Low back pain among care workers working at newly-built nursing homes for the aged.

The aim of this study was to investigate the association between severe low back pain (LBP) and work load for care workers (CWs) who were working at newly-built special nursing homes, because it has long been known that LBP is very common among CWs, and we consider that measures to reduce serious LBP should be the top priority. A total of 258 questionnaires were distributed to all CWs employed at 7 nursing homes. There were 214 replies, a response rate of 82.9%. The average age of respondents was 28.8 years old. A total of 212 (59 males and 153 females) completed questionnaires were analyzed. The results of factor analysis were based on 22 original questions about physical and mental care work load. Sixteen questions and 5 subscales were explored. Factor 1 was characteristics and ADL of care receivers; Factor 2, violence by care receivers; Factor 3, communication with staff at workplace; Factor 4, problems with work environment; and Factor 5, communication with care receivers. Severe LBP was defined as a subject who had always suffered from LBP in the last one month. Multiple logistic regression analysis was performed to estimate the relationship of severe LBP and care work load. Adjustments were made for sex and job tenure. In Factor 1, "characteristics and ADL of care receivers", heavy weight showed significant association, with adjusted Odds Ratios of 6.63 (95%CI: 1.71-25.75). Therefore, to prevent LBP of CWs, it is necessary to make staff assignments and to provide assistive devices based on careful considerations of the characteristics and ADL of care receivers.     

Costs of quality management systems in long-term care organizations: an exploration

The article describes a method for measuring and reporting the costs of quality management in 11 long-term care organizations (nursing homes, home health care organizations, and homes for the elderly) and a national survey in 489 organizations providing long-term care. Site visits and a questionnaire were used to measure the existence of quality management (QM) activities and investigate the costs per QM activity in more detail. Health care organizations differentiate between regular activities and QM activities. The costs of QM activities were found to vary between 0.3% and 3.5% of the budget in three nursing homes. An extrapolation of the costs of QM activities to the entire sector shows that the long-term care sector spent between 0.8% and 3.5% of the overall budget for QM in 1999. The costs of developing and implementing QM activities are higher than the costs of monitoring. Most long-term care organizations have no insight into failure costs (i.e. the costs of quality deviations). This makes it impossible for health care organizations to draw conclusions about the cost-effectiveness of QM.     

Multiresistant pathogens in geriatric nursing – infection control in residential facilities for geriatric nursing in Germany

Background: The increase of multidrug-resistant organisms (MDROs) causes problems in geriatric nursing homes. Older people are at increased a growing risk of infection due to multimorbidity and frequent stays in hospital. A high proportion of the elderly require residential care in geriatric nursing facilities, where hygiene requirements in nursing homes are similar to those in hospitals. For this reason we examined how well nursing homes are prepared for MDROs and how effectively protect their infection control residents and staff.Methods: A cross-sectional study was performed on infection control in residential geriatric nursing facilities in Germany 2012. The questionnaire recorded important parameters of hygiene, resident and staff protection and actions in case of existing MDROs.Results: The response was 54% in Hamburg and 27% in the rest of Germany. Nursing homes were generally well equipped for dealing with infection control: There were standards for MDROs and regular hygiene training for staff. The facilities provided adequate protective clothing, affected residents are usually isolated and hygienic laundry processing conducted. There are deficits in the communication of information on infected residents with hospitals and general practitioners. 54% of nursing homes performed risk assessments for staff infection precaution.Conclusion: There is a growing interest in MDROs and infection control will be a challenge in for residential geriatric nursing facilities in the future. This issue has also drawn increasing attention. Improvements could be achieved by improving communication between different participants in the health service, together with specific measures for staff protection at work.     

Evidence on the Effects of the Federal COVID-19 Vaccine Mandate on Nursing Home Staffing Levels

ObjectiveTo assess the federal COVID-19 vaccine mandate's effects on nursing homes' nurse aide and licensed nurse staffing levels in states both with and without state-level vaccine mandates.DesignCross-sectional study using data from Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, and Economic Innovation Group. Including nursing home facility fixed effects provides evidence on the intertemporal effects of the federal vaccine mandate within nursing homes.Setting and ParticipantsThe sample contains 15,031 nursing homes, representing all US nursing homes with available data.MethodsOn January 13, 2022, the US Supreme Court upheld the federal COVID-19 vaccine mandate for health care workers in Medicare- and Medicaid-eligible facilities, with workers generally required to be vaccinated by March 20, 2022 (ie, the compliance date). We examined actual nursing home staffing levels in 3 time periods: (1) pre-Court decision; (2) precompliance date; and (3) postcompliance date. We separately examined staffing levels for nurse aides and licensed nursing staff. Because 28% of nursing homes were in states with state-imposed vaccine mandates that predated the Supreme Court's ruling, we divided the sample into 2 groups (nursing homes in mandate states vs nonmandate states) and performed all analyses separately.ResultsStaff vaccination rates and staffing levels were higher in mandate states than nonmandate states in all 3 time periods. After the Court's decision, staff vaccination rates increased 5% in nonmandate states and 1% in mandate states (on average). We find little evidence that the Court's vaccine mandate ruling materially affected nurse aide and licensed nurse staffing levels, or that nursing homes in mandate states and nonmandate states were differentially affected by the Court's ruling. Staffing levels over time were generally flat, with some evidence of a modestly greater increase for nurse aide staffing in mandate states than nonmandate states, and a modestly smaller decrease for licensed nurse staffing in mandate states than nonmandate states. Finally, regression results suggest that for both nurse aides and licensed nurses, staffing levels were lower in rural and for-profit nursing homes, and higher in Medicare-only, higher quality, and hospital-based nursing homes.Conclusions and ImplicationsResults suggest the federal COVID-19 vaccine mandate has not caused clinically material changes in nursing home's nurse aide and licensed nurse staffing levels, which continue to be primarily associated with factors that are well-known to researchers and practitioners.     

Hospice in the Nursing Home: Perspectives of Front Line Nursing Home Staff

ObjectiveUse of hospice has been associated with improved outcomes for nursing home residents and attitudes of nursing home staff toward hospice influences hospice referral. The objective of this study is to describe attitudes of certified nursing assistants (CNAs), nurses, and social workers toward hospice care in nursing homes.Design, setting, and participantsWe conducted a survey of 1859 staff from 52 Indiana nursing homes.MeasurementsStudy data include responses to 6 scaled questions and 3 open-ended qualitative prompts. In addition, respondents who cared for a resident on hospice in the nursing home were asked how often hospice: (1) makes their job easier; (2) is responsive when a patient has symptoms or is actively dying; (3) makes care coordination smooth; (4) is needed; (5) taught them something; and (6) is appreciated by patients/families. Responses were dichotomized as always/often or sometimes/never.ResultsA total of 1229 surveys met criteria for inclusion. Of the respondents, 48% were CNAs, 49% were nurses, and 3% were social workers; 83% reported caring for a nursing home patient on hospice. The statement with the highest proportion of always/often rating was ‘patient/family appreciate added care’ (84%); the lowest was ‘hospice makes my job easier’ (54%). More social workers responded favorably regarding hospice responsiveness and coordination of care compared with CNAs (P = .03 and P = .05, respectively).ConclusionsA majority of staff responded favorably regarding hospice care in nursing homes. About one-third of nursing home staff rated coordination of care lower than other aspects, and many qualitative comments highlighted examples of when hospice was not responsive to patient needs, representing important opportunities for improvement.     

Load on the low back of care workers in nursing homes for the elderly]

In order to evaluate the load on the low back of care workers in nursing homes for the elderly, basic activities and working postures were analyzed for six care workers using the 30-s snap reading method. The trunk inclination angle (TIA) was also measured continuously using an inclination monitor. The analysis of basic activities showed that 22.5% and 21.1% of the workshift were spent on 'bathing and ablution' and 'meal', respectively, and 9.3%, 8.7% and 8.3% were spent on 'assistance with elimination', 'assistance with moving and repositioning' and 'exchange of bed sheet', respectively. Total of the assistance activity was 43.7% of the workshift. The analysis of working posture showed that 'standing' and 'standing bent forward' accounted for 36.1% and 29.5%, respectively, of the workshift. Total of three postures loading the low back ('standing bent forward', 'squatting', 'kneeling') accounted for 39.0%. The time spent in TIA of 20 degrees or more was 45.7%. The postures loading the low back during 'bathing and ablution', 'exchange of bed sheet' and 'assistance with elimination' account for 68.3%, 58.2% and 49.6%, respectively, which suggests that these activities load the low back of the care workers considerably.     

Challenges of Using Quality Improvement Methods in Nursing Homes that “Need Improvement”

ObjectivesQualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes “in need of improvement”. To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams.Design/setting/participantsA randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in “need of improvement”. Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making.ResultsA qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve: (1) a leadership team (nursing home administrator, director of nurses) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; (2) one of the leaders to be a “change champion” and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; (3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; (4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; (5) leaders willing to continuously involve all staff in quality improvement committee and team activities so they “own” the process and are responsible for change.ConclusionsResults of this qualitative analysis can help allocate expert nurse time to facilities that are actually ready to improve. Wide-spread adoption of this intervention is feasible and could be enabled by nursing home medical directors in collaborative practice with advanced practice nurses.     

Decline in Veterans’ Admissions to Nursing Homes during COVID-19: Fewer Beds,More Fear,and Finding Alternative Care Settings

ObjectiveExamine the decline in admission to community nursing homes among Veterans that occurred following the onset of the COVID-19 pandemic.DesignMultimethods study using Department of Veterans Affairs (VA) purchasing records to examine trends in total admissions and semistructured interviews with staff connected to the VA community nursing home program to contextualize observed trends.Setting and participantsAll VA-paid admissions to community nursing homes (N = 56,720 admissions) and national data on nursing home admissions from LTCFocUS. Semistructured interviews were conducted with 9 VA staff from 4 VA medical centers working in the VA community nursing home program, including social workers, nurses, and program coordinators.ResultsBetween April and December 2020, community nursing home admissions among Veterans were 35% lower compared with the same period in 2019. Nationally, total nursing home admissions decreased by 19.6%. VA community nursing home program staff described 3 themes that contributed to this decline: (1) fewer nursing home beds available, (2) lower admissions due to fear of Veterans being exposed to COVID-19 in nursing homes, and (3) leaving nursing homes in favor of living at home with home-based care.Conclusions and ImplicationsThe decline in nursing home admissions among Veterans raises questions about how replacing nursing home care in favor of home- and community-based care affects the health outcomes and well-being of Veterans and their caregivers.     

Violence exposure and burn-out among Turkish nursing home staff

AIM: The aim of this study was to describe the frequency of violence against personnel from residents and to identify the prevalence of burn-out among staff working in nursing homes. METHODS: The study was performed in two cities in the west of Turkey. A semi-structured questionnaire on violence and Pines' Burnout scale were distributed among all the staff working in six nursing homes, and 214 of them responded. RESULTS: Of the total number of respondents, 56% stated that they had been exposed to violence during the preceding year. More than 20% stated that they had reported violence to their supervisor. Less than 10% had received medical or psychological support following the event. Violent incidents were reported significantly more frequently among staff who reported problems working with elderly residents. There was no relationship between violence towards staff and burn-out. CONCLUSIONS: Violence is commonly experienced by care workers in nursing homes for the elderly. Strategies to improve occupational conditions in nursing homes are required.     

Perspectives on Parkinson Disease Care in Dutch Nursing Homes

Introduction

Parkinson's disease (PD) is a complex and disabling disorder. Ultimately, 20% to 40% of patients are admitted to a nursing home, and neurologists often lose track of these patients. Care and treatment of these institutionalized patients have not been addressed comprehensively, but anecdotal reports suggest it is suboptimal. We conducted a qualitative study to analyze the quality of PD care in Dutch nursing homes from the perspective of residents, caregivers, and health care workers.

Methods

Experiences and (unmet) needs of 15 nursing home residents with PD and parkinsonism (90% Hoehn and Yahr stage 4 and 5) and 15 informal caregivers were assessed using semistructured interviews. Furthermore, 5 focus group discussions were organized with 13 nurses and 22 other health care professionals to explore the experiences and barriers of PD care.

Results

Three core unmet needs were identified: (1) unsatisfactory empathy and emotional support, according to residents and informal caregivers; (2) insufficient staff knowledge on PD-related issues, such as motor fluctuations, leading to poorly timed administration of levodopa; (3) suboptimal organization of care with limited access to neurologists and specialized PD nurses.

Conclusions

PD care in Dutch nursing homes is suboptimal according to residents, informal caregivers, and health care workers. Three core areas for improvement were identified, including greater attention for psychosocial problems, improved PD-specific knowledge among nursing home staff, and better collaboration with hospital staff trained in movement disorders.     

The Influence of Teams to Sustain Quality Improvement in Nursing Homes that “Need Improvement”

ObjectivesQualitatively describe the use of team and group processes in intervention facilities participating in a study targeted to improve quality of care in nursing homes “in need of improvement.”Design/setting/participantsA randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes. Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making.ResultsThe qualitative analysis revealed a subgroup of homes (“Full Adopters”) likely to continue quality improvement activities that were able to effectively use teams. “Full Adopters” had either the nursing home administrator or director of nursing who supported and were actively involved in the quality improvement work of the team. “Full Adopters” also selected care topics for the focus of their quality improvement team, instead of “communication” topics of the “Partial Adopters” or “Non-Adopters” in the study who were identified as unlikely to continue to continue quality improvement activities after the intervention. “Full Adopters” had evidence of the key elements of complexity science: information flow, cognitive diversity, and positive relationships among staff; this evidence was lacking in other subgroups. All subgroups were able to recruit interdisciplinary teams, but only those that involved leaders were likely to be effective and sustain team efforts at quality improvement of care delivery systems.ConclusionsResults of this qualitative analysis can help leaders and medical directors use the key elements and promote information flow among staff, residents, and families; be inclusive as discussions about care delivery, making sure diverse points of view are included; and help build positive relationships among all those living and working in the nursing home. Wide-spread adoption of the intervention in the randomized study is feasible and could be enabled by nursing home Medical Directors in collaborative practice with Advanced Practice Nurses.     

An Exploration of Safety Climate in Nursing Homes

OBJECTIVES: Although nursing homes provide complex care requiring attention to safety, research on safety climate in nursing homes is limited. Our study assessed differences in attitudes about safety among nursing home personnel and piloted a new survey, specifically designed for the nursing home context. METHODS: Drawing on previous safety climate surveys for hospitals and nursing homes, researchers developed the Survey on Resident Safety in Nursing Homes and administered it March to June 2008 to frontline caregivers and managers in 8 randomly selected Massachusetts nursing homes. Our sample consisted of 751 employees, including all full-time, direct-care staff and managers from participating facilities. First, we performed factor analysis and determined Cronbach alphas for the Survey on Resident Safety in Nursing Homes. Then, we described facilities' safety climate and variation by personnel category and among facilities by calculating the proportion of responses that were strongly positive by item, personnel category, and nursing home. RESULTS: Of 432 respondents (57% response), 29% gave their nursing home an excellent rating overall. Scores varied by personnel category and home: 51% of senior managers gave an excellent safety grade versus 26% of nursing assistants; the range in top safety grades among nursing homes was 30 percentage points. CONCLUSIONS: Safety climate varied substantially among this small sample of nursing homes and by personnel category; managers had more positive perceptions about safety than frontline workers. Efforts to measure safety climate in nursing homes should include the full range of staff at a facility and comparisons among staff categories to provide a full understanding for decision making and to promote targeted response to improve resident safety.     

Factors associated with life satisfaction of personal care workers delivering dementia care in day care centers

This study examined the overall life satisfaction of personal care workers (PCWs) delivering dementia care in elderly day care centers in Hong Kong. A total of 142 PCWs participated in the present study. Regression analysis results showed that self-efficacy in dementia care was a robust predictor for PCWs' life satisfaction. Female gender, perceived adequacy of training, low staff to client ratio, and high emotional support from colleagues predicted a high level of self-efficacy. To promote a higher level of life satisfaction among PCWs, it is essential for organizations to enhance their sense of self-efficacy. Providing PCWs with adequate training that address areas specific to their perceived needs is of utmost importance in achieving this goal.     

Changes in use of voluntary workers in nursing homes: United States, 1985 and 1999

OBJECTIVE: This report describes changes in the use of voluntary workers in nursing homes between 1985 and 1999. Statistics are presented on selected characteristics of nursing homes using voluntary workers and the services they perform. Factors that may contribute to the increased use of voluntary workers are also discussed. METHODS: The data presented in this report were collected from the 1985 and 1999 National Nursing Home Surveys (NNHS). NNHS is a part of the National Health Care Survey, which measures health care utilization across various types of providers. Conducted periodically since 1973, NNHS obtains information from a nationally representative sample of nursing home facilities based on interviews with administrators and staff. Sample data are weighted to produce annual national estimates. RESULTS: In 1999, 87 percent of all nursing homes reported using voluntary workers, up from 78 percent in 1985. In 1985, unpaid workers were most likely found in large nursing homes (100 beds or more). By 1999, about the same proportion of nursing homes, large and small, reported their use. In 1999, the Northeast region had the greatest proportion of nursing homes that used volunteers--93 percent. Chain-affiliated and independent facilities used volunteers with about the same frequency, and about the same percentage of nursing homes not certified by either Medicaid or Medicare used voluntary workers as did dually-certified facilities. However, in 1999, proportionately fewer proprietary (for-profit) nursing homes reported having volunteers (85 percent) than did nonproprietary facilities (93 percent).     

Investigating the educational needs of licensed nursing staff and certified nursing assistants in nursing homes regarding end-of-life care

Nursing homes care for people at the end of life (EOL). There is evidence to suggest, however, that nursing staff in these settings is often unprepared to provide a high level of EOL care. This article reports the findings from three preliminary studies that investigated the needs of licensed staff and certified nursing assistants in nursing homes regarding EOL care. The studies involved needs assessment surveys, focus group interviews with staff members, and telephone interviews with nursing home administrators. Data show that the major needs included a lack of knowledge and skills in symptom management; communication difficulties; conflicts with families and physicians; and emotional distress in dealing with time constraints and attachment to residents. Implications for nursing home staff education are described.     

Intended and Unintended Consequences of Minimum Staffing Standards for Nursing Homes

Staffing is the dominant input in the production of nursing home services. Because of concerns about understaffing in many US nursing homes, a number of states have adopted minimum staffing standards. Focusing on policy changes in California and Ohio, this paper examined the effects of minimum nursing hours per resident day regulations on nursing home staffing levels and care quality. Panel data analyses of facility‐level nursing inputs and quality revealed that minimum staffing standards increased total nursing hours per resident day by 5% on average. However, because the minimum staffing standards treated all direct care staff uniformly and ignored indirect care staff, the regulation had the unintended consequences of both lowering the direct care nursing skill mix (i.e., fewer professional nurses relative to nurse aides) and reducing the absolute level of indirect care staff. Overall, the staffing regulations led to a reduction in severe deficiency citations and improvement in certain health conditions that required intensive nursing care. Copyright © 2014 John Wiley & Sons, Ltd.     

Nurses' and nursing assistants' perceptions of patient safety culture in nursing homes.

OBJECTIVE: To evaluate whether perceptions of patient safety in nursing homes vary by length of employment, type of employee, and shift worked. DESIGN: Cross-sectional study. SETTING: Twenty-six nursing homes in Ohio participating in a randomized trial to test the effectiveness of a clinical informatics tool to improve patient safety during the medication monitoring. PARTICIPANTS: Nurses (n = 367) and nursing assistants (n = 636) employed at the time of the survey in the summer and fall of 2003. MAIN OUTCOME MEASUREMENTS: Resident safety questions included 34 items on different aspects of resident safety (overall safety perception, teamwork within and between departments, communication openness, feedback and communication about error, non-punitive response to error, organizational learning, management expectations, and actions promoting safety, staffing, and management support for patient safety). RESULTS: Overall perceptions of resident safety by employees were acceptable, with clear management communication of safety goals. Approximately 40% of nursing staff found it difficult to make changes to improve things most or all of the time; similar proportions indicated that management seriously considered staff suggestions to improve resident safety; only half reported management discussions with staff to prevent recurrence of mistakes. Regardless of staff type, one in five reported feeling punished and two in five reported that reporting of errors was seen as a 'personal attack'. CONCLUSIONS: Interventions to change the safety culture in nursing homes are warranted. Nursing homes need guidance on how to use information to implement safety improvement projects in the context of a strict regulatory environment which may prohibit innovative system change.     

Partnership working by default: district nurses and care home staff providing care for older people

Older people residents in care homes that only offer residential care rely on primary healthcare services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary healthcare team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on‐site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community‐based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community‐based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.     

We're on the Same Side: Improving Communication Between Nursing Home and Family

Good communication between families and care providers is central to quality care, providing valuable insight into medical history and preferences, increasing family involvement and satisfaction, and reducing complaints. Two studies offer insight into sources of family–staff miscommunication and conflict. The Nursing Home Family Study (Study 1) interviewed 103 family caregivers to nursing home residents. The Long Term Care Community Coalition (Study 2) conducted focus groups and surveys with staff in six facilities: 323 certified nurse's assistants, 52 licensed practical nurses, and 71 registered nurses. Qualitative and quantitative data from both studies identified multiple barriers to good communication associated with both nursing homes and family caregivers. Institutional barriers include understaffing, turnover, inadequate training, policies based in a medical model, rigid routines, poor intrastaff communication, and work schedules that do not coincide with family visits. Psychosocial factors that hinder family communication include guilt, role confusion, clashes of culture and values, unrealistic expectations, and conflicting responsibilities. Specific communication problems identified by families were: making them feel guilty, criticism of their involvement, lack of information, changes made without consultation, staff have too little time to talk, high turnover, rotating shifts, and poor intrastaff communication. Similar issues were raised by nursing staff, who valued trusting, respectful relationships with supervisors and families, being consulted prior to changes, support in addressing racist or abusive comments, adequate staffing, and teamwork. Certified nursing assistants noted that family members are quick to complain but seldom offer praise, and that their intimate knowledge of the resident is rarely acknowledged. These data are applied to develop educational interventions to improve family–staff communication.