Search results for ‘Subject term:"long term care"’ Sort:
Results 1 - 10 of 85
Proceedings from an international virtual townhall: reflecting on the COVID-19 pandemic: themes from long-term care
- Authors:
- HECKMAN George A, et al
- Journal article citation:
- Journal of the American Medical Directors Association, 22(6), 2021, pp.1128-1132.
- Publisher:
- Elsevier (for the American Medical Directors Association)
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. (Edited publisher abstract)
Assuring quality in nursing homes: the black box of administrative and clinical leadership – a scoping review
- Authors:
- SIEGEL Elena O., YOUNG Heather M.
- Journal article citation:
- Gerontologist, 61(4), 2021, pp.e147-e162.
- Publisher:
- Oxford University Press
Background and Objectives: Licensed nursing home administrators (NHA) and directors of nursing (DON) are responsible for nursing home quality and assuring optimal performance and job satisfaction/retention of their nursing home workforce. NHA/DON-focused studies have generated important foundational knowledge over the last three decades; yet, targeted research is needed to understand and apply the complexities of the black box of this top management team. This scoping review identifies, reviews, synthesizes, and maps the topical areas of research in NHA/DON positions in U.S. nursing homes. Research Design and Methods: We conducted searches of 5 databases, yielding 3,479 records; screening/review yielded 88 unique records. We used thematic analysis to code the primary foci of the studies and the variables associated with the concepts of interest. Results: Most papers (n = 40) focused on role characteristics, 23 examined approaches to management and leadership, 24 focused on perceptions about the role, and the remaining 12 examined role structure. The role-related themes linked to outcomes (n = 42), processes (n = 27), and structures (n = 30). Discussion and Implications: We highlight important gaps for future research and offer a call to action for research, policy, practice, and education collaborations to accelerate the rate of research and translate the findings into best practices for NHA/DON to lead and manage the nursing home workforce and build capacity to ensure person-centered, high-quality care. Based on foundational descriptive studies, it is time to use what is known to design and implement interventions that enhance the capacity of NHA/DON to improve the structures, processes, and outcomes of nursing homes. (Edited publisher abstract)
Quality concerns in nursing homes that serve large proportions of residents with serious mental illness
- Authors:
- JESTER Dylan J., HYER Kathryn, BOWBLIS John R
- Journal article citation:
- Gerontologist, 60(7), 2020, pp.1312-1321.
- Publisher:
- Oxford University Press
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. (Edited publisher abstract)
What is nursing home quality and how is it measured?
- Authors:
- CASTLE Nicholas G., FERGUSON Jamie C.
- Journal article citation:
- Gerontologist, 50(4), August 2010, pp.426-442.
- Publisher:
- Oxford University Press
The article examines nursing home quality and the indicators that have been used to measure this quality. The authors present a brief review of the history of nursing home quality in the US to provide context and insight into currently used indicators, and Donabedian's structure, process, and outcome model is used to frame the discussion. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. The authors evaluate steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified. In conclusion, the authors suggest that while improvements in nursing home quality have been implemented, further improvements are still needed.
Defining quality in assisted living: comparing apples, oranges, and broccoli
- Authors:
- HAWES Catherine, PHILLIPS Charles D.
- Journal article citation:
- Gerontologist, 47(3), December 2007, pp.40-50.
- Publisher:
- Oxford University Press
The purpose of this article is to discuss and describe various measures of quality, quality indicators, and uses of information on quality with specific reference to the role or purpose of assisted living. A variety of major studies of assisted living quality were reviewed. These elaborated models of assisted living based on differing goals or claims made for it by providers and policy makers. The authors then searched for available quality measures that might indicate whether assisted living was meeting those goals or living up to those claims. Any meaningful concept of "quality" must embrace a variety of dimensions, including quality of care, quality of life, the physical environment, and resident rights. The ability to use a multidimensional concept of quality is complicated by the lack of consensus, confusion, and disagreement among consumers, providers, and regulators about the role of assisted living. This disagreement significantly confounds the task of comparing quality among assisted living settings and between assisted living and other types of long-term care. The authors propose ways that researchers may compare quality along dimensions claimed to be intrinsic to assisted living as part of an effort to inform consumer information systems, quality monitoring and assurance systems, and policy-relevant research. Such comparisons would vary, depending on the intended use of the indicators and role defined for assisted living. However, all uses contain structural, process, and outcome quality indicators, including direct feedback from interviews with residents that go beyond satisfaction measures.
Quality in long-term care homes for people with dementia: an assessment of specialist provision
- Authors:
- REILLY Siobahn, et al
- Journal article citation:
- Ageing and Society, 26(4), July 2006, pp.649-668.
- Publisher:
- Cambridge University Press
There has been debate for some years as to whether the best model of care for people with dementia emphasises specialist facilities or integrated service provision. Although the United Kingdom National Service Framework for Older People recommended that local authority social services departments encourage the development of specialist residential care for people with dementia, uncertainty continues as to the benefits of particular care regimes, partly because research evidence is limited. This paper examines a large number of ‘performance measures’ from long-term care facilities in North West England that have residents with dementia. Of the 287 in the survey, 56 per cent described themselves as specialist services for elderly people with mental ill-health problems (known familiarly as ‘EMI homes’). It was envisaged that EMI homes would score higher than non-EMI homes on several measures of service quality for people with dementia that were developed from research evidence and policy documents. The analysis, however, found that EMI homes performed better than non-EMI homes on only a few measures. While both home types achieved good results on some standards, on others both performed poorly. Overall, EMI and non-EMI homes offered a similar service.
Assuring the quality of long-term care insurance benefits through care management: the California Partnership for Long-term Care
- Authors:
- SCHLARBACH Andrew, DAL SANTO Teresa S., MILLS-DICK Kelly
- Journal article citation:
- Journal of Aging and Social Policy, 17(3), 2005, pp.61-83.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
Despite recent improvements in long-term care insurance (LTCI) policies, concerns have been raised regarding just how well LTCI benefits actually meet elderly consumers' health and financial needs. In this case study, we examined the quality assurance (QA) provisions in a state-sponsored LTCI program, the California Partnership for Long-Term Care (CPLTC). CPLTC invests the primary responsibility for QA with care management networks, which assure quality services through care monitoring, quarterly service record reviews, and annual documentation of care manager clinical competence. Study findings suggest a number of limitations in existing QA policies and procedures, which can undermine the ability of care managers and other third parties to identify and rectify potential unmet needs among LTCI policyholders. These findings, while based on an intensive analysis of QA provisions in a particular, state-sponsored LTCI program, are likely to have implications for other LTCI programs and policies, most of which have less well-developed QA provisions. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Care-as-service, care-as-relating, care-as-comfort: understanding nursing home residents' definitions of quality
- Authors:
- BOWERS Barbara J., FIBICH Barbara, JACOBSON Nora
- Journal article citation:
- Gerontologist, 41(4), August 2001, pp.539-545.
- Publisher:
- Oxford University Press
This study explored how nursing home residents in the USA define quality of care. Data were collected through in-depth interviews and were analysed using grounded dimensional analysis. Residents defined quality in three ways: (a) Care-as-service residents focused on instrumental aspects of care. They assessed quality using the parameters of efficiency, competence, and value. (b) Care-as-relating residents emphasised the affective aspects of care, defining quality as care that demonstrated friendship and allowed them to show reciprocity with their caregivers. (c) Care-as-comfort residents defined quality as care that allowed them to maintain their physical comfort, a state that required minute and often repetitive adjustments in response to their bodily cues. Residents' perceptions of care quality have implications for long-term care practice. The integration of these perceptions into quality assurance instruments could improve the usefulness of tools designed to obtain resident input.
Quality improvement and accreditation in long-term care: discussion paper arising from a joint workshop of the Research Unit of the Royal College of Physicians and RSAS AgeCare
- Authors:
- DICKINSON Edward, BROCKLEHURST John
- Publisher:
- Royal College of Physicians. Research Unit
- Publication year:
- 1998
- Pagination:
- 29p.
- Place of publication:
- London
Discussion document presenting the findings of a workshop looking at issues around quality and provision of long term care for older people.
Reimagining postdiagnostic care and support in young-onset dementia
- Authors:
- BAKKER Christian, VERBOOM Marjon, KOOPMANS Raymond T. C. M.
- Journal article citation:
- Journal of the American Medical Directors Association, 23(2), 2022, pp.261-265.
- Publisher:
- Elsevier (for the American Medical Directors Association)
Although dementia has a profound impact in general, young-onset dementia causes additional problems and challenges as people are affected in their prime years. Awareness has increased that people with young-onset dementia and their families have specific care needs and dedicated services are necessary to accommodate those needs. However, in many countries, age-appropriate care and support for people with young-onset dementia is still largely unavailable. In this special article, barriers as well as facilitators for the development of postdiagnostic care and support in young-onset dementia are addressed. Drawing from the experiences in the Netherlands, the establishment of an appropriate infrastructure has proven a corner stone in service development in young-onset dementia. The establishment of a centre at the national level for the development and dissemination of knowledge and affiliated regional centers that coordinate and offer care and support at the regional level has helped to reimagine, redefine, but more importantly also rearrange, postdiagnostic care and support in young-onset dementia in the Netherlands. This has resulted in care standards for service provision in young-onset dementia that have been incorporated in the dementia standard at the national level. Also, a quality hallmark has been developed to guide the arrangement of age-appropriate services at the local level. Moreover, specific training programs are in place for health care professionals involved in young-onset dementia. To be able to prioritize topics in research for the upcoming years, a scientific agenda has been established. The strong collaboration between organizations that provide a voice for people with dementia, care providers and research centers, that all strive to support people to live well with young-onset dementia has boosted these developments and may inspire other countries searching for ways to improve postdiagnostic care and support in young-onset dementia. (Edited publisher abstract)