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Young Y, Liu Y, Shayya A, Chiu WY, Hsu W, O'Grady T. Assessing the influence of nursing home size and care models on COVID-19 case and mortality rates. Geriatr Nurs 2024; 60:21-27. [PMID: 39216213 DOI: 10.1016/j.gerinurse.2024.07.039] [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: 03/20/2024] [Revised: 07/08/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION This study examines the impact of COVID-19 on older adults in traditional nursing homes, Green Houses (GHs), and Continuing Care Retirement Communities-Nursing Homes (CCRCNHs). METHODS COVID-19 cases and deaths from CMS and LTCFocus data across 11 states from 6/2020 to 9/2022 were used, and Poisson regressions to compare care settings while adjusting for covariates. RESULTS CCRCNH and GH residents were older (84.4 and 83.1 years) than those in traditional NHs (77.5 and 77.6 years, p < 0.0001), with more female and White individuals. COVID-19 risk was higher in CCRCNHs (RR 1.51, 95 % CI 1.10-2.07), large NHs (RR 1.57, 95 % CI 1.14-2.15), and highest in small NHs (RR 1.80, 95 % CI 1.32-2.47). Mortality rates across NH types showed no significant difference. CONCLUSION The study shows that smaller, person-centered GHs are more effective in controlling COVID-19 infection, suggesting a need to rethink care models to incorporating GH features for better outcomes. GEORGE2 07-AUG-2024 11:31.
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Affiliation(s)
- Yuchi Young
- Associate Professor, Dept. of Health Policy, Management & Behavior, School of Public Health, New York State University at Albany, USA.
| | - Yichun Liu
- Bureau of Environmental and Occupational Epidemiology, Department of Health, NY, USA
| | - Ashley Shayya
- Dept. of Health Policy, Management & Behavior, School of Public Health, New York State University at Albany, USA
| | - Wan-Yu Chiu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan
| | - Wanhsiang Hsu
- Research Assistant Professor, Department of Health Policy, Management & Behavior, School of Public Health, New York State University at Albany, USA
| | - Thomas O'Grady
- Research Assistant Professor, Department of Epidemiology and Biostatistics, School of Public Health, New York State University at Albany, USA
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Williams C, Joshi A. The Greenhouse Model of Nursing Home Care: A Scoping Review. J Appl Gerontol 2024; 43:803-813. [PMID: 38029726 DOI: 10.1177/07334648231216005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
The study aimed to comprehensively review and assess evidence-based outcomes of the Greenhouse model. We systematically reviewed, assessed, and reported on relevant literature using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines for the scoping review. We identified qualitative or quantitative studies that met our inclusion criteria from PubMed, Medline, CINAHL, and EBSCOhost. The review yielded 41,515 articles published between January 2015 and December 2022; eleven articles met the inclusion criteria and were included in the analysis. The emerging themes were organizational culture, clinical outcomes, and business effects. The Greenhouse model offers a favorable organizational culture with opportunities to enhance clinical and business outcomes. The scoping review was registered in Prospero: CRD42023389048.
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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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Verderber S, Koyabashi U, Cruz CD, Sadat A, Anderson DC. Residential Environments for Older Persons: A Comprehensive Literature Review (2005-2022). HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:291-337. [PMID: 37078127 PMCID: PMC10328148 DOI: 10.1177/19375867231152611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Independent noninstitutional and institutional residential long-term care environments for older persons have been the subject of significant empirical and qualitative research in the 2005-2022 period. A comprehensive review of this literature is reported, summarizing recent advancements in this rapidly expanding body of knowledge. PURPOSE AND AIM This comprehensive review conceptually structures the recent literature on environment and aging to provide conceptual clarity and identify current and future trends. METHOD AND RESULT Each source reviewed was classified as one of the five types-opinion piece/essay, cross-sectional empirical investigation, nonrandomized comparative investigation, randomized study, and policy review essay-within eight content categories: community-based aging in place; residentialism; nature, landscape, and biophilia; dementia special care units; voluntary/involuntary relocation; infection control/COVID-19, safety/environmental stress; ecological and cost-effective best practices; and recent design trends and prognostications. CONCLUSIONS Among the findings embodied in the 204 literature sources reviewed, all-private room long-term care residential units are generally safer and provide greater privacy and personal autonomy to residents, the deleterious impacts of involuntary relocation continue, family engagement in policy making and daily routines has increased, multigenerational independent living alternatives are increasing, the therapeutic role of nature and landscape is increasingly well-documented, ecological sustainability has increased in priority, and infection control measures are of high priority in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review sets the stage for further research and design advancements on this subject in light of the rapid aging of societies around the globe.
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Affiliation(s)
- Stephen Verderber
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Umi Koyabashi
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Catherine Dela Cruz
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Aseel Sadat
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Diana C. Anderson
- Boston University School of Medicine, MA, USA
- Jacobs, Dallas, TX, USA
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COVID-19 case and mortality rates lower in green houses compared to traditional nursing homes in New York state. Geriatr Nurs 2023; 50:132-137. [PMID: 36780710 PMCID: PMC9852308 DOI: 10.1016/j.gerinurse.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
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D'Cunha NM, Holloway H, Gibson D, Thompson J, Bail K, Kurrle S, Day S, Olson J, Smith N, Clarke H, Buckley C, Isbel S. Designing an Alternative, Community Integrated Model of Residential Aged Care for People Living with Dementia: Nominal Group Technique and Thematic Analysis. J Alzheimers Dis 2023; 94:1247-1263. [PMID: 37393506 PMCID: PMC10473074 DOI: 10.3233/jad-230368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Small-scale models of dementia care are a potential solution to deinstitutionalize residential aged care and have been associated with improved resident outcomes, including quality of life and reduced hospitalizations for people living with dementia. OBJECTIVE This study aimed to generate strategies and ideas on how homes for people living with dementia in a village setting within a suburban community, could be designed and function without external boundaries. In particular, how could residents of the village and members of the surrounding community access and engage safely and equitably so that interpersonal connections might be fostered? METHODS Twenty-one participants provided an idea for discussion at three Nominal Group Technique workshops, including people living with dementia, carers or former carers, academics, researchers, and clinicians. Discussion and ranking of ideas were facilitated in each workshop, and qualitative data were analyzed thematically. RESULTS All three workshops highlighted the importance of a surrounding community invested in the village; education and dementia awareness training for staff, families, services, and the community; and the necessity for adequately and appropriately trained staff. An appropriate mission, vision, and values of the organization providing care were deemed essential to facilitate an inclusive culture that promotes dignity of risk and meaningful activities. CONCLUSION These principles can be used to develop an improved model of residential aged care for people living with dementia. In particular, inclusivity, enablement, and dignity of risk are essential principles for residents to live meaningful lives free from stigma in a village without external boundaries.
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Affiliation(s)
- Nathan M D'Cunha
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- The Neighbourhood Canberra, Campbell, ACT, Australia
| | - Helen Holloway
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Diane Gibson
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Jane Thompson
- The Neighbourhood Canberra, Campbell, ACT, Australia
| | - Kasia Bail
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Susan Kurrle
- The Neighbourhood Canberra, Campbell, ACT, Australia
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sally Day
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James Olson
- Community Home Australia, Gordon, ACT, Australia
| | - Nicole Smith
- The Neighbourhood Canberra, Campbell, ACT, Australia
- Community Home Australia, Gordon, ACT, Australia
| | | | | | - Stephen Isbel
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Abstract
As the late Robert Kane observed, the term nursing home is often a misnomer. Most U.S. nursing homes lack adequate nursing staff, and they are typically not very homelike in either their physical structure or culture. These problems were magnified during the pandemic. The underlying reasons for these longstanding issues are that most state Medicaid payment systems reimburse nursing homes at a relatively low level and the government does not hold nursing homes accountable for spending dollars on direct resident care. To encourage increased staffing and more homelike models of care, policymakers need to reform how nursing homes are paid and hold facilities accountable for how they spend government dollars. With these reforms, the term nursing home will become more appropriate in the United States.
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Affiliation(s)
- David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Harrison SL, Dyer SM, Laver KE, Milte RK, Fleming R, Crotty M. Physical environmental designs in residential care to improve quality of life of older people. Cochrane Database Syst Rev 2022; 3:CD012892. [PMID: 35253911 PMCID: PMC8900466 DOI: 10.1002/14651858.cd012892.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The demand for residential aged care is increasing due to the ageing population. Optimising the design or adapting the physical environment of residential aged care facilities has the potential to influence quality of life, mood and function. OBJECTIVES To assess the effects of changes to the physical environment, which include alternative models of residential aged care such as a 'home-like' model of care (where residents live in small living units) on quality of life, behaviour, mood and depression and function in older people living in residential aged care. SEARCH METHODS CENTRAL, MEDLINE, Embase, six other databases and two trial registries were searched on 11 February 2021. Reference lists and grey literature sources were also searched. SELECTION CRITERIA Non-randomised trials, repeated measures or interrupted time series studies and controlled before-after studies with a comparison group were included. Interventions which had modified the physical design of a care home or built a care home with an alternative model of residential aged care (including design alterations) in order to enhance the environment to promote independence and well-being were included. Studies which examined quality of life or outcomes related to quality of life were included. Two reviewers independently assessed the abstracts identified in the search and the full texts of all retrieved studies. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data, assessed the risk of bias in each included study and evaluated the certainty of evidence according to GRADE criteria. Where possible, data were represented in forest plots and pooled. MAIN RESULTS Twenty studies were included with 77,265 participants, although one large study included the majority of participants (n = 74,449). The main comparison was home-like models of care incorporating changes to the scale of the building which limit the capacity of the living units to smaller numbers of residents and encourage the participation of residents with domestic activities and a person-centred care approach, compared to traditional designs which may include larger-scale buildings with a larger number of residents, hospital-like features such as nurses' stations, traditional hierarchical organisational structures and design which prioritises safety. Six controlled before-after studies compared the home-like model and the traditional environment (75,074 participants), but one controlled before-after study included 74,449 of the participants (estimated on weighting). It is uncertain whether home-like models improve health-related quality of life, behaviour, mood and depression, function or serious adverse effects compared to traditional designs because the certainty of the evidence is very low. The certainty of the evidence was downgraded from low-certainty to very low-certainty for all outcomes due to very serious concerns due to risk of bias, and also serious concerns due to imprecision for outcomes with more than 400 participants. One controlled before-after study examined the effect of home-like models on quality of life. The author stated "No statistically significant differences were observed between the intervention and control groups." Three studies reported on global behaviour (N = 257). One study found little or no difference in global behaviour change at six months using the Neuropsychiatric Inventory where lower scores indicate fewer behavioural symptoms (mean difference (MD) -0.04 (95% confidence interval (CI) -0.13 to 0.04, n = 164)), and two additional studies (N = 93) examined global behaviour, but these were unsuitable for determining a summary effect estimate. Two controlled before-after studies examined the effect of home-like models of care compared to traditional design on depression. After 18 months, one study (n = 242) reported an increase in the rate of depressive symptoms (rate ratio 1.15 (95% CI 1.02 to 1.29)), but the effect of home-like models of care on the probability of no depressive symptoms was uncertain (odds ratio 0.36 (95% CI 0.12 to 1.07)). One study (n = 164) reported little or no difference in depressive symptoms at six months using the Revised Memory and Behaviour Problems Checklist where lower scores indicate fewer depressive symptoms (MD 0.01 (95% CI -0.12 to 0.14)). Four controlled before-after studies examined function. One study (n = 242) reported little or no difference in function over 18 months using the Activities of Daily Living long-form scale where lower scores indicate better function (MD -0.09 (95% CI -0.46 to 0.28)), and one study (n = 164) reported better function scores at six months using the Interview for the Deterioration of Daily Living activities in Dementia where lower scores indicate better function (MD -4.37 (95% CI -7.06 to -1.69)). Two additional studies measured function but could not be included in the quantitative analysis. One study examined serious adverse effects (physical restraints), and reported a slight reduction in the important outcome of physical restraint use in a home-like model of care compared to a traditional design (MD between the home-like model of care and traditional design -0.3% (95% CI -0.5% to -0.1%), estimate weighted n = 74,449 participants at enrolment). The remaining studies examined smaller design interventions including refurbishment without changes to the scale of the building, special care units for people with dementia, group living corridors compared to a non-corridor design, lighting interventions, dining area redesign and a garden vignette. AUTHORS' CONCLUSIONS There is currently insufficient evidence on which to draw conclusions about the impact of physical environment design changes for older people living in residential aged care. Outcomes directly associated with the design of the built environment in a supported setting are difficult to isolate from other influences such as health changes of the residents, changes to care practices over time or different staff providing care across shifts. Cluster-randomised trials may be feasible for studies of refurbishment or specific design components within residential aged care. Studies which use a non-randomised design or cluster-randomised trials should consider approaches to reduce risk of bias to improve the certainty of evidence.
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Affiliation(s)
- Stephanie L Harrison
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate E Laver
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rachel K Milte
- Caring futures institute, Flinders University, Adelaide, Australia
| | - Richard Fleming
- School of Science Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Lima JC, Gozalo P, Clark MA, Schwartz ML, Miller SC. The Benefits of Culture Change in Nursing Homes-Obtaining Nationally Representative Evidence. J Am Med Dir Assoc 2022; 23:156-160.e9. [PMID: 34425098 PMCID: PMC9271781 DOI: 10.1016/j.jamda.2021.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/11/2021] [Accepted: 07/18/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Despite face validity and regulatory support, empirical evidence of the benefit of culture change practices in nursing homes (NHs) has been inconclusive. We used rigorous methods and large resident-level cohorts to determine whether NH increases in culture change practice adoption in the domains of environment, staff empowerment, and resident-centered care are associated with improved resident-level quality outcomes. DESIGN We linked national panel 2009-2011 and 2016-2017 survey data to Minimum Data Set assessment data to test the impact of increases in each of the culture change domains on resident quality outcomes. SETTING AND PARTICIPANTS The sample included 1584 nationally representative US NHs that responded to both surveys, and more than 188,000 long-stay residents cared for in the pre- and/or postsurvey periods. METHODS We used multivariable logistic regression with robust standard errors and a difference-in-differences methodology. Controlling for the endogeneity between increases in culture change adoption and NH characteristics that are also related to quality outcomes, we tested whether pre-post quality outcome differences (ie, improvements in outcomes) were greater for residents in NHs with culture change increases vs in those without such increases. RESULTS NH performance on most quality indicators improved, but improvement was not significantly different by whether NHs increased or did not increase their culture change domain practices. CONCLUSIONS AND IMPLICATIONS This study found that increases in an NH's culture change domain practices were not significantly associated with improved resident-level quality. It describes a number of potential limitations that may have contributed to the null findings.
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Affiliation(s)
- Julie C Lima
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA.
| | - Pedro Gozalo
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA
| | - Melissa A Clark
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA
| | - Margot L Schwartz
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA; Division of Health and Environment, Abt Associates, Cambridge, MA, USA
| | - Susan C Miller
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA
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McGarry BE, Gandhi AD, Grabowski DC, Barnett ML. Larger Nursing Home Staff Size Linked To Higher Number Of COVID-19 Cases In 2020. Health Aff (Millwood) 2021; 40:1261-1269. [PMID: 34260313 PMCID: PMC8616631 DOI: 10.1377/hlthaff.2021.00323] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Staff in skilled nursing facilities (SNFs) are essential health care workers, yet they can also be a source of COVID-19 transmission. We used detailed staffing data to examine the relationship between a novel measure of staff size (that is, the number of unique employees working daily), conventional measures of staffing quality, and COVID-19 outcomes among SNFs in the United States without confirmed COVID-19 cases by June 2020. By the end of September 2020, sample SNFs in the lowest quartile of staff size had 6.2 resident cases and 0.9 deaths per 100 beds, compared with 11.9 resident cases and 2.1 deaths per 100 beds among facilities in the highest quartile. Staff size, including staff members not involved in resident care, was strongly associated with SNFs' COVID-19 outcomes, even after facility size was accounted for. Conventional staffing quality measures, including direct care staff-to-resident ratios and skill mix, were not significant predictors of COVID-19 cases or deaths. Reducing the number of unique staff members without decreasing direct care hours, such as by relying on full-time rather than part-time staff, could help prevent outbreaks.
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Affiliation(s)
- Brian E McGarry
- Brian E. McGarry is an assistant professor in the Department of Medicine, University of Rochester, in Rochester, New York
| | - Ashvin D Gandhi
- Ashvin D. Gandhi is an assistant professor at the University of California Los Angeles Anderson School of Management, in Los Angeles, California
| | - David C Grabowski
- David C. Grabowski is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts
| | - Michael Lawrence Barnett
- Michael Lawrence Barnett is an assistant professor of health policy and management, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, and an assistant professor of medicine at Harvard Medical School
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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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Proceedings from an International Virtual Townhall: Reflecting on the COVID-19 Pandemic: Themes from Long-Term Care. J Am Med Dir Assoc 2021; 22:1128-1132. [PMID: 33932351 PMCID: PMC8030741 DOI: 10.1016/j.jamda.2021.03.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
Residents of long-term care (LTC) homes have suffered disproportionately during the COVID-19 pandemic, from the virus itself and often from the imposition of lockdown measures. Provincial Geriatrics Leadership Ontario, in collaboration with interRAI and the International Federation on Aging, hosted a virtual Town Hall on September 25, 2020. The purpose of this event was to bring together international perspectives from researchers, clinicians, and policy experts to address important themes potentially amenable to timely policy interventions. This article summarizes these themes and the ensuing discussions among 130 attendees from 5 continents. The disproportionate impact of the COVID-19 pandemic on frail residents of LTC homes reflects a systematic lack of equitable prioritization by health system decision makers around the world. The primary risk factors for an outbreak in an LTC home were outbreaks in the surrounding community, high staff and visitor traffic in large facilities, and crowding of residents in ageing buildings. Infection control measures must be prioritized in LTC homes, though care must be taken to protect frail and vulnerable residents from their overly blunt application that deprives residents from appropriate physical and psychosocial support. Staffing, in terms of overall numbers, training, and leadership skills, was inadequate. The built environment of LTC homes can be configured for both optimal resident well-being and infection control. Infection control and resident wellness need not be mutually exclusive. Improving outcomes for LTC residents requires more staffing with proper training and interprofessional leadership. All these initiatives must be underpinned by an effective quality assurance system based on standardized, comprehensive, accessible, and clinically relevant data, and which can support broad communities of practice capable of effecting real and meaningful change for frail older persons, wherever they chose to reside.
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Zimmerman S, Dumond-Stryker C, Tandan M, Preisser JS, Wretman CJ, Howell A, Ryan S. Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths. J Am Med Dir Assoc 2021; 22:489-493. [PMID: 33516670 PMCID: PMC7835101 DOI: 10.1016/j.jamda.2021.01.069] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Green House and other small nursing home (NH) models are considered "nontraditional" due to their size (10-12 beds), universal caregivers, and other home-like features. They have garnered great interest regarding their potential benefit to limit Coronavirus Disease 2019 (COVID-19) infections due to fewer people living, working, visiting, and being admitted to Green House/small NHs, and private rooms and bathrooms, but this assumption has not been tested. If they prove advantageous compared with other NHs, they may constitute an especially promising model as policy makers and providers reinvent NHs post-COVID. DESIGN This cohort study compared rates of COVID-19 infections, COVID-19 admissions/readmissions, and COVID-19 mortality, among Green House/small NHs with rates in other NHs between January 20, 2020 and July 31, 2020. SETTING AND PARTICIPANTS All Green House homes that held a skilled nursing license and received Medicaid or Medicare payment were invited to participate; other small NHs that replicate Green House physical design and operational practices were eligible if they had the same licensure and payer sources. Of 57 organizations, 43 (75%) provided complete data, which included 219 NHs. Comparison NHs (referred to as "traditional NHs") were up to 5 most geographically proximate NHs within 100 miles that had <50 beds and ≥50 beds for which data were available from the Centers for Medicare and Medicaid Services (CMS). Because Department of Veterans Affairs organizations are not required to report to CMS, they were not included. METHODS Rates per 1000 resident days were derived for COVID-19 cases and admissions, and per 100 COVID-19 positive cases for mortality. A log-rank test compared rates between Green House/small NHs and traditional NHs with <50 beds and ≥50 beds. RESULTS Rates of all outcomes were significantly lower in Green House/small NHs than in traditional NHs that had <50 beds and ≥50 beds (log-rank test P < .025 for all comparisons). The median (middle value) rates of COVID-19 cases per 1000 resident days were 0 in both Green House/small NHs and NHs <50 beds, while they were 0.06 in NHs ≥50 beds; in terms of COVID-19 mortality, the median rates per 100 positive residents were 0 (Green House/small NHs), 10 (<50 beds), and 12.5 (≥50 beds). Differences were most marked in the highest quartile: 25% of Green House/small NHs had COVID-19 case rates per 1000 resident days higher than 0.08, with the corresponding figures for other NHs being 0.15 (<50 beds) and 0.74 (≥50 beds). CONCLUSIONS AND IMPLICATIONS COVID-19 incidence and mortality rates are less in Green House/small NHs than rates in traditional NHs with <50 and ≥50 beds, especially among the higher and extreme values. Green House/small NHs are a promising model of care as NHs are reinvented post-COVID.
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Affiliation(s)
- Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Meera Tandan
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher J Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Susan Ryan
- The Green House Project, Linthicum, MD, USA
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Grabowski DC. The future of long-term care requires investment in both facility- and home-based services. ACTA ACUST UNITED AC 2021; 1:10-11. [PMID: 37117999 DOI: 10.1038/s43587-020-00018-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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Dyer SM, Tilden D, Valeri M, Judd S, Crotty M. Is a pandemic another reason the additional capital cost of home-like clustered domestic residential aged care homes is justified? Age Ageing 2020; 49:928-929. [PMID: 32866222 DOI: 10.1093/ageing/afaa190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Suzanne M Dyer
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park 5042, Australia
| | | | | | | | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park 5042, Australia
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16
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Ouslander JG, Grabowski DC. COVID-19 in Nursing Homes: Calming the Perfect Storm. J Am Geriatr Soc 2020; 68:2153-2162. [PMID: 32735036 DOI: 10.1111/jgs.16784] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 01/31/2023]
Abstract
The pandemic of viral infection with the severe acute respiratory syndrome coronavirus-2 that causes COVID-19 disease has put the nursing home industry in crisis. The combination of a vulnerable population that manifests nonspecific and atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID-19 among nursing home residents have created a "perfect storm" in our country's nursing homes. This perfect storm will continue as society begins to reopen, resulting in more infections among nursing home staff and clinicians who acquire the virus outside of work, remain asymptomatic, and unknowingly perpetuate the spread of the virus in their workplaces. Because of the elements of the perfect storm, nursing homes are like a tinderbox, and it only takes one person to start a fire that could cause many deaths in a single facility. Several public health interventions and health policy strategies, adequate resources, and focused clinical quality improvement initiatives can help calm the storm. The saddest part of this perfect storm is that many years of inaction on the part of policy makers contributed to its impact. We now have an opportunity to improve nursing homes to protect residents and their caregivers ahead of the next storm. It is time to reimagine how we pay for and regulate nursing home care to achieve this goal. J Am Geriatr Soc 68:2153-2162, 2020.
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Affiliation(s)
- Joseph G Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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17
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Reinhardt JP, Burack OR, Cimarolli VR, Weiner AS. Dementia-Focused Person-Directed Care Training With Direct Care Workers in Nursing Homes: Effect on Symptom Reduction. J Gerontol Nurs 2020; 46:7-11. [PMID: 32936924 DOI: 10.3928/00989134-20200707-01] [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
The majority of older adult nursing home residents have dementia and are at risk of not having their care needs met, largely due to communication deficits. Promoting comfort and minimizing distress for these residents is important. Direct care workers (DCW) and clinical staff completed a 6-day training on a person-directed care (PDC) model-a model guided by the needs of the individual that focuses on empowering DCW to understand and support resident preferences and remaining abilities supported by relationship development and consistent staffing. A retrospective comparison was conducted of residents in two PDC communities with matched residents (n = 72) and three traditional communities (n = 72) on functional and clinical outcomes over a 6-month period. A two-way analysis of variance showed a significant interaction between group and time, where only those in the PDC group had a decreased number of clinical symptoms (e.g., pain, depression, agitation) over time. This study found support for the benefit of PDC on clinical outcomes of interest over time. PDC training for DCW and clinical staff promotes quality care and the reduction of clinical symptoms, leading to improved quality of life. [Journal of Gerontological Nursing, 46(8), 7-11.].
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18
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[Health-related outcomes in shared-housing arrangements-results of a rapid review]. Z Gerontol Geriatr 2020; 53:513-521. [PMID: 32052187 DOI: 10.1007/s00391-020-01705-6] [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: 10/10/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shared-housing arrangements are relevant as a possible living arrangement alternative to living in a nursing home or residing in their own home for people in need of care. The aim was to record demonstrable differences in health-related outcomes between residents of shared-housing arrangements and residents of nursing homes. MATERIALS AND METHODS A rapid review was conducted to identify health-related outcomes in shared-housing arrangements. The literature search was carried out in September 2017 in the databases PubMed, CINAHL, Gerolit and LIVIVO. Comparative studies of German or English language were included when the nursing home was examined as a control group. RESULTS The majority of the 21 studies included describes a favorable contribution of shared-housing arrangements compared to nursing homes. Quality of life is a frequently examined outcome that provides evidence of an advantage of shared-housing arrangements, especially for persons with dementia. CONCLUSION A variety of health-related outcomes were examined. The results provide indications of favorable contributions of shared-housing arrangements. For the most part, there is still no conclusive evidence for outcomes based on studies of higher levels of evidence.
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19
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Sloane PD, Zimmerman S, Nace DA. Progress and Challenges in the Management of Nursing Home Infections. J Am Med Dir Assoc 2020; 21:1-4. [DOI: 10.1016/j.jamda.2019.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 01/08/2023]
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20
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S Gnanamanickam E, M Dyer S, Milte R, Liu E, Ratcliffe J, Crotty M. Clustered domestic model of residential care is associated with better consumer rated quality of care. Int J Qual Health Care 2019; 31:419-425. [PMID: 30169780 PMCID: PMC6804479 DOI: 10.1093/intqhc/mzy181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/24/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022] Open
Abstract
Objective To compare consumer rated quality of care among individuals living long-term in homelike clustered domestic and standard models of residential care in Australia. Design Cross-sectional study. Setting Seventeen residential aged care facilities in four Australian states providing alternative models of care. Study participants A sample of individuals with high prevalence of cognitive impairment living in residential care for 12 months or longer, not immediately in palliative care and having a proxy available to provide consent and assist with data collection. Of 901 eligible participants, 541 consented and participated in the study. Main outcome measure Consumer rated quality of care was measured using the Consumer Choice Index–6 Dimension instrument (CCI-6D) providing a preference weighted summary score ranging from 0 to 1. The six dimensions of care time, shared-spaces, own-room, outside and gardens, meaningful activities and care flexibility were individually evaluated. Results Overall consumer rated quality of care (Mean ∆: 0.138, 95% CI 0.073–0.203 P < 0.001) was higher in clustered domestic models after adjusting for potential confounders. Individually, the dimensions of access to outside and gardens (P < 0.001) and flexibility of care (P < 0.001) were rated significantly better compared to those living in standard model of care. Conclusions Homelike, clustered domestic models of care are associated with better consumer rated quality of care, specifically the domains of access to outdoors and care flexibility, in a sample of individuals with cognitive impairment. Including consumer views on quality of care is feasible and should be standard in future evaluations of residential care.
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Affiliation(s)
- Emmanuel S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, Adelaide, SA, Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Musculoskeletal Health and Ageing Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Flinders Health Economics Group, Flinders University, Adelaide, SA, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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21
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Eckermann S, Phillipson L, Fleming R. Re-design of Aged Care Environments is Key to Improved Care Quality and Cost Effective Reform of Aged and Health System Care. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:127-130. [PMID: 30328015 DOI: 10.1007/s40258-018-0435-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Simon Eckermann
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.
| | - Lyn Phillipson
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
| | - Richard Fleming
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
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22
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Hermer L, Cornelison L, Kaup ML, Poey JL, Drake PN, Stone RI, Doll GA. Person-Centered Care as Facilitated by Kansas' PEAK 2.0 Medicaid Pay-for-Performance Program and Nursing Home Resident Clinical Outcomes. Innov Aging 2018; 2:igy033. [PMID: 30591952 PMCID: PMC6304069 DOI: 10.1093/geroni/igy033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose of the Study Person-centered care (PCC) is intended to improve nursing home residents’ quality of life, but the closer bonds it engenders between residents and staff may also facilitate improvements to residents’ clinical health. Findings on whether adoption ameliorates resident clinical outcomes are conflicting, with some evidence of harm as well as benefit. To provide clearer evidence, the present study made use of Kansas’ PEAK 2.0 Medicaid pay-for-performance (P4P) program, which incents the adoption of PCC. The program is distinctive in training facilities’ staff on adopting PCC through a series of well-defined stages and providing regular feedback about their progress. Design and Methods A retrospective cohort study was performed with 349 Kansas facilities spread across several well-defined PCC adoption stages, ranging from nonadoption to comprehensive adoption. The outcomes were thirteen 2014–2016 Nursing Home Compare long-stay resident clinical measures and a composite measure incorporating only nonimputed data for those 13 outcomes. Observed facility demographic differences were controlled for with propensity score adjustment. Treatment effect analyses were run with each outcome, with the predictor variable of program stage. Results Seven of the 13 clinical measures plus the composite measure indicated better health for residents in homes at higher program stages, relative to those in nonparticipating homes, including a 49% lower prevalence of major depressive symptoms in strongly adopting facilities. Implications The findings suggest that greater PCC adoption through PEAK participation is associated with better quality of care. Policymakers in other states may want to consider implementing a program modeled on PEAK 2.0.
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Affiliation(s)
- Linda Hermer
- LeadingAge LTSS Center at UMass Boston, LeadingAge, Washington, District of Columbia
| | | | - Migette L Kaup
- Department of Apparel, Textiles and Interior Design, Kansas State University, Manhattan, KS
| | - Judith L Poey
- LeadingAge LTSS Center at UMass Boston, LeadingAge, Washington, District of Columbia
| | - Patrick N Drake
- LeadingAge LTSS Center at UMass Boston, LeadingAge, Washington, District of Columbia
| | - Robyn I Stone
- LeadingAge LTSS Center at UMass Boston, LeadingAge, Washington, District of Columbia
| | - Gayle A Doll
- Center on Aging, Kansas State University, Manhattan, KS
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23
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Dyer SM, Liu E, Gnanamanickam ES, Milte R, Easton T, Harrison SL, Bradley CE, Ratcliffe J, Crotty M. Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life. Med J Aust 2018; 208:433-438. [DOI: 10.5694/mja17.00861] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/06/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Suzanne M Dyer
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
| | - Enwu Liu
- Flinders University, Adelaide, SA
- Mary MacKillop Institute for Health Research, Melbourne, VIC
| | - Emmanuel S Gnanamanickam
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
| | - Rachel Milte
- Flinders University, Adelaide, SA
- Institute for Choice, University of South Australia Business School, Adelaide, SA
| | - Tiffany Easton
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
| | - Stephanie L Harrison
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
| | - Clare E Bradley
- Flinders University, Adelaide, SA
- South Australian Health and Medical Research Institute, Adelaide, SA
| | - Julie Ratcliffe
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
- Institute for Choice, University of South Australia Business School, Adelaide, SA
| | - Maria Crotty
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
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24
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Sullivan JL, Shwartz M, Stolzmann K, Afable MK, Burgess JF. A Longitudinal Assessment of the Effect of Resident-Centered Care on Quality in Veterans Health Administration Community Living Centers. Health Serv Res 2017; 53:1819-1833. [PMID: 28369887 DOI: 10.1111/1475-6773.12688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine whether changes in resident-centered care (RCC) over time were associated with changes in quality. DATA SOURCES/STUDY SETTING Data sources were the Minimum Dataset quality indicators (which consist of measures of both prevalence and incidence of adverse events) and the Artifacts of Culture Change Tool (which measures RCC; FYs 2009-2012) from 130 Veterans Health Administration community living centers. STUDY DESIGN A retrospective longitudinal study. DATA COLLECTION/EXTRACTION METHODS Data were from VA secondary data sources. PRINCIPAL FINDINGS The overall relationship between RCC and quality was not statistically significant (p = .22), although there was a weakly significant negative relationship (i.e., increased RCC was associated with poorer quality) in the seven quarters after implementation of an automated version of the Artifacts Tool (p = .08). In facility-specific analyses, there were 15 facilities with a weakly significant (p < .10) positive relationship between RCC and quality and 21 with a weakly significant negative relationship. Adjusted cost per patient day was over 50 percent higher in the 21 facilities with a negative relationship than in the 15 facilities with a positive relationship (p < .05). CONCLUSIONS The Artifacts score is a formal performance metric in the VA, and thus, facilities were explicitly incentivized to increase RCC. Using qualitative methods to identify characteristics that distinguished those facilities able to increase both RCC and quality from those that suffered declines in quality as RCC was improved is an important follow-up to this study.
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Affiliation(s)
- Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.,Boston University School of Public Health, Boston, MA
| | - Michael Shwartz
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.,Boston University Questrom School of Management, Boston, MA
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Melissa K Afable
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - James F Burgess
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.,Boston University School of Public Health, Boston, MA
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25
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Hockley J, Harrison JK, Watson J, Randall M, Murray S. Fixing the broken image of care homes, could a 'care home innovation centre' be the answer? Age Ageing 2017; 46:175-178. [PMID: 27609210 DOI: 10.1093/ageing/afw154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/01/2016] [Indexed: 11/13/2022] Open
Abstract
The UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of 'good' from regulators, still significant numbers are identified as requiring 'improvement' or are 'inadequate'. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible-as well as impacting on the career choices of health and social care students. Projections of current demographics highlight that, within 10 years, the part of our population that will be growing the fastest will be those people older than 80 years old with the suggestion that spending on long-term care provision needs to rise from 0.6% of our Gross Domestic Product in 2002 to 0.96% by 2031. Teaching/research-based care homes have been developed in the USA, Canada, Norway, the Netherlands and Australia in response to scandals about care, and the shortage of trained geriatric healthcare staff. There is increasing evidence that such facilities help to reduce inappropriate hospital admissions, increase staff competency and bring increased enthusiasm about working in care homes and improve the quality of care. Is this something that the UK should think of developing? This commentary details the core goals of a Care Home Innovation Centre for training and research as a radical vision to change the culture and image of care homes, and help address this huge public health issue we face.
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Affiliation(s)
- Jo Hockley
- Usher Institute of Population Health Sciences and Informatics, Primary Palliative Care Research Group, Medical School, Edinburgh EH8 9AG, UK
| | - Jennifer Kirsty Harrison
- Alzheimer Scotland Dementia Research Centre & Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | | | | | - Scott Murray
- Usher Institute of Population Health Sciences and Informatics, Primary Palliative Care Research Group, Medical School, Edinburgh EH8 9AG, UK
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26
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Chang E, Ruder T, Setodji C, Saliba D, Hanson M, Zingmond DS, Wenger NS, Ganz DA. Differences in Nursing Home Quality Between Medicare Advantage and Traditional Medicare Patients. J Am Med Dir Assoc 2016; 17:960.e9-960.e14. [DOI: 10.1016/j.jamda.2016.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/18/2016] [Accepted: 07/21/2016] [Indexed: 11/26/2022]
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27
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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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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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Miller SC, Mor V, Burgess JF. Studying Nursing Home Innovation: The Green House Model of Nursing Home Care. Health Serv Res 2016; 51 Suppl 1:335-43. [PMID: 26729237 DOI: 10.1111/1475-6773.12437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Susan C Miller
- Department of Health Services, Policy & Practice and Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI
| | - Vincent Mor
- Department of Health Services, Policy & Practice and Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI.,Providence Veterans Administration Medical Center, Providence, RI
| | - James F Burgess
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
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30
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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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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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