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Commentary: COVID in care homes- challenges and dilemmas in healthcare delivery
- Journal article citation:
- Age and Ageing, 49(5), 2020, pp.701-705.
- Publisher:
- Oxford University Press
The COVID-19 pandemic has disproportionately affected care home residents internationally, with 19–72% of COVID-19 deaths occurring in care homes. COVID-19 presents atypically in care home residents and up to 56% of residents may test positive whilst pre-symptomatic. In this article, the authors provide a commentary on challenges and dilemmas identified in the response to COVID-19 for care homes and their residents. The authors highlight the low sensitivity of polymerase chain reaction testing and the difficulties this poses for blanket screening and isolation of residents. They discuss quarantine of residents and the potential harms associated with this. Personal protective equipment supply for care homes during the pandemic has been suboptimal and they suggest that better integration of procurement and supply is required. Advance care planning has been challenged by the pandemic and the authors say there is a need to for healthcare staff to provide support to care homes with this. Finally, the authors discuss measures to implement augmented care in care homes, including treatment with oxygen and subcutaneous fluids, and the frameworks which will be required if these are to be sustainable. The authors say that all of these challenges must be met by healthcare, social care and government agencies if care home residents and staff are to be physically and psychologically supported during this time of crisis for care homes. (Edited publisher abstract)
The quality of quality measurement in U.S. nursing homes
- Authors:
- MOR Vincent, et al
- Journal article citation:
- Gerontologist, 43(Special Issue II), April 2003, pp.37-46.
- Publisher:
- Oxford University Press
This article examines various technical challenges inherent in the design, implementation, and dissemination of health care quality performance measures. Using national and state-specific Minimum Data Set data from 1999, the authors examined sample size, measure stability, creation of ordinal ranks, and risk adjustment as applied to aggregated facility quality indicators. Nursing home Quality Indicators now in use are multidimensional and quarterly estimates of incidence-based measures can be relatively unstable, suggesting the need for some averaging of measures over time. Current public reports benchmarking nursing homes' performances may require additional technical modifications to avoid compromising the fairness of comparisons.
Elder care providers and Covid-19: cross-cultural perspectives
- Author:
- KIYOTA Emi
- Publisher:
- Global Ageing Network
- Publication year:
- 2021
- Pagination:
- 36
- Place of publication:
- Washington, DC
This study aims to understand whether existing emergency and infection control plans were effective; learn how elder care providers protected their residents from COVID-19; understand how elder care providers perceive the effectiveness of their countries’ policies and guidelines; identify key issues related to operations and workforce during a global pandemic; and explore innovative solutions and strategies for managing the spread of infection while maintaining quality of life for residents. Information included in this report comes from academics, policy makers, executive directors of elder care associations, and chief executive officers and chief operating officers of elder care organizations in 11 countries. Findings from interviews and content analysis are organised by 3 themes: emergency and infection control plans; immediate response; and policies and guidelines relating to COVID-19. The immediate response theme is further divided into 5 sub-themes: workforce issues, visitation protocols, testing, communication with health authorities, and the physical environment. Similarities and differences among the various responses and experiences are discussed, along with unique approaches employed by providers to meet pandemic-related challenges. The report finds that providers in all 11 countries had an infection control plan in place before the coronavirus pandemic began. However, none of these pandemic-related plans and strategies were adequate to help providers prepare properly for the COVID-19 outbreak, due to the virus’s high infection rate, the possibility of asymptomatic infection, the many early unknowns about COVID-19’s progression and treatment, and other unusual features of the virus that are still coming to light. (Edited publisher abstract)
Nursing home litigation and tort reform: a case for exceptionalism
- Authors:
- STUDDERT David M., STEVENSON David G.
- Journal article citation:
- Gerontologist, 44(5), October 2004, pp.588-595.
- Publisher:
- Oxford University Press
The medical malpractice crisis that is currently spreading across the United States bears many similarities to earlier crises. One novel aspect of the current crisis is the explicit inclusion of litigation against nursing homes as a target of reform. Encouraged by the nursing home industry, policymakers are considering the extension of conventional medical malpractice tort reforms to the nursing home sector. In this article, we caution against such an approach. Nursing home litigation has a number of distinctive features that raise serious questions about the wisdom of implementing reforms generically across the care continuum. Drawing on findings from our previous study of nursing home litigation, the authors outline these features and argue for careful attention to them as policymakers evaluate options for reform.
The nursing home problem in Florida
- Authors:
- POVLIKA Larry, et al
- Journal article citation:
- Gerontologist, 43(Special Issue II), April 2003, pp.7-18.
- Publisher:
- Oxford University Press
The nursing home problem in Florida was characterized as a debate over quality of care and the rapid increase of lawsuits against nursing homes that led to a decline in the availability of affordable liability insurance. The staff for Florida's Task Force on Availability and Affordability of Long-Term Care analyzed lawsuit and quality-of-care data from one county in Florida and quality-of-care data statewide to understand the relationship between the two sides of the argument. Analyses showed support for both positions and a middle-ground policy position was achieved. The subsequent nursing home reform legislation and implications for the future of long-term care in Florida are discussed.
Definition, measurement, and correlates of quality of life in nursing homes: toward a reasonable practice, research, and policy agenda
- Author:
- KANE Rosalie
- Journal article citation:
- Gerontologist, 43(Special Issue II), April 2003, pp.28-36.
- Publisher:
- Oxford University Press
This article identifies challenges in defining, measuring, and studying quality of life of nursing home residents. A theoretical analysis was conducted based on literature and the author's own large-scale studies of quality of life of nursing home residents. Measuring quality of life is a relatively low priority in nursing homes because of focus on markers of poor quality of care, pervasive sense that nursing homes are powerless to influence quality of life, and impatience with research among those dedicated to culture change. The research argues that the resident voice must be sought in reaching operational definitions for quality of life and as reporters on the quality of their own lives, and that resident burden is a spurious concern that should not deter direct interviews with residents. Five challenges in measuring quality of life were identified: designing questions with appropriate response categories and time frames, developing a sampling strategy, aggregating information at the individual and facility level, validating what are ultimately subjective constructs, and developing an approach using observations and proxies to assess quality of life for approximately the 40% of the residents who will be impossible to interview. Although residents' perceived quality of life is partly a product of their health, social supports, and personalities, nursing homes can directly influence quality of life through their polices, practices, and environments, and, indirectly, through their approaches to family and community. A research agenda is needed, which includes both methodological research and studies of the correlates of quality of life.
Who cares, who pays?
- Author:
- BURSTOW Paul
- Publisher:
- Liberal Democrats
- Publication year:
- 2002
- Pagination:
- 24p.
- Place of publication:
- London
Concerns how the sick and vulnerable are forced to sell their homes for care that should be free.
Towards continence: a discussion document about approaches to continence in homes for older people
- Author:
- CHESTER Rosie
- Publisher:
- Counsel and Care
- Publication year:
- 1998
- Pagination:
- 49p.,list of orgs.,bibliog.
- Place of publication:
- London
Study attempting to address some of the issues arising from the continence care of older people in residential and nursing homes, with the hope that it will contribute to opening up an issue in urgent need of discussion.
Paying for nursing in nursing homes
- Authors:
- AGE CONCERN ENGLAND, ROYAL COLLEGE OF NURSING
- Publishers:
- Age Concern, Royal College of Nursing
- Publication year:
- 1997
- Pagination:
- 17p.
- Place of publication:
- London
Presents a proposal for paying for nursing in nursing homes based on the idea of ensuring that people in nursing homes are not means-tested for nursing care. Instead it is suggested that nursing homes are given a single payment for all the nursing care they provide.
Regulating long term care: proposals for a single registered care home; a paper prepared for the Joseph Rowntree Foundation
- Authors:
- JOHNSON Malcolm, HOYES Lesley
- Publisher:
- University of Bristol. School for Policy Studies
- Publication year:
- 1996
- Pagination:
- 13p.
- Place of publication:
- Bristol
Puts forward the case for a single system of registration, replacing the current distinction between nursing and residential care homes.