The actual condition of musculoskeletal disorders of workers working at new special nursing homes for the aged in Osaka Prefecture--comparison of musculoskeletal disorder between manager's awareness and care workers' complaints by questionnaire survey]

In order to examine the actual condition of health problems of workers working at new special nursing homes for the aged, we conducted an interview survey with the managers and a questionnaire survey among the workers. Subjects of the interview survey were managers at the 7 nursing homes. Subjects of the questionnaire survey were 362 workers employed at the 7 nursing homes, 214 care workers (CWs) and 104 workers other than care workers (non-CWs); 299 questionnaires were returned. The response rate was 82.6%. We asked the managers "How many CWs are complaining of low back pain (LBP) and upper extremity pain at your nursing home?" One manager answered that 80% of CWs were complaining of LBP, but other managers answered that a few but no more than 5 CWs were complaining of LBP. On the other hand, the prevalence of LBP among CWs by the questionnaire survey was high. The point prevalence of LBP was 70.0%, the one month prevalence of LBP was 81.6%, and the period prevalence of LBP in present job was 88.6%. The managers had less interest in upper extremity pain than in LBP. But more than 60% of CWs had complained of upper extremity pain in the previous 1 month. Seventy-three percent of CWs had not received any education about work-related musculoskeletal disorders although about half of them had got some education or training to minimize the risk of injury in training school. Regarding female workers (77% of all CWs, 73% of all non-CWs), the percentages of current smokers and night shift workers were higher in CWs than in non-CWs with statistically significant differences. The percentages of workers working without work breaks and working overtime were higher in non-CWs than in CWs with statistically significant differences. For prevalence of LBP among female CWs and female non-CWs, the workers having LBP now, having had LBP in present job, and having first experienced LBP in present job were higher in CWs than in non-CWs with statistically significant differences. All nursing homes surveyed had provided no special health examination for LBP. For managers to grasp the actual condition of musculoskeletal disorders of workers working at the nursing homes for the aged, we recommend that care workers should have a special health examination for LBP.     

Front-line Nursing Home Staff Experiences During the COVID-19 Pandemic

ObjectiveThe Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for nursing homes, where staff have faced rapidly evolving circumstances to care for a vulnerable resident population. Our objective was to document the experiences of these front-line health care professionals during the pandemic.DesignElectronic survey of long-term care staff. This report summarizes qualitative data from open-ended questions for the subset of respondents working in nursing homes.Setting and ParticipantsA total of 152 nursing home staff from 32 states, including direct-care staff and administrators.MethodsFrom May 11 through June 4, 2020, we used social media and professional networks to disseminate an electronic survey with closed- and open-ended questions to a convenience sample of long-term care staff. Four investigators identified themes from qualitative responses for staff working in nursing homes.ResultsRespondents described ongoing constraints on testing and continued reliance on crisis standards for extended use and reuse of personal protective equipment. Administrators discussed the burden of tracking and implementing sometimes confusing or contradictory guidance from numerous agencies. Direct-care staff expressed fears of infecting themselves and their families, and expressed sincere empathy and concern for their residents. They described experiencing burnout due to increased workloads, staffing shortages, and the emotional burden of caring for residents facing significant isolation, illness, and death. Respondents cited the presence or lack of organizational communication and teamwork as important factors influencing their ability to work under challenging circumstances. They also described the demoralizing impact of negative media coverage of nursing homes, contrasting this with the heroic public recognition given to hospital staff.Conclusions and ImplicationsNursing home staff described working under complex and stressful circumstances during the COVID-19 pandemic. These challenges have added significant burden to an already strained and vulnerable workforce and are likely to contribute to increased burnout, turnover, and staff shortages in the long term.     

Knowledge of and Perceived Need for Evidence-Based Education About Antipsychotic Medications Among Nursing Home Leadership and Staff

Background/Objectives

Antipsychotic use is common in US nursing homes, despite evidence of increased risk of morbidity and mortality, and limited efficacy in older adults with dementia. Knowledge, attitudes, and beliefs regarding antipsychotic use among nursing home staff are unclear. The study aim was to describe nursing home leadership and direct care staff members’ knowledge of antipsychotic risks, beliefs and attitudes about the effectiveness of antipsychotics and nonpharmacologic management of dementia-related behaviors, and perceived need for evidence-based training about antipsychotic medication safety.

Design, Setting, Participants, and Measurements

Survey of leadership and direct care staff of nursing homes in Connecticut was conducted in June 2011. Questionnaire domains included knowledge of antipsychotic risks, attitudes about caring for residents with dementia, satisfaction with current behavior management training, beliefs about antipsychotic effectiveness, and need for staff training about antipsychotics and behavior management.

Results

A total of 138 nursing home leaders and 779 direct care staff provided useable questionnaires. Only 24% of nursing home leaders identified at least 1 severe adverse effect of antipsychotics; 13% of LPNs and 12% of RNs listed at least 1 severe adverse effect. Fifty-six percent of direct care staff believed that medications worked well to manage resident behavior. Leaders were satisfied with the training that staff received to manage residents with challenging behaviors (62%). Fifty-five percent of direct care staff felt that they had enough training on how to handle difficult residents; only 37% felt they could do so without using medications.

Conclusions

Findings suggest that a comprehensive multifaceted intervention designed for nursing homes should aim to improve knowledge of antipsychotic medication risks, change beliefs about appropriateness and effectiveness of antipsychotics for behavior management, and impart strategies and approaches for nonpharmacologic behavior management.     

The work pattern of personal care workers in two Australian nursing homes: a time-motion study

ABSTRACT: BACKGROUND: The aim of the study is to describe the work pattern of personal care workers (PCWs) in nursing homes. This knowledge is important for staff performance appraisal, task allocation and scheduling. It will also support funding allocation based on activities. METHODS: A time-motion study was conducted in 2010 at two Australian nursing homes. The observation at Site 1 was between the hours of 7:00 and 14:00 or 15:00 for 14 days. One PCW was observed on each day. The observation at Site 2 was from 10:00 to 17:00 for 16 days. One PCW working on a morning shift and another one working on an afternoon shift were observed on each day. Fifty-eight work activities done by PCWs were grouped into eight categories. Activity time, frequency, duration and the switch between two consecutive activities were used as measurements to describe the work pattern. RESULTS: Personal care workers spent about 70.0% of their time on four types of activities consistently at both sites: direct care (30.7%), indirect care (17.6%), infection control (6.4%) and staff break (15.2%). Oral communication was the most frequently observed activity. It could occur independently or concurrently with other activities. At Site 2, PCWs spent significantly more time than their counterparts at Site 1 on oral communication (Site 1: 47.3% vs. Site 2: 63.5%, P = 0.003), transit (Site 1: 3.4% vs. Site 2: 5.5%, P < 0.001) and others (Site 1: 0.5% vs. Site 2: 1.8%, P < 0.001). They spent less time on documentation (Site 1: 4.1% vs. Site 2: 2.3%, P < 0.001). More than two-thirds of the observed activities had a very short duration (1 minute or less). Personal care workers frequently switched within or between oral communication, direct and indirect care activities. CONCLUSIONS: At both nursing homes, direct care, indirect care, infection control and staff break occupied the major part of a PCW's work, however oral communication was the most time consuming activity. Personal care workers frequently switched between activities, suggesting that looking after the elderly in nursing homes is a busy and demanding job.     

Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain

Aims: To assess dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain.

Methods: A cohort of 523 subjects, working in nursing homes and homes for the elderly, was followed prospectively for one year. Physical load for different occupations was assessed by quantitative observations at the workplace. Information on low back pain and other factors was gathered with questionnaires administered at baseline and at one year. Two outcome measures of low back pain incidence were used: any new episode of pain lasting for at least a few hours during follow up (LBP); and any new episode of disabling pain that interfered with daily activities during follow up (LBP/D). Hierarchical regression analysis with a spline function was used to estimate dose-response relations.

Results: The risk of LBP was not associated with physical factors, controlling for confounders; but this outcome was inversely associated with age and weakly, though imprecisely, associated with two psychosocial factors—low decision authority and high work demands. In contrast, the risk of LBP/D was positively associated with age and not associated with the psychosocial factors. Trunk flexion over 45 degrees was monotonically associated with the risk of LBP/D; the estimated relative risk was 3.18 (95% CI 1.13 to 9.00) for 1 hour and 45 minutes of bending per week (90th centile), relative to 30 minutes per week. The hierarchical estimates of effect were more stable than were the maximum likelihood estimates.

Conclusion: Occupational exposure to trunk flexion over 45 degrees appears to be a risk factor for low back pain with disability among persons employed in nursing homes and homes for the elderly in the Netherlands.

     

Psychosocial risk factors for musculoskeletal symptoms among women working in geriatric care

BACKGROUND: Nursing is a stressful, physically demanding occupation and a rush setting for musculoskeletal problems. The aim of this study is to explore the extent of the association between psychosocial work characteristics and musculoskeletal symptoms among women working in geriatric care. METHODS: The participants were female employees of all geriatric nursing homes and geriatric hospital wards in Iceland having a staff of 10 or more. A total of 1,886 questionnaires were distributed. The response rate was 80%. RESULTS: Finding the job mentally difficult, mental exhaustion after one's shift, dissatisfaction with supervisors or the flow of information, insufficient influence at work, dissatisfaction with the hierarchy, intense time pressure, lack of solidarity, dissatisfaction with the job, harassment, violence or threats at work; all of the aforementioned gave crude odds ratios (OR) two or above for one or more musculoskeletal symptoms. Mental exhaustion and harassment, violence, and threats were the factors connected with symptoms from all the body regions studied. CONCLUSIONS: The extent of the association of work-related psychosocial factors and musculoskeletal symptoms among the geriatric female nursing staff is substantial and needs to be taken into account by occupational health services and others involved in preventive work. Am. J. Ind. Med. 44:679-684, 2003.     

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.     

Activities of daily living and costs in nursing homes

Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created. The developed ADL index is a readily determined measure of functional status useful in allocating nursing staff within nursing homes and in comparing the functional status of groups of residents, explaining 30 percent of variance in nursing costs among nursing home residents.     

Nursing Homes and End-of-Life Care in Japan

Objectives

To describe end-of-life care in Japanese nursing homes by comparing facility and characteristics of residents dying in nursing homes with those who had been transferred and had died in hospitals, and by comparing the quality of end-of-life care with hospitals and with their respective counterparts in the United States.

Setting

National sample of 653 nursing homes with responses from 371 (57%) on their facility characteristics, 241 (37%) on their resident characteristics, and 92 (14%) on the residents’ quality of life. All 5 hospitals in a city 80 miles from Tokyo cooperated.

Participants

Nursing home staff answered questionnaires on facility and resident characteristics. Resident level data were obtained from 1158. The questionnaire on the quality of care was responded to by 256 (63%) of the decedents’ families in nursing homes and 205 (48%) in hospitals.

Measurements

Facility characteristics included items on physicians, nurse staffing, and the facility’s end-of-life care policy. Resident characteristics included basic demographics, level of dementia, and resident’s and family’s preference for the site of death. The Toolkit was used to measure the quality of end-of-life care.

Results

The proportion of those dying within the nursing home was related to the facility’s policy on end-of-life care and the family’s preference. The quality of end-of-life care in nursing homes was generally better than in hospitals, and than in their respective counterparts in the United States.

Conclusion

Financial incentives by the Japanese government to promote end-of-life care in nursing homes may have contributed to increasing the proportion of deaths within the facility. The quality of care in nursing homes was evaluated as being better than hospitals.     

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.     

Low back load and satisfaction rating of caregivers & care receivers in bathing assistance given in a nursing home for the elderly practicing individual care]

Since the public nursing care insurance system was enacted by the Japanese government, a transition from conventional group treatment to the individual care is required. In Japanese nursing homes for the elderly, bathing assistance methods have shifted from use of traditional mechanical bathtubs or a big bathtub to methods using small homestyle bathtubs, known as "individual bathing assistance". A study on the work load of caregivers with individual bathing assistance has never been conducted. Therefore, in a nursing home for the elderly practicing the individual bathing assistance method, we explored low back load using surface electromyography and trunk inclination angle measurement. Moreover, subjective evaluations by not only the caregivers but also the care receivers were investigated. The individual bathing assistance time per person was about 35 min. When caregiver used the mechanical lift equipment to assist getting into and out of the bathtub, trunk inclination angle and muscle load were lower than with manual handling. Mechanical lift equipment had the advantage of reducing low back load. When caregivers gave assistance with dressing and ablution of the lower limbs, and in setting wheelchair footrests, trunk inclination angle and muscle load showed high values. The satisfaction rating of using the mechanical lift equipment showed the best score, and ratings of perceived exertion were about the same. Thus, the importance of safe and comfortable care for both caregivers and care receivers should be stressed to make effective use of assistance products and care equipment.     

Sampling Challenges in Nursing Home Research

BackgroundResearch on end-of-life care in nursing homes is hampered by challenges in retaining facilities in samples through study completion. Large-scale longitudinal studies in which data are collected on-site can be particularly challenging.ObjectivesTo compare characteristics of nursing homes that dropped from the study to those that completed the study.MethodsOne hundred two nursing homes in a large geographic 2-state area were enrolled in a prospective study of end-of-life care of residents who died in the facility. The focus of the study was the relationship of staff communication, teamwork, and palliative/end-of-life care practices to symptom distress and other care outcomes as perceived by family members. Data were collected from public data bases of nursing homes, clinical staff on site at each facility at 2 points in time, and from decedents’ family members in a telephone interview.ResultsSeventeen of the 102 nursing homes dropped from the study before completion. These non-completer facilities had significantly more deficiencies and a higher rate of turnover of key personnel compared to completer facilities. A few facilities with a profile typical of non-completers actually did complete the study after an extraordinary investment of retention effort by the research team.ConclusionNursing homes with a high rate of deficiencies and turnover have much to contribute to the goal of improving end-of-life care, and their loss to study is a significant sampling challenge. Investigators should be prepared to invest extra resources to maximize retention.     

Health care for older people in Italy: The U.L.I.S.S.E. project (Un Link Informatico sui Servizi Sanitari Esistenti per l’anziano — a computerized network on health care services for older people)

Objectives

The U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy.

Design

The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study.

Setting

Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study.

Measurements

The patient’s evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires.

Results

The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented.

Conclusions

Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system.     

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.     

Preparing Long-Term Care Staff to Meet the Needs of Aging Persons With Serious Mental Illness

ObjectivesIndividuals with serious mental illness (SMI; schizophrenia spectrum disorders and affective psychoses) are increasingly aging into older adulthood and are overrepresented in residential long-term care settings. The present study aimed to examine the preparedness of staff in these settings to care for individuals with SMI.DesignA multidisciplinary US Department of Veterans Affairs (VA) workgroup of professionals with expertise in geriatric mental health collected voluntary feedback via online questionnaire as part of a quality improvement project.Setting and ParticipantsRespondents were mental health providers (N=51) embedded in VA nursing homes called Community Living Centers (CLCs).MeasuresThe questionnaire contained multiple-choice, Likert-type scale, and open-ended questions regarding the opportunities and challenges associated with caring for Veterans with SMI in CLCs.ResultsRespondents identified a lack of training of front-line staff as a key challenge in providing high-quality care to residents with SMI. Specifically, respondents indicated a need to increase staff knowledge about SMI symptoms and diagnoses, to improve staff communication and interactions with residents with SMI, and to decrease mental illness stigma among staff.Conclusions/ImplicationsThe present study revealed significant areas of training need for front-line staff in nursing homes. Many perceived staff training needs overlap with the knowledge and skill set required to provide high-quality dementia care. Integrating training regarding the care of residents with SMI into dementia care training efforts may be a fruitful future direction. Strategies for this and a suggested curriculum are provided.     

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.     

Caring for the institutionalised elderly: how easy is it?

In the light of long-standing criticism of nursing homes an assessment of staff's ability to provide care was required. By creating a profile of nursing home staff it may be possible to explain and predict difficulties in providing care. One hundred and five staff from 15 nursing homes and 18 hostel staff were interviewed to examine demographic characteristics, attitudes to the job and to the elderly, as well as sources of stress in the workplace. Staff were predominantly female, with children, and had a strong sense of altruism and desire to nurture. They foster an atmosphere of care and protection and may unwittingly encourage dependence. This may preclude challenge and rehabilitation for nursing home residents. Constraints such as staff shortages, stress (35.3 per cent cases on the General Health Questionnaire), lack of training, conflict among staff and lack of support may hamper care. These problems could be addressed by additional training and incentives for staff, increased staff cooperation and communication. Medical practitioners and other health professionals have a significant role to play in assuming greater responsibility for supporting the caregivers in nursing homes.     

Educating Nursing Home Staff in Dementia Sensitive Communication: Impact on Antipsychotic Medication Use

Objectives

An educational program to enhance communication in nursing home dementia care increased person-centered communication by staff and resulted in reduced resident behavioral symptoms measured as resistiveness to care. The purpose of this analysis was to evaluate effects on resident antipsychotic medication use in participating nursing homes. The National Partnership to Improve Dementia Care set a goal of reducing antipsychotic medications in nursing homes by 15% during the study period.

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.