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Journal article

The provision of care for residents dying in UK nursing care homes

Authors:
KINLEY Julie, et al
Journal article citation:
Age and Ageing, 43(3), 2014, pp.375-379.
Publisher:
Oxford University Press

Objectives: To identify the care currently provided to residents dying in UK nursing care homes. Method: Study participants were residents who had died within 38 nursing care homes in southeast England over a 3-year period. The nursing care homes had been recruited to take part in a cluster randomised controlled trial looking at different models of facilitation while implementing the Gold Standards Framework in Care Homes (GSFCH) programme. Two researchers examined the notes and daily records of all residents who died in each of these homes between the 1 June 2008 and the 31 May 2011. Results: A total of 2,444 residents died during the 3-year period. Fifty-six percent of these residents died within a year of admission. The support from specialist healthcare services to residents during their last 6 months of life was variable. Conclusions: Nursing care homes have established links with some external healthcare providers. These links included the GP, palliative care nurses and physiotherapy. As dependency of resident increase with 56% residents dying within a year of admission these links need to be expanded. The provision of health care that meets the needs of future nursing care home residents needs to be ‘proactively’ obtained rather than left to chance.

Journal article

Trajectories of at-homeness and health in usual care and small house nursing homes

Authors:
MOLONY Sheila, et al
Journal article citation:
Gerontologist, 51(4), August 2011, pp.504-515.
Publisher:
Gerontological Society of America

Long-term care providers across the United States are building new residential environments that weave humanistic person-centred philosophies into clinical care, organisational policies, and built environments. The small house model (SmH) relocates the resident from institutional care to a place that is believed to better emulate home. The aim of this study was to compare and contrast trajectories of at-homeness and health over time between residents remaining in a usual care nursing home and residents moving from that home to a SmH. The setting for the study was a 100-bed nursing home in a continuing care retirement community in the Midwest. Five new SmHs were built as part of this retirement community. Interviews were conducted with residents before the move to the SmHs and 1, 3, and 6 months after the move. The findings showed that prior to the move individuals who decided to relocate to the SmH had more depressive symptoms and lower levels of at-homeness. Their levels of at-homeness increased after the move, and, in addition, their levels of functional dependence decreased. Most participants who chose to stay in the nursing home reported high baseline levels of at-homeness and maintained this over the next 6 months. Qualitative findings highlight the variables that contributed to at-homeness in both groups. The study demonstrates that a ‘one size fits all’ approach may not be best because at-homeness is an individualised construct.

Journal article

Neglect of older adults in Michigan nursing homes

Authors:
ZHANG Zhenmei, et al
Journal article citation:
Journal of Elder Abuse and Neglect, 23(1), January 2011, pp.58-74.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Although research on domestic elder abuse and neglect is a rapidly growing area, it is relatively poorly understood in the nursing home environment. The purpose of this study was to estimate the incidence of elder neglect in nursing homes and to identify the individual and contextual risks associated with elder neglect. Data came from a 2005 random digit dial survey of individuals in Michigan who had relatives in long term care. The sample included 414 family members who had a relative aged 65 or older in a nursing home. The collated responses suggest that about 21% of nursing home residents were neglected on one or more occasion in the last 12 months. Two nursing home residents' characteristics reported by family members appear to significantly increase the odds of neglect: functional impairments in activities of daily living and previous resident-to-resident victimisation. Behaviour problems were also associated with higher odds of neglect. However there was no strong evidence that social support reduced the risk of abuse except perhaps a suggestion of a link with frequency of visits. The authors emphasise that estimates of neglect were based solely on family reports and this may be a limitation of the study. Policy implications of these results are discussed.

Journal article

Self-injurious behavior in the nursing home setting

Authors:
MAHGOUB Nahla, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 26(1), January 2011, pp.27-30.
Publisher:
Wiley-Blackwell

Self-injurious behaviour in older adults is defined as harm inflicted on oneself without conscious suicidal intent. In this literature search aiming to determine the scope of the literature, online database searches identified 10 publications concerning self-injurious behaviour in older adults, 4 of which included studies investigating this in nursing homes. The results showed that there are few clinical studies of self-injurious behaviour in older adult nursing home residents, but that the limited literature suggests that it is a prevalent phenomenon, reported to be strongly associated with dementia and a risk of accidental death. The authors conclude that there is little evidence-based treatment guidance for self-injurious behaviour in older populations, and that clinical studies are urgently needed to help clarify causes and treatment approaches.

Digital Media Full text available online for free

Bettercaring

Publisher:
Pavilion Interactive

Bettercaring offers a searchable database of all registered care homes in the UK with more than four beds. The database contains information on more than 20,000 care homes, in all regions of the UK. It is possible to search by location, size, cost and special support services offered. The resource also provides a frequently-asked questions page, and a number of articles on topics related to residential care.

Journal article

Use of physical restraints and antipsychotic medication is in nursing homes: a cross-national study

Authors:
FENG Zhanlian, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 24(10), October 2009, pp.1110-1118.
Publisher:
Wiley-Blackwell

This study compared inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, looking at aggregated residence conditions and organisational characteristics correlated with these treatments. Data were collected from long-term care facilities providing nursing home services in five countries. The findings were that the prevalence of physical restraint use varied more than five-fold across the study countries with an average 6% in Switzerland, 9% in the United States (US), 20% in Hong Kong (China), 28% in Finland, and over 31% in Canada. Prevalence of antipsychotic use ranged from 11% in Hong Kong, between 26-27% in Canada and the US, 34% in Switzerland, and nearly 38% in Finland. Within each country, substantial variations existed, but neither facility case mix nor organisational characteristics were particularly predictive of the prevalence of either treatment. The study concluded that there is large, unexplained variability in the prevalence of physical restraint and antipsychotic use in nursing home facilities both between and within countries, and that since restraints and antipsychotics are associated with adverse outcomes, it is important to understand the factors specific to each country that contribute to variation in use rates.

Journal article

Family members’ reports of abuse in Michigan nursing homes

Authors:
GRIFFORE Robert J., et al
Journal article citation:
Journal of Elder Abuse and Neglect, 21(2), April 2009, pp.105-114.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Data on the abuse and neglect of people aged 65 and over in Michigan nursing homes over a 12-month period were collected using list-assisted random-digit dialling of relatives. Most of the residents represented in the study were female, widowed and Caucasian. Neglect and caretaking mistreatment were the most frequent types of abuse reported. Comparison of the data with information from the National Ombudsman Reporting System suggests that the incidence of abuse is substantially higher than reflected in official data and warrants further research to investigate reasons for this discrepancy to provide accurate and validated data on abuse in nursing homes.

Journal article

Care planning systems in care homes for older people

Authors:
WORDEN Angela, CHALLISS David
Journal article citation:
Quality in Ageing, 9(2), June 2008, pp.28-38.
Publisher:
Pier Professional
Place of publication:
Brighton

The National Minimum Care Standards in England now require that all residents in care homes have a service users plan. This study examined the format and content of 117 blank care plan documents used in Manchester and Cheshire care homes in 2001/02. Sixty-eight per cent of homes used a problem-orientated care plan document, 25% used a problem-orientated care plan with assessment domains defined, 15% used standard care plans and five per cent used daily care plans. Although the government had stressed the importance of involving the users in the care planning process, only 16% of the homes had a care plan that specifically asked for a resident's signature or agreement. There were also differences in content of care plans by home type, which may reflect the professional background and training of staff in nursing homes. The variety in types and format of care plans suggests that the interpretation and recording of care planning may not be uniform across homes and there is need for further detailed work in this area using interviews or observational approaches.

Journal article

Determinants of remaining in the community after discharge: results from New Jersey's nursing home transition program

Authors:
HOWELL Sandra, et al
Journal article citation:
Gerontologist, 47(4), August 2007, pp.535-547.
Publisher:
Gerontological Society of America

To inform states with nursing home transition programs, this study aimed to determine what risk factors are associated with participants' long-term readmission to nursing homes within 1 year after discharge. The authors obtained administrative data for all 1,354 nursing home residents who were discharged, and interviewed 628 transitioning through New Jersey's nursing home transition program in 2000. The Andersen behavioral model was used to select predictors of long-term nursing home readmission, and the Cox proportional hazards regressions was used to examine the relative risk of experiencing such readmissions.  Overall, 72.6% of the 1,354 individuals remained in the community, with 8.6% readmitted to a nursing home for long stays (>90 days) and 18.8% dying during the study year. Cox proportional hazards regression analysis showed that being male, single, and dissatisfied with one's living situation; living with others; and falling within 8 to 10 weeks after discharge were significant predictors of long-term nursing home readmission during the first year after discharge. Most of the factors predicting long-term readmission were predisposing, not need, factors. This fact points to the limits of formulaic approaches to assessing candidates for discharge and the importance of working with clients to understand and address their particular vulnerabilities. Consumers, state policy makers, nursing home transition staff, discharge planners, and caregivers can use these findings to understand and help clients understand their particular risks and options, and to identify those individuals needing the greatest attention during the transition period as well as risk-specific services such as fall-prevention programs that should be made available to them.

Digital Media

Switching on a light: an introduction to life story work

Authors:
UNIVERSITY OF STIRLING. Dementia Services Development Centre, (Producer)
Publisher:
University of Stirling. Dementia Services Development Centre
Publication year:
2007
Pagination:
DVD, booklet
Place of publication:
Stirling

This new DVD demonstrates what is meant by life story work and how this can be used with people with dementia. Filmed in a nursing home and using interviews with practitioners and people with dementia, the benefits for those involved are considered. The accompanying booklet gives more detailed information about getting started and the issues to be considered. An outline for a suggested training session is also included.

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