Determinants of transitory and permanent nursing home admissions

This article describes an analysis of data from the 1982-84 National Long-Term Care Demonstration Project to estimate the risks of any nursing home admission, a temporary or transitory admission, and a permanent admission. Using a multinomial logit model, the relative predictive power of several individual characteristics on nursing home use and admission type were evaluated. It was found that the cognitively impaired subgroup was at the greatest risk of entering a nursing home, especially on a permanent basis. The results also demonstrated that the combination of cognitive impairment and functional impairment further increased the risk of a nursing home admission, particularly a permanent one. Other subgroups that had high probabilities of experiencing a nursing home admission were whites, nonhomeowners, those living alone, and those with prior nursing home stays. The findings identified several aged subgroups that were at no greater risk of nursing home admission regardless of admission type: older persons who were unmarried, had a low income, had no assets, and those on Medicaid.     

The length-of-stay pattern of nursing home admissions

The length of stay (LOS) pattern of nursing home admissions has not been directly measured because the long duration of stay of some patients (e.g., 25% of persons admitted reside in homes for longer than 1 year) makes it impractical to follow specific admission cohorts until the members have been discharged. By applying life-table methods to data on current and discharged residents from the 1977 National Nursing Home Survey, the authors were able to generate estimates of this distribution. They estimated that the typical nursing home admission initially has an expected LOS of 456 days, but, more interesting, the remaining LOS is expected to increase, in the intermediate term, with the amount of time spent in the facility. They also examined LOS distributions of subsets of the national nursing home population, and illustrated potential applications for this new information for policy formulation.     

The transition to nursing home life: a comparison of planned and unplanned admissions

The percentage of elderly people in nursing homes increases with age from 7% for adults aged 75–84 years to 20% for those over 85 years old. Limited research has been done with elderly people whose admission to a nursing home was planned or unplanned. This study addressed: what are the initial experiences of elderly people in making the transition to nursing home life when the admission was planned or unplanned? A grounded theory approach using constant comparative methods was used to discover the process and patterns of transition to nursing home life. Data were collected 24 hours after admission and every other day for 2 weeks, and 1 month post-admission using in-depth semistructured interviews and field notes. Data analysis demonstrated that the transition to nursing home life occurred in three phases: overwhelmed, adjustment and initial acceptance phase. The phases of adjustment are discussed along with interventions to assist older adults in making this transition.     

Cardiovascular drug use and hospitalizations attributable to type 2 diabetes

OBJECTIVE: To investigate cardiovascular drug use and hospitalizations attributable to type 2 diabetes from 1 year before until 6 years after the start of oral antidiabetic therapy. RESEARCH DESIGN AND METHODS: In this cohort study, 2,584 patients with type 2 diabetes were selected from the PHARMO Record Linkage System, comprising pharmacy records and hospitalizations for all 320,000 residents of six Dutch cities. Patients with type 2 diabetes were identified as incident oral antidiabetic drug users between 1992 and 1997. Nondiabetic subjects were 1:1-matched for age, sex, pharmacy, and index date and received no insulin, oral antidiabetic drugs, or glucose-testing supplies. RESULTS: Patients with type 2 diabetes were more likely to use cardiovascular drugs (RR 1.28 [95% CI 1.23-1.34]) and to be hospitalized because of cardiovascular diseases (1.54 [1.33-1.78]) after the start of oral antidiabetic therapy than nondiabetic subjects. Differences between patients with type 2 diabetes and nondiabetic subjects lessened from 1 year before until 6 years after the start of oral antidiabetic therapy, reflected by decreasing attributable risks for diuretics, beta-blockers, calcium channel blockers, and cardiac and antithrombotic drugs. The difference in use of angiotensin-converting enzyme inhibitors and lipid-lowering drugs increased. Cardiovascular hospitalizations attributable to type 2 diabetes were approximately 50% in the years close to the start of oral antidiabetic treatment and decreased to approximately 33% in the following years. CONCLUSIONS: Although cardiovascular drug use and hospitalizations remained increased in patients with type 2 diabetes after the start of oral antidiabetic therapy, cardiovascular drug use attributable to type 2 diabetes decreased after the start of oral antidiabetic therapy, especially beta-blockers, whereas cardiovascular hospitalizations first decreased and then stabilized.     

Examining economic improvements in managing diabetes in the nursing home

In 1997, two-thirds of the medical cost of diabetes was borne by the elderly and nursing home care attributable to diabetes accounted for a third of that financial burden. The development of the Insulin Delivery Pen system can provide cost efficiency, and concurrently reduce the potential for contamination, free up nursing time, improve the administration process, and maintain dosing accuracy. The insulin pen delivery system (vs. the traditional vial and syringe method) is an attractive and cost effective option in the treatment of diabetes mellitus for residents in nursing facilities.     

Teaching communication skills to nursing home certified nursing assistants

Increasing numbers of terminally ill patients are admitted to nursing homes. Quality palliative care requires good communication skills, but certified nursing assistants (CNAs), who spend the most time with residents, are inadequately trained. They receive little education in communication during training programs or as in-services in the nursing home. Education and role-playing during their training program could be used to learn these skills, as could a series of short videos. Further research is needed to develop and test new methods of teaching communication skills to nursing home CNAs.     

Changing traditional nursing home roles to nursing case management

1. The role of nursing case manager described here was derived from the concept of primary nursing in acute care, team nursing, and the community-based social service role. 2. Nurses in nursing homes often function within a bureaucratic, physician advocate role instead of within a professional, patient advocate role. 3. Following implementation of the nursing case manager role, nurses were able to see results of their intervention, nursing accountability was enhanced, and the number of documented positive patient outcomes increased. 4. The two primary paper tools used by nurses in this project were the care plan to direct individualized care and the progress note to report problem resolution.