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Associations of special care units and outcomes of residents with dementia: 2004 national nursing home survey
- Authors:
- LUO Huabin, et al
- Journal article citation:
- Gerontologist, 50(4), August 2010, pp.509-518.
- Publisher:
- Oxford University Press
This study examined the rates of specialised care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and explored the associations of SCU residence with process of care and resident outcomes. The indicators of process of care included physical restraints, continence management, feeding tubes, and influenza and pneumococcal vaccinations. Resident outcomes included pressure ulcers, hospitalisation, emergency room visits, weight loss, and falls. Findings revealed that SCU residents were more likely to have received specialised dementia care and specialised behavioural problem management. They were less likely to have bed rails, use catheters, and yet more likely to have toilet plans/bladder training for incontinence control than those in regular units and those in NHs without an SCU. Also, SCU residents were less likely to have: pressure ulcers; hospitalisation; experienced weight loss. However, they were more likely to have falls than those in regular units and those in NHs without an SCU. The results showed that SCU residents had, in general, better process of care than those in regular units and in NHs without an SCU.
Improving communication between hospitals and care homes: the development of a daily living plan for older people
- Authors:
- REED Jan, STANLEY David
- Journal article citation:
- Health and Social Care in the Community, 11(4), July 2003, pp.356-363.
- Publisher:
- Wiley
Describes a practice development project that produced a user-led daily living plan, developed in partnership with older people and staff from health and social care settings and designed to facilitate communication of the daily living preferences of older people, ensuring that continuity of care and support could be maintained and their future care planned on an individualised basis when they move from hospital to a care home. In developing and implementing the plan more effective person-centred communication between hospitals and care homes was achieved, and some of the hospital staff's ideas about care homes changed.
Community and residential care in Devon: a follow up to the "Choice with Care" study of 100 care management referrals; report to Devon Social Services
- Authors:
- LANKSHEAR Gloria, GIARCHI G.G
- Publisher:
- University of Plymouth. Faculty of Human Sciences. Community Research Centre
- Publication year:
- 1994
- Pagination:
- 84p.,tables.
- Place of publication:
- Plymouth
Research study following up 100 care management referrals (50 resulting in nursing or residential home referrals, 50 resulting in people choosing to remain in their own homes) 6 months after the original assessments.
‘If they don't use it, they lose it’: how organisational structures and practices shape residents’ physical movement in care home settings
- Authors:
- HAWKINS Rebecca J., et al
- Journal article citation:
- Ageing and Society, 38(9), 2018, pp.1817-1842.
- Publisher:
- Cambridge University Press
Older people living in long-term facilities (nursing and residential homes providing 24-hour care) spend the majority of their time inactive, despite the known health and wellbeing benefits of physical activity and reduced time spent sedentary. In order to successfully embed interventions that aim to increase physical activity or reduce sedentary behaviour, it is necessary to understand the features of the care environment that influence residents’ routine patterns of movement. Drawing on an organisational perspective, this paper explores the structures and mechanisms that shaped different care practices concerning residents’ movement in two contrasting care homes in the north of England. This study adopted an ethnographic approach, using a combination of qualitative observations, informal conversations and interviews. A grounded theory approach to data analysis was adopted. The findings illustrate the importance of translating espoused values of care into tangible and acceptable care practices, systems of management, staff training and development, and the use of care planning in residents’ routine patterns of movement. Understanding how organisational factors shape routine movement among care home residents will help inform the development of embedded and sustainable interventions that enhance physical activity and reduce sedentary behaviour. This study is part of a wider programme of research developing and testing a complex intervention, embedded within routine care, to reduce sedentary behaviour among care home residents. (Edited publisher abstract)
Improving nursing home quality of care through outcomes data: the MDS quality indicators
- Author:
- ZIMMERMAN David R.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(3), March 2003, pp.250-257.
- Publisher:
- Wiley
The quality of care provided to nursing home residents is a continuing source of concern throughout the world. In the United States, the Health Care Financing Administration mandated the use of a standardised resident assessment instrument, called the Minimum Data Set (MDS) which facilitated the development of a set of nursing home quality of care indicators. The MDS Quality Indicators were developed by a team of researchers and covered 12 domains, as well as associated risk factors. This initial set of indicators then went through an iterative process of review by national clinical panels, further empirical analysis, validation studies, and pilot tests, to confirm whether they were accurate, reliable and useful tools for identifying quality problems. The final set of MDS Quality Indicators includes 24 variables that include both processes and outcomes of care and prevalence and incidence measures. They are defined at both the resident and facility level. Four of the indicators are risk-adjusted. The indicators have several possible applications: a source of consumer information; to help guide policy makers; and to assist providers in conducting quality improvement initiatives and to evaluate the impact of these efforts.
The development of a national standard assessment instrument for use in continuing care homes
- Authors:
- CHALLIS David, et al
- Journal article citation:
- Working with Older People, 3(2), April 1999, pp.24-26.
- Publisher:
- Emerald
Following a focused training programme in eight homes, staff using a modified American Minimum Data Set/Resident Assessment Instrument carried out 125 assessments. The pilot study found that the MDS/RAI has potential to be used in continuing care homes in the UK. Reports on a study to examine the possibility of developing a standard assessment instrument for residents in care homes, which could assess individual care needs, assist in constructing care plans and provide appropriate information to permit costing the level of care provided.
Two models of managed long-term care: comparing PACE with a Medicaid-only plan
- Author:
- NADASH Pamela
- Journal article citation:
- Gerontologist, 44(5), October 2004, pp.644-654.
- Publisher:
- Oxford University Press
In this study an attempt is made to understand how a Medicaid-only managed long-term-care (MMLTC) plan for elders differs from the Program of All-Inclusive Care for the Elderly (PACE), a fully integrated model, in terms of structure, operations, patient population, and service utilization. With the use of information from the Outcome and Assessment Information Set and administrative data from a MMLTC plan in New York City, enrollees were compared at the start of care and their first-year service utilization with PACE, using the PACE national data set. The plans differ in the range of services covered and in the larger number of members served by the MMLTC plan. The served populations differ in their sociodemographic profiles and have levels of functional need that are high, but they also differ in their relative severity of dependency in activities of daily living and instrumental activities of daily living. During the first year of enrollment, the utilization of traditional home- and community-based services was higher in PACE than in the MMLTC plan, although MMLTC plan members received much more care in the home. Total hospital utilization was lower in PACE, but nursing home utilization was higher. MMLTC is a feasible option for serving a population whose level of impairment is similar to that of PACE. Whereas PACE's reliance on adult day centers is seemingly associated with a stronger medical focus and lower hospital use, the MMLTC plan's emphasis on home-based personal care seems to be linked with lower nursing home use.
People with preserved rights: a socially excluded minority
- Author:
- LAING William
- Publisher:
- Joseph Rowntree Foundation,|York Publishing Services
- Publication year:
- 2000
- Pagination:
- 33p.
- Place of publication:
- York
This study assesses different policy options to address the anomalous position of care homes residents with ‘preserved rights’. By August 1999, there were still some 64,000 care home residents whose only source of state funding was ‘preserved rights’ Income Support. The main brunt of financial disadvantage is borne by older claimants and their families in the more affluent parts of the country, where Income Support limits are insufficient to meet typical market fee rates. In addition, claimants of all ages are excluded from non-financial support and advocacy offered by social services departments under the community care reforms, which have passed preserved rights residents by. The author concludes that the best option is to abolish the preserved rights regime and transfer funding and care management for claimants to local authorities. The research shows that the cost to the state of meeting fee shortfalls would be small. The largest impact would be the extra cost to local authorities of purchasing and care management arrangements.
Financial abuse and charging for care: the views of social work and legal professionals
- Author:
- PENHALE Bridget
- Journal article citation:
- Journal of Adult Protection, 5(2), May 2003, pp.11-20.
- Publisher:
- Emerald
Draws on findings from a study examining attitudes, practices and policy in relation to charging and assessing older people who were considering entering residential and nursing home care. A mixture of quantitative and qualitative methods were used, and professionals in five local authorities were contacted. Out of a sample of 323 care mangers who were approached in the postal survey, 177 questionnaires were returned. A total of 64 people were also interviewed. The article focuses on exploring the views of care managers and legal practitioners towards their work in relation to older people, finances and charging for long-term care. Although the study did not set out to examine financial abuse, the topic arose within the findings. However, despite increased awareness of abuse on the part of practitioners the study also found evidence of a lack of clarity concerning intervention and best practice.
Benchmarking and quality in residential and nursing homes: lessons from the US
- Authors:
- MOR Vincent, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(3), March 2003, pp.258-266.
- Publisher:
- Wiley
Performance measurement and benchmarking are common concerns in the delivery of long term care. It is common to measure the performance of providers and to publicly report these data. This paper examines selected technical challenges facing those who design, implement and disseminate health care quality performance measures. The article reviews the application of measures of performance in the US nursing home sector. Using examples drawn from the skilled nursing home arena, problems ranging from data reliability and validity, the multi-dimensional nature of quality measures and selection bias as well as differential measurement abilities are discussed. Benchmarking of performance is an inherently complex issue. However, to ensure that such comparisons are both fair and valid requires measures to be more technically sophisticated and sensitive to real changes attributable to changes in care.