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Temkin-Greener H, Guo W, McGarry B, Cai S. Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement. J Am Med Dir Assoc 2024; 25:917-922. [PMID: 38575115 PMCID: PMC11065589 DOI: 10.1016/j.jamda.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Assess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. DESIGN 2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for up to 2 years to track their NH placement. We used data from the Medicare Enrollment Database, the Medicare Beneficiary Summary File, Minimum Data Set, and a national directory of state-licensed AL communities. AL residents were identified using a validated, previously reported 9-digit zip code methodology. SETTING AND PARTICIPANTS A cross-sectional study sample included 289,350 Medicare beneficiaries in 17,265 AL communities across 50 states and in the District of Columbia. METHODS The outcome was permanent NH placement: a continuous stay for more than 90 days. Key independent variable was presence of SMI-schizophrenia, bipolar disorder, and major depression. Other covariates included sociodemographic factors and presence of other chronic conditions, including ADRD. A linear probability model with robust SEs, and AL-level random effects, was used to test the association between SMI diagnoses, ADRD, and their interactions on NH placement. RESULTS More than half (55.65%) of AL residents had a diagnosis of SMI, among them 93.2% had major depression, 28.5% schizophrenia, and 22.2% bipolar disorder. Individuals with schizophrenia and bipolar disorder had a significantly lower probability of NH placement, a 32% and a 15% decrease relative to the cohort mean, respectively. Placement risk was significantly greater for residents with ADRD compared to those without, increasing for those who also had schizophrenia or bipolar disorder, 12.9% and 1.5% relative to the sample mean, respectively. CONCLUSION AND IMPLICATIONS Presence of schizophrenia and bipolar disorder, in conjunction with ADRD, significantly increases the risk of long-term NH placement, suggesting that ALs may not be well prepared to care for these residents.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
| | - Wenhan Guo
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Brian McGarry
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
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2
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McGarry BE, Mao Y, Nelson DL, Temkin-Greener H. Hospital Proximity and Emergency Department Use among Assisted Living Residents. J Am Med Dir Assoc 2023; 24:1349-1355.e5. [PMID: 37301223 PMCID: PMC10524627 DOI: 10.1016/j.jamda.2023.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To examine the relationship between AL communities' distance to the nearest hospital and residents' rates of emergency department (ED) use. We hypothesize that when access to an ED is more convenient, as measured by a shorter distance, assisted living (AL)-to-ED transfers are more common, particularly for nonemergent conditions. DESIGN Retrospective cohort study, where the main exposure of interest was the distance between each AL and the nearest hospital. SETTING AND PARTICIPANTS 2018-2019 Medicare claims were used to identify fee-for-service Medicare beneficiaries aged ≥55 years residing in AL communities. METHODS The primary outcome of interest was ED visit rates, classified into those that resulted in an inpatient hospital admission and those that did not (ie, ED treat-and-release visits). ED treat-and-release visits were further classified, based on the NYU ED Algorithm, as (1) nonemergent; (2) emergent, primary care treatable; (3) emergent, not primary care treatable; and (4) injury-related. Linear regression models adjusting for resident characteristics and hospital referral region fixed effects were used to estimate the relationship between distance to the nearest hospital and AL resident ED use rates. RESULTS Among 540,944 resident-years from 16,514 AL communities, the median distance to the nearest hospital was 2.5 miles. After adjustment, a doubling of distance to the nearest hospital was associated with 43.5 fewer ED treat-and-release visits per 1000 resident years (95% CI -53.1, -33.7) and no significant difference in the rate of ED visits resulting in an inpatient admission. Among ED treat-and-release visits, a doubling of distance was associated with a 3.0% (95% CI -4.1, -1.9) decline in visits classified as nonemergent, and a 1.6% (95% CI -2.4%, -0.8%) decline in visits classified as emergent, not primary care treatable. CONCLUSIONS AND IMPLICATIONS Distance to the nearest hospital is an important predictor of ED use rates among AL residents, particularly for visits that are potentially avoidable. AL facilities may rely on nearby EDs to provide nonemergent primary care to residents, potentially placing residents at risk of iatrogenic events and generating wasteful Medicare spending.
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Affiliation(s)
- Brian E McGarry
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Yunjiao Mao
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Dallas L Nelson
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Guo X, Shen H, Wen Q, Liu S, Yang Y, Zhang H. Research on layout model and construction planning of aged care institutions for disabled elders in China: based on Nanjing city data. BMC Geriatr 2023; 23:237. [PMID: 37081383 PMCID: PMC10116451 DOI: 10.1186/s12877-023-03924-z] [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: 03/02/2022] [Accepted: 03/24/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND To meet the needs of diversified pension services and the construction of aged care institutions is one of the urgent livelihood issues in China. Under the major national needs of pension and care for the elderly, it is necessary to optimize the allocation of pension and care for the elderly resources, and formulate operational coping strategies and optimization plans. It is of great significance to deal with the urgent problem of population aging in a timely and scientific way. METHODS The economic benefits and social costs of aged care institutions are regarded as objective functions. To satisfy the economic benefits, it is necessary to reduce the social costs, and its construction quantity can only be an integer. The multi-objective genetic algorithm is improved with integer programming, and the global optimal solution is achieved after several times of searching. Under the multi-objective optimization model, the improved genetic algorithm was combined with the superior and inferior solution distance method to solve the genetic algorithm, and the corresponding objective function value was obtained after rounding. Finally, Pareto optimal solution set is selected by multi-objective decision, and the result of construction planning is obtained. RESULTS Based on multi-attribute decision analysis and taking three years as the construction cycle, the planning scheme of aged care institutions construction in each district of Nanjing in the next 15 years was proposed. In addition, considering the intelligent trend of future pension, the proportion of home-based pension is increasing year by year, and the model is promoted to meet the needs of diversified pension services. With the gradual increase of the elderly population in Nanjing, the proportion of intelligent home-based care has been increasing year by year since 2027, and the construction demand of aged care institutions has also increased. The number of construction at all levels rises gradually in each cycle, and the increase is more obvious after 2027. CONCLUSIONS The layout and planning of aged care institutions proposed in this paper not only considers economic and environmental benefits, but also combines the current situation of aged care institutions in various districts of Nanjing. The model is reasonable and effective, and has practical application value. It will help China optimize the allocation of elderly care resources under the target of active aging, and scientifically and comprehensively deal with the problem of population aging.
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Affiliation(s)
- Xiaojun Guo
- School of Science, Nantong University, 9 Seyuan Road, Nantong, 226019, China.
- College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, China.
| | - Houxue Shen
- School of Science, Nantong University, 9 Seyuan Road, Nantong, 226019, China
| | - Qinglan Wen
- School of Science, Nantong University, 9 Seyuan Road, Nantong, 226019, China
| | - Sifeng Liu
- College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, China
| | - Yingjie Yang
- Institute of Artificial Intelligence, De Montfort University, Leicester, LE1 9BH, UK
| | - Hui Zhang
- School of Science, Nantong University, 9 Seyuan Road, Nantong, 226019, China
- College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, China
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4
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Xu H, Li S, Mehta HB, Hommel EL, Goodwin JS. Excess deaths from COVID-19 among Medicare beneficiaries with psychiatric diagnoses: Community versus nursing home. J Am Geriatr Soc 2023; 71:167-177. [PMID: 36137264 PMCID: PMC9537955 DOI: 10.1111/jgs.18062] [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: 03/07/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Psychiatric illness may pose an additional risk of death for older adults during the COVID-19 pandemic. Older adults in the community versus institutions might be influenced by the pandemic differently. This study examines excess deaths during the COVID-19 pandemic among Medicare beneficiaries with and without psychiatric diagnoses (depression, anxiety, bipolar disorder, and schizophrenia) in the community versus nursing homes. METHODS This is a retrospective cohort study of a 20% random sample of 15,229,713 fee-for-service Medicare beneficiaries, from January 2019 through December 2021. Unadjusted monthly mortality risks, COVID-19 infection rates, and case-fatality rates after COVID-19 diagnosis were calculated. Excess deaths in 2020, compared to 2019 were estimated from multivariable logistic regressions. RESULTS Of all included Medicare beneficiaries in 2020 (N = 5,140,619), 28.9% had a psychiatric diagnosis; 1.7% lived in nursing homes. In 2020, there were 246,422 observed deaths, compared to 215,264 expected, representing a 14.5% increase over expected. Patients with psychiatric diagnoses had more excess deaths than those without psychiatric diagnoses (1,107 vs. 403 excess deaths per 100,000 beneficiaries, p < 0.01). The largest increases in mortality risks were observed among patients with schizophrenia (32.4% increase) and bipolar disorder (25.4% increase). The pandemic-associated increase in deaths with psychiatric diagnoses was only found in the community, not in nursing homes. The increased mortality for patients with psychiatric diagnoses was limited to those with medical comorbidities. The increase in mortality for psychiatric diagnoses was associated with higher COVID-19 infection rates (1-year infection rate = 7.9% vs. 4.2% in 2020), rather than excess case fatality. CONCLUSIONS Excess deaths during the COVID-19 pandemic were disproportionally greater in beneficiaries with psychiatric diagnoses, at least in part due to higher infection rates. Policy interventions should focus on preventing COVID-19 infections and deaths among community-dwelling patients with major psychiatric disorders in addition to those living the nursing homes.
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Affiliation(s)
- Huiwen Xu
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX;,Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX;,Corresponding author: Huiwen Xu, PhD, School of Public and Population Health and Sealy Center on Aging, University of Texas Medical Branch. 301 University Blvd., Galveston, TX 77555-1150. Phone: +1 409-772-5899; ; Twitter handle: @Dr_HuiwenXu
| | - Shuang Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Hemalkumar B. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Erin L. Hommel
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX;,Department of Medicine, University of Texas Medical Branch, Galveston, TX
| | - James S. Goodwin
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX;,Department of Medicine, University of Texas Medical Branch, Galveston, TX
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5
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Fuchs K, Vögeli S, Schori D, Händler-Schuster D. Nurses' experiences of an outreach interprofessional mental health service for nursing homes: a qualitative descriptive study. J Psychiatr Ment Health Nurs 2022; 29:755-765. [PMID: 35620909 PMCID: PMC9546410 DOI: 10.1111/jpm.12847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/17/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Treatment and mental health care in familiar environments are beneficial for older people experiencing mental health issues. But there are not enough qualified and specialized nurses who can meet the complex needs of nursing home residents experiencing mental health issues. The University Hospital of Psychiatry Zurich, Switzerland, established an outreach interprofessional mental health service to foster the care for residents experiencing mental health issues in nursing homes. Based on existing studies, little can be said about whether nurses in nursing homes find these types of services helpful. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Nurses in nursing homes caring for residents experiencing mental health issues felt relieved by having inclusive support from the interprofessional mental health service. Nurses appreciated the mental health team and felt accompanied and more confident in their daily work. Results showed that nurses wanted to be included in the care and treatment processes and to work as partners on an equal footing with the mental health team. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Outreach interprofessional mental health services for nursing homes should take into account nurses' views and professional experience, and value and respect their role as nurses. Outreach interprofessional mental health services for nursing homes should offer further training in psychiatric nursing, include an accessible contact person in the team, and develop clear processes and responsibilities. ABSTRACT INTRODUCTION: Outreach interprofessional mental health services for nursing homes can increase the quality of care for residents experiencing mental health issues but research on how nurses in nursing homes experience such a service is lacking worldwide. AIM To describe how nurses experience the involvement of an outreach interprofessional mental health team in the care for older people experiencing mental health issues in nursing homes and to identify barriers to and facilitators of interprofessional collaboration. METHOD Qualitative descriptive analysis based on 13 semi-structured interviews. Framework analysis and complex adaptive systems theory were applied. RESULTS One core theme with two main categories: Nurses experienced relief from burden through inclusive support provided by the mental health team. Main categories were feeling accompanied and confident as a nurse and partnership-based collaboration. DISCUSSION Results showed for the first time that nurses felt supported by the mental health team and were encouraged to find new ways of coping with challenging situations. IMPLICATIONS FOR PRACTICE To empower nurses, mental health teams should take into account nurses' perceptions in the treatment process, value and respect their role as nurses, transfer knowledge in both formal and informal settings, establish a steady and reliable contact person, and define processes and responsibilities.
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Affiliation(s)
- Karin Fuchs
- Institute of Nursing, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Samuel Vögeli
- Directorate of Nursing, Therapies and Social Work, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Dominik Schori
- Directorate of Nursing, Therapies and Social Work, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Daniela Händler-Schuster
- Institute of Nursing, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland.,Department Nursing Science and Gerontology, Private University of Health Sciences, Medical Informatics and Technology (UMIT TIROL), Hall in Tyrol, Austria.,School of Nursing, Midwifery and Health Practice, Faculty of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
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6
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Bucy T, Moeller K, Skarphol T, Shippee N, Bowblis JR, Winkelman T, Shippee T. Serious Mental Illness in Nursing Homes: Stakeholder Perspectives on the Federal Preadmission Screening Program. J Aging Soc Policy 2022; 34:769-787. [PMID: 35786383 DOI: 10.1080/08959420.2022.2083882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The federal Preadmission Screening and Resident Review (PASRR) program was enacted in the 1980s amid concerns surrounding the quality of nursing home (NH) care. This program is meant to serve as a tool to assist with level of care determinations for NH applicants with serious mental illness (SMI) and was intended to limit the growth in the number of NH residents with SMI. Despite this policy effort, the prevalence of SMI in NHs has continued to increase, and little is known about the mechanisms driving the heterogeneous and suboptimal administration of the PASRR program, absent routine evaluative efforts. We conducted 20 semi-structured interviews with state and national stakeholders to identify factors affecting PASRR program administration and NH care for residents with SMI. Stakeholders expressed concern regarding fragmentation, specifically lack of clarity in the value of assessments beyond a regulatory requirement. Additionally, they cited variable program administration as contributing to fragmented communication patterns and inconsistent training across jurisdictions. Given the number of people with SMI currently residing in NHs, policy and practice should take a person-centered approach to assess how PASRR can be better used to support resident needs.
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Affiliation(s)
- Taylor Bucy
- Graduate Research Assistant, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kelly Moeller
- Project Support Coordinator, Center for Healthy Aging and Innovation, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Tricia Skarphol
- Research Project Manager, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nathan Shippee
- Associate Professor, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - John R Bowblis
- Professor, Farmer School of Business, Miami University, Oxford, OH, USA
| | - Tyler Winkelman
- Assistant Professor of Medicine & Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA.,Co-Director, Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Tetyana Shippee
- Associate Professor, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Hugunin J, Chen Q, Baek J, Clark RE, Lapane KL, Ulbricht CM. Quality of Nursing Homes Admitting Working-Age Adults With Serious Mental Illness. Psychiatr Serv 2022; 73:745-751. [PMID: 34911354 PMCID: PMC9200905 DOI: 10.1176/appi.ps.202100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This cross-sectional study examined the association between nursing home quality and admission of working-age persons (ages 22-64 years) with serious mental illness. METHODS The study used 2015 national Minimum Data Set 3.0 and Nursing Home Compare (NHC) data. A logistic mixed-effects model estimated the likelihood (adjusted odds ratios [AORs] and 95% confidence intervals [CIs]) of a working-age nursing home resident having serious mental illness, by NHC health inspection quality rating. The variance partition coefficient (VPC) was calculated to quantify the variation in serious mental illness attributable to nursing home characteristics. Measures included serious mental illness (i.e., schizophrenia, bipolar disorder, and other psychotic disorders), health inspection quality rating (ranging from one star, below average, to five stars, above average), and other sociodemographic and clinical covariates. RESULTS Of the 343,783 working-age adults newly admitted to a nursing home in 2015 (N=14,307 facilities), 15.5% had active serious mental illness. The odds of a working-age resident having serious mental illness was lowest among nursing homes of above-average quality, compared with nursing homes of below-average quality (five-star vs. one-star facility, AOR=0.78, 95% CI=0.73-0.84). The calculated VPC from the full model was 0.11. CONCLUSIONS These findings indicate an association between below-average nursing homes and admission of working-age persons with serious mental illness, suggesting that persons with serious mental illness may experience inequitable access to nursing homes of above-average quality. Access to alternatives to care, integration of mental health services in the community, and improving mental health care in nursing homes may help address this disparity.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Qiaoxi Chen
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Jonggyu Baek
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Robin E Clark
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Kate L Lapane
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Christine M Ulbricht
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
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8
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Jester DJ, Molinari V, Bowblis JR, Dobbs D, Zgibor JC, Andel R. Abuse and Neglect in Nursing Homes: The Role of Serious Mental Illness. THE GERONTOLOGIST 2022; 62:1038-1049. [PMID: 35022710 DOI: 10.1093/geront/gnab183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing homes (NH) are serving a large number of residents with serious mental illness (SMI). We analyze the highest ("High-SMI") quartile of NHs based on the proportion of residents with SMI and compare NHs on health deficiencies and the incidence of deficiencies given for resident abuse, neglect, and involuntary seclusion. RESEARCH DESIGN AND METHODS We used national Certification and Survey Provider Enhanced Reports (CASPER) data for all freestanding certified NHs in the continental United States from 2014 to 2017 (14,698 NHs; 41,717 recertification inspections; 246,528 deficiencies). Differences in the number of deficiencies, a weighted deficiency score, the deficiency grade, and the facility characteristics associated with deficiencies for abuse, neglect, and involuntary seclusion were examined in High-SMI. Incidence rate ratios (IRR) and odds ratios (OR) were reported with 95% confidence intervals. RESULTS High-SMI NHs did not receive more deficiencies or a greater weighted deficiency score per recertification inspection. Deficiencies given to High-SMI NHs were associated with a wider scope, especially Pattern (IRR:1.03;[1.00, 1.07]) and Widespread (IRR:1.07;[1.02, 1.11]). High-SMI NHs were more likely to be cited for resident abuse and neglect (OR:1.49;[1.23, 1.81]) and the policies to prohibit and monitor for abuse and neglect (OR:1.18;[1.08, 1.30]) in comparison to all other NHs. DISCUSSION AND IMPLICATIONS Although resident abuse, neglect, and involuntary seclusion are rarely cited, these deficiencies are disproportionately found in High-SMI NHs. Further work is needed to disentangle the antecedents to potential resident abuse and neglect in those with mental healthcare needs.
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Affiliation(s)
- Dylan J Jester
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Victor Molinari
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - John R Bowblis
- Department of Economics and Scripps Gerontology Center, Miami University, Oxford, OH
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Janice C Zgibor
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Ross Andel
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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9
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Bucy T, Moeller K, Bowblis JR, Shippee N, Fashaw-Walters S, Winkelman T, Shippee T. Serious Mental Illness in the Nursing Home Literature: A Scoping Review. Gerontol Geriatr Med 2022; 8:23337214221101260. [PMID: 35573081 PMCID: PMC9096203 DOI: 10.1177/23337214221101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
Nursing homes (NH) and other institutional-based long-term care settings are not considered an appropriate place for the care of those with serious mental illness, absent other medical conditions or functional impairment that warrants skilled care. Despite policy and regulatory efforts intended to curb the unnecessary placement of people with serious mental illness (SMI) in these settings, the number of adults with SMI who receive care in NHs has continued to rise. Through a scoping review, we sought to summarize the available literature describing NH care for adults with SMI from 2000 to 2020. We found that SMI was operationalized and measured using a variety of methods and diagnoses. Most articles focused on a national sample, with the main unit of analysis being at the NH resident-level and based on analysis of secondary data sets. Understanding current evidence about the use of NHs by older adults with SMI is important to policy and practice, especially as we continue to grapple as a nation with how to provide quality care for older adults with SMI.
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Affiliation(s)
- Taylor Bucy
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kelly Moeller
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - John R Bowblis
- Farmer School of Business, Miami University, Oxford, OH, USA
| | - Nathan Shippee
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Tyler Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Tetyana Shippee
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
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10
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Xu H, Intrator O, Culakova E, Bowblis JR. Changing landscape of nursing homes serving residents with dementia and mental illnesses. Health Serv Res 2021; 57:505-514. [PMID: 34747498 DOI: 10.1111/1475-6773.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/29/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Nursing homes (NHs) are serving an increasing proportion of residents with cognitive issues (e.g., dementia) and mental health conditions. This study aims to: (1) implement unsupervised machine learning to cluster NHs based on residents' dementia and mental health conditions; (2) examine NH staffing related to the clusters; and (3) investigate the association of staffing and NH quality (measured by the number of deficiencies and deficiency scores) in each cluster. DATA SOURCES 2009-2017 Certification and Survey Provider Enhanced Reporting (CASPER) were merged with LTCFocUS.org data on NHs in the United States. STUDY DESIGN Unsupervised machine learning algorithm (K-means) clustered NHs based on percent residents with dementia, depression, and serious mental illness (SMI, e.g., schizophrenia, anxiety). Panel fixed-effects regressions on deficiency outcomes with staffing-cluster interactions were conducted to examine the effects of staffing on deficiency outcomes in each cluster. DATA EXTRACTION METHODS We identified 110,463 NH-year observations from 14,671 unique NHs using CASPER data. PRINCIPAL FINDINGS Three clusters were identified: low dementia and mental illnesses (Postacute Cluster); high dementia and depression, but low SMI (Long-stay Cluster); and high dementia and mental illnesses (Cognitive-mental Cluster). From 2009 to 2017, the number of Postacute Cluster NHs increased from 3074 to 5719, while the number of Long-stay Cluster NHs decreased from 6745 to 3058. NHs in Long-stay/Cognitive-mental Clusters reported slightly lower nursing staff hours in 2017. Regressions suggested the effect of increasing staffing on reducing deficiencies is statistically similar across NH clusters. For example, 1 hour increase in registered nurse hours per resident day was associated with -0.67 (standard error [SE] = 0.11), -0.88 (SE = 0.12), and -0.97 (SE = 0.15) deficiencies in Postacute Cluster, Long-stay Cluster, and Cognitive-mental Cluster, respectively. CONCLUSIONS Unsupervised machine learning detected a changing landscape of NH serving residents with dementia and mental illnesses, which requires assuring staffing levels and trainings are suited to residents' needs.
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Affiliation(s)
- Huiwen Xu
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York, USA
| | - Eva Culakova
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - John R Bowblis
- Department of Economics, Farmer School of Business, Miami University, Oxford, Ohio, USA.,Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
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11
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Gammonley D, Wang X, Simons K, Smith KM, Bern-Klug M. Serious Mental Illness in Nursing Homes: Roles and Perceived Competence of Social Services Directors. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:721-739. [PMID: 33851901 DOI: 10.1080/01634372.2021.1912241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
Providing nursing home psychosocial care to persons with serious mental illnesses (SMI) requires understanding of comorbidities and attention to resident rights, needs and preferences. This quantitative study reports how 924 social service directors (SSDs) taking part in the National Nursing Home Social Service Director survey identified their roles and competence, stratified by the percentage of residents with SMI. More than 70% of SSDs, across all categories of homes, reported the social services department was "always" involved in conducting depression screening, biopsychosocial assessments and PASRR planning. SSDs in homes with lower concentrations of residents with SMI reported less involvement in anxiety screening. Those employed in homes with higher concentrations of residents with SMI reported lower involvement conducting staff interventions for resident aggression or making referrals. More than one-fifth of SSDs lacked confidence in their ability to compare/contrast dementia, depression, and delirium or to develop care plans for residents with SMI. SSDs' perceived competence in developing care plans for residents with SMI was associated with education and involvement in care planning. About one-quarter of social services directors reported not being prepared to train a colleague on how to develop care plans for residents with SMI. Training in SMI could enhance psychosocial care.
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Affiliation(s)
- Denise Gammonley
- School of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
| | - Xiaochuan Wang
- School of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
| | - Kelsey Simons
- University of Rochester School of Medicine & Dentistry, Department of Psychiatry, Rochester, New York, USA
| | - Kevin M Smith
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa, USA
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12
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Hua CL, Cornell PY, Zimmerman S, Winfree J, Thomas KS. Trends in Serious Mental Illness in US Assisted Living Compared to Nursing Homes and the Community: 2007-2017. Am J Geriatr Psychiatry 2021; 29:434-444. [PMID: 33032928 PMCID: PMC7972995 DOI: 10.1016/j.jagp.2020.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Little is known about the prevalence of serious mental illness (SMI) in assisted living (AL) communities in the United States. Trends in the prevalence of SMI in AL communities were examined over time and in relationship to characteristics such as dual eligibility and health conditions. Within- and between-state variability of SMI in AL was also examined. DESIGN Samples of Medicare beneficiaries who lived in the 48 contiguous states were created: individuals who resided in the community, in a nursing home (NH), and in an AL community on December 31st of each year (2007-2017). We conducted univariate analysis to display the trends in SMI over time in AL compared with NHs and the community. To demonstrate intrastate variability, we examined the prevalence of SMI for each state. We described within-nation and within-state variability using a Lorenz curve and GINI coefficients, respectively. RESULTS The prevalence of SMI in AL increased by 54%, rising from 7.4% in 2007 to 11.4% in 2017. Residents with SMI were more likely to be dually eligible for Medicare and Medicaid than residents without SMI. The prevalence of SMI in AL ranged from to 3.2% in Wyoming to 33.1% in New York. Approximately 10% of AL communities had over half of the sample's AL residents with SMI. CONCLUSION Given the increased proportion of residents with SMI in AL, research is needed into the mental health and social care needs of this population. Analysis is needed to uncover reasons for variations among states.
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Affiliation(s)
- Cassandra L Hua
- School of Public Health, Brown University (CLH, PYC, KST), Providence, RI.
| | - Portia Y Cornell
- School of Public Health, Brown University (CLH, PYC, KST), Providence, RI; Providence VA Medical Center (PYC, KST), Providence, RI
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and the School of Social Work and Gillings School of Global Public Health, University of North Carolina at Chapel Hill (SZ), Chapel Hill, NC
| | - Jaclyn Winfree
- Institute on Aging, College of Urban and Public Affairs (JW), Portland State University, Portland, OR
| | - Kali S Thomas
- School of Public Health, Brown University (CLH, PYC, KST), Providence, RI; Providence VA Medical Center (PYC, KST), Providence, RI
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13
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Expert nurse response to workforce recommendations made by the coronavirus commission for safety and quality in nursing homes. Nurs Outlook 2021; 69:735-743. [PMID: 33993987 PMCID: PMC8020094 DOI: 10.1016/j.outlook.2021.03.017] [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: 02/06/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022]
Abstract
COVID-19 has exposed the longstanding internal problems in nursing homes and the weak structures and policies that are meant to protect residents. The Centers for Medicare and Medicaid Services convened the Coronavirus Commission for Safety and Quality in NHs in April, 2020 to address this situation by recommending steps to improve infection prevention and control, safety procedures, and the quality of life of residents in nursing homes. The authors of this paper respond to the Final Report of the Commission and put forth additional recommendations to federal policymakers for meaningful nursing home reform: 1) ensuring 24/7 registered nurse (RN) coverage and adequate compensation to maintain total staffing levels that are based on residents’ care needs; 2) ensuring RNs have geriatric nursing and leadership competencies; 3) increasing efforts to recruit and retain the NH workforce, particularly RNs; and 4) supporting care delivery models that strengthen the role of the RN for quality resident-centered care.
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14
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Brown MT, Mutambudzi M. Risk of Nursing Home Use among Older Americans: The Impact of Psychiatric History and Trajectories of Cognitive Function. J Gerontol B Psychol Sci Soc Sci 2021; 77:577-588. [PMID: 33720295 DOI: 10.1093/geronb/gbab045] [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: 11/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Mental illness and cognitive functioning may be independently associated with nursing home use. We investigated the strength of the association between baseline (1998) psychiatric history, eight-year cognitive function trajectories, and prospective incidence of nursing home use over a ten-year period while accounting for relevant covariates in U.S. adults aged 65 and older. We hypothesized that self-reported baseline history of psychiatric, emotional or nervous problems would be associated with greater risk of nursing home use, and that cognition trajectories with the greatest decline would be associated with subsequent higher risk of nursing home use. METHODS We used eight waves (1998-2016) of Health and Retirement Study data for adults aged 65 years and older. Latent class mixture modeling identified four distinct cognitive function trajectory classes (1998-2006): low-declining, medium-declining, medium-stable, high-declining. Participants from the 1998 wave (N = 5628) were classified into these four classes. Competing risks regression analysis modeled the sub-hazard of nursing home use between 2006 and 2016 as a function of baseline psychiatric history and cognitive function trajectories. RESULTS Psychiatric history was independently associated with greater risk of nursing home use (SHR 1.26, 95% CI 1.06-1.51, p<.01), net the effects of life course variables. Further, "low declining" (SHR 2.255, 95% CI 1.70-2.99, p<.001) and "medium declining" (2.103, 95% CI 1.69-2.61, p<.001) trajectories predicted increased risk of nursing home use. DISCUSSION Evidence of these associations can be used to educate policymakers and providers about the need for appropriate psychiatric training for staff in community-based and residential long-term care programs.
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15
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Jester DJ, Hyer K, Bowblis JR. Quality Concerns in Nursing Homes That Serve Large Proportions of Residents With Serious Mental Illness. THE GERONTOLOGIST 2020; 60:1312-1321. [DOI: 10.1093/geront/gnaa044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Nursing homes (NHs) are serving greater proportions of residents with serious mental illness (SMI), and it is unclear whether this affects NH quality. We analyze the highest and lowest quartiles of NHs based on the proportion of residents with SMI and compare these NHs on facility characteristics, staffing, and quality stars.
Research Design and Methods
National Certification and Survey Provider Enhanced Reports data were merged with NH Compare data for all freestanding certified NHs in the continental United States in 2016 (N = 14,460). NHs were categorized into “low-SMI” and “high-SMI” facilities using the lowest and highest quartiles, respectively, of the proportion of residents in the NH with SMI. Bivariate analyses and logistic models were used to examine differences in organizational structure, payer mix, resident characteristics, and staffing levels associated with high-SMI NHs. Linear models examined differences in quality stars.
Results
High-SMI facilities were found to report lower direct-care staffing hours, have a greater Medicaid-paying resident census, were more likely to be for-profit, and scored lower on all NH Compare star ratings in comparison to all other NHs.
Discussion and Implications
As the SMI population in NHs continues to grow, a large number of residents have concentrated in a few NHs. These are uniquely different from typical NHs in terms of facility characteristics, staffing, and care practices. While further research is needed to understand the implications of these trends, public policymakers and NH providers need to be aware of this population’s unique—and potentially unmet—needs.
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Affiliation(s)
- Dylan J Jester
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| | - John R Bowblis
- Department of Economics, Farmer School of Business, Miami University, Oxford, Ohio
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