Admissions to skilled nursing facilities from assisted living facilities

Minimum Data Set data from 15,977 residents were analyzed to investigate the reasons older adults were admitted to skilled nursing facilities from assisted living facilities. Residents admitted from assisted living facilities, private homes, hospitals, and hospitals with previous assisted living facility residence were compared. Findings suggest that residents admitted from assisted living facilities are more likely to be older, to have diagnoses of dementia and depression, and to be placed in Alzheimer's special care units.     

Transitioning the practical nursing student into practice: outcomes of a geriatric initiative

Schools of nursing for practical nursing students typically follow the traditional model of acute care facilities. The purpose of this pilot study was to evaluate an initiative project examining the use of a skilled nursing facility as a final clinical site in a practical nursing program. The pilot study proved to generate a successful academic and practice partnership between the school of nursing and skilled nursing facility, provide opportunities for students to gain confidence and practice in caring for older adults, and meet the goals and outcomes of the clinical practicum. Clinical experiences offered in a skilled nursing facility prepare practical nursing students to care for older adults and transition from student to graduate.     

Geriatrics training for nurses in a skilled nursing facility: a GWEP feasibility study

Geriatrics knowledge and expertise is critical to the care of older adults in skilled nursing facilities. However, opportunities for ongoing geriatrics training for nurses working in skilled nursing facilities are often scarce or nonexistent. This feasibility study describes a mixed-methods analysis of nurses' educational needs and barriers to continuing education in a for-profit skilled nursing facility in an underserved, urban environment. Potential mechanisms to overcome barriers are proposed.     

Correlates of post-hospital physical function at 1 year in skilled nursing facility residents

Title. Correlates of post‐hospital physical function at 1 year in skilled nursing facility residents Aim. This paper is a report of a study to examine the relationship between health‐related admission factors and post‐hospital physical function at 3, 6, 9 and 12 months in older adult nursing facility residents. Background. Physical functional decline is a significant health problem for older adults and has far‐reaching effects. In particular, the immediate post‐hospital period is a high‐risk time, because shortened hospital stays make it likely that older patients are discharged in a state of incomplete recovery. Method. Data spanning from July 2002 to June 2005 were extracted from a comprehensive assessment tool, the Minimum Data Set, for 38,591 beneficiaries of a federal health insurance programme covering older adults in the Midwestern region of the United States of America. We investigated relationships between admission factors and post‐hospital physical function at 3, 6, 9 and 12 months. The admission factors were health‐related variables assessed at the time of skilled nursing facility admission from an acute care hospital. Findings. The most important admission factors related to post‐hospital physical function at 3, 6, 9 and 12 months were baseline physical function, urinary incontinence and pressure ulcer. Cognitive impairment at admission demonstrated a stronger relationship with poor physical function as resident length of stay increased. Conclusion. Nurses in skilled nursing facilities should screen post‐hospital older adults for risk of physical functional decline at admission using identified admission factors. For continuous nursing care, older adults need to be assessed at least once a month during the first 3 months after hospital discharge.     

The effects of light therapy on depression and sleep disruption in older adults in a long‐term care facility

This study aims to evaluate the effect of light therapy on depression and sleep disruption in older adults residing in a long‐term care facility. Psychological morbidity is a problem commonly seen in older adults residing in long‐term care facilities. Limited research has addressed the effect of light therapy on depression in this population. A quasi‐experimental pretest and posttest design was used. Thirty‐four participants in the experimental group received light therapy by sitting in front of a 10000‐lux light box 30 min in the morning, three times a week for 4 weeks. Thirty‐one participants in the control group received routine care without light therapy. Depression was measured by Geriatric Depression Scale‐Short Form at baseline and week 4. After receiving 4 weeks of light therapy, the mean depression score in the experimental group decreased from 7.24 (SD3.42) at pretest to 5.91 (SD 3.40) at posttest, and had a significant reduction (t = 2.22, P = 0.03). However, there was no significant difference in depression score and sleep disruption between the experimental group and control group. Light therapy might have the potential to reduce depressive symptoms and sleep disruption and may be a viable intervention to improve mental health of older adults in the long‐term care facilities.     

Is there a nurse in the house? The role of nurses in assisted living: past, present, and future

The large increase in the number of older adults in the United States has mandated more supportive housing options. Assisted living facilities (ALFs) were developed as a necessary, desirable, and available residential option for older adults. The lower cost of ALFs compared with skilled nursing facilities and the emphasis on greater autonomy within these facilities are appealing to older consumers and their families. However, although many ALF residents have chronic health care needs, the roles and availability of nurses in these facilities vary greatly. This article discusses the history and creation of ALFs, the current role of nurses within these facilities, and the many factors influencing nursing in the assisted living industry. The role of nurse practitioners in these facilities is discussed. Finally, a vision for the future of nursing in ALFs is presented.     

Structured reminiscence: an intervention to decrease depression and increase self-transcendence in older women

Aims/objectives. The purpose of this study was to assess the effect of group reminiscing on depression and self‐transcendence of older women residing in an assisted living facility in southeast Texas. There were two major objectives for this study. One objective was to determine if depression decreased in older women after structured reminiscence group sessions held twice weekly for a six‐week period. A second objective was to determine if self‐transcendence increased after structured reminiscence group sessions held twice weekly for a six‐week period. Background. Reminiscence has been studied to determine its impact on a variety of conditions including but not limited to depression, self‐esteem, fatigue, isolation, socialization, well‐being, language acquisition and cognitive functioning. This review of research specifically focused on reminiscence, depression, self‐transcendence and older people. Design/methods. Two groups were assessed at baseline, three and six weeks to answer the research questions. A sample of 24 women between the ages of 72 and 96 years were randomly assigned to either a reminiscence (experimental) group or the activity (control) group of the facility. Pearson's r was used to determine the magnitude of the relationship between subjects’ responses on the Geriatric Depression Scale and the Self‐Transcendence Scale. A mixed design analysis of variance (anova ) was used to determine if there was a difference between the experimental and control groups on scores of the Geriatric Depression Scale and the Self‐Transcendence Scale at baseline, three and six weeks. Conclusions. Data revealed a non‐significant decrease in depression and increase in self‐transcendence in the reminiscence group at the completion of six weeks, indicating a trend toward a positive result with reminiscence group sessions. The study also revealed an inverse relationship between depression and self‐transcendence. These findings underscore the importance of screening older people for depression. Relevance to clinical practice. One of the primary modalities used for the treatment of depression in elderly women is medication. Antidepressant medications lead to harmful side effects without alleviating the underlying depression. For these reasons, there is a need to research alternative therapies for treatment of depression in the older female. Reminiscence offers a possible intervention for treatment of depression in older women.     

Effectiveness and Acceptability within a Skilled Nursing Facility Setting

ABSTRACT

Aims: The program evaluated the effectiveness and acceptability of the Stepping On protocol (Clemson L, Swann M, Mahoney J. (2011). Stepping On: Building confidence and reducing falls in older adults (3rd ed.). Cedar Falls, IA: Freiberg Press Inc.) in reducing fall risk in older adults when delivered in a skilled nursing facility (SNF). Method: Stepping On was delivered by an occupational therapist to participants (n = 11) over 7 weeks followed by a 3-month session (Clemson et al., 2011). Results: Through comparison of pre and post data (n = 7) and 3-month outcomes (n = 4), trends revealed an overall increase in the use of protective behaviors and self-perceived physical health. Trends showed sustained outcomes at all measures, with exception of a decline in fall efficacy. The program was well received by participants and staff at the SNF with high satisfaction rates. Conclusion: Stepping On has the potential to be an effective fall prevention program for older adults with trends towards fall prevention while providing needed support to current and past SNF residents, and community members.     

Dignity and its related factors among older adults in long-term care facilities: A cross-sectional study

ObjectivesThis study aimed to explore the dignity and related factors among older adults in long-term care facilities.MethodsCross-sectional data were obtained from a sample of 253 Chinese older adults dwelling in long-term care facilities. Dignity among older adults was measured using the Dignity Scale, and its potential correlates were explored using multiple linear regressions.ResultsResults showed that the total score of the Dignity Scale is 151.95 ± 11.75. From high to low, the different factors of dignity among older adults in long-term care facilities were as follows: caring factors (4.83 ± 0.33), social factors (4.73 ± 0.41), psychological factors (4.66 ± 0.71), value factors (4.56 ± 0.53), autonomous factors (4.50 ± 0.57), and physical factors (4.38 ± 0.55). A higher score of the Dignity Scale was associated with higher economic status, fewer chronic diseases, less medication, better daily living ability and long-time lived in cities.ConclusionOlder adults with low economic status, more chronic diseases, and poor daily living ability, taking more medications, or the previous residence in rural areas seem to be most at low-level dignity in long-term care facilities and thus require more attention than their peers.     

Factors influencing the decision of older people living in independent units to enter the acute care system

Aims and objectives. This South Australian‐based study explored and described the factors influencing the decision of older people living in the community in independent living units to enter the acute care system. Background. Community‐based older Australians, an increasing population segment, make choices about support needed to optimize health and well‐being. This includes when to enter the acute care system. Entering this system has potential risks as well as benefits. The current South Australian Department of Human Services policies of ‘keeping older people out’ of the acute care system has implications for prevention and early intervention measures and requires an understanding of how and why older people enter the acute care system. Method. In‐depth interviews were conducted with older people (N = 31) and their families (N = 10), drawn from three South Australian aged care organizations providing independent living unit accommodation, and focus groups (N = 14) were conducted with stakeholders to identify factors influencing the decision of older people living in independent living units to enter the acute care system. Findings. Analysis of the data revealed eight facets influencing this group of older people's decision‐making with respect to entering the acute care system; they were: expectations of support in the independent living unit not being met; the presence/absence of safety nets; lack of after‐hours support; the desire to remain independent; the general practitioner as pivotal; the influence of others; perceptions of the emergency department; and having access to information. Relevance to practice. These facets provide insights into entry processes, links and relationships that form an interface between primary care, community care, the aged care industry and the acute system. Analysis of these insights highlight prevention and early intervention responses that can promote the health and well‐being of older people, potential ways to streamline services, as well as gaps in current services.     

Self‐worth therapy for depressive symptoms in older nursing home residents

Title. Self‐worth therapy for depressive symptoms in older nursing home residents. Aim. The aim of this study is to report the effects of self‐worth therapy on depressive symptoms of older nursing home residents. Background. Depression in older people has become a serious healthcare issue worldwide. Pharmacological and non‐pharmacological therapies have been shown to have inconsistent effects, and drug treatment can have important side‐effects. Method. A quasi‐experimental design was used. Older people were sampled by convenience from residents of a nursing home in northern Taiwan between 2005 and 2006. To be included in the study participants had to: (i) have no severe cognitive deficits; (ii) test positive for depressive status and (iii) take the same anti‐depressant medication in the previous 3 months and throughout the study. Participants in the experimental group (n = 31) received 30 minutes of one‐to‐one self‐worth therapy on 1 day a week for 4 weeks. Control group participants (n = 32) received no therapy, but were individually visited by the same research assistant, who chatted with them for 30 minutes on 1 day/week for 4 weeks. Depressive status, cognitive status and functional status were measured at baseline, immediately after the intervention and 2 months later. Data were analysed by mean, standard deviations, t‐test, chi‐squared test and univariate anova . Findings. Self‐worth therapy immediately decreased depressive symptoms relative to baseline, but not relative to control treatment. However, 2 months later, depressive symptoms were statistically significantly reduced relative to control. Conclusion. Self‐worth therapy is an easily‐administered, effective, non‐pharmacological treatment with potential for decreasing depressive symptoms in older nursing home residents.     

Addressing future demands: Nursing students,elders, and pet birds: A student-initiated quality improvement project

The purpose of this quality improvement (QI) project was to promote the enthusiasm of baccalaureate nursing students in providing service to older adults by using the concept of service learning as a teaching strategy. An additional goal of the student-initiated QI project, which later also included graduate social work students, was to explore the impact of caring for a pet for older adults in an assisted living facility (ALF). After completing a student-elder team QI project, nursing students' journals yielded three themes: Improved Communication Skills with Elders, Becoming Interested in The Eden Alternative^® Principles, and Skills in Implementing and Evaluating Interprofessional Interventions. Elders' anecdotal comments and interviews yielded four themes: Improved Self Care, Decreased Anxiety, Sense of Purpose, and Sense of Belonging. These outcomes demonstrate ways to drive student interest in interdisciplinary gerontological care and to promote elders' well-being when transitioning to residential care.     

Mental health nurses’ disaster nursing competencies: A cross-sectional study

The unprecedented and prolonged coronavirus disease 2019 (COVID-19) pandemic has escalated the gravity of disasters in the field of mental health. Nurses are health care providers who play a pivotal role in all phases of disaster management and psychiatric nurses are required to be prepared and equipped with competencies to respond to such disasters. This cross-sectional study aimed to investigate the effects of mental health nurses’ professional quality of life on disaster nursing competencies. This study adhered to the STROBE checklist for observational research. Data were collected from 196 mental health nurses working in various settings, including hospitals and communities in South Korea. Compassion satisfaction and compassion fatigue were measured using the Korean version of the Professional Quality of Life Scale. Disaster nursing competencies were measured using the Disaster Nursing Preparedness-Response Competencies Scale. Multiple regression analysis showed that compassion satisfaction (β = 0.36, P < 0.001) was the most potent predictor of disaster nursing competencies of mental health nurses, followed by participation in disaster nursing (β = 0.15, P = 0.023) and disaster nursing-related education (β = 0.15, P = 0.026); these factors explained 30.1% of the variance. Education programmes ensuring that mental health nurses are adequately prepared for disaster management should include theoretical content as well as simulation training using virtual situations that resemble actual disasters. Further, supportive leadership and work environments that encourage cohesive teamwork are needed to increase compassion satisfaction of nurses.     

Self-care ability among home-dwelling older people in rural areas in southern Norway

Scand J Caring Sci; 2012; 26; 113–122
Self‐care ability among home‐dwelling older people in rural areas in southern Norway Introduction: The growing number of older people is assumed to represent many challenges in the future. Self‐care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self‐care ability is closely related to perceived health, sense of coherence and nutritional risk. Aim: The aim of this study was to describe self‐care ability among home‐dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation. Methods: A cross‐sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health‐related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+ years), and 1050 respondents were included in the study. Data were analysed with statistical methods. Results: A total of 780 persons were found to have higher self‐care ability and 240 to have lower self‐care ability using the Self‐care Ability Scale for the Elderly. Self‐care ability was found to be closely related to health‐related issues, self‐care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self‐care ability were to have higher self‐care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age. Conclusions: When self‐care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency.     

Are the Leisure and Social Needs of Older Adults Residing in Assisted Living Facilities Being Met?

Abstract

Aims: This retrospective study explored if there was a change in participation in leisure activities among older adults after transitioning into an assisted living facility. Supports and barriers to leisure and social engagement were also investigated. Methods: The Activity Card Sort (modified) was administered to explore and compare the participants’ engagement in leisure and social activities prior to and after moving into an assisted living facility. Semi-structured interviews were conducted to examine the participants’ perspectives regarding the current supports and barriers to engagement in their individual and meaningful interests. Results: Quantitative data gathered from the Activity Card Sort (modified) revealed the participants engaged in only 34.13% of the activities they participated in prior to moving into an assisted living facility; results also revealed that only 42% of the participants engaged in a new leisure activity after moving into an assisted living facility. Qualitative data revealed four themes concerning supports and barriers to participation: physical abilities, social supports, available resources, and personal influences. Conclusion: Older adults in assisted living facilities face a decline in engagement in leisure participation and may be at risk for occupational deprivation. Occupational therapists are well-suited to address these concerns.     

Activities of daily living and rehabilitation needs for older adults with a stroke: A comparison of home care and nursing home care

Aim

To compare the changes in benefit levels of activities of daily living (ADLs), rehabilitation, and long‐term care services (LTCS) in older adults with a stroke in different modalities of LTCS, which include home care and nursing home care.

Methods

This study analyzed national data regarding LTCS from 2008 to 2009 in South Korea. The data about 7668 older adults with a stroke were extracted from a pool of 182,535 total beneficiaries. In order to control for the baseline differences between older adults who received home care and those who received nursing home care, propensity score matching (PSM) was carried out and there were 1099 matched pairs of participants ( n = 2198). After the PSM, the changes in ADLs and rehabilitation between the two groups were analyzed by using a paired t‐test and the changes in LTCS benefit levels were compared by using the χ²‐test.

Results

The ADLs and rehabilitation needs of the older adults who received home care improved, while the older adults who received nursing home care experienced deterioration. After 1 year, the LTCS benefit levels were significantly different between the home care and the nursing home care groups

Conclusion

All of the ADLs, rehabilitation needs, and LTCS benefit levels for 1 year had improved in the home care patients, while they worsened in those who received nursing home care. This finding provides evidence to direct the policy of LTCS and offers information to guide older adults with a stroke and their family when deciding between the modalities of LTCS.

     

The continued success of registered nurse care coordination in a state evaluation of aging in place in senior housing

Older adults prefer to age in place, remaining in their home as their health care needs intensify. In a state evaluation of aging in place (AIP), the University of Missouri Sinclair School of Nursing and Americare System Inc, Sikeston, MO, developed an elder housing facility to be an ideal housing environment for older adults to test the AIP care delivery model. An evaluation of the first 4 years (2005–2008) of the AIP program at TigerPlace (n = 66) revealed that the program was effective in restoring health and maintaining independence while being cost-effective. Similar results evaluating the subsequent 4 years (2009–2012) of the program (N = 128) revealed positive health outcomes (fall risk, gait velocity, Functional Ambulation Profile, handgrips, Short-Form 12 Physical Health, Short-Form 12 Mental Health, and Geriatric Depression Scale); slightly negative activities of daily living, independent activities of daily living, and Mini-Mental State Examination; and positive cost-effectiveness results. Combined care and housing costs for any resident who was receiving additional care services and qualified for nursing home care (n = 44) was about $20,000 less per year per person than nursing home care. Importantly, residents continued to live in private apartments and were encouraged to be as independent as possible through the end of life.