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Brouwers M, de Boer B, Groen WG, Gabrio A, Verbeek H. Depressive Signs and Daily Life of Residents When Relocating From a Regular to an Innovative Nursing Home. J Am Med Dir Assoc 2024:105298. [PMID: 39395811 DOI: 10.1016/j.jamda.2024.105298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 09/05/2024] [Accepted: 09/08/2024] [Indexed: 10/14/2024]
Abstract
OBJECTIVES In this study, we examine how residents are affected by moving from a regular nursing home into an innovative living arrangement. In the past decade, a culture change has taken place, leading to rapid developments of innovative nursing homes that aim to change the physical, social, and organizational environment to better suit the needs of older adults needing 24-hour care. This has inevitably led to more group relocations in long-term care. Insight into the change in residents when relocating is lacking. DESIGN An observational longitudinal study. SETTING AND PARTICIPANTS Four Dutch care organizations in which 5 relocations took place from a regular to an innovative living arrangement. Residents (N = 97) requiring 24-hour care who were relocated from a regular nursing home to an innovative living arrangement were included. METHODS Data were collected 1 month before, 2 weeks after, and 6 months after relocating. Depressive symptoms, cognitive functioning, and dependence in activities of daily living were measured using questionnaires. Furthermore, the daily lives of the residents were assessed using ecological momentary assessments. RESULTS Overall, no long-term change in depressive symptoms, cognitive functioning, and dependence in activities of daily living was found when relocating. Furthermore, the daily life of residents was not different 6 months after moving. Relocating was accompanied by a significant short-term increase in depressive signs and symptoms in 2 out of 4 locations (P < .001). CONCLUSIONS AND IMPLICATIONS This study shows that relocating to an innovative nursing home does not lead to long-term changes in residents. There are indications that there might be a short-term change in depressive symptoms that could be prevented by considering the approach and context. More research is needed into the changes in the physical, social, and organizational environment that are necessary for a positive impact on the daily lives of residents.
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Affiliation(s)
- Mara Brouwers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - Bram de Boer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Andrea Gabrio
- Department of Methodology and Statistics, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Cremer S, Rosteius K, Zwakhalen SMG, Verbeek H, Bleijlevens MHC, de Boer B. Utilizing the physical green care environment to support activities of daily living for nursing home residents: a focused ethnographic case study. BMC Nurs 2024; 23:160. [PMID: 38443854 PMCID: PMC10913440 DOI: 10.1186/s12912-024-01782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The nursing home residents' ability to carry out Activities of Daily Living (ADLs) is influenced by the physical care environment. One emerging area of interest in scientific research is the green care environment within nursing home care, where agricultural activities such as gardening and animal care are integrated alongside daily care. Previous research has neglected to explore how these environments can be employed to enhance ADL performance. This study, therefore, explores how a green care environment, specifically one with an animal shelter, can be used to support nursing home residents in their ADLs. METHODS A focused ethnographic case study was conducted in one nursing home. Data was collected employing participatory observations, informal conversations, and semi-structured interviews, which we analyzed by employing a thematic analysis. RESULTS Overall, 25 residents were observed for a total time of 89h, and interviews were conducted with 10 staff members. The nursing home integrates activities in the green care environment into daily care for a broad scope of residents. The analysis revealed four themes: (1) The (in)visibility of ADL, (2) Reciprocal care dynamics: Fostering ADL performance through connection and teamwork, (3) Seized and missed opportunities for meaningful integration of ADL in the physical green care environment, and Theme (4) Professional fulfillment and ADL task obligation: Views from staff and management. CONCLUSIONS This physical green care environment carries the potential to enhance the residents' daily activities and foster better staff-resident relationships. Yet, there are varying views among staff and management regarding its integration into the residents' lives and care.
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Affiliation(s)
- Svenja Cremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT Maastricht Postbus 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - Katharina Rosteius
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT Maastricht Postbus 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Sandra M G Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT Maastricht Postbus 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - H Verbeek
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT Maastricht Postbus 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT Maastricht Postbus 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Bram de Boer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT Maastricht Postbus 616, 6200 MD, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Young Y, Hsu WH, Shayya A, Barnes V, Perre T, O'Grady T. Revealing the divide: Contrasting COVID-19 outcomes in Green Houses and traditional nursing homes in the United States. Geriatr Nurs 2024; 55:136-143. [PMID: 37992476 DOI: 10.1016/j.gerinurse.2023.11.001] [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] [Received: 08/30/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION This study compares COVID-19 case and mortality rates in Green Houses (GHs) and traditional nursing homes (NHs) during the COVID-19 pandemic. METHODS CMS data from 10 states (June 2020 to September 2022) were analyzed for GHs (n = 19), small NHs (n = 266), and large NHs (n = 2,932). Multivariate Poisson regressions with GEE were used. RESULTS Participants (mean age 73.4) were predominantly female (57.8 %) and White (78.2 %). Small and large NHs had a significantly higher COVID-19 case risk (RR = 1.61; 95 % CI 1.25-2.08 and RR = 1.75; 95 % CI 1.36-2.24, respectively) compared to GHs. Large NHs also had an increased mortality risk (RR = 1.67; 95 % CI 1.01-2.77) compared to GHs, with no difference found between GHs and small NHs. CONCLUSION After adjusting for age, gender, and ADL disability, GHs demonstrated lower COVID-19 case and mortality rates than traditional NHs, likely due to their unique features, including person-centered care, size, and physical structure.
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Affiliation(s)
- Yuchi Young
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA.
| | - Wan-Hsiang Hsu
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA; Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY 12237, USA
| | - Ashley Shayya
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA
| | - Virgile Barnes
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA
| | - Taylor Perre
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA; Home Care Association of New York State, Albany, NY 12207, USA
| | - Thomas O'Grady
- Department of Epidemiology & Biostatistics, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA; Bureau of HIV/AIDS Epidemiology, New York State Department of Health, Albany, NY 12237, USA
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Brouwers M, Broekharst DSE, de Boer B, Groen WG, Verbeek H. An overview of innovative living arrangements within long-term care and their characteristics: a scoping review. BMC Geriatr 2023; 23:442. [PMID: 37464287 PMCID: PMC10355008 DOI: 10.1186/s12877-023-04158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Within long-term care, a culture change (e.g. focus on increasing autonomy in everyday life) is leading to the development of innovative living arrangements for older adults. Insight into characteristics of innovative living arrangements, which are described as an alternative to regular nursing homes, is lacking. This review aims to provide an overview of innovative living arrangements and to describe their defining characteristics. METHODS A scoping review was performed following the framework of Arksey and O'Malley. The preferred reporting items for systematic reviews and meta-analyses with extension, for scoping reviews (PRISMA-ScR) was also followed. The databases PubMed, PsycInfo, CINAHL, and Web of Science were searched. Articles, published between 2012 and 2023 were included when they presented an innovative living arrangement as an alternative to regular nursing homes. A thematic analysis was performed, describing the physical, social, and organizational environment of the innovative living arrangements. RESULTS Fifty-six articles were identified describing seven types of distinct innovative living arrangements: small-scale living, the green house model, shared housing arrangements, green care farms, dementia villages, group homes, intergenerational living, and an 'other' category. The themes included supporting autonomy and creating a small-scale and/or homelike environment, which were emphasized in most innovative living arrangements. Other themes, such as involvement of the community, focus on nature, integration of work tasks, and involvement of family members, were emphasized in a subsection of the described living arrangements. Twenty-eight articles reported on the effects of the innovative living environment on residents, family members, or staff members. Most articles (N = 22) studied resident-related outcomes, focusing mainly on quality of life and aspects of daily life. CONCLUSION More insight into the mechanisms of the social and organizational environments is needed, which may lead to greater transparency and homogeneity regarding the description of living arrangements. This review shows that more knowledge is needed about the potential key elements of innovative living arrangements, especially related to their social and organizational environment. This may provide a better guide for developers within long-term care.
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Affiliation(s)
- Mara Brouwers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. BOX 616, Maastricht, 6200 MD, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Damien S E Broekharst
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- University Network for the care sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Bram de Boer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. BOX 616, Maastricht, 6200 MD, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. BOX 616, Maastricht, 6200 MD, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Behrens LL, Madrigal C, Dellefield ME. Assessment of Nursing Staff Learning Needs Around Person-Centered Risk Management in Nursing Homes. J Gerontol Nurs 2023; 49:7-12. [PMID: 36719662 DOI: 10.3928/00989134-20230106-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of the current study was to describe nursing home (NH) staff's perceived learning and practice competency needs to facilitate effective delivery of person-centered care (PCC) when older adult residents' care preferences involve perceived risks. This needs assessment included a survey of NH staff and leaders (N = 87) and two focus groups (FGs) (N = 14). Results indicated staff were most confident handling preferences related to medication refusal (mean item rating = 4.1) and least confident in preferences related to smoking (mean item rating = 2.4). Staff were challenged in denying residents' preferences (mean item rating = 3.6) and worried about risk outcomes for residents or themselves (71.6%), reporting lack of policy and procedures to support them (48.1%). Survey results were enriched by FG themes: Establishing Person-Centered Values, Navigating Risk, and Operational Characteristics. Together, this information informed the development of a practice protocol to improve nursing competence in situations involving negotiation of resident and/or NH risks in care delivery. [Journal of Gerontological Nursing, 49(2), 7-12.].
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Siegel EO, Kolanowski AM, Bowers BJ. A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models. Res Gerontol Nurs 2023; 16:5-13. [PMID: 36692436 DOI: 10.3928/19404921-20230104-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].
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Tierney L, Doherty K, Breen J, Courtney‐Pratt H. Community expectations of a village for people living with dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5875-e5884. [PMID: 36106476 PMCID: PMC10086954 DOI: 10.1111/hsc.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/22/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Small-scale models of dementia care are a progressive approach to improve care for people living with dementia. These models intend to provide a home-like environment with a small number of residents in each living unit, easy access to services and facilities, a dedicated team of staff and flexible routines. This study was undertaken during the construction phase of a new village and provided a unique opportunity to explore expectations of the village among the local community. Twelve community members participated in two sequential online focus groups over a 2-month period. Focus group discussions were recorded, transcribed and analysed using a reflexive thematic analysis approach. Knowledge of the village varied and was informed by familiarity with other village developments and local marketing about the new village. The findings indicate that the community expect the village to provide residents with optimum dementia care, a safe and enabling physical environment and a vibrant daily life where they are engaged in 'normal' activities. While participants expected the village to be self-contained, they also anticipated strong connections with the wider community. Participants acknowledged that the community need dementia education to ensure these interactions are positive. Community expectations of a new village development for people living with dementia are largely positive and often idealistic. Organisations need to consider these expectations when developing new small-scale facilities and be mindful of how they market these developments to foster realistic expectations. While community enthusiasm about dementia care is encouraging, education is needed to ensure the success of the model.
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Affiliation(s)
- Laura Tierney
- Wicking Dementia Research and Education Centre, College of Health and MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - Kathleen Doherty
- Wicking Dementia Research and Education Centre, College of Health and MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - Juanita Breen
- Wicking Dementia Research and Education Centre, College of Health and MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - Helen Courtney‐Pratt
- Wicking Dementia Research and Education Centre, College of Health and MedicineUniversity of TasmaniaHobartTasmaniaAustralia
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Beynon C, Siegel EO, Supiano K, Edelman LS. Working Dynamics of Licensed Nurses and Nurse Aides in Nursing Homes: A Scoping Review. J Gerontol Nurs 2022; 48:27-34. [PMID: 35511065 DOI: 10.3928/00989134-20220405-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Collaboration between licensed nurses (LNs) and nurse aides (NAs) is critical in the provision of quality care for residents living in nursing homes (NHs). The current scoping review explores how working dynamics between LNs and NAs in the NH setting are researched and described in the literature. Thirty-five articles were identified and reviewed that address the LN/NA relationship in the context of (a) the LN role as a supervisor and leader; (b) variation in structure; (c) expanding, understanding, and supporting staff roles; and (d) communication. We found that the LN/NA relationship has been primarily explored through the LN lens and often studied in the context of role expansion and revision associated with new models of care. Our contribution to the literature includes the following main points: efforts to improve LN/NA collaboration may be hindered without substantial structural change; collaboration may be limited within the hierarchal LN/NA relationship; LNs and NAs in NHs need greater support, recognition, and empowerment; and NAs require a representative voice. [Journal of Gerontological Nursing, 48(5), 27-34.].
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Scales K. Transforming Direct Care Jobs, Reimagining Long-Term Services and Supports. J Am Med Dir Assoc 2021; 23:207-213. [PMID: 34973168 DOI: 10.1016/j.jamda.2021.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022]
Abstract
The diverse array of individuals who receive long-term services and supports share one common experience, which is the need for assistance with personal care and/or other daily activities. The direct care workers (including nursing assistants, home health aides, and personal care aides) who provide this assistance play a critical role in keeping individuals safe, supporting their health and well-being, and helping prevent adverse outcomes. Yet despite decades of research, advocacy, and incremental policy and practice reform, direct care workers remain inadequately compensated, supported, and respected. Long-standing direct care job quality concerns are linked to high turnover and job vacancy rates in this workforce, which in turn compromise the availability and quality of essential care for older adults and people with disabilities-which has never been more evident than during the COVID-19 pandemic. This special article makes the case for transforming direct care jobs and stabilizing this workforce as a centerpiece of efforts to reimagine long-term services and supports system in the United States, as a public health priority, and as a social justice imperative. Drawing on research evidence and examples from the field, the article demonstrates that a strong, stable direct care workforce requires: a competitive wage and adequate employment benefits for direct care workers; updated training standards and delivery systems that prepare these workers to meet increasingly complex care needs across settings, while also enhancing career mobility and workforce flexibility; investment in well-trained frontline supervisors and peer mentors to help direct care workers navigate their challenging roles; and an elevated position for direct care workers in relation to the interdisciplinary care team. The article concludes by highlighting federal and state policy opportunities to achieve direct care job transformation, as well as discussing research and practice implications.
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de Boer B, Buist Y, de Bruin SR, Backhaus R, Verbeek H. Working at Green Care Farms and Other Innovative Small-Scale Long-Term Dementia Care Facilities Requires Different Competencies of Care Staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010747. [PMID: 34682485 PMCID: PMC8535722 DOI: 10.3390/ijerph182010747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
The culture change movement within long-term care in which radical changes in the physical, social and organizational care environments are being implemented provides opportunities for the development of innovative long-term care facilities. The aim of this study was to investigate which competencies care staff working at green care farms and other innovative types of small-scale long-term dementia care facilities require, according to care staff themselves and managers, and how these competencies were different from those of care staff working in more traditional large-scale long-term dementia care facilities. A qualitative descriptive research design was used. Interviews were conducted with care staff (n = 19) and managers (n = 23) across a diverse range of long-term facilities. Thematic content analysis was used. Two competencies were mainly mentioned by participants working in green care farms: (1) being able to integrate activities for residents into daily practice, and (2) being able to undertake multiple responsibilities. Two other competencies for working in long-term dementia care in general were identified: (3) having good communication skills, and (4) being able to provide medical and direct care activities. This study found unique competencies at green care farms, showing that providing care in innovative long-term care facilities requires looking further than the physical environment and the design of a care facility; it is crucial to look at the role of care staff and the competencies they require.
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Affiliation(s)
- Bram de Boer
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands;
- Correspondence: (B.d.B.); (H.V.)
| | - Yvette Buist
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands; (Y.B.); (S.R.d.B.)
- Social Sciences Department, Chairgroup Health and Society, Wageningen University & Research, 6708 PB Wageningen, The Netherlands
| | - Simone R. de Bruin
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands; (Y.B.); (S.R.d.B.)
- Research Group Living Well with Dementia, Department of Health and Wellbeing, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands
| | - Ramona Backhaus
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands;
- Correspondence: (B.d.B.); (H.V.)
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Olson NL, Albensi BC. Dementia-Friendly "Design": Impact on COVID-19 Death Rates in Long-Term Care Facilities Around the World. J Alzheimers Dis 2021; 81:427-450. [PMID: 33814449 DOI: 10.3233/jad-210017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Persons with dementia (PWD) make up a large portion of the long-term care (LTC) population the world over. Before a global pandemic swept the world, governments and healthcare providers struggled with how to best care for this unique population. One of the greatest challenges is a PWD's tendency to "walk with purpose" and exhibit unsafe wayfinding and elopement, which places them at risk of falls and injury. Past solutions included increased use of restraints and pharmacological interventions, but these have fallen out of favor over the years and are not optimal. These challenges put enormous strain on staff and caregivers, who are often poorly trained in dementia care, underpaid, overworked, and overstressed. PWD are impacted by these stresses, and unmet needs in LTC places an even greater stress on them and increases their risks of morbidity and mortality. The physical design of their environments contributes to the problem. Old, institutionalized buildings have poor lighting, poor ventilation, long dead-end hallways, poor visual cues, lack of home-like décor, shared bedrooms and bathrooms, and are often dense and overcrowded. These design elements contribute to the four 'A's' of dementia: apathy, anxiety, agitation, and aggression, and they also contributed to the rapid spread of COVID-19 in these facilities the world over. In this review, we present current "dementia friendly" design models in the home, community, and LTC, and argue how they could have saved lives during the pandemic and reduced the stresses on both the dementia resident and the caregiver/staff.
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Affiliation(s)
- Nancy L Olson
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.,Department of Pharmacology & Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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12
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Bogner MP, Ivanitskaya LV, Jeong YR, DeLellis NO. Nursing staff member experiences with household model implementation in a nursing home setting. Geriatr Nurs 2021; 42:748-755. [PMID: 33872859 DOI: 10.1016/j.gerinurse.2021.03.018] [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] [Received: 02/26/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022]
Abstract
This qualitative study used conventional content analysis of interview data to examine nursing staff members' experiences with Household Model implementation in a nursing home setting. Staff members were recruited from the skilled nursing center post implementation and completed individual interviews (N=16). Participants described the impact of implementation in relation to three categories: antecedents, explicit reactions and change consequences. Participants described barriers and facilitators to implementation as well as outcomes such as role strain, feelings of isolation and harder working conditions. This study provides opportunities for further examination of nursing staff members' experiences with person centered care models in nursing homes, how those experiences may relate to effectiveness of implementation and the need for support of nursing home staff.
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Affiliation(s)
- Matthew P Bogner
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI 48859, USA.
| | - Lana V Ivanitskaya
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI 48859, USA
| | - Ye Ra Jeong
- Psychology Department, Radford University, Radford, VA, 24060, USA
| | - Nailya O DeLellis
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI 48859, USA
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Hrybyk RL, Frankowski AC, Nemec M, Peeples AD. "It's a lot!" the universal worker model and dementia care in assisted living. Geriatr Nurs 2020; 42:233-239. [PMID: 33317815 DOI: 10.1016/j.gerinurse.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 10/22/2022]
Abstract
The culture change movement aims to create a more home-like environment in long-term care settings, promote person-centered care, and support the well-being of staff and residents. One feature of Culture Change is the Universal Worker (UW) model where direct care workers (DCWs) are responsible for housekeeping, laundry, and activities in addition to administering medication and personal support. The longitudinal approach in the ethnographic study on which this paper is based compares data collected from one assisted living across three NIA-supported research grants. This paper focuses on modifications to the UW model following the implementation of culture change over a period of ten years. As DCWs cared for residents with increasing levels of dementia, time constraints under the UW model led to sporadic attention to housekeeping chores and challenged person-centered care. Modifying the UW model, by using dedicated cleaning staff and other support workers, better preserves the intent of the culture change movement.
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Affiliation(s)
- Regina L Hrybyk
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County 1000 Hilltop Circle, Baltimore, MD 21250, United States.
| | - Ann Christine Frankowski
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Mary Nemec
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Amanda D Peeples
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County 1000 Hilltop Circle, Baltimore, MD 21250, United States
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14
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Zhang A, Kong D, Jiang L, Sun F, Dunkle RE, Liu C. Understanding the Effectiveness of Psychosocial Services for Anxiety and Depression in Chinese Older Adults: A Systematic Review and Meta-Analysis of Controlled Trials. THE GERONTOLOGIST 2020; 60:e76-e92. [PMID: 30753474 DOI: 10.1093/geront/gny185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There exists an imperative need to comprehensively evaluate the effectiveness of psychosocial interventions for Chinese geriatric populations' mental wellbeing. This study conducted a systematic review and meta-analysis of psychosocial services for Chinese older adults' depression and anxiety. RESEARCH DESIGN AND METHODS A search of nine electronic databases, five geriatric mental health journals, and reference lists was conducted for studies published between 1980 and April. 2018. Thirty-three studies (including totally 3,478 participants, 107 effect sizes) of true and quasiexperimental controlled trials were eligible and included for meta-analysis using robust variance estimation in meta-regression. Outcome indicators were geriatric depression and anxiety. RESULTS An overall significant treatment effect was identified for geriatric depression and anxiety (d = 0.577, 95% confidence interval [CI]: 0.288, 0.867, p < .001). Outcomes, geographic area, participants' marriage, service setting, and types of control group were moderators for treatment effects. Subgroup analysis observed statistically significant effect size among studies in Taiwan, used innovative service methods and small group interventions. Both in-person, home-based interventions and interventions provided by nurse practitioners and specially trained providers were statistically significant. DISCUSSION AND IMPLICATIONS Psychosocial services can benefit Chinese geriatric populations. Innovative and culturally relevant programs received strongest research supports. Future research should incorporate social interaction as an important component for serving Chinese older adults' mental wellbeing.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor
| | - Dexia Kong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, The State University of New Jersey, New Brunswick
| | - Lin Jiang
- School of Social Work, The University of Texas Rio Grande Valley, Edinburg
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing
| | - Ruth E Dunkle
- School of Social Work, University of Michigan, Ann Arbor
| | - Chun Liu
- The University of Texas at Austin, Steve Hicks School of Social Work
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15
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Harrison SL, Dyer SM, Milte R, Liu E, Gnanamanickam ES, Crotty M. Alternative staffing structures in a clustered domestic model of residential aged care in Australia. Australas J Ageing 2019; 38 Suppl 2:68-74. [PMID: 31496059 DOI: 10.1111/ajag.12674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A clustered domestic model of residential aged care has been associated with better consumer-rated quality of care. Our objective was to examine differences in staffing structures between clustered domestic and standard models. METHODS A cross-sectional study involving 541 individuals living in 17 Australian not-for-profit residential aged care homes. RESULTS Four of the homes offered dementia-specific clustered domestic models of care with higher personal care attendant (PCA) hours-per-resident-per-day (mean [SD] 2.43 [0.29] vs. 1.74 [0.46], P < 0.001), slightly higher direct care hours-per-resident-per-day (2.66 [0.35] vs. 2.58 [0.44], P = 0.006), higher staff training costs ($1492 [258] vs. $989 [928], P < 0.001) and lower registered/enrolled nurse hours-per-resident-per-day (0.23 [0.10] vs. 0.85 [0.17], P < 0.001) compared to standard models. CONCLUSIONS An Australian clustered domestic model of care had higher PCA hours, more staff training and more direct care time compared to standard models. Further research to determine optimal staffing structures within alternative models of care is warranted.
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Affiliation(s)
- Stephanie L Harrison
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne M Dyer
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Milte
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Institute for Choice, University of South Australia, Adelaide, South Australia, Australia
| | - Enwu Liu
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Emmanuel S Gnanamanickam
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Health Economics and Social Policy, Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
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16
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Snow AL, Jacobs ML, Palmer JA, Parmelee PA, Allen RS, Wewiorski NJ, Hilgeman MM, Vinson LD, Berlowitz DR, Halli-Tierney AD, Hartmann CW. Development of a New Tool for Systematic Observation of Nursing Home Resident and Staff Engagement and Relationship. THE GERONTOLOGIST 2018; 58:e15-e24. [PMID: 28499032 PMCID: PMC6281332 DOI: 10.1093/geront/gnw255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/13/2017] [Indexed: 11/12/2022] Open
Abstract
Purpose of Study To develop a structured observational tool, the Resident-centered Assessment of Interactions with Staff and Engagement tool (RAISE), to measure 2 critical, multi-faceted, organizational-level aspects of person-centered care (PCC) in nursing homes: (a) resident engagement and (b) the quality and frequency of staff-resident interactions. Design and Methods In this multi-method psychometric development study, we conducted (a) 120 hr of ethnographic observations in one nursing home and (b) a targeted literature review to enable construct development. Two constructs for which no current structured observation measures existed emerged from this phase: nursing home resident-staff engagement and interaction. We developed the preliminary RAISE to measure these constructs and used the tool in 8 nursing homes at an average of 16 times. We conducted 8 iterative psychometric testing and refinement cycles with multi-disciplinary research team members. Each cycle consisted of observations using the draft tool, results review, and tool modification. Results The final RAISE included a set of coding rules and procedures enabling simultaneously efficient, non-reactive, and representative quantitative measurement of the interaction and engagement components of nursing home life for staff and residents. It comprised 8 observational variables, each represented by extensive numeric codes. Raters achieved adequate to high reliability with all variables. There is preliminary evidence of face and construct validity via expert panel review. Implications The RAISE represents a valuable step forward in the measurement of PCC, providing objective, reliable data based on systematic observation.
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Affiliation(s)
- A Lynn Snow
- Research & Development, Tuscaloosa VA Medical Center, Alabama
- Alabama Research Institute on Aging and Psychology Department, The University of Alabama, Tuscaloosa
| | - M Lindsey Jacobs
- Mental Health Service, VA Boston Healthcare System Brockton Division, Massachusetts
| | - Jennifer A Palmer
- Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
| | - Patricia A Parmelee
- Alabama Research Institute on Aging and Psychology Department, The University of Alabama, Tuscaloosa
| | - Rebecca S Allen
- Alabama Research Institute on Aging and Psychology Department, The University of Alabama, Tuscaloosa
| | - Nancy J Wewiorski
- Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
| | - Michelle M Hilgeman
- Research & Development, Tuscaloosa VA Medical Center, Alabama
- Alabama Research Institute on Aging and Psychology Department, The University of Alabama, Tuscaloosa
| | - Latrice D Vinson
- Mental Illness Research, Education & Clinical Center, VA Maryland Health Care System, Baltimore
| | - Dan R Berlowitz
- Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
- Health Law, Policy, & Management, Boston University School of Public Health, Massachusetts
| | - Anne D Halli-Tierney
- Alabama Research Institute on Aging and College of Community Health Sciences, The University of Alabama, Tuscaloosa
| | - Christine W Hartmann
- Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
- Health Law, Policy, & Management, Boston University School of Public Health, Massachusetts
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Berridge C, Tyler DA, Miller SC. Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey. J Appl Gerontol 2016; 37:419-434. [PMID: 27566304 DOI: 10.1177/0733464816665204] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. Data from 2,034 nursing home administrators from a 2009/2010 national nursing home survey and ordered logistic regression were used. After adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44% greater likelihood of having higher CNA retention (odds ratio [OR] = 1.44; 95% confidence interval [CI] = [1.15, 1.81], p = .001) and those with high empowerment scores had a 64% greater likelihood of having higher CNA retention (OR = 1.64; 95% CI = [1.34, 2.00], p < 001). Greater opportunities for CNA empowerment are associated with longer CNA retention. This research suggests that staffing empowerment practices on the whole are worthwhile from the CNA staffing stability perspective.
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18
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Shannon K, McKenzie-Green B. Current role challenges in New Zealand aged residential care: the potential consequences for healthcare assistant role expansion. Contemp Nurse 2016; 52:140-51. [DOI: 10.1080/10376178.2016.1221322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fishman NW, Lowe JI, Ryan SF. Promoting an Alternative to Traditional Nursing Home Care: Evaluating the Green House Small Home Model. An Introduction from the Funders and the Green House Project. Health Serv Res 2016; 51 Suppl 1:344-51. [PMID: 26799687 DOI: 10.1111/1475-6773.12429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Petriwskyj A, Parker D, Brown Wilson C, Gibson A. Evaluation of Subscription-based Culture Change Models in Care Settings: Findings From a Systematic Review. THE GERONTOLOGIST 2016; 56:e46-62. [PMID: 26893491 DOI: 10.1093/geront/gnw012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/23/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY Person-centered culture change models to which aged care service providers subscribe are gaining increasing traction. It has been suggested that culture change initiatives broadly are subject to a range of issues. It is difficult, however, to draw out from the existing literature specific information about the scope and quality of evidence regarding subscription-based approaches. The purpose of this study was to identify and review the peer-reviewed literature regarding these subscription-based models. DESIGN AND METHODS The review used the Joanna Briggs Institute process and tools. Studies reporting on subscription-based person-centered culture change models in health and aged care, published in peer-reviewed literature in English up to and including 2015 were identified and assessed. In all, 28 articles reporting on 33 studies were included in the review. RESULTS There was no single model for which a significant body of evidence was identified, and approaches to outcomes were fragmented. Research approaches varied. Rigor and reporting were of concern; however, strengths of the evidence base included generally adequate sample sizes and the use of multiple methods including large data sets and standardized scales. IMPLICATIONS Despite their structured approaches, research and evaluation for subscription-based models are limited, ad hoc, and fragmented. A more comprehensive program of research that is embedded in the implementation process is needed. Recommendations include use of longitudinal study designs, attention to implementation and contextual factors, and measurement of both process and outcomes across the full range of culture change domains.
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Affiliation(s)
- Andrea Petriwskyj
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
| | - Deborah Parker
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Christine Brown Wilson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Alexandra Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
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21
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Bowers B, Roberts T, Nolet K, Ryther B. Inside the Green House "Black Box": Opportunities for High-Quality Clinical Decision Making. Health Serv Res 2016; 51 Suppl 1:378-97. [PMID: 26708135 PMCID: PMC4939731 DOI: 10.1111/1475-6773.12427] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To develop a conceptual model that explained common and divergent care processes in Green House (GH) nursing homes with high and low hospital transfer rates. DATA SOURCES/SETTINGS Eighty-four face-to-face, semistructured interviews were conducted with direct care, professional, and administrative staff with knowledge of care processes in six GH organizations in six states. STUDY DESIGN/DATA COLLECTION The qualitative grounded theory method was used for data collection and analysis. Data were analyzed using open, axial, and selective coding. Data collection and analysis occurred iteratively. PRINCIPAL FINDINGS Elements of the GH model created significant opportunities to identify, communicate, and respond to early changes in resident condition. Staff in GH homes with lower hospital transfer rates employed care processes that maximized these opportunities. Staff in GH homes with higher transfer rates failed to maximize, or actively undermined, these opportunities. CONCLUSIONS Variations in how the GH model was implemented across GH homes suggest possible explanations for inconsistencies found in past research on the care outcomes, including hospital transfer rates, in culture change models. The findings further suggest that the details of culture change implementation are important considerations in model replication and policies that create incentives for care improvements.
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Affiliation(s)
- Barbara Bowers
- School of NursingUniversity of Wisconsin‐MadisonMadisonWI
| | - Tonya Roberts
- School of NursingUniversity of Wisconsin‐MadisonMadisonWI
| | - Kimberly Nolet
- School of NursingUniversity of Wisconsin‐MadisonMadisonWI
| | - Brenda Ryther
- Center for Health Systems Research and AnalysisUniversity of Wisconsin‐MadisonMadisonWI
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22
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Grabowski DC, Afendulis CC, Caudry DJ, O'Malley AJ, Kemper P. The Impact of Green House Adoption on Medicare Spending and Utilization. Health Serv Res 2016; 51 Suppl 1:433-53. [PMID: 26743665 DOI: 10.1111/1475-6773.12438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To evaluate the impact of the Green House (GH) model of nursing home care on Medicare acute hospital, other hospital, skilled nursing facility, and hospice spending and utilization. DATA SOURCES/STUDY SETTING Medicare claims and enrollment data from 2005 through 2010 merged with resident-level minimum data set (MDS) assessments. STUDY DESIGN Using a difference-in-differences framework, we compared Medicare Part A and hospice expenditures and utilization in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nonadopting nursing homes. We applied the same method for residents of GH homes and for residents of "legacy" homes, the original nursing homes that stay open alongside the GH home(s). PRINCIPAL FINDINGS The adoption of GH had no detectable impact on Medicare Part A (plus hospice) spending and utilization across all residents living in the nursing home. When we analyzed residents living in GH homes and legacy units separately, however, we found that the adoption of the GH model reduced overall annual Medicare Part A spending by $7,746 per resident, although this appeared to be partially offset by an increase in spending in legacy homes. CONCLUSIONS To the extent that the GH model reduces Medicare spending, adopting nursing homes do not receive any of the related Medicare savings under traditional payment mechanisms. New approaches that are currently being developed and piloted, which better align financial incentives for providers and payers, could incentivize greater adoption of the GH model.
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Affiliation(s)
- David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | | | - Daryl J Caudry
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - A James O'Malley
- Geisel School of Medicine, The Dartmouth Institute, Dartmouth College, Lebanon, NH
| | - Peter Kemper
- The Pennsylvania State University, University Park, PA
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Zimmerman S, Bowers BJ, Cohen LW, Grabowski DC, Horn SD, Kemper P. New Evidence on the Green House Model of Nursing Home Care: Synthesis of Findings and Implications for Policy, Practice, and Research. Health Serv Res 2015; 51 Suppl 1:475-96. [PMID: 26708381 DOI: 10.1111/1475-6773.12430] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To synthesize new findings from the THRIVE Research Collaborative (The Research Initiative Valuing Eldercare) related to the Green House (GH) model of nursing home care and broadly consider their implications. DATA SOURCES Interviews and observations conducted in GH and comparison homes, Minimum Data Set (MDS) assessments, Medicare data, and Online Survey, Certification and Reporting data. STUDY DESIGN Critical integration and interpretation of findings based on primary data collected 2011-2014 in 28 GH homes (from 16 organizations), and 15 comparison nursing home units (from 8 organizations); and secondary data derived from 2005 to 2010 for 72 GH homes (from 15 organizations) and 223 comparison homes. PRINCIPAL FINDINGS Implementation of the GH model is inconsistent, sometimes differing from design. Among residents of GH homes, adoption lowers hospital readmissions, three MDS measures of poor quality, and Part A/hospice Medicare expenditures. Some evidence suggests the model is associated with lower direct care staff turnover. CONCLUSIONS Recommendations relate to assessing fidelity, monitoring quality, capitalizing opportunities to improve care, incorporating evidence-based practices, including primary care providers, supporting high-performance workforce practices, aligning Medicare financial incentives, promoting equity, informing broad culture change, and conducting future research.
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Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Lauren W Cohen
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Susan D Horn
- Health System Innovation and Research Program, University of Utah School of Medicine, Salt Lake City, UT
| | - Peter Kemper
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA
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24
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Brown PB, Hudak SL, Horn SD, Cohen LW, Reed DA, Zimmerman S. Workforce Characteristics, Perceptions, Stress, and Satisfaction among Staff in Green House and Other Nursing Homes. Health Serv Res 2015; 51 Suppl 1:418-32. [PMID: 26708511 DOI: 10.1111/1475-6773.12431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare workforce characteristics and staff perceptions of safety, satisfaction, and stress between Green House (GH) and comparison nursing homes (CNHs). DATA SOURCES/STUDY SETTING Primary data on staff perceptions of safety, stress, and satisfaction from 13 GHs and 8 comparison NHs in 11 states; secondary data from human resources records on workforce characteristics, turnover, and staffing from 01/01/2011-06/30/2012. STUDY DESIGN Observational study. DATA COLLECTION METHODS Workforce data were from human resources offices; staff perceptions were from surveys. PRINCIPAL FINDINGS Few significant differences were found between GH and CNHs. Exceptions were GH direct caregivers were older, provided twice the normalized hours per week budgeted per resident than CNAs in CNHs or Legacy NHs, and trended toward lower turnover. CONCLUSIONS GH environment may promote staff longevity and does not negatively affect worker's stress, safety perceptions, or satisfaction. Larger studies are needed to confirm findings.
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Affiliation(s)
- Patrick B Brown
- International Severity Information Systems, Inc., Salt Lake City, UT
| | | | - Susan D Horn
- Department of Population Health Sciences, Health System Innovation and Research Program, University of Utah School of Medicine, Salt Lake City, UT
| | - Lauren W Cohen
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Allen Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
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25
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Bowers B, Nolet K, Jacobson N. Sustaining Culture Change: Experiences in the Green House Model. Health Serv Res 2015; 51 Suppl 1:398-417. [PMID: 26708269 DOI: 10.1111/1475-6773.12428] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe conditions that influence how Green House (GH) organizations are sustaining culture change principles and practices in a sample of GH skilled nursing homes. DATA SOURCES/STUDY SETTING Primary data were collected at 11 skilled nursing GH organizations from 2012 to 2014. These organizations have adopted the comprehensive and prescriptive GH model of culture change. STUDY DESIGN To develop an understanding of sustainability from the perspective of staff who are immersed in GH daily work, grounded theory qualitative methods were used. DATA COLLECTION METHODS Data were collected using semi-structured interviews with 166 staff and observation of house meetings and daily operations. Data were analyzed using grounded dimensional analysis. PRINCIPAL FINDINGS Organizations varied in their ability to sustain GH principles and practices. An organization's approach to problem solving was central to sustaining the model. Key conditions influenced reinforcement or erosion of GH principles and practices. CONCLUSIONS Reinforcing the GH model requires a highly skilled team of staff with the ability to frequently and collaboratively solve both mundane and complex problems in ways that are consistent with the GH model. This raises questions about the type of human resources practices and policy supports that could assist organizations in sustaining culture change.
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Affiliation(s)
- Barbara Bowers
- School of Nursing, University of Wisconsin-Madison, Madison, WI
| | - Kimberly Nolet
- School of Nursing, University of Wisconsin-Madison, Madison, WI
| | - Nora Jacobson
- School of Nursing, University of Wisconsin-Madison, Madison, WI
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26
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McGilton KS, Bowers BJ, Heath H, Shannon K, Dellefield ME, Prentice D, Siegel EO, Meyer J, Chu CH, Ploeg J, Boscart VM, Corazzini KN, Anderson RA, Mueller CA. Recommendations From the International Consortium on Professional Nursing Practice in Long-Term Care Homes. J Am Med Dir Assoc 2015; 17:99-103. [PMID: 26712302 DOI: 10.1016/j.jamda.2015.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
In response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regarding the current state of professional nursing practice in LTCHs. At its invitational, 2-day inaugural meeting, the Consortium brought together international nurse experts to explore the potential of registered nurses (RNs) who work as supervisors or charge nurses within the LTCHs and the value of their contribution in nursing homes, consider what RN competencies might be needed, discuss effective educational (curriculum and practice) experiences, health care policy, and human resources planning requirements, and to identify what sustainable nurse leadership strategies and models might enhance the effectiveness of RNs in improving resident, family, and staff outcomes. The Consortium made recommendations about the following priority issues for action: (1) define the competencies of RNs required to care for older adults in LTCHs; (2) create an LTCH environment in which the RN role is differentiated from other team members and RNs can practice to their full scope; and (3) prepare RN leaders to operate effectively in person-centered care LTCH environments. In addition to clear recommendations for practice, the Consortium identified several areas in which further research is needed. The Consortium advocated for a research agenda that emphasizes an international coordination of research efforts to explore similar issues, the pursuit of examining the impact of nursing and organizational models, and the showcasing of excellence in nursing practice in care homes, so that others might learn from what works. Several studies already under way are also described.
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Affiliation(s)
- Katherine S McGilton
- Toronto Rehabilitation Institute-UHN, Toronto, ON, Canada; Lawrence S. Bloomberg of Nursing, University of Toronto, Toronto, ON, Canada.
| | | | - Hazel Heath
- Division of Nursing, School of Health Sciences, City University London, London, England, UK
| | - Kay Shannon
- Auckland University of Technology, Auckland, New Zealand
| | | | - Dawn Prentice
- Department of Nursing, Brock University, St. Catharines, ON, Canada
| | - Elena O Siegel
- Betty Irene Moore School of Nursing at UC Davis, UC Davis Health System, Sacramento, CA
| | - Julienne Meyer
- Division of Nursing, School of Health Sciences, City University London, London, England, UK
| | - Charlene H Chu
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- School of Health and Life Sciences and Community Services, Conestoga College, Kitchener, ON, Canada
| | - Veronique M Boscart
- School of Health and Life Sciences and Community Services, Conestoga College, Kitchener, ON, Canada
| | - Kirsten N Corazzini
- School of Nursing, Duke University Centre for the Study of Aging and Human Development, Durham, NC
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Cohen LW, Zimmerman S, Reed D, Brown P, Bowers BJ, Nolet K, Hudak S, Horn S. The Green House Model of Nursing Home Care in Design and Implementation. Health Serv Res 2015; 51 Suppl 1:352-77. [PMID: 26601799 DOI: 10.1111/1475-6773.12418] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the Green House (GH) model of nursing home (NH) care, and examine how GH homes vary from the model, one another, and their founding (or legacy) NH. DATA SOURCES/STUDY SETTING Data include primary quantitative and qualitative data and secondary quantitative data, derived from 12 GH/legacy NH organizations February 2012-September 2014. STUDY DESIGN This mixed methods, cross-sectional study used structured interviews to obtain information about presence of, and variation in, GH-relevant structures and processes of care. Qualitative questions explored reasons for variation in model implementation. DATA COLLECTION/EXTRACTION METHODS Interview data were analyzed using related-sample tests, and qualitative data were iteratively analyzed using a directed content approach. PRINCIPAL FINDINGS GH homes showed substantial variation in practices to support resident choice and decision making; neither GH nor legacy homes provided complete choice, and all GH homes excluded residents from some key decisions. GH homes were most consistent with the model and one another in elements to create a real home, such as private rooms and baths and open kitchens, and in staff-related elements, such as self-managed work teams and consistent, universal workers. CONCLUSIONS Although variation in model implementation complicates evaluation, if expansion is to continue, it is essential to examine GH elements and their outcomes.
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Affiliation(s)
- Lauren W Cohen
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Kimberly Nolet
- School of Nursing, University of Wisconsin-Madison, Madison, WI
| | | | - Susan Horn
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
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28
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Yeatts DE, Shen Y, Yeatts PE, Solakoglu O, Seckin G. Shared Decision-Making in Nursing Homes. J Aging Health 2015; 28:621-43. [DOI: 10.1177/0898264315600689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The advantages of empowering direct care workers (DCWs) within nursing homes (NHs) are well documented. Our objective is to identify factors that create DCW empowerment as this has not received adequate attention. Method: The data come from a larger study focused on the empowerment of DCWs in NHs. A self-administered instrument was completed by 372 DCWs within 11 NHs in the north Texas region. Cluster analysis and ordinary least squares (OLS) regression were performed. Results: Feedback from nurse management to DCWs was positively associated with shared decision-making (SDM) and ranked highest followed by information exchange, trust in management, and wages linked to performance. Discussion: SDM may be enhanced where nurse management shares relevant information with the DCWs, listens to their ideas, provides explanations when DCW suggestions are not used, and does so in a supportive environment. Organizational characteristics of importance include linking wages to DCW performance and providing an accessible training program.
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Yoon JY, Brown RL, Bowers BJ, Sharkey SS, Horn SD. The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study. Int J Nurs Stud 2015; 53:238-47. [PMID: 26260709 DOI: 10.1016/j.ijnurstu.2015.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House nursing home model, has shown positive psychological outcomes. However, little is known about whether the Green House nursing home model has positive effects on physical function compared to traditional nursing homes. OBJECTIVES To examine the longitudinal effects of the Green House nursing home model by comparing change patterns of activities of daily living function over time between Green House home residents and traditional nursing home residents. DESIGN A retrospective longitudinal study. SETTINGS Four Green House organizations (nine Green House units and four traditional units). PARTICIPANTS A total of 242 residents (93 Green House residents and 149 traditional home residents) who had stayed in the nursing home at least 6 months from admission. METHODS The outcome was activities of daily living function, and the main independent variable was the facility type in which the resident stayed: a Green House or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses. RESULTS The mean activities of daily living function showed deterioration over time, and the rates of deterioration between Green House and traditional home residents were not different over time. Four different activities of daily living function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups. CONCLUSIONS Although Green House nursing homes are considered to represent an innovative model changing the nursing home environment into more person-centered, this study did not demonstrate significant differences in activities of daily living function changes for residents in the Green House nursing homes compared to traditional nursing homes. Given that the Green House model continues to evolve as it is being implemented and variations within and across Green House homes are identified, large-scale longitudinal studies are needed to provide further relevant information on the effects of the Green House model.
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Affiliation(s)
- Ju Young Yoon
- School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 3117, 701 Highland Avenue, Madison, WI 534792-2455, USA.
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 4187, 701 Highland Avenue, Madison, WI 534792-2455, USA.
| | - Barbara J Bowers
- School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 5113, 701 Highland Avenue, Madison, WI 534792-2455, USA.
| | - Siobhan S Sharkey
- Health Management Strategies, 9600 Escarpment Blvd, Suite 745-21, Austin, TX 78749, USA.
| | - Susan D Horn
- International Severity Information Systems/Institute for Clinical Outcomes Research, 699 East South Temple, Suite 300, Salt Lake City, UT 84102-1282, USA.
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Longitudinal psychological outcomes of the small-scale nursing home model: a latent growth curve zero-inflated Poisson model. Int Psychogeriatr 2015; 27:1009-16. [PMID: 25583275 PMCID: PMC4545602 DOI: 10.1017/s1041610214002865] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aims to examine the longitudinal effects of a small-scale nursing home model on the change rates of psychological outcomes by comparing green house (GH) and traditional nursing home residents. METHODS A total of 242 residents (93 GH and 149 traditional home residents) who resided at the home least 6 months from admission. Four minimum dataset assessments every six months from admission were included. The main psychological outcomes were depressive mood, and social engagement. The main independent variable was the facility type that the resident resided in: a GH or traditional unit. Age, gender, ADL function, and cognitive function at admission were controlled in the model. A zero-inflated Poisson (ZIP) growth curve model was utilized to compare change rates of two psychological outcomes between the two groups taking into account many zero counts of two outcome measures. RESULTS A rate of increase in depressive symptoms for GH home residents was higher than that of traditional home residents (β = 0.135, p-value = 0.025). GH home residents had a lower rate of increase of the probability of "not being socially engaged" over time compared to traditional home residents (β = -0.274, p-value = 0.010). CONCLUSION The GH nursing home model had a longitudinal effect on increasing the probability of residents' social engagement over time, but also increasing the recognition of depressive symptoms compared to traditional nursing homes.
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Bishop CE. High-performance workplace practices in nursing homes: an economic perspective. THE GERONTOLOGIST 2014; 54 Suppl 1:S46-52. [PMID: 24443605 DOI: 10.1093/geront/gnt163] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To develop implications for research, practice and policy, selected economics and human resources management research literature was reviewed to compare and contrast nursing home culture change work practices with high-performance human resource management systems in other industries. The organization of nursing home work under culture change has much in common with high-performance work systems, which are characterized by increased autonomy for front-line workers, self-managed teams, flattened supervisory hierarchy, and the aspiration that workers use specific knowledge gained on the job to enhance quality and customization. However, successful high-performance work systems also entail intensive recruitment, screening, and on-going training of workers, and compensation that supports selective hiring and worker commitment; these features are not usual in the nursing home sector. Thus despite many parallels with high-performance work systems, culture change work systems are missing essential elements: those that require higher compensation. If purchasers, including public payers, were willing to pay for customized, resident-centered care, productivity gains could be shared with workers, and the nursing home sector could move from a low-road to a high-road employment system.
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Affiliation(s)
- Christine E Bishop
- Address correspondence to Christine E. Bishop, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA 02254-9110. E-mail:
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