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Improving outcomes for residents in care homes: evidence briefing
- Author:
- IMPROVEMENT ACADEMY
- Publisher:
- Improvement Academy
- Publication year:
- 2016
- Pagination:
- 4
- Place of publication:
- Bradford
An overview of the evidence around optimising care to care home residents - to improve their health and well-being and to reduce the need for unscheduled care. Key messages for providers of care in care home are: offer staff training regarding recognition of cognitive states including delirium, supporting meaningful activity, end of life care; have clear processes in place for access to healthcare; provide information regarding dementia diagnosis and prognosis; ensure advance care planning takes place; offer opportunities to take part in meaningful activity. In addition, the briefing suggests that commissioners of old peoples’ services should: support the delivery of Comprehensive Geriatric Assessment (CGA); ensure broad involvement of stakeholders including care home providers and patients or representatives to ensure services are tailored; ensure service specifications include interventions such as cognitive reframing; ensure services are available and coordinated in relation to end of life care; ensure stable leadership and clear strategy of overall system; use of specific models of care can have benefit; do not neglect long term population strategies to support healthy ageing and prevent increasing disease burden; support the development of relationships between care homes and service providers, and ensure clear lines of responsibility; commission targeted training for staff; ensure evaluation and monitoring is fed back for continuous improvement. (Edited publisher abstract)
Determinants and effects of nurse staffing intensity and skill mix in residential care/assisted living settings
- Authors:
- STEARNS Sally C., et al
- Journal article citation:
- Gerontologist, 47(5), October 2007, pp.662-671.
- Publisher:
- Oxford University Press
Residential care/assisted living facilities have become an alternative to nursing homes for many individuals, yet little information exists about staffing in these settings and the effect of staffing. This study analyzed the intensity and skill mix of nursing staff using data from a four-state study, and their relationship to outcomes. The study used longitudinal data for 1,894 residents of 170 residential care/assisted living facilities participating in the Collaborative Studies of Long-Term Care. Descriptive statistics assessed the levels of direct care staff (registered nurse, licensed practical nurse, personal care aide). Regression analyses evaluated the relationship between two staffing measures (intensity measured as care hours per resident and skill mix measured as the percentage of total care hours by licensed nurses), facility characteristics, and four health outcomes (mortality, nursing home transfer, hospitalization, and incident morbidity). Care hours per resident decreased with facility size (economies of scale) only for very small facilities and increased with dementia prevalence (case-mix effect). Licensed staff accounted for a greater proportion of total hours in nonprofit settings. Health outcomes did not vary by total care hours per resident, but hospitalization rates were significantly lower in facilities with higher proportions of skilled staff hours; this effect was stronger as dementia case mix increased. Current staffing levels for the outcomes analyzed meet most residents' needs. Reduced hospitalization in relation to greater use of licensed staff suggests that increased use of these workers might result in reductions in acute care expenditures.
The adverse effects of the COVID-19 pandemic on nursing home resident well-being
- Authors:
- LEVERE Michael, ROWAN Patricia, WYSOCKI Andrea
- Journal article citation:
- Journal of the American Medical Directors Association, 22(5), 2021, pp.948-954.e2.
- Publisher:
- Elsevier (for the American Medical Directors Association)
Objective: Quantify the effects of the COVID-19 pandemic on nursing home resident well-being. Design: Quantitative analysis of resident-level assessment data. Setting and participants: Long-stay residents living in Connecticut nursing homes. Methods: this study used Minimum Data Set assessments to measure nursing home resident outcomes observed in each week between March and July 2020 for long-stay residents (eg, those in the nursing home for at least 100 days) who lived in a nursing home at the beginning of the pandemic. This study compared outcomes to those observed at the beginning of the pandemic, controlling for both resident characteristics and patterns for outcomes observed in 2017-2019. Results: This study found that nursing home resident outcomes worsened on a broad array of measures. The prevalence of depressive symptoms increased by 6 percentage points relative to before the pandemic in the beginning of March - representing a 15% increase. The share of residents with unplanned substantial weight loss also increased by 6 percentage points relative to the beginning of March—representing a 150% increase. This study also found significant increases in episodes of incontinence (4 percentage points) and significant reductions in cognitive functioning. The findings suggest that loneliness and isolation play an important role. Though unplanned substantial weight loss was greatest for those who contracted COVID-19 (about 10% of residents observed in each week), residents who did not contract COVID-19 also physically deteriorated (about 7.5% of residents in each week). Conclusions and Implications: These analyses show that the pandemic had substantial impacts on nursing home residents beyond what can be quantified by cases and deaths, adversely affecting the physical and emotional well-being of residents. Future policy changes to limit the spread of COVID-19 or other infectious disease outbreaks should consider any additional costs beyond the direct effects of morbidity and mortality due to COVID-19. (Edited publisher abstract)
The adverse effects of the COVID-19 pandemic on nursing home resident well-being
- Authors:
- LEVERE Michael, ROWAN Patricia, WYSOCKI Andrea
- Journal article citation:
- Journal of the American Medical Directors Association, early cite March 2021,
- Publisher:
- Elsevier (for the American Medical Directors Association)
Objective: Quantify the effects of the COVID-19 pandemic on nursing home resident well-being. Design: Quantitative analysis of resident-level assessment data Setting and participants: Long-stay residents living in Connecticut nursing homes Methods: This study used Minimum Data Set assessments to measure nursing home resident outcomes observed in each week between March and July 2020 for long-stay residents (e.g., those in the nursing home for at least 100 days) who lived in a nursing home at the beginning of the pandemic. This study compared outcomes to those observed at the beginning of the pandemic, controlling for both resident characteristics and patterns for outcomes observed in 2017 to 2019. Results: this study found that nursing home resident outcomes worsened on a broad array of measures. The prevalence of depressive symptoms increased by 6 percentage points relative to before the pandemic in the beginning of March - representing a 15 percent increase. The share of residents with unplanned substantial weight loss also increased by 6 percentage points relative to the beginning of March - representing a 150 percent increase. This study also found significant increases in episodes of incontinence (4 percentage points) and significant reductions in cognitive functioning. Our findings suggest that loneliness and isolation play an important role. Though unplanned substantial weight loss was greatest for those who contracted COVID-19 (about 10 percent of residents observed in each week), residents who did not contract COVID-19 also physically deteriorated (about 7.5 percent of residents in each week). Conclusions and implications: These analyses show that the pandemic had substantial impacts on nursing home residents beyond what can be quantified by cases and deaths, adversely affecting the physical and emotional well-being of residents. Future policy changes to limit the spread of COVID-19 or other infectious disease outbreaks should consider any additional costs beyond the direct effects of morbidity and mortality due to COVID-19. (Edited publisher abstract)
Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity
- Authors:
- SCHREINER A. S., YAMANOTO E., SHOTANI H.
- Journal article citation:
- Aging and Mental Health, 9(2), March 2005, pp.129-134.
- Publisher:
- Taylor and Francis
The experience of positive emotions is an integral component of quality of life. Research suggests that cognitive deficits in persons with dementia may impede their ability to generate pleasurable moments and hence decrease their positive affect. Therefore, structured recreation activities may have the potential to significantly improve resident affect. However, differences in affect between ordinary time and recreation time are not well known. The present study used previously published structured-observation instruments to measure affect and behaviour among 35 dementia residents at two nursing homes in Japan during ordinary time and during recreation time. A total of 3,854 one-minute observations were coded. Dementia residents expressed happiness over seven times more often during recreation time than during ordinary time. Over 60% of ordinary time was solitary, with 65.72% of all observed affect being ‘Null Affect'. A total of 43.75% of residents expressed happiness only during recreation time. In addition 48.9% of all behaviour during ‘Ordinary Time' was coded as ‘Null Behaviour', which indicated that the resident was sitting and doing nothing. Findings indicate that recreation time is significantly higher in positive affect than ordinary time and that virtually all residents benefited from recreation.
A scoping review: characteristics and outcomes of residents who experience involuntary relocation
- Authors:
- WEAVER Raven H., ROBERTO Karen A., BROSSOIE Nancy
- Journal article citation:
- Gerontologist, 60(1), 2020, pp.e20-e37.
- Publisher:
- Oxford University Press
Background and Objectives: Relocation to a residential care facility has been described as the most significant relocation affecting older adults, yet subsequent relocations, like in the case of a facility closure, have received minimal attention in the scholarly research literature. This paper reviews the published literature on involuntary relocation, focusing on the experiences of residents, families, and staff and the effects of involuntary relocation on nursing home residents’ health. Research Design and Methods: A scoping review was conducted to identify peer-reviewed studies reporting on involuntary relocation of nursing home residents. A total of 28 quantitative, qualitative, and mixed-method articles met inclusion criteria. Results: Researchers mostly relied on longitudinal designs and quantitative indicators of functional health, cognitive status, psychological and emotional well-being, environment, and relocation context to examine residents’ mortality risk and health outcomes associated with involuntary relocation. Inclusion of qualitative and mixed-method approaches was infrequent, as were indicators of social engagement and perceptions of relocation. Residents’ awareness of and preparation for involuntary relocation positively influenced their health and well-being. Family involvement was frequently hindered by communication challenges with facilities. Staff expressed concern about residents, experienced increased workload demands, and acknowledged challenges with planning and communication. Discussion and Implications: Based on the collective findings, the authors propose a conceptual model of critical factors at play during relocation for consideration for guiding future research and developing provisions to current policies guiding relocation processes. Facilities and policymakers need to consider procedures that enhance planning efforts and decision-making among this vulnerable population and their families. (Edited publisher abstract)
Using ASCOT to improve care practice
- Author:
- UNIVERSITY OF KENT. Personal Social Services Research Unit
- Publisher:
- NIHR School for Social Care Research
- Publication year:
- 2015
- Pagination:
- 3
- Place of publication:
- London
Reports on research to explore the use of the Adult Social Care Outcomes Toolkit (ASCOT) to assess the social care-related quality of life (SCRQoL) of residents in care homes and to examine whether the information collected could be used to provide feedback to staff and managers in those homes in order to improve practice. The research team measured the SCRQoL of 58 residents in four homes for older adults through observations and SCRQoL interviews with residents, family members and staff. Using ASCOT data, which measures quality of life in eight domains, the research team provided staff and management with feedback on the areas where residents have a good quality of life and why, the impact of care and support delivered, and areas of improvement. Staff and managers said they were able to use this to make changes to practice that would hopefully improve residents’ lives. Despite some changes to practice being make, no direct improvements in SCRQoL were identified in the homes when ASCOT assessments were repeated three months after giving the feedback. Possible reasons for this were the natural decline in residents' health and that three months may not be enough for changes to have taken effect. The study concluded that there may be scope to use ASCOT as a tool to improve practice if the feedback relates directly to individual residents and can then be used to improve their care. (Edited publisher abstract)
CQC: how to achieve outcome 5
- Author:
- -
- Journal article citation:
- Nursing and Residential Care, 14(1), January 2012, pp.36-38.
- Publisher:
- MA Healthcare Ltd.
- Place of publication:
- London
Outcome 5 of the Care Quality Commission essential quality and safety standards covers meeting the nutritional needs of residents. This is dependent on care workers knowing how to produced food that is nutritious and meets diverse needs. This article provides advice on how managers can ensure they meet these standards. It covers relevant policy and procedures, nutritional screening, care plans, training, artificial hydration and nutrition and how to ensure that best interest legislation is followed for those lacking mental capacity to make their own decisions. A listing of the 10 characteristics of good nutritional care is also included.
Determining the efficacy of Dementia Care Mapping as an outcome measure and a process for change: a pilot study
- Author:
- CHENOWETH Lynn
- Journal article citation:
- Aging and Mental Health, 11(3), May 2007, pp.237-245.
- Publisher:
- Taylor and Francis
Dementia Care Mapping (DCM) is increasingly being promoted world-wide as a useful approach in assisting staff to improve the well-being of residents with dementia. While DCM is employed as an outcome measure of well-being and as a process to assist staff improve quality of care, it has not been subject to the rigorous scrutiny of a controlled trial to establish its efficacy as an outcome measure, or as an intervention. This paper reports on a pilot study conducted with 35 dementia care residents in three secure residential care units in the state of New South Wales, Australia, prior to a larger randomised control trial. The main aims of the pilot were to determine the sensitivity of DCM against the validated baseline and outcome measures selected for the trial and to evaluate the utility of the research plan. The utility of the research plan was established. Whilst a significant improvement was shown in staff interactions with residents over time, there was no evidence that DCM improved the residents' quality of life and well-being in relation to physical and cognitive functioning, although there was a reduction in the residents' levels of agitation and depression. While as a research tool DCM needs further refinement to match the strength of validated outcome measures that more accurately assess the residents' well-being, DCM procedures improved staff's attention to monitoring and attending to the residents' well-being.
The Friendly Companion Programme
- Author:
- GOLDMAN Lisa Marmor
- Journal article citation:
- Journal of Gerontological Social Work, 40(1/2), 2002, pp.123-133.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The Friendly Companion Programme was initiated in May of 1999 to enhance social support for VAMC Northport Nursing Home residents who have infrequent or no visitation by family, friends, or significant others. Friendly Companions are adult and youth volunteers who make a commitment to visit residents on a regular basis. The resulting relationship appears to stimulate increased social interaction and maximize quality of life for nursing home residents. The programme is considered part of the overall patient clinical care with multi-disciplinary involvement for volunteer training, patient referral, and evaluation by staff and patients. Social Work Performance Improvement measures and outcomes are discussed. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)