Advance care planning among residents in long-term care

This study was conducted to determine whether two types of advance directives exist for individuals residing in long-term care facilities. Findings were based on data from the Medical Expenditure Panel Study-Nursing Home Component (MEPS-NHC), a survey using a two-stage stratified probability sample of nursing homes and residents to produce valid national estimates of the nursing home population in the United States. The two types of advance directives included basic, i.e., living will or do-not-resuscitate (DNR) order, and progressive (do-not-hospitalize order or orders restricting feeding, medication, or other treatment). Approximately 59 percent of long-term care residents had a basic advance directive, 9 percent have a progressive directive, and 60 percent have some type of directive. Logistic regression results indicate that the factors associated with the likelihood of each type of directive differ considerably, and only two variables (African American ethnicity and less time in the facility) were associated with a reduced likelihood of having either type of directive. Our results indicate that the two proposed types of advance directives are distinct with regard to the variables predicting each.     

Advance care planning

Advance care planning is the process of planning for future medical care, particularly for the event when the patient is unable to make his or her own decisions. It should be a routine part of standard medical care and, when possible, conducted with the proxy decision maker present. It is helpful to think of the process as a stepwise approach. The steps include the appropriate introduction of the topic, structured discussions covering potential scenarios, documentation of preferences, periodic review and update of the directives, and application of the wishes when needed. The steps can be integrated flexibly into routine clinical encounters by the physician and other members of the health care team. The process fosters personal resolution for the patient, preparedness for the proxy, and effective teamwork for the professionals. The process also has pitfalls of which to be aware. Arch Fam Med. 2000;9:1181-1187     

Quality of care assessment in long-term care facilities

Quality of care assessment is in a rather rudimentary state of development in most long-term health care settings. Some of the mandates and initiatives in this area of evaluation are described and discussed. A few caveats are presented and suggestions made as to appropriate approaches to quality assessment in chronic care facilities, which are different in many respects from the more traditional approaches used in acute care hospitals. Of particular importance, and at the same time of greatest difficulty, is the assessment of quality of life in institutions where many patients spend the remainder of their lives.     

Infection control in Queensland long-term care facilities

In July 2000 a statewide infection control survey was mailed out to 483 long-term care facilities (LTCFs) in Queensland, Australia. The survey aimed to identify the presence and composition of infection control programmes in LTCFs and to investigate their relationship to the process elements of infection control programmes. A response rate of 43 per cent (n=206) was achieved.The survey found that almost all LTCFs (97 per cent) had an infection control programme in place. A majority (70 per cent) had an infection control committee or another committee with responsibility for infection control. The time allocated to infection control was only 1-2 hours per week in the majority (56 per cent) of facilities, and there was no correlation between this time allocation and bed numbers. Almost all (99 per cent) facilities provided infection control education to their staff. Most facilities conducted surveillance for urinary tract infection, respiratory tract infection or wound and skin infection. Surveillance data was used for staff feedback, education and/or accreditation in 95 per cent of facilities.Further investigation is warranted in order to identify the amount of time required to fulfil infection control responsibilities in LTCFs. This study also suggests that minimum standard definitions for surveillance are required for the LTCF in order to facilitate data collection and analysis, benchmarking ability and possible aggregation of information.     

Mattress evaluation for long-term care facilities

Patients spend more than a third of their hospital time in bed and considerably more than that if they are residents in a long-term care facility. When our facility, Fair Acres Geriatric Center, a 911-bed long-term care facility in Lima, PA, noticed increasing losses of our standard mattresses, we decided to evaluate new products. We listed very important criteria (bacteria resistance, flame retardation, self-deodorization and comfort and resiliency) and important criteria (stain resistance, cost and warranty) and then brought in three standard mattresses for our staff to evaluate. We were able to procure a mattress that met our criteria and halved our costs in the process.