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Turbow SD, Perkins MM, Vaughan CP, Klemensen T, Culler SD, Rask KJ, Clevenger CK, Ali MK. Fragmented Readmissions From a Nursing Facility in Medicare Beneficiaries. J Appl Gerontol 2024:7334648241254282. [PMID: 38798097 DOI: 10.1177/07334648241254282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Over one-third of Medicare beneficiaries discharged to nursing facilities require readmission. When those readmissions are to a different hospital than the original admission, or "fragmented readmissions," they carry increased risks of mortality and subsequent readmissions. This study examines whether Medicare beneficiaries readmitted from a nursing facility are more likely to have a fragmented readmission than beneficiaries readmitted from home among a 2018 cohort of Medicare beneficiaries, and examined whether this association was affected by a diagnosis of Alzheimer's Disease (AD). In fully adjusted models, readmissions from a nursing facility were 19% more likely to be fragmented (AOR 1.19, 95% CI 1.16, 1.22); this association was not affected by a diagnosis of AD. These results suggest that readmission from nursing facilities may contribute to care fragmentation for older adults, underscoring it as a potentially modifiable pre-hospital risk factor for fragmented readmissions.
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Affiliation(s)
- Sara D Turbow
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Family & Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Molly M Perkins
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Camille P Vaughan
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA
| | - Terry Klemensen
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven D Culler
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Mohammed K Ali
- Department of Family & Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Liu R, Wyk BV, Quiñones AR, Allore HG. Longitudinal Care Network Changes and Associated Healthcare Utilization Among Care Recipients. Res Aging 2024; 46:327-338. [PMID: 38261524 DOI: 10.1177/01640275241229162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
This study examines caregiver networks, including size, composition, and stability, and their associations with the likelihood of hospitalization and skilled-nursing facility (SNF) admissions. Data from the National Health and Aging Trends Study linked to Center for Medicare and Medicaid Services data were analyzed for 3855 older adults across five survey waves. Generalized estimating equation models assessed the associations. The findings indicate each additional paid caregiver was associated with higher adjusted risk ratios (aRR) for hospitalization (aRR = 1.24, 95% CI 1.10-1.41) and SNF admission (aRR = 1.28, 95% CI 1.06-1.54) among care recipients, a pattern that is also observed with the addition of unpaid caregivers (hospitalization: aRR = 1.13, 95% CI 1.06-1.20; SNF: aRR = 1.12, 95% CI 1.02-1.23). These results suggest that policies and approaches to enhance the quality and coordination of caregivers may be warranted to support improved outcomes for care recipients.
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Affiliation(s)
- Ruotong Liu
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Brent Vander Wyk
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - Heather G Allore
- Department of Biostatistics, Yale University, New Haven, CT, USA
- Department of Internal Medicine, Yale University, New Haven, CT, USA
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Leggett AN, Koo HJ, Strominger J, Maust DT. Gatekeepers: The Association of Caregiving Network Characteristics With Emergency Department Use by Persons Living With Dementia. J Gerontol B Psychol Sci Soc Sci 2023; 78:1073-1084. [PMID: 36562342 PMCID: PMC10214653 DOI: 10.1093/geronb/gbac198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Caregivers are typically enmeshed in networks of family and friends who assist with care, yet this network is largely neglected in research. In light of the fact that caregivers are key medical decision makers and play a critical role in how persons living with dementia (PLwDs) interface with the health care system, this study explores how features of the caregiver network relate to PLwD emergency department (ED) use. METHODS Using 2015 National Health and Aging Trends Study data linked with fee-for-service Medicare claims, we examine ED use in a nationally representative sample of community-dwelling persons aged 65 and older with dementia and at least 1 caregiver. We consider aspects of the caregiver network including membership (e.g., daughter in network), network size, hours of care received, and the presence of generalists and specialists (i.e., broad vs narrow functional assistance) as predictors of ED encounters among PLwD. RESULTS PLwDs were 81.5 years old on average, 50% were female, and 33% were non-White. Care networks including nonimmediate family members involved in task sharing for mobility and self-care difficulties and those with more generalists had significantly higher odds of an ED visit. Networks that only consisted of specialist caregivers had significantly lower odds of an ED visit. DISCUSSION Greater complexity of care networks increases risk of presenting to the ED for care. Better understanding how caregiving networks help PLwD interact with the health care system can inform intervention design and targeting in order to help care networks improve care coordination, management, and shared decision making.
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Affiliation(s)
- Amanda N Leggett
- Institute of Gerontology & Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Hyun Jung Koo
- Department of Statistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julie Strominger
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Donovan T Maust
- Department of Statistics, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Parmar JK, L'Heureux T, Anderson S, Duggleby W, Pollard C, Poole L, Charles L, Sonnenberg LK, Leslie M, McGhan G, Huhn A, Sereda S, Marion C, Tarnowski G, Mah J, Melenberg D, Weir C, Pooler C, MacLachlan N, Bremault-Phillips S, Tian PGJ, Sacrey LAR. Optimizing the integration of family caregivers in the delivery of person-centered care: evaluation of an educational program for the healthcare workforce. BMC Health Serv Res 2022; 22:364. [PMID: 35303870 PMCID: PMC8932680 DOI: 10.1186/s12913-022-07689-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background While family caregivers provide 70-90% of care for people living in the community and assist with 10-30% of the care in congregate living, most healthcare providers do not meaningfully involve family caregivers as partners in care. Recent research recommends that the healthcare workforce receive competency-based education to identify, assess, support, and partner with family caregivers across the care trajectory. Objective This paper reports a mixed-methods evaluation of a person-centered competency-based education program on Caregiver-Centered Care for the healthcare workforce. Methods This foundational education was designed for all healthcare providers and trainees who work with family caregivers and is offered free online (caregivercare.ca). Healthcare providers from five healthcare settings (primary, acute, home, supportive living, long-term care) and trainees in medicine, nursing, and allied health were recruited via email and social media. We used the Kirkpatrick-Barr health workforce training evaluation framework to evaluate the education program, measuring various healthcare providers’ learner satisfaction with the content (Level 1), pre-post changes in knowledge and confidence when working with family caregivers (Level 2), and changes in behaviors in practice (Level 3). Results Participants were primarily healthcare employees (68.9%) and trainees (21.7%) and represented 5 healthcare settings. Evaluation of the first 161 learners completing the program indicated that on a 5-point Likert scale, the majority were satisfied with the overall quality of the education (Mean(M) = 4.69; SD = .60). Paired T-tests indicated that out of a score of 50, post-education changes in knowledge and confidence to work with family caregivers was significantly higher than pre-education scores (pre M = 38.90, SD = 6.90; post M = 46.60, SD = 4.10; t(150) = − 16.75, p < .0001). Qualitative results derived from open responses echoed the quantitative findings in satisfaction with the education delivery as well as improvements in learners’ knowledge and confidence. Conclusion Health workforce education to provide person-centered care to all family caregivers is an innovative approach to addressing the current inconsistent system of supports for family caregivers. The education program evaluated here was effective at increasing self-reported knowledge and confidence to work with family caregivers. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07689-w.
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Affiliation(s)
- Jasneet K Parmar
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada.,Home Living and Transitions, Alberta Health Services - Edmonton Zone Continuing Care, Strathcona Health Centre, 2 Brower Drive, Baseline Road, Sherwood Park, AB, T8H1V4, Canada
| | - Tanya L'Heureux
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada
| | - Sharon Anderson
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada. .,Department of Human Ecology, University of Alberta, 335 Human Ecology Building, 8905 - 116 St NW, Edmonton, Alberta, T6G 2N1, Canada.
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, 3-141 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada
| | - Cheryl Pollard
- Faculty of Nursing, University of Regina, RI 508, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2, Canada
| | - Lisa Poole
- Dementia Advocacy Canada, Calgary Dementia Network Strategic Council, Glencoe Club Dementia Advisory Group, Calgary, Canada
| | - Lesley Charles
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada.,Care of the Elderly, Glenrose Rehabilitation Hospital-East, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada
| | - Lyn K Sonnenberg
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada.,Faculty of Rehabilitation Medicine, University of Alberta, 3-14 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Myles Leslie
- School of Public Policy, University of Calgary, Calgary, 906 8th Avenue S.W. 5th Floor, Alberta, T2P 1H9, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, 3D10, 3280 Hospital Drive NW, Alberta, T2N 4Z6 , Canada
| | - Gwen McGhan
- Faculty of Nursing, University of Calgary, PF 3204, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Arlene Huhn
- Client Services & Programs, Alzheimer Society of Alberta and Northwest Territories, Suite 306, 10430-61 Avenue, Edmonton, AB, T6H 2J3, Canada
| | - Sandy Sereda
- Caregivers Alberta, 12122 68 St NW, Edmonton, Alberta, T5B 1R1, Canada
| | - Cecilia Marion
- Youville Home, Covenant Health, 9A St Vital Ave, St. Albert, Alberta, T8N 1K1, Canada
| | - Glenda Tarnowski
- College of Licensed Practical Nurses of Alberta, St. Albert Trail Place, 13163-146 Street, Edmonton, AB, T5L 4S8, Canada
| | - Jennifer Mah
- Faculty of Health and Community Studies, Norquest College, Edmonton, Canada
| | - Denise Melenberg
- Palliative Care Programs/Education and Practice Development/Community Programs, Alberta Health Services, Edmonton, Canada
| | - Carolyn Weir
- Palliative Care Programs/Education and Practice Development/Community Programs, Alberta Health Services, Edmonton, Canada.,Mother Rosalie Health Service Centre, 16930 87 Ave, Edmonton, AB, T5R4H5, Canada
| | - Charlotte Pooler
- Faculty of Nursing, University of Alberta, 3-141 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada.,Palliative Care Programs/Education and Practice Development/Community Programs, Alberta Health Services, Edmonton, Canada
| | - Nora MacLachlan
- Health and Community Studies, Bow Valley College, Calgary, North Campus, Seventh Floor, 345 - 6 Avenue SE., Alberta, AB T2G 4S6, Canada
| | - Suzette Bremault-Phillips
- Faculty of Rehabilitation Medicine, University of Alberta, 3-14 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Peter George J Tian
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada
| | - Lori-Ann R Sacrey
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Autism Research Centre (E209), Glenrose Rehabilitation Hospital, 10230 - 111 Avenue, Edmonton, AB, T5G 0B7, Canada
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Ali T, McAvay GJ, Monin JK, Gill TM. Patterns of Caregiving Among Older Adults With and Without Dementia: A Latent Class Analysis. J Gerontol B Psychol Sci Soc Sci 2022; 77:S74-S85. [PMID: 35032392 PMCID: PMC9122635 DOI: 10.1093/geronb/gbab237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES We identify common patterns of caregiving or "care types" among older adults with and without dementia. Prior research has focused on primary caregivers and on the independent effects of individual caregiving attributes. We examine multiple caregivers of older adults, including the primary caregiver, and how multiple caregiving attributes co-occur to shape caregiving types. METHODS We link 2015 care recipient (N = 1,423) and unpaid caregiver data (N = 2,146) from the National Health and Aging Trends Study and the National Study of Caregiving. Latent class analysis of caregiving attributes, representing care intensity and regularity, and various care activities, was used to construct care types. Multinomial logistic regression was used to examine if the recipients' dementia status and caregivers' background characteristics predicted membership in care types. RESULTS Five distinguishable care types were identified. Caregivers who were female, adult children, or coresidents, those caring for persons with dementia, and those who had paid help had higher odds of being in the more demanding care types. Conversely, older, White caregivers and those with support for their caregiving activities were less likely to be in a demanding care type. DISCUSSION Care types can help us understand sources of heterogeneity in caregiving and effectively target caregiver support services and interventions.
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Affiliation(s)
- Talha Ali
- Address correspondence to: Talha Ali, PhD, Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA. E-mail:
| | - Gail J McAvay
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joan K Monin
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Jamieson H, Abey-Nesbit R, Nishtala PS, Allore H, Han L, Deely JM, Pickering JW. Predictors of Residential Care Admission in Community-Dwelling Older People With Dementia. J Am Med Dir Assoc 2020; 21:1665-1670. [PMID: 32646821 PMCID: PMC7641960 DOI: 10.1016/j.jamda.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objectives of this study were to identify variables associated with dementia and entry into aged residential care (ARC) and derive and validate a risk prediction model for dementia and entry into ARC. DESIGN This was an observational study of prospectively collected Home Care International Residential Assessment Instrument (interRAI-HC) assessment data. SETTING AND PARTICIPANTS Participants included all people age ≥65 years who had completed an interRAI-HC assessment between July 1, 2012 and June 30, 2018. Exclusion criteria included death or entry into ARC within 30 days of assessment and not living at home at the time of the assessment. MEASURES InterRAI data from 94,202 older New Zealanders were evaluated for presence or absence of dementia. A multivariable competing-risks model for entry into ARC with death as the competing event was used to estimate subdistribution hazard ratios (SHR). RESULTS In total, there were 18,672 (19.8%) persons with dementia (PWD). PWD were almost twice as likely to enter ARC as persons without dementia [42.8% vs 25.3%; difference 17.5% (95% confidence interval 16.7%‒18.2%)]. PWD at highest risk of entering ARC were those where there was a desire to live elsewhere (SHR 1.44), depression (indicated, SHR 1.15), poor cognitive performance (Cognitive Performance Scale minimal SHR 1.32 and severe plus SHR 1.91), and wandering (SHR 1.19). Factors associated with reduced risks of PWD entering ARC were living with a child or relative, alcohol consumption, and comorbidities. CONCLUSIONS AND IMPLICATIONS A desire to live elsewhere, social isolation, independent activities of daily living, and depression were independently associated with entry into ARC. Supporting caregivers may improve outcomes for PWD that delay entry into ARC. Future revisions of the interRAI questionnaire could provide more insight on this matter.
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Affiliation(s)
- Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand; Burwood Hospital, Christchurch, New Zealand.
| | | | - Prasad S Nishtala
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Heather Allore
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA; Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Ling Han
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Joanne M Deely
- Canterbury District Health Board, Christchurch, New Zealand; Research Management Office, Lincoln University, Lincoln, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
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