canada
| | | | | | - Carrie McAiney
- Department of Psychiatry and Behavioural Neurosciences; McMaster University; Hamilton ON Canada
- St. Joseph's Healthcare Hamilton; Hamilton ON Canada
| | - Mary Lou Kelley
- School of Social Work; Lakehead University; Thunder Bay ON Canada
| | - Paul Stolee
- School of Public Health and Health Systems; University of Waterloo; Waterloo ON Canada
| | | | - Robert S McKelvie
- Department of Medicine; Population Health Research Institute; McMaster University; Hamilton ON Canada
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8
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Phelan A. Protecting care home residents from mistreatment and abuse: on the need for policy. Risk Manag Healthc Policy 2015; 8:215-23. [PMID: 26640391 PMCID: PMC4657805 DOI: 10.2147/rmhp.s70191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
With a rising older person population with increasing life expectancies, the demand for care homes will increase in the future. Older people in care homes are particularly vulnerable due to their dependencies related to cognitive and/or functional self-care challenges. Although many care homes provide good care, maltreatment and abuse of older people can and does occur. One major step in preventing and addressing maltreatment in care homes is having comprehensive and responsive policy, which delineates national expectations that are locally implemented. This paper examines the literature related to maltreatment in care homes and argues for policy based on a multisystems approach. Policy needs to firstly acknowledge and address general societal issues which tacitly impact on older person care delivery, underpin how care homes and related systems should be operationalized, and finally delineate expected standards and outcomes for individual experience of care. Such a policy demands attention at every level of the health care and societal system. Furthermore, contemporary issues central to policy evolution in care homes are discussed, such as safeguarding education and training and fostering organization whistle-blowing protection.
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Affiliation(s)
- Amanda Phelan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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9
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Cooper C, Livingston G. Mental Health/Psychiatric Issues in Elder Abuse and Neglect. Clin Geriatr Med 2014; 30:839-50. [DOI: 10.1016/j.cger.2014.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Wangmo T, Teaster PB, Grace J, Wong W, Mendiondo MS, Blandford C, Fisher S, Fardo DW. An Ecological Systems Examination of Elder Abuse: A Week in the Life of Adult Protective Services. J Elder Abuse Negl 2014; 26:440-57. [DOI: 10.1080/08946566.2013.800463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Clark MA, Roman A, Rogers ML, Tyler DA, Mor V. Surveying multiple health professional team members within institutional settings: an example from the nursing home industry. Eval Health Prof 2014; 37:287-313. [PMID: 24500999 PMCID: PMC4380513 DOI: 10.1177/0163278714521633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality improvement and cost containment initiatives in health care increasingly involve interdisciplinary teams of providers. To understand organizational functioning, information is often needed from multiple members of a leadership team since no one person may have sufficient knowledge of all aspects of the organization. To minimize survey burden, it is ideal to ask unique questions of each member of the leadership team in areas of their expertise. However, this risks substantial missing data if all eligible members of the organization do not respond to the survey. Nursing home administrators (NHA) and directors of nursing (DoN) play important roles in the leadership of long-term care facilities. Surveys were administered to NHAs and DoNs from a random, nationally representative sample of U.S. nursing homes about the impact of state policies, market forces, and organizational factors that impact provider performance and residents' outcomes. Responses were obtained from a total of 2,686 facilities (response rate [RR] = 66.6%) in which at least one individual completed the questionnaire and 1,693 facilities (RR = 42.0%) in which both providers participated. No evidence of nonresponse bias was detected. A high-quality representative sample of two providers in a long-term care facility can be obtained. It is possible to optimize data collection by obtaining unique information about the organization from each provider while minimizing the number of items asked of each individual. However, sufficient resources must be available for follow-up to nonresponders with particular attention paid to lower resourced, lower quality facilities caring for higher acuity residents in highly competitive nursing home markets.
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Affiliation(s)
- Melissa A Clark
- School of Public Health, Brown University, Providence, RI, USA
| | - Anthony Roman
- Center for Survey Research, University of Massachusetts-Boston, Boston, MA, USA
| | | | - Denise A Tyler
- School of Public Health, Brown University, Providence, RI, USA
| | - Vincent Mor
- School of Public Health, Brown University, Providence, RI, USA
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12
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Tsai HH, Tsai YF, Weng LC, Chou HF. More than communication skills: experiences of communication conflict in nursing home nurses. MEDICAL EDUCATION 2013; 47:990-1000. [PMID: 24016169 DOI: 10.1111/medu.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/10/2012] [Accepted: 03/15/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT Communication conflicts are inevitable in nursing homes. Understanding communication conflicts experienced by practising nurses could provide insights to guide the development of sound communication education programmes. OBJECTIVES The purpose of this study was to explore the experiences of nurses in nursing homes of communication conflict in encounters with nursing home residents and their families in Taiwan. METHODS Data were collected from April 2010 to December 2011 through audiotaped, individual, in-depth interviews with 26 nurses at five nursing homes in Taiwan. Data were analysed according to van Manen's interpretive phenomenological method. RESULTS Data analysis revealed that nurses' experiences of communication conflicts during encounters with nursing home residents and their families could be categorised under three themes: differences in perspectives of nursing home services; differences in views of nurturing health, and mediation between family members and others. CONCLUSIONS The findings of this study can be considered by clinical educators and policymakers when designing communication education programmes for nurses and other clinicians. These programmes should include ways to increase nurses' independent thinking in settings in which power differences exist, as well as their cultural sensitivity as embodied in Leininger's culture care theory. These programmes should also include education in telephone communication and alternative methods of communication (e.g. videoconferencing).
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Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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13
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Kaasalainen S, Strachan PH, Heckman GA, D'Elia T, McKelvie RS, McAiney C, Stolee P, van der Horst ML, Kelley ML, Demers C. Living and dying with heart failure in long-term care: experiences of residents and their family members. Int J Palliat Nurs 2013; 19:375-82. [DOI: 10.12968/ijpn.2013.19.8.375] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sharon Kaasalainen
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - George A Heckman
- Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Teresa D'Elia
- School of Public Health and Health Systems, University of Waterloo
| | - Robert S McKelvie
- Faculty of Health Sciences, Department of Medicine, McMaster University/Hamilton Health Sciences, and Medical Director, Heart Failure Program, Hamilton, Ontario, Canada
| | - Carrie McAiney
- Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo
| | | | - Mary Lou Kelley
- School of Social Work, Lakehead University, Thunder Bay, Ontario, Canada
| | - Catherine Demers
- Department of Medicine, Division of Cardiology, McMaster University
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14
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Durkin DW, Umayam SP, Sims N, Cleeton P, Simmons SF. Whom Do Veteran Nursing Home Residents Prefer to Talk to About Satisfaction With Care?: Implications for Nursing Staff. J Gerontol Nurs 2012. [DOI: 10.3928/00989134-20121109-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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McDonald L, Beaulieu M, Harbison J, Hirst S, Lowenstein A, Podnieks E, Wahl J. Institutional abuse of older adults: what we know, what we need to know. J Elder Abuse Negl 2012; 24:138-60. [PMID: 22471513 DOI: 10.1080/08946566.2011.646512] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although Canadian policies support "aging in place," there still will be a number of older adults who will require institutional care in the future. Most research on elder abuse, however, has focused on domestic abuse and has paid less attention to institutional abuse. The purpose of this article is to comprehensively review current research to identify gaps in knowledge and methodological issues in the study of institutional abuse. Overall, 49 studies in English and 20 studies in French were reviewed, and 11 key-informant interviews were conducted with methodological experts. Methodological challenges are addressed in light of the review and interviews.
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Affiliation(s)
- Lynn McDonald
- Institute for the Life Course and Aging, University of Toronto, Toronto, Ontario, Canada.
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16
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Abstract
The purpose of this research was to provide a systematic review of, and assign an evidence grade to, the research articles on elder abuse. Sixteen health care and criminal justice literature databases were searched. Publications were reviewed by at least two independent readers who graded each from A (evidence of well-designed meta-analysis) to D (evidence from expert opinion or multiple case reports) on the quality of the evidence gained from the research. Of 6,676 titles identified in the search, 1,700 publications met inclusion criteria; omitting duplicates, 590 publications were annotated and graded.
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Affiliation(s)
- Jeanette M Daly
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
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17
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Marcella J, Nadarajah J, Kelley ML, Heckman GA, Kaasalainen S, Strachan PH, McKelvie RS, Newhouse I, Stolee P, McAiney CA, Demers C. Understanding organizational context and heart failure management in long term care homes in Ontario, Canada. Health (London) 2012. [DOI: 10.4236/health.2012.429113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Clark M, Rogers M, Foster A, Dvorchak F, Saadeh F, Weaver J, Mor V. A randomized trial of the impact of survey design characteristics on response rates among nursing home providers. Eval Health Prof 2011; 34:464-86. [PMID: 21411474 DOI: 10.1177/0163278710397791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An experiment was conducted to maximize participation of both the Director of Nursing (DoN) and the Administrator (ADMIN) in long-term care facilities. Providers in each of the 224 randomly selected facilities were randomly assigned to 1 of 16 conditions based on the combination of data collection mode (web vs. mail), questionnaire length (short vs. long), and incentive structure. Incentive structures were determined by amount compensated if the individual completed and an additional amount per individual if the pair completed (a) $30 individual/$5 pair/$35 total; (b) $10 individual/$25 pair/$35 total; (c) $30 individual/$20 pair/$50 total; and (d) $10 individual/$40 pair/$50 total. Overall, 47.4% of eligible respondents participated; both respondents participated in 29.3% of facilities. In multivariable analyses, there were no differences in the likelihood of both respondents participating by mode, questionnaire length, or incentive structure. Providing incentives contingent on participation by both providers of a facility was an ineffective strategy for significantly increasing response rates.
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Affiliation(s)
- Melissa Clark
- Program in Public Health, Brown University, Providence, RI 02912, USA.
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19
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Phillips LR, Guo G. Mistreatment in assisted living facilities: complaints, substantiations, and risk factors. THE GERONTOLOGIST 2011; 51:343-53. [PMID: 21278080 DOI: 10.1093/geront/gnq122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Use archived public data from Arizona to explore relationships among selected institutional and resident risk and situation-specific factors and complaints and substantiated allegations of various types of mistreatment in assisted living facilities (ALFs). DESIGN AND METHODS An exploratory/descriptive 2-group design was used. Facilities in the complaint group were identified from narrative data that appeared suspicious for mistreatment based on definitions for physical, verbal, psychological, medication, sexual abuse, neglect, financial exploitation, and physical restraint. Facilities in the comparison group were those that had no citations or complaints in 2007-2008. Narrative data were content analyzed, and chi-square analysis was used to answer 3 research questions. RESULTS The complaint group was comprised of significantly more assisted living centers, large facilities (51-101+), facilities licensed to provide personal care services, and facilities owned by national corporations. Substantiated allegations were significantly more frequent in assisted living centers, facilities with more than 51 beds, and those owned by national corporations. Facility risk factors were related to some types of substantiated mistreatment and not others. IMPLICATIONS Findings suggest the need to evaluate use of only unlicensed assistive personnel in facilities, increase oversight of care by professional nurses, rethink the practice of not licensing small facilities, and monitor more closely practices and procedures in facilities operated by national corporations.
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Affiliation(s)
- Linda R Phillips
- School of Nursing, University of California-Los Angeles, Los Angeles, CA 90095, USA.
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Zhang Z, Schiamberg LB, Oehmke J, Barboza GE, Griffore RJ, Post LA, Weatherill RP, Mastin T. Neglect of Older Adults in Michigan Nursing Homes. J Elder Abuse Negl 2011; 23:58-74. [DOI: 10.1080/08946566.2011.534708] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Zhenmei Zhang
- a Department of Sociology , Michigan State University , East Lansing, Michigan, USA
| | - Lawrence B. Schiamberg
- b Department of Family and Child Ecology , Michigan State University , East Lansing, Michigan, USA
| | - James Oehmke
- c The George Morris Centre , Guelph, Ontario, Canada
| | - Gia E. Barboza
- d Department of Criminal Justice , California State University , Long Beach, California, USA
| | - Robert J. Griffore
- e Department of Family and Child Ecology , Michigan State University , East Lansing, Michigan, USA
| | - Lori A. Post
- f Department of Emergency Medicine , Yale School of Medicine , New Haven, Connecticut, USA
| | - Robin P. Weatherill
- g National Center for PTSD , VA Boston Healthcare System , Boston, Massachusetts, USA
| | - Teresa Mastin
- h College of Communication , DePaul University , Chicago, Illinois, USA
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21
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Zimmerman S, Cohen LW. Evidence behind The Green House and similar models of nursing home care. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/ahe.10.66] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The Green House and similar models of nursing home care offer a solution to the institutional nature of nursing homes. In The Green House model, small houses are home to 6–12 residents in which care is given as much attention as treatment and is provided by a consistent, self-directed team of staff who are responsible for all care, including preparing meals in a centrally located open kitchen. Residents have private rooms and bathrooms that open onto a central living area. Although a nurse is available 24 h a day and the clinical care team is nearby and visits the home to provide care, the sense is that one is receiving care in a family-type setting. While these homes are expanding rapidly and seem to embody a better culture of nursing home care, their future growth may depend on the evidence that supports or refutes the quality of care that they provide.
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Affiliation(s)
- Sheryl Zimmerman
- Cecil G Sheps Center for Health Services Research & the School of Social Work, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Campus Box 7590, Chapel Hill, NC 27599-27590, USA
| | - Lauren W Cohen
- Cecil G Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Campus Box 7590, Chapel Hill, NC 27599-27590, USA
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22
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Kaasalainen S, Williams J, Hadjistavropoulos T, Thorpe L, Whiting S, Neville S, Tremeer J. Creating bridges between researchers and long-term care homes to promote quality of life for residents. QUALITATIVE HEALTH RESEARCH 2010; 20:1689-1704. [PMID: 20682964 DOI: 10.1177/1049732310377456] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Improving the quality of life for long-term care (LTC) residents is of vital importance. Researchers need to involve LTC staff in planning and implementing interventions to maximize the likelihood of success. The purposes of this study were to (a) identify barriers and facilitators of LTC homes' readiness to implement evidence-based interventions, and (b) develop strategies to facilitate their implementation. A mixed methods design was used, primarily driven by the qualitative method and supplemented by two smaller, embedded quantitative components. Data were collected from health care providers and administrators using 13 focus groups, 26 interviews, and two surveys. Findings revealed that participants appreciated being involved at early stages of the project, but receptiveness to implementing innovations was influenced by study characteristics and demands within their respective practice environment. Engaging staff at the planning stage facilitated effective communication and helped strategize implementation within the constraints of the system.
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Affiliation(s)
- Sharon Kaasalainen
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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23
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Abstract
Verbal, physical, psychological, caregiving, medication, material, and sexual abuse perpetrated by staff are examined. Information came from nurse aides included in the Pennsylvania nurse aide registry. A total of 4,451 nurse aides returned a 46-item questionnaire (response rate = 64%). A 3-month frame of reference was used, and the questionnaire asked about abuse in the prior nursing home of employment. Nurse aide responses to the verbal abuse and psychological abuse items were higher than for the other categories of abuse examined. For example, 36% of nurse aides observed argumentative behavior with residents and 28% observed intimidation. Lower figures were reported for physical abuse (6% observed pushing, grabbing, or pinching), caregiving abuse (10% observed staff to threaten to stop taking care of a resident), medication abuse (19% observed inappropriate delays in medication administration), material exploitation (10% observed taking assets), and sexual abuse (1% observed unwelcome discussion of sexual activity). These findings clearly show that some types of resident abuse by staff are reported to be a common occurrence by nurse aides. This likely influences the health outcomes, quality of life, quality of care, and the safety of residents.
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24
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Abstract
Deficiency citations for resident abuse from U.S. nursing homes from 2000 to 2007 are examined. Deficiency citations are given to nursing homes that are in violation of Medicare/Medicaid regulations and four specific deficiency citations (representing, abuse; neglect by staff; criminal screening investigating and reporting; and, abuse prevention and policy development and implementation) were examined. The data came from the Online Survey, Certification, and Reporting (OSCAR) system data ( N = 173,219) and the analyses used generalized estimating equations. Abuse deficiency citation rates were relatively stable (from 2000 to 2007), with approximately 20% of facilities per year receiving any one of these citations. For the factors of interest, few significant findings were identified for staffing levels; whereas, a high number of deficiency citations related to quality of care, high number of the most severe deficiency citations, high Medicaid reimbursement rates, and the Medicaid occupancy/reimbursement rate interaction were significantly associated with a greater likelihood of receiving a deficiency citation for abuse.
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25
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Natan MB, Lowenstein A, Eisikovits Z. Psycho-social factors affecting elders' maltreatment in long-term care facilities. Int Nurs Rev 2010; 57:113-20. [DOI: 10.1111/j.1466-7657.2009.00771.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Culp K, Ramey S, Karlman S. Iowa certified nursing assistants study: self-reported ratings of the nursing home work environment. Res Gerontol Nurs 2010; 1:87-96. [PMID: 20078021 DOI: 10.3928/19404921-20080401-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Certified nursing assistants (CNAs) are the principal bedside caregivers in nursing homes, yet little is known about their perceptions of the work environment. This population-based, cross-sectional study used a mailed questionnaire to a random sample of Iowa CNAs (N=584), representing 166 nursing homes. Of the respondents, 88.5% (n=517) were currently employed in long-term care settings; however, 11.5% (n=67) indicated they had left their jobs. When CNA responses were compared with those of other occupational groups, general workers reported higher scores on involvement, coworker cohesion, work pressure, and supervisor support. Those who left their CNA jobs rated their work environment as characteristic of excessive managerial control and task orientation. Results of this study emphasize the importance of the relationship between CNAs and their supervisors, CNAs' need for greater autonomy and innovation, and the need for the work environment to change dramatically in the area of human resource management.
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Affiliation(s)
- Kennith Culp
- Adult and Gerontological Area of Study, The University of Iowa College of Nursing, Iowa City, IA 52241, USA.
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27
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Knowledge, detection, and reporting of abuse by health and social care professionals: a systematic review. Am J Geriatr Psychiatry 2009; 17:826-38. [PMID: 19916205 DOI: 10.1097/jgp.0b013e3181b0fa2e] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors systematically reviewed the 32 articles fitting predetermined criteria that investigated health and social care professionals' knowledge, detection, and reporting of elder abuse. These included 21 surveys (of 5,325 professionals), nine analyses of elder abuse reports to statutory bodies, and two intervention studies. Compatible results were pooled in a meta-analysis. Professionals consistently underestimated the prevalence of elder abuse. Only a quarter of U.S. physicians were aware of American Medical Association elder abuse guidelines. The authors found that 33.7% (95% confidence interval: 27.5-40.1) of health care professionals had detected a case of older adult abuse in the last year. This was slightly higher when only studies judged to be most representative, which all surveyed physicians, were included (39.9% [23.4-57.7]). About half of the detected abuse cases were reported. Professionals who recalled receiving any training on abuse were no more likely to detect abuse than those who stated they had not had training, although they were more likely to report the abuse if they detected it. Interventions that taught professionals about the management of abuse by face-to-face training were effective in increasing knowledge, whereas giving written information was not. No intervention studies have investigated whether detection and reporting of abuse can also be increased through education. Current evidence would support the development and testing of interventions to increase professionals' detection and reporting of abuse. These would encourage them to ask older people about abuse, and address professionals' concerns about the impact of reporting on therapeutic relationships, victims; and legal consequences for the reporter.
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28
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Abstract
SummaryPeople with dementia are particularly vulnerable to abuse. It is inherently difficult to study as it is a hidden offence, perpetrated against vulnerable people with memory impairment, by those on whom they depend. In the general population, 6% of older people have experienced abuse in the last month and this rises to approximately 25% in vulnerable populations such as people with dementia. We know that various factors in the carer and the care recipient can predispose to a higher rate of abuse and this knowledge can be harnessed to try and improve prevention. There are also valid and reliable scales available to help detect abuse in vulnerable older adults. All health and social care professionals have a responsibility to act on any suspicion or evidence of significant abuse or neglect in order to ensure that appropriate management is taken.
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29
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McCool JJ, Jogerst GJ, Daly JM, Xu Y. Multidisciplinary reports of nursing home mistreatment. J Am Med Dir Assoc 2009; 10:174-80. [PMID: 19233057 DOI: 10.1016/j.jamda.2008.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 09/16/2008] [Accepted: 09/17/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this research was to learn about nursing home employees' knowledge and perspectives on mandatory reporting of elder abuse. DESIGN Mailed questionnaire and personal interviews. SETTING Two nursing facilities in Iowa. PARTICIPANTS All employees of the two nursing facilities. MEASUREMENTS A 28-item questionnaire that included questions on demographics, personal experiences with suspected elder abuse and reporting, legislation, facility protocols, and opinions on mandatory reporting was mailed to participants. An interview composed of 11 open-ended questions was conducted in the nursing facilities. RESULTS Forty-nine (15%) of the 335 employees who were sent the mailing returned the questionnaire and 22 (7%) participated in the interview. Over half (53%) of those who returned questionnaires reported suspecting a case of abuse in the facility where they currently work. Of these, 35% stated that they had not reported all the cases they suspected. Interviews of the 22 employees were about 15 minutes in length and took place at the nursing facility. Four themes emerged from these interviews, including the need for more staff education/training on the subject of elder abuse, difficulty in making judgments about whether the situation needs to be reported, barriers to reporting, and a sense that some abuse situations may occur because the staff is overworked, inexperienced, and/or frustrated from dealing with difficult residents. CONCLUSION Nursing home employees are knowledgeable about the mandatory reporter laws, but many remain hesitant to report suspected abuse for various reasons.
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Affiliation(s)
- Jessica J McCool
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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30
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Cooper C, Selwood A, Livingston G. The prevalence of elder abuse and neglect: a systematic review. Age Ageing 2008; 37:151-60. [PMID: 18349012 DOI: 10.1093/ageing/afm194] [Citation(s) in RCA: 288] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to perform a systematic review of studies measuring the prevalence of elder abuse or neglect, either reported by older people themselves, or family and professional caregivers or investigated using objective measures. METHODS we conducted a comprehensive literature search of multiple databases up to October 2006, supplemented by a search of the references of all relevant articles. Validity of studies was graded by two authors independently using a standardised checklist. RESULTS forty-nine studies met our inclusion criteria, of which only seven used measures for which reliability and validity had been assessed. In the general population studies, 6% of older people reported significant abuse in the last month and 5.6% of couples reported physical violence in their relationship in the last year. In studies using valid instruments involving vulnerable elders, nearly a quarter reported significant levels of psychological abuse. Five per cent of family caregivers reported physical abuse towards care recipients with dementia in a year, and a third reported any significant abuse. Sixteen per cent of care home staff admitted significant psychological abuse. Rates of abuse recorded using objective measures (5%) or reported to home management or adult protective services (APS) (1-2%) were low. CONCLUSION one in four vulnerable elders are at risk of abuse and only a small proportion of this is currently detected. Elders and family and professional caregivers are willing to report abuse and should be asked about it routinely. Valid, reliable measures and consensus on what constitutes an adequate standard for validity of abuse measures are needed.
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Affiliation(s)
- Claudia Cooper
- University College London, Camden and Islington Mental Health and Social Care Trust, UK.
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