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Halifax E, Harrington C. Proposed Minimum Nurse Staffing Levels in Nursing Homes. Policy Polit Nurs Pract 2024; 25:67-69. [PMID: 38587362 DOI: 10.1177/15271544241237653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Elizabeth Halifax
- Department of Social & Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Charlene Harrington
- Department of Social & Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
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Dong S, Jutkowitz E, Giardina J, Bilinski A. Screening Strategies to Reduce COVID-19 Mortality in Nursing Homes. JAMA Health Forum 2024; 5:e240688. [PMID: 38669030 PMCID: PMC11065177 DOI: 10.1001/jamahealthforum.2024.0688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/03/2024] [Indexed: 05/01/2024] Open
Abstract
Importance Nursing home residents continue to bear a disproportionate share of COVID-19 morbidity and mortality, accounting for 9% of all US COVID-19 deaths in 2023, despite comprising only 0.4% of the population. Objective To evaluate the cost-effectiveness of screening strategies in reducing COVID-19 mortality in nursing homes. Design and Setting An agent-based model was developed to simulate SARS-CoV-2 transmission in the nursing home setting. Parameters were determined using SARS-CoV-2 virus data and COVID-19 data from the Centers for Medicare & Medicaid Services and US Centers for Disease Control and Prevention that were published between 2020 and 2023, as well as data on nursing homes published between 2010 and 2023. The model used in this study simulated interactions and SARS-CoV-2 transmission between residents, staff, and visitors in a nursing home setting. The population used in the simulation model was based on the size of the average US nursing home and recommended staffing levels, with 90 residents, 90 visitors (1 per resident), and 83 nursing staff members. Exposure Screening frequency (none, weekly, and twice weekly) was varied over 30 days against varying levels of COVID-19 community incidence, booster uptake, and antiviral use. Main Outcomes and Measures The main outcomes were SARS-CoV-2 infections, detected cases per 1000 tests, and incremental cost of screening per life-year gained. Results Nursing home interactions were modeled between 90 residents, 90 visitors, and 83 nursing staff over 30 days, completing 4000 to 8000 simulations per parameter combination. The incremental cost-effectiveness ratios of weekly and twice-weekly screening were less than $150 000 per resident life-year with moderate (50 cases per 100 000) and high (100 cases per 100 000) COVID-19 community incidence across low-booster uptake and high-booster uptake levels. When COVID-19 antiviral use reached 100%, screening incremental cost-effectiveness ratios increased to more than $150 000 per life-year when booster uptake was low and community incidence was high. Conclusions and Relevance The results of this cost-effectiveness analysis suggest that screening may be effective for reducing COVID-19 mortality in nursing homes when COVID-19 community incidence is high and/or booster uptake is low. Nursing home administrators can use these findings to guide planning in the context of widely varying levels of SARS-CoV-2 transmission and intervention measures across the US.
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Affiliation(s)
- Shirley Dong
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
- Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island
| | - John Giardina
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Alyssa Bilinski
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
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Harrington C, Mollot R, Braun RT, Williams D. United States' Nursing Home Finances: Spending, Profitability, and Capital Structure. Int J Soc Determinants Health Health Serv 2024; 54:131-142. [PMID: 38115716 PMCID: PMC10955796 DOI: 10.1177/27551938231221509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
Little is known about nursing home (NH) financial status in the United States even though most NH care is publicly funded. To address this gap, this descriptive study used 2019 Medicare cost reports to examine NH revenues, expenditures, net income, related-party expenses, expense categories, and capital structure. After a cleaning process for all free-standing NHs, a study population of 11,752 NHs was examined. NHs had total net revenues of US$126 billion and a profit of US$730 million (0.58%) in 2019. When US$6.4 billion in disallowed costs and US$3.9 billion in non-cash depreciation expenses were excluded, the profit margin was 8.84 percent. About 77 percent of NHs reported US$11 billion in payments to related-party organizations (9.54% of net revenues). Overall spending for direct care was 66 percent of net revenues, including 27 percent on nursing, in contrast to 34 percent spent on administration, capital, other, and profits. Finally, NHs had long-term debts that outweighed their total available financing. The study shows the value of analyzing cost reports. It indicates the need to ensure greater accuracy and completeness of cost reports, financial transparency, and accountability for government funding, with implications for policy changes to improve rate setting and spending limits.
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Affiliation(s)
- Charlene Harrington
- Department of Social & Behavioral Sciences, University of California, San Francisco, CA, USA
| | | | | | - Dunc Williams
- Department of Health Care Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Bhattacharyya KK, Peterson L, Molinari V, Fauth EB, Andel R. The Importance of Zero-Deficiency Complaints in Nursing Homes: A Mere Consequence or Serious Concern? J Appl Gerontol 2024:7334648241229548. [PMID: 38290528 DOI: 10.1177/07334648241229548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Complaints represent an important metric for assessing the quality of nursing home (NH) care. Using the Automated Survey Processing Environment (ASPEN) Complaints/Incidents Tracking System dataset (2017), we examined the relationships between zero-deficiency complaints (ZDCs) and zero-deficiency substantiated complaints (ZDSCs) and the proportion of residents with dementia. NHs (N = 15,339) were separated into three groups-proportion of residents with dementia in the top, two middle, and the bottom quartiles. Negative binomial regressions assessed zero-deficiency complaint patterns in relation to NHs' proportion of residents with dementia, controlling for facility characteristics, staffing, and racial pattern. We reported average marginal effects (AMEs) and 95% confidence intervals (CIs). NHs in the top quartile yielded higher numbers of both ZDC (AME = .189, 95% CI: .102-.276, p < .001) and ZDSC (AME = .236, 95% CI: .094-.378, p = .001), than NHs in the bottom quartile. Results suggest a need for more uniform investigation processes and staff training to promote a more valid complaint process for residents with dementia.
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Affiliation(s)
| | | | | | | | - Ross Andel
- Arizona State University, Phoenix, AZ, USA
- St Anne's University Hospital, Brno, Czech Republic
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Jun H, Grabowski DC. Nursing Home Staffing: Share Of Immigrant Certified Nursing Assistants Grew As US-Born Staff Numbers Fell, 2010-21. Health Aff (Millwood) 2024; 43:108-117. [PMID: 38190591 PMCID: PMC10824124 DOI: 10.1377/hlthaff.2023.00881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Nursing homes have long faced a shortage of direct care workers, a problem that was magnified during the COVID-19 pandemic. Using nationally representative data from three sources, we found that much of the certified nursing assistant (CNA) workforce in US nursing homes is filled by immigrant labor. The number of native-born CNAs has been declining rapidly since the mid-2010s, whereas the number of foreign-born CNAs has remained relatively constant. During the first two years of the COVID-19 pandemic, the share of immigrant CNAs employed by nursing homes surged, which can be explained by a simultaneous drop in the share of native-born staff. Staffing shortages observed during the pandemic would have been worse if not for foreign-born CNAs remaining in the workforce. However, the share of foreign-born CNAs varied considerably across states, from less than 1 percent in West Virginia to more than 70 percent in Hawaii. In an analysis of prepandemic data, we found that nursing homes in regions with a higher share of immigrant CNAs were associated with more direct care staff hours per resident day and better nursing home quality performance. With the growing demand for long-term care, creating pathways for job-seeking immigrants to fill the gaps in direct care will be crucial to meeting future staffing needs.
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Affiliation(s)
- Hankyung Jun
- Hankyung Jun , Harvard University, Boston, Massachusetts
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Tomas N, Mandume AM. Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study. Nurs Open 2024; 11:e2079. [PMID: 38268250 PMCID: PMC10782216 DOI: 10.1002/nop2.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIM The aim of the study was to explore nurses' barriers to the pressure ulcer risk assessment scales implementation. DESIGN A qualitative descriptive phenomenological study. METHODS The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi's 7-step method. RESULTS The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses' utilization of the scales. CONCLUSION The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.
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Affiliation(s)
- Nestor Tomas
- Department of General Nursing Science, School of Nursing and Publish Health, Faculty of Health Sciences and Veterinary MedicineUniversity of Namibia (UNAM)RunduNamibia
| | - Annalisa M. Mandume
- Department of General Nursing Science, School of Nursing, Faculty of Health Sciences and Veterinary MedicineUniversity of Namibia (UNAM)RunduNamibia
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Kang YJ, Mueller CA, Gaugler JE, Mathiason Moore MA, Monsen KA. Toward ensuring care quality and safety across settings: examining time pressure in a nursing home with observational time motion study metrics based on the Omaha system. J Am Med Inform Assoc 2023; 30:1837-1845. [PMID: 37352394 PMCID: PMC10586029 DOI: 10.1093/jamia/ocad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Meaningful data to determine safe and efficient nursing workload are needed. Reasoning a nurse can accomplish a finite number of interventions and location changes per hour, examination of time pressure using time motion study (TMS) methods will provide a comparable indication of safe and efficient workload for an individual nurse. METHODS An observer shadowed 11 nurses at a 250-bed nursing home in the Southeastern United States and recorded 160 h of observations using TimeCaT, web-based TMS data recording software. Predefined Omaha System nursing interventions (N = 57) and locations (N = 8) were embedded within TimeCaT. The time-stamped data were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. Five time pressure metrics were derived from previous TMS findings in acute care settings. RESULTS Overall, nurses spent 66 s for each intervention, performed 65 interventions per hour, stayed 130 s at each location, changed locations 28 times per hour, and multitasked for 29% of working time. Computed hourly time pressure metrics enabled visualization of variability in time pressure metrics over time, with differences in multitasking by licensure, unit/role, and observation session time. CONCLUSIONS Nursing home nurses consistently experienced a high degree of time pressure, especially multitasking for one-third of their working time. To inform staffing decision making and improve the quality of care, resident outcomes, and nurse satisfaction, it is critical to identify ways to mitigate time pressure. Additional research is needed to refine and extend the use of the time pressure metrics.
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Affiliation(s)
- Yu Jin Kang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | | | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Karen A Monsen
- School of Nursing, University of Minnesota, Twin Cities, Minnesota, USA
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Kunkle R, Chaperon C, Popejoy LL, Struwe L, Wengel S, Berger AM. Understanding Formal Caregiver Burden in Nursing Assistants in Nursing Homes: A Mixed Methods Approach. Res Gerontol Nurs 2023; 16:231-240. [PMID: 37450780 DOI: 10.3928/19404921-20230706-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The current study aimed to describe formal caregiver burden of nursing assistants in nursing homes. A descriptive, cross-sectional, convergent mixed methods approach identified attributes of formal caregiver burden using phenomenological interviews and established self-report measures. Themes included nursing assistants' experiences of stress, close relationships, extensive assistance of residents, balancing needs and routines, and feeling accomplished. Self-report measures demonstrated moderate stress, moderate caring behaviors, responsibility, and competence. MDS 3.0 results showed moderate cognitive impairment, minimal depressive symptoms, and decreased functional status of residents. The mixed methods synthesis confirmed the presence of five attributes of formal caregiver burden: perceived stress, caring for another, dependency of the older adult, responsibility, and competence. Burnout was not confirmed. Future investigation of attributes among a larger, diverse sample of nursing assistants, residents, and nursing homes will advance knowledge and inform research design and methods of interventions. [Research in Gerontological Nursing, 16(5), 231-240.].
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Cho E, Min D, Heo SJ, Lee K, Kim H. Effects of registered nurses' staffing levels, work environment and education levels on nursing home residents' quality of life and nurse outcomes. J Clin Nurs 2023; 32:6494-6503. [PMID: 36932041 DOI: 10.1111/jocn.16689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/23/2022] [Accepted: 02/20/2023] [Indexed: 03/19/2023]
Abstract
AIMS AND OBJECTIVES To examine the effects of registered nurse staffing levels, work environment and education levels on the residents' quality of life and nurses' job dissatisfaction, burnout and turnover intention. BACKGROUND Registered nurse staffing status and work environment are suboptimal in nursing homes worldwide. Nursing home care aims to maximise residents' quality of life. However, evidence on the impact of registered nurse staffing levels, work environment and education levels on the residents' quality of life and nurse outcomes in nursing homes is limited. DESIGN This is a cross-sectional observational study. METHODS A total of 513 residents and 117 registered nurses from 39 nursing homes in South Korea participated in surveys. The main measures included registered nurses' staffing levels, work environment, education levels, residents' quality of life, registered nurses' job dissatisfaction, burnout and turnover intention. We analysed data using the generalised estimating equations and reported the study using the STROBE checklist. RESULTS Overall, the residents' quality-of-life score was 13.7 ± 2.6 (out of 17). Residents in nursing homes with a higher number of registered nurses or with work environment evaluated as 'mixed' or 'better' (compared with 'poor') had a higher quality of life. Regarding nurse outcomes, 74.4% of the registered nurses were dissatisfied with their current jobs, 12.0% had burnout and 18.8% had a turnover intention. Registered nurses working in 'mixed' or 'better' work environment were less likely to have job dissatisfaction. Registered nurses' education levels did not have a statistically significant effect on the resident and nurse outcomes. CONCLUSIONS Registered nurse staffing levels and work environment should be considered important for improving residents' quality of life and nurses' job satisfaction. RELEVANCE TO CLINICAL PRACTICE Regulation and policy reforms are needed to increase the registered nurse staffing levels and to create a good work environment in nursing homes. PATIENT OR PUBLIC CONTRIBUTION Nursing home residents and registered nurses participated in the surveys of this study. Registered nurses facilitated resident recruitment by identifying and introducing the study to residents who were eligible for study participation. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Eunhee Cho
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Korea
| | - Seok-Jae Heo
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Korea
| | - Kyoungeun Lee
- Department of Nursing, Tongmyong University, Busan, Korea
| | - Hyejin Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Affiliation(s)
| | - Vivian Ewa
- Department of Family Medicine, University of Calgary, Alberta, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Nova Scotia, Canada
| | - Sharon E Straus
- KT Program, Li Ka Shing Knowledge Institute, St Michael's Hospital-Unity Health Toronto, Toronto, Ontario Canada
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Choi S, Lee J. Factors Influencing RNs' Intention to Stay in Nursing Homes: Multilevel Modeling Approach. J Gerontol Nurs 2023; 49:40-48. [PMID: 37379045 DOI: 10.3928/00989134-20230616-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
The current study investigated factors that influence the intention to stay (ITS) of RNs working in South Korean nursing homes (NHs). Thirty-six questionnaire responses from organizational NHs and 101 from individual RNs were analyzed using multilevel regression analysis. At the individual level, RNs' ITS increased with years of work at their current NH, and that of RNs who received emergency calls to work at night was lower than that of RNs with fixed night shifts. At the organizational level, ITS was higher when the ratios of RNs to residents and RNs to nursing staff were higher. To improve ITS, NHs should consider adopting mandatory deployment of RNs, increasing their RN to resident ratios, and implementing a fixed night shift RN system, wherein night shift working hours count as twice the daytime hours, and night shift is voluntary. [Journal of Gerontological Nursing, 49(7), 40-48.].
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Alkaissi A, Said NB, Qadous S, Alkony M, Almahmoud O. Factors associated with perceived resilience among unergraduate nursing students: findings of the first cross-sectional study in Palestine. BMC Nurs 2023; 22:148. [PMID: 37143045 PMCID: PMC10161405 DOI: 10.1186/s12912-023-01325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/29/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Resilience has emerged as a concept that could explain and predict good academic and well-being of students in stressful and traumatic situations. This study was conducted to assess resilience and identify predictors of high or low resilience scores among future nurses in Palestine. METHODS This cross-sectional study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology statement. Undergraduate nursing students in all academic years were recruited and asked to complete a questionnaire that contained the Trait Resilience Scale and the State-Resilience Scale. Multiple linear regression models were used to identify predictors of higher resilience scores and to control for potentially confounding factors. RESULTS In this study, 290 students completed the questionnaire (response rate = 92.4%). The means of trait, state, and combined resilience scores were 71.4 (SD: 7.5), 62.7 (SD: 6.7), and 134.1 (SD: 12.8), respectively. There was a significant moderate positive correlation between state resilience scores and trait resilience scores (r = 0.63, p < 0.001). Having a study routine on daily basis predicted higher trait (β = -0.20, p < 0.001), state (β = -0.12, p = 0.032), and combined (β = -0.18, p = 0.001) resilience scores. Trait and combined resilience scores were predicted by the absence of chronic diseases (β = 0.12, p < 0.05), experiencing addiction issues (β = -0.11, p < 0.05), living in Israeli seized areas (β = 0.16, p < 0.05), and living in a house with enough number of rooms per siblings (β = 0.13, p < 0.05). On the other hand, state and combined resilience scores were predicted by being in the first academic year (β = -0.18, p < 0.01), and state resilience scores were predicted by living in urban areas (β = -0.12, p < 0.05). CONCLUSIONS Undergraduate nursing students in Palestine reported relatively high trait and state resilience scores. Higher trait, state, and combined resilience scores were predicted by having a study routine on daily basis. More studies are still needed to investigate the relationship between resilience scores, perceived well-being, willingness to care, and the future success of nursing students in Palestine.
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Affiliation(s)
- Aidah Alkaissi
- Nursing and Midwifery Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Nizar B Said
- Nursing and Midwifery Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Shorooq Qadous
- Nursing and Midwifery Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mahdia Alkony
- Nursing and Midwifery Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Omar Almahmoud
- Nursing and Midwifery Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Nursing and Health Professions College, Birzeit University, Birzeit, Palestine
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Matays J, Scruth E, Kawar LN, Cluff SC, Fogli A, Salas M, Harrington C. Advocating for the Vulnerable: The Clinical Nurse Specialist and Nursing Home Reform. CLIN NURSE SPEC 2023; 37:124-132. [PMID: 37058703 DOI: 10.1097/nur.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Nursing homes have been disproportionally affected by the COVID-19 pandemic, particularly because of resident vulnerability, inadequate staffing, and poor quality of care. CURRENT STATE Despite billions of dollars in funding, nursing homes often do not meet minimum federal staffing requirements and are frequently cited for infection prevention and control deficiencies. These factors significantly contributed to resident and staff deaths. For-profit nursing homes were associated with more COVID-19 infections and deaths. Nearly 70% of US nursing homes are for-profit ownership, where quality measures and staffing levels are often lower than their nonprofit counterparts. Nursing home reform is urgently needed to improve staffing and care quality in these facilities. Some states, such as Massachusetts, New Jersey, and New York, have made legislative progress in establishing standards for nursing home spending. The Biden Administration has also announced initiatives, through the Special Focus Facilities Program, to improve nursing home quality and the safety of residents and staff. Concurrently, the "National Imperative to Improve Nursing Home Quality" report from the National Academies of Science, Engineering, and Medicine made specific staffing recommendations, including an increase in direct care registered nurse coverage. CONCLUSION There is an urgent need to advocate for nursing home reform by partnering with congressional representatives or supporting nursing home legislation to improve care for this vulnerable patient population. Adult-gerontology clinical nurse specialists have an opportunity to leverage their advanced knowledge and unique skill set to lead and facilitate change to improve quality of care and patient outcomes.
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Affiliation(s)
- Jennie Matays
- Author Affiliations: Critical Care Clinical Nurse Specialist (Dr Matays), Kaiser Permanente, South Sacramento, Sacramento, California; Executive Director (Dr Scruth), Clinical Quality Programs, Data Analytics, and Tele Critical Care, NCAL Safety, Quality, and Regulatory Services-Kaiser Foundation Hospital and Health Plan, Oakland, California; Nurse Scientist (Dr Kawar), Kaiser Permanente, Southern California Patient Care Services, Regional Nursing Research Program, Pasadena, California; Outpatient Palliative Care RN Case Manager (Ms Cluff), Kaiser Permanente East Bay, Oakland, California; Geriatric Clinical Nurse Specialist (Ms Fogli), Kaiser Permanente, Walnut Creek Medical Center, California; Clinical Nurse Specialist (Ms Salas), Kaiser Permanente Antioch Medical Center, California; and Professor Emerita (Dr Harrington), Department of Social and Behavioral Sciences, University of California San Francisco
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Naughton C, Hayes N, Ezhova I, Fitzpatrick JM. Evaluation of the feasibility of an Education-Career pathway in Healthcare for Older People (ECHO) for early career nurses. Int J Older People Nurs 2023; 18:e12526. [PMID: 36658469 DOI: 10.1111/opn.12526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Rapid population ageing is driving demand for qualified gerontological nurses. Yet, early career nurse attrition and limited focus on retention in the speciality limits supply. OBJECTIVES To test the feasibility and acceptability of an Education-Career pathway in Healthcare for Older People (ECHO) intervention for early career nurses to improve retention and capability in gerontological nursing. ECHO is a multicomponent intervention with integrated education, career planning and coaching components, tested over two 6-month cycles. METHODS A feasibility study with a pre-post design using a multi-methods evaluation. Twenty-nine early career nurse participants were recruited from eight NHS acute and community care Trusts in England. ECHO participants completed online questionnaires at baseline (Time 1), 6-month (T2, end of intervention) and follow-up at 18 months from baseline (T3). Outcome measures were career intention, self-reported knowledge, career planning confidence, and burnout using the Maslach Burnout Inventory. Qualitative interviews were undertaken with participants (n = 23) and organizational stakeholders (n = 16) who facilitated ECHO. Data analysis used descriptive statistics and non-parametric tests for paired data and thematic analysis for qualitative data. RESULTS Overall, 19 of 29 participants (65%) completed all aspects of the intervention. The evaluation was completed by 23 participants. ECHO was well received by participants and stakeholders. At T3, the 23 participants were working in the speciality, though two had changed organizations. There was a significant improvement in self-reported gerontological knowledge, pre 87 (IQR 81-102), post 107 (IQR 98-112) p = 0.006, but no significant changes in other outcomes. In qualitative data, participants and organizational stakeholders held similar views, presented under four main themes: intended outcomes (personal and professional development, raise gerontological profile, expand horizons); nurse retention-a double-edged sword, ECHO logistics, and sustainability. CONCLUSION Education-Career pathway in Healthcare for Older People was feasible and may positively impact early career nurse retention, capability and socialization into gerontological nursing. ECHO requires further refinement and piloting, but learning can contribute to retention strategies. IMPLICATIONS FOR PRACTICE Attracting and retaining early-career nurses to the gerontological speciality requires greater innovation, organizational and senior nurse leadership.
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Affiliation(s)
- Corina Naughton
- Clinical Nursing in Older People's Healthcare, School of Nursing and Midwifery, College of Medicine and Health, South SouthWest Hospital Group (SSWHG), Cork, Ireland
| | - Nicky Hayes
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Joanne M Fitzpatrick
- Older People's Healthcare, Care for Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Falvey JR, Hade EM, Friedman S, Deng R, Jabbour J, Stone RI, Travers JL. Severe neighborhood deprivation and nursing home staffing in the United States. J Am Geriatr Soc 2023; 71:711-719. [PMID: 36929467 PMCID: PMC10023834 DOI: 10.1111/jgs.17990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States. METHODS This cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates. RESULTS Compared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2-6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs. CONCLUSIONS Significant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods.
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Affiliation(s)
- Jason R. Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Erinn M. Hade
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Steven Friedman
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Rebecca Deng
- Department of Epidemiology, NYU School of Global Public Health, New York, NY
| | - Joelle Jabbour
- NYU Robert F. Wagner Graduate School of Public Service, New York, NY
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16
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Brunt CS. Assessing the impact of enforcement and compliance with minimum staffing standards on the quality of care in nursing homes: Evidence from the Centers for Medicare and Medicaid Services' staff star rating downgrade policy. Health Econ 2023; 32:235-276. [PMID: 36403199 DOI: 10.1002/hec.4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
Policymakers have historically attempted to influence quality in nursing homes through the imposition of minimum staffing standards and through the public dissemination of quality on websites like Care Compare. One current Federal standard necessitates a registered nurse (RN) on duty for at least eight consecutive hours each day. In 2018, the Centers for Medicare and Medicaid Services announced that they would incentivize compliance with this requirement by downgrading nursing homes with 7+ days without an RN present during the quarter by one star on their Care Compare staffing domain quality rating. This study evaluates the impact of this new enforcement mechanism. Using an intent-to-treat sample of nursing homes at risk for downgrade with difference-in-differences and event study models, it finds that the policy increased compliance and staffing levels. Using the policy to instrument for full compliance, it finds that the daily presence of an RN causally improves several quality dimensions.
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Affiliation(s)
- Christopher S Brunt
- Department of Economics, Georgia Southern University, Statesboro, Georgia, USA
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17
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Bowblis JR, Brunt CS, Xu H, Grabowski DC. Understanding Nursing Home Spending And Staff Levels In The Context Of Recent Nursing Staff Recommendations. Health Aff (Millwood) 2023; 42:197-206. [PMID: 36745835 DOI: 10.1377/hlthaff.2022.00692] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
To provide context for evaluating proposed nursing home staff regulations, we examined the proportion of facility revenues spent on nursing staff, as well as nursing staff levels in hours worked and paid per resident day, in 2019. Nationally, the median proportion of revenues spent on nursing staff was 33.9 percent, and median nursing staff levels were 3.67 hours worked and 4.08 hours paid per resident day. Facilities with higher shares of Medicaid residents spent a larger share of revenues on nursing staff but had lower staffing levels. States varied significantly with respect to median spending on nursing staff (26.8-44.0 percent of revenues) and median nursing staff levels (3.2-5.6 hours worked and 3.6-5.7 hours paid per resident day). These findings indicate that raising the proportion of revenues spent by nursing homes on nursing staff to a regulated minimum would not guarantee the achievement of adequate nursing staff levels unless it was paired with other regulatory mechanisms.
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Affiliation(s)
| | | | - Huiwen Xu
- Huiwen Xu, University of Texas Medical Branch, Galveston, Texas
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18
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Dunbar P, Keyes LM, Browne JP. Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research. PLoS One 2023; 18:e0278007. [PMID: 37053186 PMCID: PMC10101495 DOI: 10.1371/journal.pone.0278007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of services by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. METHODS Searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two reviewers independently. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. RESULTS The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. Determinants were largely structural in nature and allocated most frequently to the inner and outer setting domains of the CFIR. The following structural characteristics and compliance were found to be positively associated: smaller facilities (measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility's geographic location and compliance was also associated. It was difficult to make findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. CONCLUSION The literature in this field has focused to date on structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work, are evident in the literature and further research in this area is needed to provide a clearer picture.
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Affiliation(s)
- Paul Dunbar
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - John P Browne
- School of Public Health, University College Cork, Cork, Ireland
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19
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Min D, Cho E, Kim GS, Lee KH, Yoon JY, Kim HJ, Choi MH. Factors associated with retention intention of Registered Nurses in Korean nursing homes. Int Nurs Rev 2022; 69:459-469. [PMID: 35413132 PMCID: PMC9790496 DOI: 10.1111/inr.12754] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
AIM To identify the factors associated with retention intention among Registered Nurses in South Korean nursing homes. BACKGROUND Although nurses are not mandatory personnel, Korean nursing homes employ Registered Nurses. INTRODUCTION Determining the factors related to Registered Nurses' retention intention is important for their job stability and ensure provision of quality care. METHODS This mixed-methods study employed a sequential explanatory design. A self-reported questionnaire survey was conducted between May 1 and July 3, 2019, with 155 Registered Nurses providing direct care from 37 nursing homes. In-depth qualitative interviews were conducted with 10 participants from August 1 to September 30, 2019. Data were analyzed using multilevel analysis for quantitative study and thematic analysis for qualitative study. RESULTS The participants' average age was 48.48 years. Personal factors related to retention intention were Registered Nurses' role, educational level, and job satisfaction. Institutional factors were ownership, number of beds, and working environment. The qualitative study revealed five themes: "Satisfaction with meaningful relationships," "Potential for professional growth," "Nursing service accompanied by emotional labor," "Poor working environments in nursing homes," and "Unprotected nursing expertise." DISCUSSION A nursing home's work environment is related to the Registered Nurses' retention intention. Most Registered Nurses in Korea received low wages, lacked access to career management programs, and experienced emotional labor. CONCLUSION This study highlighted the personal and institutional factors related to retention intention among Registered Nurses in South Korean nursing homes. IMPLICATIONS FOR NURSING AND NURSING POLICY A law that designates Registered Nurses as an essential nursing home workforce is required. Further, nursing homes should increase the number of Registered Nurses to improve working conditions and thereby job satisfaction. It is also necessary to foster a working environment that facilitates professional development opportunities and job clarity.
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Affiliation(s)
- Deulle Min
- Department of NursingCollege of MedicineWonkwang UniversityIksanRepublic of Korea
| | - Eunhee Cho
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Gwang Suk Kim
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Kyung Hee Lee
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Ju Young Yoon
- College of Nursing and Research Institute of Nursing ScienceSeoul National UniversitySeoulRepublic of Korea
| | - Hyun Joo Kim
- Yonhee Seniors Nursing HomeSeoulRepublic of Korea
| | - Moon Hee Choi
- Korea Social Science Data Archive at Asia Center Seoul National UniversitySeoulRepublic of Korea
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20
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Temkin-Greener H, Mao Y, McGarry B, Zimmerman S. Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations. J Am Med Dir Assoc 2022; 23:1997-2002.e3. [PMID: 36265562 PMCID: PMC9742293 DOI: 10.1016/j.jamda.2022.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To examine perceptions of patient safety culture (PSC) among assisted living (AL) administrators and direct care workers (DCWs), and their associations with state regulations. DESIGN We conducted a survey using the PSC instrument developed by the Agency for Healthcare Research & Quality. Secondary data on ALs and residents were derived from the Medicare Master Beneficiary Summary Files. Other data sources were the Area Health Resource Files, a previously compiled national AL directory, and the US census. Data on state AL regulations were available from a prior study. SETTING AND PARTICIPANTS Participants included administrators and DCWs working in assisted living communities serving Medicare beneficiary residents. METHODS We employed exploratory factor analysis, examined Pearson correlations, and obtained standardized Cronbach alphas to test the PSC instrument. We estimated linear regression models with the dependent variable being the proportion of positive PSC assessments, for each PSC domain, with SEs clustered at the AL level. RESULTS Surveys were completed by 714 administrators and DCWs in 257 ALs. The PSC instrument tested reliable and valid for AL communities. Administrators' and DCWs' perceptions of PSC differed significantly across almost all domains. A 1-unit increase in state regulatory specificity for DCW staffing was associated with a 4.13-percentage point (P < .05) increase in the PSC staffing domain. Associations with regulatory specificity in staff training were also found for other PSC domains. CONCLUSIONS AND IMPLICATIONS PSC is an important metric for assessing organizational performance. DCWs have significantly worse perceptions of PSC than do administrators, suggesting it is crucial to understand the source of these differing perceptions. Because state regulations relate to PSC, achieving a comprehensive focus on patient safety in AL may require regulatory action, particularly increasing specificity with regard to staffing and training.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY.
| | - Yunjiao Mao
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Brian McGarry
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY; Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY
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21
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Yoon JM, Trinkoff AM, Galik E, Storr CL, Lerner NB, Brandt N, Zhu S. Nurse staffing and deficiency of care for inappropriate psychotropic medication use in nursing home residents with dementia. J Nurs Scholarsh 2022; 54:728-737. [PMID: 35388951 DOI: 10.1111/jnu.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Psychotropic medications are used to manage behavioral symptoms of dementia in nursing homes despite limited efficacy and the risk of adverse effects, and may be considered an easier solution for the treatment of behavioral symptoms. However, non-pharmacologic interventions are preferable but are most effective with consistent staffing. To address this, the Centers for Medicare and Medicaid Services implemented additional regulatory scrutiny through F-tag for deficiencies of care, targeting inappropriate psychotropic medication use (F-758 tag). The purpose of this study was to examine associations between nurse staffing levels and the occurrence of deficiency citations for inappropriate psychotropic medication use in residents with dementia symptoms. DESIGN This was secondary data analysis of a cross-sectional study using CASPER (Certification and Survey Provider Enhanced Reporting) and PBJ (Payroll-Based Journal) data from 14,548 Medicare or Medicaid-certified facilities surveyed between December 1, 2017 and December 31, 2018. METHODS Staffing measures included nursing hours per resident day and registered nurse skill-mix. Generalized linear mixed models with facilities nested within states, were used to estimate the magnitude of the associations between the occurrence of inappropriate psychotropics use deficiency citations and nurse staffing levels. Covariates included facility location, size, ownership, the presence of dementia special care units, and the proportion of residents with dementia, depression, psychiatric disorders, mental behavioral symptoms, and residents with Medicare/Medicaid. RESULTS There were 1875 facilities with deficiency citations regarding inappropriate psychotropics use for residents with dementia. When controlling for covariates, facilities with greater hours per resident day for registered nurses (odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.44-0.67), certified nursing assistants (OR = 0.87, 95% CI = 0.77-0.99) and total nurse staff (OR = 0.87, 95% CI = 0.79-0.96) had significantly lower odds of inappropriate psychotropics use deficiency citations. Nursing homes with greater registered nurse skill-mix had significantly lower odds of receiving the deficiency tags (OR = 0.10, 95% CI = 0.04-0.26). CONCLUSION Citations for inappropriate psychotropic medication use among residents with dementia were less likely to occur in facilities with higher staffing levels for registered nurses, certified nursing assistants, total nurse staff, and greater registered nurse skill-mix. Facilities need to be equipped with adequate nurse staffing levels to facilitate the use of non-pharmacological interventions and reduce inappropriate psychotropic medication use. CLINICAL RELEVANCE Adequate nursing staffing is associated with fewer deficiencies related to the use of psychotropic medications to treat behavioral symptoms. Nursing home administrators and policymakers need to focus on assuring adequate nurse staffing levels to provide safe and high-quality dementia care.
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Affiliation(s)
- Jung Min Yoon
- Ewha Womans University, College of Nursing, Seoul, South Korea
| | | | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Carla L Storr
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Nancy B Lerner
- Ewha Womans University, College of Nursing, Seoul, South Korea
| | - Nicole Brandt
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Shijun Zhu
- Ewha Womans University, College of Nursing, Seoul, South Korea
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22
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Crowley R, Atiq O, Hilden D. Long-Term Services and Supports for Older Adults: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1172-1174. [PMID: 35816710 DOI: 10.7326/m22-0864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The number of Americans aged 65 years or older is expected to increase in the coming decades. Because the risk for disability increases with age, more persons will need long-term services and supports (LTSS) to help with bathing, eating, dressing, and other everyday tasks. Long-term services and supports are delivered in nursing homes, assisted living facilities, the person's home, and other settings. However, the LTSS sector faces several challenges, including keeping patients and staff safe during the COVID-19 pandemic, workforce shortages, quality problems, and fragmented coverage options. In this position paper, the American College of Physicians offers policy recommendations on LTSS coverage, financing, workforce, safety and quality, and emergency preparedness and calls on policymakers and other stakeholders to reform and improve the LTSS sector so that care is high quality, accessible, equitable, and affordable.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
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23
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Heger D, Herr A, Mensen A. Paying for the view? How nursing home prices affect certified staffing ratios. Health Econ 2022; 31:1618-1632. [PMID: 35581684 DOI: 10.1002/hec.4532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Many countries limit public and private reimbursement for nursing care costs for social or financial reasons. Still, quality varies across nursing homes. We explore the causal link between case-mix adjusted nurse staffing ratios as an indicator of care quality and different price components in Swiss nursing homes. The Swiss reimbursement system limits and subsidizes the care price at the cantonal level, which implicitly limits staffing ratios, while the residents cover the nursing home-specific lodging price privately. To estimate causal effects, we exploit (i) the exogeneity of the Swiss care price regulation, (ii) nursing-home fixed effects estimations and (iii) instrumental variables for the lodging price. Our estimates show a positive impact of prices on certified staffing ratios. We find that a 10% increase in care prices increases certified staffing ratios by 3-4%. A comparable 10% increase in lodging prices raises certified staffing ratios by 1.5-10% (depending on the model). Our findings highlight that price limits for nursing care impose a limit on staffing ratios. Furthermore, our results indicate that providers circumvent price limits by increasing lodging prices that are privately covered. Thus, this cost shifting implicitly shifts the financial burden to the residents.
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Affiliation(s)
- Dörte Heger
- RWI - Leibniz Institute for Economic Research, Essen, Germany
- Leibniz Science Campus Ruhr, Essen, Germany
| | - Annika Herr
- Institute of Health Economics and CHERH, Leibniz University Hannover, Hannover, Germany
- CINCH - Health Economics Research Center, Essen, Germany
| | - Anne Mensen
- RWI - Leibniz Institute for Economic Research, Essen, Germany
- Leibniz Science Campus Ruhr, Essen, Germany
- Ruhr-University Bochum, Bochum, Germany
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24
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Shen K, McGarry BE, Grabowski DC, Gruber J, Gandhi AD. Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks. JAMA Health Forum 2022; 3:e222151. [PMID: 35977215 PMCID: PMC9308062 DOI: 10.1001/jamahealthforum.2022.2151] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/25/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Staff absences and departures at nursing homes may put residents at risk and present operational challenges. Objective To quantify changes in nursing home facility staffing during and after a severe COVID-19 outbreak. Design Setting and Participants In this cohort study, daily staffing payroll data were used to construct weekly measures of facility staffing, absences, departures, and use of overtime and contract staff among US nursing homes experiencing a severe COVID-19 outbreak that started between June 14, 2020, and January 1, 2021. Facility outbreaks were identified using COVID-19 case data. An event-study design with facility and week fixed effects was used to investigate the association of severe outbreaks with staffing measures. Exposures Weeks since the beginning of a severe COVID-19 outbreak (4 weeks prior to 16 weeks after). Main Outcomes and Measures Total weekly staffing hours, staff counts, staff absences, departures, new hires, overtime and contract staff hours measured for all nursing staff and separately by staff type (registered nurses, licensed practical nurses, certified nursing assistants), facility self-reported staff shortages, and resident deaths. Results Of the included 2967 nursing homes experiencing severe COVID-19 outbreaks, severe outbreaks were associated with a statistically significant drop in nursing staffing levels owing to elevated absences and departures. Four weeks after an outbreak's start, around when average new cases peaked, staffing hours were 2.6% (95% CI, 2.1%-3.2%) of the mean below preoutbreak levels, despite facilities taking substantial measures to bolster staffing through increased hiring and the use of contract staff and overtime. Because these measures were mostly temporary, staffing declined further in later weeks; 16 weeks after an outbreak's start, staffing hours were 5.5% (95% CI, 4.5%-6.5%) of the mean below preoutbreak levels. Staffing declines were greatest among certified nursing assistants, primarily owing to smaller increases in new hires of this staff type compared with licensed practical nurses and registered nurses. Conclusions and Relevance In this cohort study of nursing homes experiencing severe COVID-19 outbreaks, facilities experienced considerable staffing challenges during and after outbreaks. These results suggest the need for policy action to ensure facilities' abilities to maintain adequate staffing levels during and after infectious disease outbreaks.
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Affiliation(s)
- Karen Shen
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Brian E McGarry
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Gruber
- Department of Economics, Massachusetts Institute of Technology, Cambridge
| | - Ashvin D Gandhi
- UCLA Anderson School of Management, University of California, Los Angeles
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Abstract
Nursing home residents are vulnerable to disproportionate harm during disasters and health emergencies, as evidenced by the recent impact of COVID-19 and extreme weather events. Evaluation of these disasters shows that the nursing homes in question were often in compliance with relevant regulations around emergency planning. However, advance planning for disasters cannot anticipate every contingency, leading to the need for flexibility and quick adaptation on the part of nursing home leaders. In addition, disasters often involve larger, regional problems and situations that individual providers cannot solve. We suggest that policy makers need to prioritize development and expectations around leadership skills in nursing home management and better integrate the long-term care sector into local, state, and federal public health planning for future pandemics and other disasters.
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26
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Kolanowski A, Heid AR, Behrens L, Riley K, Madrigal C, Boltz M, Van Haitsma K, Resnick B, Galik E, Ellis J, Eshraghi K. Community Goal Setting and Attainment: Organizational Characteristics and Indicators of Staff Adoption. J Gerontol Nurs 2022; 48:5-12. [PMID: 35511062 DOI: 10.3928/00989134-20220404-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In residential care communities (CCs), implementation strategies can improve the use of person-centered approaches for residents' behavioral symptoms of distress. We examined staff perceptions of how well their organizational goals for achieving person-centered care (PCC) were met following implementation of the strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Distress. We also identified organizational characteristics and indicators of staff adoption associated with perceived goal attainment. Goal attainment was evaluated by staff using goal attainment scaling (GAS) at the completion of the implementation trial in 26 CCs. Correlations, t tests, and linear regression were used to determine which factors were associated with goal attainment. Total time spent with the research facilitator, stable staff group membership, and presence of a survey deficiency during the study period explained 63% of the variance in goal attainment. Staff can set achievable organizational goals to improve PCC for residents' behavioral symptoms of distress. [Journal of Gerontological Nursing, 48(5), 5-12.].
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27
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Bowblis JR. The Need for an Economically Feasible Nursing Home Staffing Regulation: Evaluating an Acuity-Based Nursing Staff Benchmark. Innov Aging 2022; 6:igac017. [PMID: 35712323 PMCID: PMC9196696 DOI: 10.1093/geroni/igac017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives Despite concerns about the adequacy of nursing home (NH) staffing, the federal agency responsible for NH certification and regulation has never adopted an explicit quantitative nursing staff standard. A prior study has proposed a benchmark for this purpose based on the 1995/97 Staff Time Measurement (STM) studies. This article aims to assess the extent to which NHs staff to this proposed STM benchmark, the extent to which regulators already implicitly apply the STM benchmark, and compute the additional operating expenses NHs would incur to adhere to the STM benchmark. Research Design and Methods Using NH Compare Archive data, the STM benchmark was compared to staffing levels reported by the facility and whether NHs received a nursing staff deficiency. Using financial information from Medicare Cost Reports, the additional annual operating expenses required to staff to the STM benchmark were calculated for each state and nationwide. Results The vast majority of NHs did not staff to the STM benchmark; 80.2% for registered nurses and 60.0% for total nursing staff. Deficiency patterns showed that NH regulators were not using the STM benchmark to determine sufficiency of nursing staff. Implementing the STM benchmark as a regulatory standard would increase operating expenses for 59.1% of NHs, at an average annual cost of half-million dollars per facility. The nationwide increase in operating expense is estimated to be at least $4.9 billion per year. Discussion and Implications Without clear guidance on the staffing level needed to be sufficiently staffed, most NHs are subject to a community standard of care, which some have argued could be associated with suboptimal staffing levels. Implementing an acuity-based benchmark could result in improved staffing levels but also comes with significant economic costs. The STM benchmark is not economically feasible at current Medicare and Medicaid reimbursement levels.
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Affiliation(s)
- John R Bowblis
- Address correspondence to: John R. Bowblis, PhD, Department of Economics and Scripps Gerontology Center, Miami University, 800 E. High St., Oxford, OH 45056, USA. E-mail:
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28
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Franzosa E, Mak W, R Burack O, Hokenstad A, Wiggins F, Boockvar KS, Reinhardt JP. Perspectives of certified nursing assistants and administrators on staffing the nursing home frontline during the COVID-19 pandemic. Health Serv Res 2022; 57:905-913. [PMID: 35274293 PMCID: PMC9111312 DOI: 10.1111/1475-6773.13954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To identify best practices to support and grow the frontline nursing home workforce based on the lived experience of certified nursing assistants (CNAs) and administrators during COVID‐19. Study setting Primary data collection with CNAs and administrators in six New York metro area nursing homes during fall 2020. Study design Semi‐structured interviews and focus groups exploring staffing challenges during COVID‐19, strategies used to address them, and recommendations moving forward. Data collection We conducted interviews with 6 administrators and held 10 focus groups with day and evening shift CNAs (n = 56) at 6 nursing homes. Data were recorded and transcribed verbatim and analyzed through directed content analysis using a combined inductive and deductive approach to compare perceptions across sites and roles. Principal findings CNAs and administrators identified chronic staffing shortages that affected resident care and staff burnout as a primary concern moving forward. CNAs who felt most supported and confident in their continued ability to manage their work and the pandemic described leadership efforts to support workers' emotional health and work–life balance, teamwork across staff and management, and accessible and responsive leadership. However, not all CNAs felt these strategies were in place. Conclusions Based on priorities identified by CNAs and administrators, we recommend several organizational/industry and policy‐level practices to support retention for this workforce. Practices to stabilize the workforce should include 1) teamwork and person‐centered operational practices including transparent communication; 2) increasing permanent staff to avoid shortages; and 3) evaluating and building on successful COVID‐related innovations (self‐managed teams and flexible benefits). Policy and regulatory changes to promote these efforts are necessary to developing industry‐wide structural practices that target CNA recruitment and retention.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Wingyun Mak
- The New Jewish Home Research Institute on Aging, New York, New York, USA
| | - Orah R Burack
- The New Jewish Home Research Institute on Aging, New York, New York, USA
| | - Alene Hokenstad
- Ladders to Value Workforce Investment Organization, 1199SEIU Training and Employment Funds, New York, New York, USA
| | - Faith Wiggins
- 1199SEIU Training and Employment Funds, New York, New York, USA
| | - Kenneth S Boockvar
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Joann P Reinhardt
- The New Jewish Home Research Institute on Aging, New York, New York, USA
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Li C, Shi C. Adverse Events and Risk Management in Residential Aged Care Facilities: A Cross-Sectional Study in Hunan, China. Risk Manag Healthc Policy 2022; 15:529-542. [PMID: 35378829 PMCID: PMC8976485 DOI: 10.2147/rmhp.s351821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Adverse events threaten residents’ safety. Risk management is important to provide proper care and maintain quality in residential aged care facilities (RACFs). However, there is little data on adverse events, risk management, and risk early warning in RACFs in the Chinese mainland. This study aimed to fill this gap by investigating the prevalence of the aforementioned aspects and related factors in China. Participants and Methods Using a cross-sectional design, a field survey of 272 RACFs in Hunan Province was conducted from January 25 to June 1, 2020. Data were collected using four main tools on prevalence of nursing adverse events, risk management, risk early warning, and general information. Descriptive statistics were described by frequency (percentage) and median (interquartile range). Mann–Whitney U-test and Kruskal–Wallis H-test, and Spearman coefficient were used for statistical analysis. Results RACFs experienced an average of five (15) adverse events in 2019, with falls and pressure ulcers being the most common. The total average score of risk management in RACFs was 4.72 (0.98) out of 5, with the environment and personnel management dimensions scoring the highest with 4.75 (1) and the service management dimension scoring the lowest with 4.60 (1). Only 72.79% had trained their staff on ethical and legal knowledge and 84.56% had utilized pre-hospital first aid. Further, 30% to 40% were unprepared for contingency plans of suicide, electric shock, gas poisoning, and drowning. There were significant risk management differences among the following variables: facilities’ locations, accreditation with the Practice Certificate of Social Welfare Facilities, bed-size, nursing hours per resident day, requirement for nursing staff with certificates, and payment for nursing staff (p < 0.05). Conclusion RACFs are facing safety challenges with a high prevalence of nursing adverse events. These facilities need to improve risk early warning and management to ensure residents’ safety.
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Affiliation(s)
- Chunyan Li
- School of Nursing, Hunan University of Chinese Medicine, Changsha, People’s Republic of China
| | - Chunhong Shi
- School of Nursing, Xiangnan University, Chenzhou, People’s Republic of China
- Correspondence: Chunhong Shi, Tel +86 15907354840, Fax +86 735 2325007, Email
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30
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Hawk T, White EM, Bishnoi C, Schwartz LB, Baier RR, Gifford DR. Facility characteristics and costs associated with meeting proposed minimum staffing levels in skilled nursing facilities. J Am Geriatr Soc 2022; 70:1198-1207. [PMID: 35113449 DOI: 10.1111/jgs.17678] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Federal minimum nurse staffing levels for skilled nursing facilities (SNFs) were proposed in 2019 U.S. Congressional bills. We estimated costs and personnel needed to meet the proposed staffing levels, and examined characteristics of SNFs not meeting these thresholds. METHODS This was a cross-sectional analysis of 2019Q4 payroll data, the Hospital Wage Index, and other administrative data for 14,964 Medicare and Medicaid-certified SNFs. We examined characteristics of SNFs not meeting proposed minimum thresholds: 4.1 total nursing hours per resident day (HPRD); 0.75 registered nurse (RN) HPRD; 0.54 licensed practical nurse (LPN) HPRD; and 2.81 certified nursing assistant (CNA) HPRD. For SNFs falling below the thresholds, we calculated the additional HPRD needed, along with the associated full-time equivalent (FTE) personnel and salary costs. RESULTS In 2019, 25.0% of SNFs met the minimum 4.1 total nursing HPRD, while 31.0%, 84.5%, and 10.7% met the RN, LPN, and CNA thresholds, respectively. Only 5.0% met all four categories. In adjusted analyses, factors most strongly associated with SNFs not meeting the proposed minimums were: higher Medicaid census, larger bed size, for-profit ownership, higher county SNF competition; and, for RNs specifically, higher community poverty and lower Medicare census. Rural SNFs were less likely to meet all categories and this was explained primarily by county SNF competition. We estimate that achieving the proposed federal minimums across SNFs nationwide would require an estimated additional 35,804 RN, 3509 LPN, and 116,929 CNA FTEs at $7.25 billion annually in salary costs based on current wage rates and prepandemic resident census levels. CONCLUSIONS Achieving proposed minimum nurse staffing levels in SNFs will require substantial financial investment in the workforce and targeted support of low-resource facilities. Extensive recruitment and retention efforts are needed to overcome supply constraints, particularly in the aftermath of the COVID-19 pandemic.
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Affiliation(s)
- Terry Hawk
- Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, District of Columbia, USA
| | - Elizabeth M White
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Courtney Bishnoi
- Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, District of Columbia, USA
| | - Lindsay B Schwartz
- Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, District of Columbia, USA
| | - Rosa R Baier
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David R Gifford
- Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, District of Columbia, USA.,Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
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31
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Robinson-Lane SG, Block L, Bowers BJ, Cacchione PZ, Gilmore-Bykovskyi A. The Intersections of Structural Racism and Ageism in the Time of COVID-19: A Call to Action for Gerontological Nursing Science. Res Gerontol Nurs 2022; 15:6-13. [PMID: 35044863 PMCID: PMC8856583 DOI: 10.3928/19404921-20211209-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The health consequences of systemic racism and ageism have received growing attention as the coronavirus disease 2019 pandemic has illuminated long-standing inadequacies and injustices that are structurally engrained in our health systems. The current State of the Science Commentary addresses the intersecting influences of systemic racism and ageism, and other "-isms" that conspire to create disparate health outcomes for older adults from historically excluded and marginalized backgrounds. We focus specifically on the long-term care sector as a representative microcosm of structural inequities, while recognizing that these unjust barriers to health are widespread, endemic, and pervasive. We present a call to action for gerontological nursing science to engage deeply and robustly in these realities, and the ethical and scientific imperative they present to ensure that all older adults encounter just conditions for maximizing their health and well-being. [Research in Gerontological Nursing, 15(1), 6-13.].
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Affiliation(s)
| | | | | | - Pamela Z. Cacchione
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Andrea Gilmore-Bykovskyi
- School of Nursing, Madison, Wisconsin, USA,University of Wisconsin-Madison Center for Health Disparities Research, Madison, Wisconsin, USA
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32
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Peters MDJ, Marnie C, Butler A. Royal Commission into Aged Care recommendations on minimum staff time standard for nursing homes. AUST HEALTH REV 2021; 46:388-390. [PMID: 34749883 DOI: 10.1071/ah21283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
The Royal Commission's recommendation for nursing home minimum time standards and the Australian Government's response do not support best practice resident care. We recommend that higher mandated minimum staffing levels and skills mix should be phased in by mid-2026.What is known about the topic?The Australian Government has not committed to fully implementing the Commission's recommendations for mandated minimum staff time standards.What does this paper add?We highlight issues with the Commission's recommendations and the Australian Government's response where they do not support sufficient minimum time to provide best practice care.What are the implications for practitioners?Mandated evidence-based minimum staffing levels and skills mix should be phased in by mid-2026 to support best practice care.
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Affiliation(s)
- Micah D J Peters
- National Policy Research Unit (Federal Office), Australian Nursing and Midwifery Federation, Adelaide, SA, Australia; and University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, SA, Australia
| | - Casey Marnie
- National Policy Research Unit (Federal Office), Australian Nursing and Midwifery Federation, Adelaide, SA, Australia; and University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, SA, Australia
| | - Annie Butler
- Australian Nursing and Midwifery Federation (Federal Office), Melbourne, Vic., Australia
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33
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Choi YR, Chang SO. Nurses' conceptualizations of managing emergencies in nursing homes. Nurs Health Sci 2021; 24:113-122. [PMID: 34741563 DOI: 10.1111/nhs.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022]
Abstract
Emergencies can negatively affect the morbidity and mortality of nursing home residents. As nurses employed at nursing homes play a key role in such situations, their conceptualizations of emergency management should be considered to improve care. Accordingly, this study aimed to identify nurses' conceptualizations of managing emergencies in nursing homes. A qualitative research design was conducted using interviews with 20 nurses working in five different nursing homes in the Republic of Korea between September 2019 and August 2020. The data were analyzed using phenomenography. This study identified two main perspectives used by nurses in nursing homes to manage emergencies, depending on the resident's condition: emergency care and daily preventive care. Nurses' conceptualizations of care provided in emergencies were organized under the frames of assessment and intervention, whereas routine care carried out during daily life activities fell under the frame of prevention. This study's findings, which elucidate nurses' complex practical and experiential knowledge, provide insights for the development of emergency management training.
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Affiliation(s)
- Young-Rim Choi
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
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34
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Zirves M, Demirer I, Pfaff H. Everyday Life and Social Contacts of Dementia and Non-Dementia Residents over 80 Years in Long-Term Inpatient Care: A Multi-Level Analysis on the Effect of Staffing. Int J Environ Res Public Health 2021; 18:11300. [PMID: 34769817 DOI: 10.3390/ijerph182111300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
The relationship between nurse staffing, physical outcomes of residents, as well as quality of care receives major attention. The impact of staffing levels on residents’ ability to organize their everyday life and maintain social contacts, however, has not been analyzed to date. This study examines whether a relationship between the staff-to-resident ratio for registered nurses and nursing home residents with and without dementia aged over 80 exists. Secondary data collected in the project inQS (indikatorengestützte Qualitätsförderung) were used (n = 1782, mean age = 88.14). The analyzed cross-sectional data were collected in winter 2019 in facilities of the Diocesan Caritas Association in Germany. A sum score formed from variables measuring residents’ abilities to independently organize their everyday life and maintain social contacts functioned as the dependent variable. A multi-level regression analysis was performed. The results revealed that the ability of residents without dementia was significantly associated with the staff-to-resident ratio of registered nurses. This was not true for residents with dementia. For the latter, however, whether the facility offers a segregated care unit turned out to be significant. Additional and longitudinal research is indispensable to explain the inequality between the two groups analyzed.
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35
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Rayner JA, Fetherstonhaugh D. What factors influence nursing home use of hospital avoidance programs? An interview study. J Adv Nurs 2021; 78:510-522. [PMID: 34617613 DOI: 10.1111/jan.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/05/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
AIMS To understand why some nursing homes use hospital avoidance programs more frequently than others. DESIGN Two hospital avoidance programs, called residential-in-reach services in Victoria, Australia, were evaluated using a qualitative descriptive design. METHODS Between 2014 and 2018, 127 semi-structured interviews were conducted with staff from nursing homes, general practitioners and staff from the residential-in reach services. The interviews took an average of 45 min and transcripts were thematically analysed. RESULTS Nursing home reliance on residential-in-reach services to manage deteriorating residents was evident in both evaluations. Irrespective of the model of service provision, reliance was associated with: the increased care needs of residents; difficulties accessing timely and appropriate medical care; and the reduced numbers of skilled registered nurses to assess and manage deteriorating residents. CONCLUSION The residential-in-reach services are highly regarded by nursing homes. However, some are reliant on these services to provide nursing assessment and management. Using residential-in-reach services to substitute for nursing care, deskills nurses and shifts the cost of providing care from the service provider to other agencies. To provide residents with quality nursing care, the number of skilled registered nurses able to work within their scope of practice needs to be increased in Australian nursing homes. IMPACT The findings highlight the challenges of providing care in older people living in aged care. Increasing the number of skilled registered nurses in Australian nursing homes, would support deteriorating residents to stay in familiar surroundings and reduce reliance on external services to provide nursing care.
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Affiliation(s)
- Jo-Anne Rayner
- Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Victoria, Australia
| | - Deirdre Fetherstonhaugh
- Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Victoria, Australia
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Abstract
The high rates of nursing home deaths in the wake of COVID-19 have led to calls for their elimination and their replacement by home care. Based on years of research in Canada and abroad, this article argues that nursing homes are not just necessary, they provide significant benefits for those living in, working in, and visiting in them. In developing this argument, the article begins by setting out why long-term residential care is necessary before moving on to consider the benefits of such care, benefits that go beyond the clinical. It concludes by identifying factors that can make nursing homes a positive option while helping to avoid pandemic horrors in the future.
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Affiliation(s)
- Pat Armstrong
- Distinguished Research Professor of Sociology, York University, Toronto, Ontario, Canada
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37
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Dykgraaf SH, Matenge S, Desborough J, Sturgiss E, Dut G, Roberts L, McMillan A, Kidd M. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc 2021; 22:1969-1988. [PMID: 34428466 PMCID: PMC8328566 DOI: 10.1016/j.jamda.2021.07.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia.
| | - Sethunya Matenge
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Elizabeth Sturgiss
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Garang Dut
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Canberra ACT, Australia
| | - Alison McMillan
- Australian Government Department of Health, Canberra ACT, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra ACT, Australia
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Deguigne M, Cellier M, Hamon Y, Legay M, Descatha A. Poisoning exposure from non-pharmaceutical products in residents of structured living facilities. Clin Toxicol (Phila) 2021; 60:371-378. [PMID: 34409905 DOI: 10.1080/15563650.2021.1965158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objectives of this study were to describe poisonings occurring in older or disabled patients residing in structured living facilities, identify risk factors, and propose preventive measures. METHOD This was a prospective and observational study, covering all cases of poisoning occurring in structured living facilities in the Brittany region of France. All calls were received at the Grand Ouest Poison Control Centre (PCC) of Angers and were recorded from 1 February 2019 to 31 January 2020. The clinical severity of the poisonings was assessed using the Poisoning Severity Score (PSS). Clinical severity was compared by univariate and multivariate analyses using the following dependent variables: PSS score < 2 and PSS ≥ 2. RESULTS This study included 158 residents with a median age of 83 years (5-116 years old). The average number of residents supervised by a member of the supervisory staff was 11 (+/-10.7). The substance ingested was a personal hygiene product or a cleaning product in 48% and 25% of cases, respectively. The most frequently ingested product was a bar of soap (n = 20). All moderate to severe cases (4.6%, n = 8 including one death) occurred in residents with dementia living in nursing homes for elderly patients, and 9% of residents required hospital treatment. In more than 50% of cases (n = 83), the product was provided by the facility and in 23% (n = 40), it was brought in by the family. Ingestion of a bar of soap or a product brought in by the family was significantly associated with higher poisoning severity (PSS ≥ 2). After adjustment for age, sex and the number of residents per supervisor, the severity of poisoning was significantly greater after ingestion of a bar of soap (OR = 12.33, CI95 [2.12, 71.63], p = 0.005). CONCLUSION Older adults residing in medical facilities who have a history of dementia and/or cognitive impairment are more at risk of non-medicinal product poisoning. Clinical severity and the hospitalisation rate were greater when bar soap was ingested.
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Affiliation(s)
- Marie Deguigne
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Morgane Cellier
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Yveline Hamon
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Marion Legay
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Alexis Descatha
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France.,Univ Angers, CHU Angers, Univ Rennes, Inserm, Ehesp, Irset (Institut de recherche en santé, environnement et travail - Research Institute for Environmental and Occupational Health), Angers, France
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Rummel E, Evans EM, O'Neal PV. Educating Certified Nursing Assistants to Communicate Skin Changes to Reduce Pressure Injuries. J Gerontol Nurs 2021; 47:21-28. [PMID: 34309451 DOI: 10.3928/00989134-20210624-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pressure injuries (PIs) are common and costly complications in long-term care (LTC) residents. Educating and coaching certified nursing assistants (CNAs) to communicate early skin changes is a PI surveillance strategy that may influence PI outcomes. A communication guide related to Skin, Clean, Activity, and Nutrition was developed for CNAs to promote prompt upstream communication to licensed nurses. A pre-/post-intervention design measured PI knowledge and skills in 24 CNAs, and PI incidence was tracked over a 6-week time period. CNAs demonstrated improvement in their PI surveillance role, comfort in identifying and reporting skin changes, keeping skin clean and dry, and resident nutritional status. Baseline PI incidence of 9.6% decreased to 0% by Week 3, and no new PIs occurred over 6 weeks. CNAs developed role awareness and knowledge in primary PI surveillance and were instrumental in a team approach to decrease PIs in a LTC setting. [Journal of Gerontological Nursing, 47(8), 21-28.].
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Usher K, Hickman LD, Jackson D. Put 'nursing' back into aged care: Nursing care is essential to aged care homes beyond the COVID-19 pandemic. Contemp Nurse 2021; 57:1-3. [PMID: 34112058 DOI: 10.1080/10376178.2020.1843511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kim Usher
- School of Health, Armidale, Australia
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Walker VG, Walker EK. Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice. J Holist Nurs 2021; 40:181-192. [PMID: 34106020 DOI: 10.1177/08980101211025372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.
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Jester DJ, Thomas KS, Peterson LJ, Dosa DM, Andel R, Hyer K. Effect of Hurricane Irma on daily direct-care nurse staffing in nursing homes. J Am Geriatr Soc 2021; 69:2298-2305. [PMID: 33979461 DOI: 10.1111/jgs.17220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the effect of Hurricane Irma on staff-related financial expenditures and daily direct-care nurse staffing levels. DESIGN Retrospective cohort study. SETTING September 3-24, 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10, 2017. PARTICIPANTS Six hundred and fifty-three nursing homes (NHs), 81 evacuated facilities, and 572 facilities that sheltered-in-place. MEASUREMENTS This study used data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida's health providers' emergency reporting system. PBJ provided estimates of daily direct-care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility-level characteristics such as profit status, chain membership, and special care unit availability. Florida's emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed-effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3 to 10. RESULTS Among all facilities, we found significant increases in staffing for licensed practical nurses (p = 0.02) and certified nursing assistants (p < 0.001), but not for registered nurses (p = 0.10) before Hurricane Irma made landfall. From 1 week before landfall to 2 weeks after landfall (September 3-24), an additional estimated $2.41 million was spent on direct-care nurse staffing. In comparison to facilities that sheltered-in-place, evacuated facilities increased staffing levels of all nurse types (all p < 0.001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident whereas facilities that sheltered-in-place spent $76.10 on nurse staffing per resident. CONCLUSION NHs face unprecedented challenges during hurricanes, including maintaining adequate direct-care nurse staffing levels to meet the needs of their residents. NHs that evacuated residents had an increase in direct-care nurse staffing that was greater than that seen in NHs that sheltered-in-place.
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Affiliation(s)
- Dylan J Jester
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kali S Thomas
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Lindsay J Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - David M Dosa
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,School of Public Health, Brown University, Providence, Rhode Island, USA.,Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Ross Andel
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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Bakerjian D, Boltz M, Bowers B, Gray-Miceli D, Harrington C, Kolanowski A, Mueller CA. Expert nurse response to workforce recommendations made by the coronavirus commission for safety and quality in nursing homes. Nurs Outlook 2021:S0029-6554(21)00091-9. [PMID: 33993987 DOI: 10.1016/j.outlook.2021.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022]
Abstract
COVID-19 has exposed the longstanding internal problems in nursing homes and the weak structures and policies that are meant to protect residents. The Centers for Medicare and Medicaid Services convened the Coronavirus Commission for Safety and Quality in NHs in April, 2020 to address this situation by recommending steps to improve infection prevention and control, safety procedures, and the quality of life of residents in nursing homes. The authors of this paper respond to the Final Report of the Commission and put forth additional recommendations to federal policymakers for meaningful nursing home reform: 1) ensuring 24/7 registered nurse (RN) coverage and adequate compensation to maintain total staffing levels that are based on residents’ care needs; 2) ensuring RNs have geriatric nursing and leadership competencies; 3) increasing efforts to recruit and retain the NH workforce, particularly RNs; and 4) supporting care delivery models that strengthen the role of the RN for quality resident-centered care.
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Hara Y, Asakura K, Sugiyama S, Takada N, Ito Y, Nihei Y. Nurses Working in Nursing Homes: A Mediation Model for Work Engagement Based on Job Demands-Resources Theory. Healthcare (Basel) 2021; 9:316. [PMID: 33809246 PMCID: PMC7999486 DOI: 10.3390/healthcare9030316] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Abstract
This study examined the impact that the attractiveness of working in nursing homes and autonomous clinical judgment have on affective occupational commitment, and whether work engagement mediates these relationships. This analysis was based on the job demands-resources theory. The study setting was 1200 nursing homes (including long-term care welfare facilities and long-term care health facilities) in eastern Japan. An anonymous, self-report questionnaire survey was administered to two nurses from each facility, resulting in a prospective sample of 2400 participants. Overall, 552 questionnaires were analyzed, in which structural equation modeling and mediation analysis using the bootstrap method were performed. The results showed that the attractiveness of working in nursing homes does not directly affect affective occupational commitment; work engagement fully mediates the impact of attractiveness of working in nursing homes on affective occupational commitment. Additionally, autonomous clinical judgment showed a direct impact on both work engagement and affective occupational commitment, indicating that work engagement partially mediates the impact on affective occupational commitment. To increase the affective occupational commitment of nurses working in nursing homes, managers should help nurses recognize the attractiveness of working in nursing homes, and then provide appropriate support to help such nurses work in a motivated manner.
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Affiliation(s)
- Yukari Hara
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; (K.A.); (S.S.); (N.T.); (Y.I.); (Y.N.)
| | - Kyoko Asakura
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; (K.A.); (S.S.); (N.T.); (Y.I.); (Y.N.)
| | - Shoko Sugiyama
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; (K.A.); (S.S.); (N.T.); (Y.I.); (Y.N.)
| | - Nozomu Takada
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; (K.A.); (S.S.); (N.T.); (Y.I.); (Y.N.)
| | - Yoshimi Ito
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; (K.A.); (S.S.); (N.T.); (Y.I.); (Y.N.)
- School of Nursing, Miyagi University, 1-1 Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi 981-3298, Japan
| | - Yoko Nihei
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; (K.A.); (S.S.); (N.T.); (Y.I.); (Y.N.)
- Department of Nursing, Faculty of Health Sciences, Tohoku Fukushi University, 1-8-1 Kunimi, Aoba-ku, Sendai, Miyagi 981-8522, Japan
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Affiliation(s)
- Margaret J McGregor
- Department of Family Practice (McGregor), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; University of California San Francisco (Harrington), San Francisco, Calif.
| | - Charlene Harrington
- Department of Family Practice (McGregor), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; University of California San Francisco (Harrington), San Francisco, Calif
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Estabrooks CA, Straus SE, Flood CM, Keefe J, Armstrong P, Donner GJ, Boscart V, Ducharme F, Silvius JL, Wolfson MC. Restoring trust: COVID-19 and the future of long-term care in Canada. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0056] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.
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Affiliation(s)
| | - Sharon E. Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Pat Armstrong
- Department of Sociology, York University, Toronto, ON, Canada
| | - Gail J. Donner
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Véronique Boscart
- CIHR/Schlegel Industrial Research Chair for Colleges in Seniors Care, Conestoga College, Kitchener, ON, Canada
| | | | - James L. Silvius
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael C. Wolfson
- School of Epidemiology and Public Health and Faculty of Law, University of Ottawa, Ottawa, ON, Canada
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