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Grabowski DC, Chen A, Saliba D. Paying for Nursing Home Quality: An Elusive But Important Goal. J Am Geriatr Soc 2023; 71:342-348. [PMID: 36795634 PMCID: PMC10030098 DOI: 10.1111/jgs.18260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/17/2023]
Affiliation(s)
- David C. Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda Chen
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Debra Saliba
- Borun Center for Gerontological Research, University of California Los Angeles, Los Angeles, California, USA
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- RAND Health, Santa Monica, California, USA
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2
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Inoue M, Li MH, Layman S, Tompkins CJ, Ihara ES. Characteristics of Nursing Facilities and Staff Willingness to Implement a Non-Pharmacological Intervention. Gerontol Geriatr Med 2022; 8:23337214221146410. [PMID: 36582661 PMCID: PMC9793045 DOI: 10.1177/23337214221146410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022] Open
Abstract
While non-pharmacological interventions could positively impact mood and behaviors of nursing-home residents who are living with dementia, some facilities are more willing to adopt such interventions than others. This study investigated the characteristics of Medicaid-funded nursing facilities that were associated with their willingness to implement a non-pharmacological intervention, personalized music. Using the publicly-available dataset (aka LTCfocus) from Brown University, this study examined characteristics of nursing homes in Virginia that have implemented or are in the process of implementing a personalized music intervention (n = 59) and that have decided not to implement it (n = 216). The findings indicate that nursing facilities with a higher proportion of long-term residents are more likely to implement the intervention. The findings can inform future research recruitment strategies. In addition, a greater understanding of the use of non-pharmacological interventions in relation to the characteristics of nursing facilities offers insight to policymakers and public health officials regarding resource allocations to facilities.
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Affiliation(s)
- Megumi Inoue
- George Mason University, Fairfax, VA,
USA,Megumi Inoue, Department of Social Work,
George Mason University, 4400 University Drive, MSN: 1F8, Fairfax, VA 22030,
USA.
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3
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Implementation of Goals of Care Communication Innovation Among Nursing Homes: A Multiple Case Study Design. J Am Med Dir Assoc 2021; 23:1215-1220. [PMID: 34454921 DOI: 10.1016/j.jamda.2021.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/03/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Nursing homes (NHs) provide care to residents with serious illness and related complex health care needs. As such, discussions about end-of-life care between NH staff and residents and families are necessary to ensure residents receive care consistent with their goals. Interventions such as video decision aids have been developed to promote discussions and improve advance care planning, but few studies have examined how NH characteristics may relate to the implementation of these interventions; such information might lead toward more use of successful interventions. The purpose of this study is to understand NH characteristics that are associated with the implementation of the Goals of Care (GOC) intervention, which combined a video decision aid with a structured discussion to guide decision-making in advanced dementia. DESIGN A multiple case study. SETTING AND PARTICIPANTS Staff surveys were conducted to examine factors related to implementation effectiveness in 11 NHs in North Carolina that participated in the GOC trial. METHODS Questions measured the dependent variable of implementation effectiveness: the consistency and quality of use of the GOC intervention. NH organizational characteristics were measured using publicly available data and an administrator survey. The analysis consisted of pattern matching logic. RESULTS High management support aligned with implementation effectiveness within NHs. In addition, the within case pattern analysis indicated additional characteristics related to implementation effectiveness. Facility size, Medicare beds, residents' racial composition, and star rating were related to implementation effectiveness across 6 of the 11 NHs. NH financial resources, such as size and number of Medicare beds, may be important factors for successful implementation. CONCLUSION AND IMPLICATIONS NHs seeking to implement advance care planning interventions should focus on within and across NH differences, such as adequate management and financial support prior to implementation to increase the likelihood of implementation effectiveness.
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Gray‐Miceli D, Rogowski J, de Cordova PB, Boltz M. A framework for delivering nursing care to older adults with COVID-19 in nursing homes. Public Health Nurs 2021; 38:610-626. [PMID: 33715193 PMCID: PMC8251143 DOI: 10.1111/phn.12885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
Public health emergencies threaten the lives of U.S. citizens, often in disproportionate ways. Hardest hit are vulnerable populations of older adults (OAs) residing in nursing homes (NHs), who comprised nearly 43% of all deaths from COVID-19 in NHs in 2020. New Jersey (NJ) ranks #2 nationally behind New York with the highest numbers of resident deaths; more than 50% of all COVID-19-related deaths in NJ have occurred in NHs. This public health emergency has prompted investigators to evaluate existing structural, resident, process of care, regulatory, and policy characteristics that have impacted the delivery of nursing care within NJ NHs. In this manuscript, we discuss data from NJ NHs during COVID-19, drawing from publicly available data, state reports, and the geriatric literature to offer recommendations. Based on evidence-based practices (EBPs), we present a series of recommendations to modify existing contextual factors in NHs to best prepare for the next health disaster.
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Affiliation(s)
- Deanna Gray‐Miceli
- Jefferson College of Nursing, Thomas Jefferson UniversityPhiladelphiaPAUSA
| | - Jeannette Rogowski
- Department of Health Policy and AdministrationThe Pennsylvania State UniversityUniversity ParkPAUSA
| | | | - Marie Boltz
- Penn State College of NursingUniversity ParkPAUSA
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Kaup ML, Poey JL, Corneilson L, Doll G. Environmental Attributes of Person-Centered Care. JOURNAL OF AGING AND ENVIRONMENT 2019. [DOI: 10.1080/02763893.2019.1627266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Migette L. Kaup
- College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Judith L. Poey
- College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Laci Corneilson
- College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Gayle Doll
- College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
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Berridge C, Halpern J, Levy K. Cameras on beds: The ethics of surveillance in nursing home rooms. AJOB Empir Bioeth 2019; 10:55-62. [PMID: 30794112 DOI: 10.1080/23294515.2019.1568320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Surveillance cameras are increasingly being deployed in nursing homes and assisted living facilities, with insufficient attention to what is ethically fraught about this way of assuaging concerns about abuse and other personnel challenges. With seven state laws now regulating camera monitoring and more on the way, it is urgent for us to consider the ethical implications of how we use technology to keep older adults safe. Drawing on findings from the first facility survey on this topic, we address three ethical issues: the risk that in-room cameras pose to residents' privacy and dignity, the risk of undermining care workers' sense of being fiduciaries for residents, and the probable extension of camera use by facilities to monitor staff and residents. We argue that with an aging population, intensifying strain on the care workforce, and ease of access to Web-connected cameras, this is a critical moment to address these ethical challenges.
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Affiliation(s)
- Clara Berridge
- a School of Social Work, University of Washington , Seattle , Washington , USA
| | - Jodi Halpern
- b School of Public Health, University of California, Berkeley , Berkeley , California , USA
| | - Karen Levy
- c Cornell University , Information Science , Ithaca , New York , USA
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Chisholm L, Zhang NJ, Hyer K, Pradhan R, Unruh L, Lin FC. Culture Change in Nursing Homes: What Is the Role of Nursing Home Resources? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018787043. [PMID: 30015532 PMCID: PMC6050816 DOI: 10.1177/0046958018787043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Quality of care has been a long-standing issue in US nursing homes. The culture
change movement attempts to transition nursing homes from health care
institutions to person-centered homes. While the adoption of culture change has
been spreading across nursing homes, barriers to adoption persist. Nursing homes
that disproportionately serve minority residents may have additional challenges
implementing culture change compared with other facilities due to limited
financial and staffing resources. The objective of this study was to examine how
nursing home characteristics are associated with culture change adoption in
Central Florida nursing homes. This cross-sectional study included 81 directors
of nursing (DONs) who completed the Artifacts of Culture Change survey. In
addition, nursing home organizational data were obtained from the Certification
and Survey Provider Enhanced Reports (CASPER). A logistic regression was
conducted to examine the relationship between high culture change adoption and
nursing home characteristics. The overall adoption of culture change scores in
Central Florida nursing homes was low. Nevertheless, there was variability
across nursing homes in the adoption of culture change. High culture change
adoption was associated with nursing homes having lower proportions of Medicaid
residents.
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Affiliation(s)
| | | | | | - Rohit Pradhan
- 4 University of Arkansas for Medical Sciences, Little Rock, USA
| | - Lynn Unruh
- 1 University of Central Florida, Orlando, USA
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Azios JH, Damico JS, Roussel N. Communicative Accessibility in Aphasia: An Investigation of the Interactional Context of Long-Term Care Facilities. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1474-1490. [PMID: 30208487 DOI: 10.1044/2018_ajslp-17-0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study was to examine the ability of persons with aphasia to access interaction and be included in social encounters in long-term care facilities (LTCFs). METHOD Four persons with aphasia were the focus of this investigation. A qualitative research approach using ethnographic methods was used to conduct participant observation, semistructured interviews, and artifact analysis. Expanded field notes from observations, transcribed interviews, and artifacts were then coded to identify patterns in the data. RESULTS The interactional context of LTCFs negatively influenced the ability of persons with aphasia to communicate with others and develop meaningful relationships. Three major themes emerged from the data detailing the contextual elements leading to communication accessibility and inclusion: (a) lack of support, (b) social hierarchy, and (c) focus on performance. CONCLUSIONS Findings highlighted several barriers in LTCFs that worked to discourage persons with aphasia from living social and expressive lives. Specific obstacles included a misunderstanding of aphasia and its influence on communicative exchanges and performance-oriented environment that overlooked psychosocial needs. Speech-language pathologists have an important role for advocacy in LTCFs. Clinical implications for assessment and treatment in institutions are discussed.
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Affiliation(s)
- Jamie H Azios
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
| | - Jack S Damico
- Department of Communicative Disorders, University of Louisiana at Lafayette
| | - Nancye Roussel
- Department of Communicative Disorders, University of Louisiana at Lafayette
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Yuan Y, Louis C, Cabral H, Schneider JC, Ryan CM, Kazis LE. Socioeconomic and Geographic Disparities in Accessing Nursing Homes With High Star Ratings. J Am Med Dir Assoc 2018; 19:852-859.e2. [DOI: 10.1016/j.jamda.2018.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/26/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
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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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Kolanowski A, Van Haitsma K, Penrod J, Hill N, Yevchak A. "Wish we would have known that!" Communication Breakdown Impedes Person-Centered Care. THE GERONTOLOGIST 2016; 55 Suppl 1:S50-60. [PMID: 26055781 DOI: 10.1093/geront/gnv014] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To understand how nursing home staff obtain information needed for implementing person-centered care (PCC) to residents with dementia who exhibit behavioral and psychological symptoms of dementia (BPSD), and how they communicate this information to other staff. Barriers to PCC and information exchange were also explored. DESIGN AND METHODS Participants were 59 staff from two nursing homes. Focus group methodology captured discussions in eight 1-hr sessions. Sessions were audiotaped and transcribed. Data were analyzed using qualitative content analysis to provide a comprehensive summary of real world context of implementing PCC. RESULTS To deliver PCC staff identified a need for access to psychosocial/medical history of the resident and knowledge of strategies families used for managing BPSD in the past. However, resident information is not routinely shared with all staff and written documentation systems for communicating resident-specific information do not support the time-pressured work pattern of certified nursing assistants (CNAs). Word-of-mouth was considered more reliable and expedient than educational sessions. CNAs described themselves as visual learners who prefer educational programs addressing individual resident emergent behaviors and programs that are scheduled at dedicated times. IMPLICATIONS To improve PCC the flow of information exchange requires: inclusion of all staff, particularly CNAs; systems of communication that consider the time and resource constraints of nursing homes; development of educational programs for BPSD that are responsive to staff learning styles; administrative investment in nursing leadership to effect these changes; and reimbursement approaches to encourage culture change investments.
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Affiliation(s)
- Ann Kolanowski
- Elouise Ross Eberly Professor, College of Nursing, Penn State, University Park, Pennsylvania.
| | | | - Janice Penrod
- College of Nursing, Penn State, University Park, Pennsylvania
| | - Nikki Hill
- Clare M. Fagin Fellow, College of Nursing, Penn State, University Park, Pennsylvania
| | - Andrea Yevchak
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
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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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Tyler DA, Shield RR, Miller SC. Diffusion of palliative care in nursing homes: lessons from the culture change movement. J Pain Symptom Manage 2015; 49:846-52. [PMID: 25499827 PMCID: PMC4441856 DOI: 10.1016/j.jpainsymman.2014.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/16/2014] [Accepted: 10/24/2014] [Indexed: 11/28/2022]
Abstract
CONTEXT Studies have found that nursing homes (NHs) that rely heavily on Medicaid funding are less likely to implement innovative approaches to care, such as palliative care (PC) or resident-centered approaches commonly referred to as "culture change" (CC). However, a nationally representative survey we previously conducted found that some high Medicaid facilities have implemented these innovative approaches. OBJECTIVES The purpose of this study was to identify the factors that enable some high Medicaid NHs to implement innovative approaches to care. METHODS We conducted telephone interviews with 16 NH administrators in four categories of facilities: 1) low PC and low CC, 2) low PC and high CC, 3) high PC and low CC, and 4) high PC and high CC. Interviews explored strategies used to overcome barriers to implementation and the resources needed for implementation. RESULTS We had expected to find differences between low and high NHs but instead found differences in NHs' experiences with CC and PC. Since the time of our national survey in 2009-2010, most previously low CC NHs had implemented at least some CC practices; however, we did not find similar changes around PC. Administrators reported numerous ways in which they had received information and assistance from outside entities for implementing CC. This was not the case for PC where administrators reported relying exclusively and heavily on hospices for both their residents' PC needs and information related to PC. CONCLUSION PC advocates could learn much from the CC model in which advocates have used multipronged efforts to institute reform.
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Affiliation(s)
- Denise A Tyler
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA; Health Services Research Program, Providence Veterans Administration Medical Center, Providence, Rhode Island, USA.
| | - Renée R Shield
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan C Miller
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
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Shield RR, Tyler D, Lepore M, Looze J, Miller SC. "Would You Do That in Your Home?" Making Nursing Homes Home-like in Culture Change Implementation. ACTA ACUST UNITED AC 2014; 28:383-398. [PMID: 28344379 PMCID: PMC5363857 DOI: 10.1080/02763893.2014.930369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Qualitative interviews with nursing home administrators reveal innovative and cost-conscious ways to physically modify facilities that help institute culture change practices. Telephone interviews were conducted following a national survey of nursing home nursing directors and administrators. In this cross-sectional snapshot of administrator experiences, motivations for making facilities more home-like and less institutional and creative responses to challenges are described. State and corporate support and regulator encouragement are noted that help their reform efforts. Administrators note that small steps to create a more home-like environment can result in a positive impact that minimizes disruption to existing care processes. They describe how they respond to challenges, such as the physical plant and high costs, and note how comparative shopping, cost-conscious physical improvements, and continuous involvement of staff and residents contribute to successful efforts. Their examples illustrate novel ways to humanize long-term care facilities that other nursing homes can emulate.
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Affiliation(s)
| | | | - Michael Lepore
- RTI International, Washington, DC, USA, and Brown University, Providence, Rhode Island, USA
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Simmons SF, Rahman AN. Next Steps for Achieving Person-Centered Care in Nursing Homes. J Am Med Dir Assoc 2014; 15:615-9. [DOI: 10.1016/j.jamda.2014.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
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Abstract
Close to two-thirds of all US nursing home residents have some type of cognitive impairment such as Alzheimer's disease, and the quality of care and quality of life of these people has long been called into question. In this overview we first clarify the ongoing importance of nursing home care for people with Alzheimer's, even as policy makers "rebalance" long-term supports and services with home and community-based programs. We next identify the components of optimal care for people with Alzheimer's in nursing homes, and we highlight care innovations already in use. Finally, we summarize policy-relevant challenges to implementing best practices and innovations and explore potential policy solutions. Federal and state policy makers have a critical role to play in ensuring that nursing home residents with Alzheimer's disease have access to the appropriate, high-quality care that they and their families expect.
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