Browsing by Subject "nursing homes"
Item COVID-19 in Older Adults: Transfers Between Nursing Homes and Hospitals(ACEP, 2020) Levine, Stacie; Bonner, Alice; Perry, Adam; Melady, Donald; Unroe, Kathleen T.; Medicine, School of MedicineItem Daily Situational Brief, December 1, 2014(MESH Coalition, 12/01/14) MESH CoalitionItem A National County-Level Assessment of U.S. Nursing Facility Characteristics Associated with Long-Term Exposure to Traffic Pollution in Older Adults(2018-03) Wang, Yi; Fan, Hao; Banerjee, Aniruddha; Weaver, Anne M.; Weiner, MichaelLong-term exposure to ambient air pollution increases disease risk in older adults. Nursing facilities located near major roadways potentially expose older adults to traffic pollution. No studies, however, have described the association between nursing facilities and traffic pollution. We obtained data on facility- and census-tract-level characteristics of 15,706 U.S. facilities from the Medicare Nursing Home Compare datasets. We calculated distance to major roadways and traffic density for each facility. In the contiguous U.S. (as of 2014), 345,792 older adults, about 27% of residents in non-hospital facilities, lived within 150 m major roadways (A1 or A2) in 3876 (28% of sampled) facilities. Nationally, for-profit facilities, high-occupancy facilities, and facilities in census tracts with higher percentages of minorities were more likely to have higher exposure to traffic. Counties in Virginia, New York City, and Rhode Island have the highest percent of residents and facilities near major roads. Nationally, over one-quarter of sampled facilities are located near major roadways. Attributes potentially associated with higher exposure to traffic included “for-profit” and “higher minority census tract”. Proximity to major roadways may be an important factor to consider in siting nursing facilities. Our results inform potential intervention strategy at both county and facility level.Item Nursing Home Regulations Redefined: Implications for Providers(Wiley, 2018-01) Unroe, Kathleen T.; Ouslander, Joseph G.; Saliba, Debra; Medicine, School of MedicineThe Centers for Medicare and Medicaid Services (CMS) finalized a comprehensive update to nursing home requirements of participation in October 2016. Nearly 10,000 public comments were received regarding the proposed rule, and CMS made multiple modifications based on comments from providers, advocacy organizations, and others before issuing the final rule. The final rule describing nursing home requirements of participation modernizes nursing home regulation. It is being implemented in three phases—beginning in November 2016, November 2017, and November 2019. There are multiple provisions that have implications for clinicians caring for nursing home residents, particularly in terms of management of infections, medication prescribing and monitoring, and delegation of medical orders.Item The Pandemic Creates Urgency around Designing Health System Support Structures for Nursing Homes(Wiley, 2021-01) Unroe, Kathleen T.; Medicine, School of MedicineItem Physician Orders for Life Sustaining Treatment for Nursing Home Residents with Dementia(Wiley, 2015) Kim, Hyejin; Ersek, Mary; Bradway, Christine; Hickman, Susan E.; Department of Nursing, IU School of NursingPurpose Many nursing home (NH) residents with dementia receive burdensome, aggressive treatments at the end of life (EOL). The Physician Orders for Life-Sustaining Treatments (POLSTs) paradigm is a strategy to enhance EOL care. This article describes the history and features of the POLST paradigm, discusses the potential advantages of using this paradigm for NH residents with dementia, and briefly explores challenges that nurse practitioners (NPs) face in using the POLST for persons with dementia. Data sources Review of the literature. Conclusions Potential advantages associated with implementation of POLST in NH residents with dementia include increased communication and documentation about residents’ EOL care preferences, increased concordance between care preferences documented in POLST forms and EOL care provided to residents, and lower rates of unwanted, burdensome treatments at EOL. POLST may also guide NPs in communicating EOL care options with residents and/or their surrogates. However, difficulty interpreting and explaining POLST care options, lack of understanding of POLST, limited discussions, and issues with surrogate authority and scope of practice are challenges that NPs may face in caring for NH residents with dementia. Implications for practice NPs should assess and optimize their knowledge and skills to conduct goals of care discussions, including POLST discussions.Item Quality Improvement in Skilled Nursing Facilities for Residents With Alzheimer's Disease(Sage, 2016) Farlow, Martin R.; Borson, Soo; Connor, Stephen R.; Grossberg, George T.; Mittelman, Mary S.; Neurology, School of MedicineBackground/rationale: This report describes a quality improvement continuing medical education activity designed to enhance the recognition and treatment of residents with Alzheimer's disease (AD) or other dementias in skilled-nursing facilities (SNFs). Methods: Charts were compared in 6 areas prior to and following (stages A and C) a live, faculty-led workshop (stage B). Four SNFs completed stages A (n = 67 residents) and B, and 3 SNFs completed stage C (n = 52 residents). All charts came from residents with AD or a diagnosis of dementia or dementia-like symptoms. Results/conclusion: The SNFs had >95% baseline performance in both the frequency of cognitive assessments and documented medication reviews. The percentage of residents who received a quality-of-life assessment and those who had a mental health care plan in place represent areas for improvement. As part of this activity, a toolkit was developed to help guide facilities and clinicians in instituting care improvements for residents with AD/dementia.Item Things that matter to residents in nursing homes and the nursing care implications(2014) Reimer, Nila B.; Horton-Deutsch, Sara L.; Baird, Carol L.; Ironside, Pamela M.; Pesut, Daniel J.A move toward care of residents in nursing homes where they are respected and heard is finally emerging. Common strategies used in nursing homes to improve quality of care for residents are integration of person-centered care and assessing care using satisfaction surveys. Although approaches of integrating person-centered care and satisfaction surveys have been valuable in improving nursing home quality, strategies of care that include things that matter from residents’ perspectives while living in nursing homes need investigation. The purpose of this qualitative descriptive study was to describe things that residents age 65 and older state matter to them while living in the long-term care sections of nursing homes. A qualitative mode of inquiry using purposeful sampling led to a natural unfolding of data that revealed things that mattered to residents. Content analysis was used to reduce the data in a manner that kept the data close to the context yet moved the data toward new ideas about including things that mattered to residents in nursing care. The findings revealed residents’ positive and negative experiences and addressed the question: How can nurses manage residents’ positive and negative aspects of care in nursing homes? This study substantiated the importance of developing nursing care strategies derived from residents’ descriptions of care. Finding ways to promote nurses’ investment in attitudes about a person-centered care philosophy is essential for successful person-centered care implementation. Enhancing nurses’ knowledge, skills, and attitudes with an investment in person centeredness will be more likely to put nurses in a position to role-model care that is person-centered from residents’ perspectives.