Physical Abuse of Older Adults in Nursing Homes: A Random Sample Survey of Adults With an Elderly Family Member in a Nursing Home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Family Support in Nursing Homes Serving Residents with a Mental Health History

Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were found to be in regular contact with their relatives and supportive of their care. In nursing homes, daily contact, an ongoing relationship, involvement in assessment, and being responsible for the resident constitute the model family support. This study advances the understanding of family support in nursing homes and conveys information to guide practice through proposing ways to enhance family support and involvement in nursing homes.     

Differences in Facilities' Acceptance of Patients Under Long-Term Care Insurance in Japan

Abstract

Objectives. In April 2000, Japan launched a public, long-term care insurance (LTCI) plan for elderly people who need support. This study describes how medical support for the elderly is delivered at LTCI care facilities in Japan now and gaps between system goals and current activity. Recommendations are made for enhancing the implementation of LTCI.

Methods. We mailed questionnaires to all health service facilities for the elderly (HSF) and special nursing homes for the elderly (SNH) located in the Kyushu area of Japan, asking whether they would accept patients with nine specific conditions.

Results. We found that HSFs, which are required to employ a full-time doctor and are reimbursed at a higher rate, accept significantly fewer patients with four conditions that need medical support than are accepted by SNHs, which are not required to employ a full-time doctor.

Discussion. In this study, we find discrepancies between system goals and current activities at LTCI care facilities. For the Japanese LTCI system to work well in the limitation of medical resources, we must understand how it really works and to reform the system continuously.     

Consistent Assignment of Nurse Aides: Association With Turnover and Absenteeism

Consistent assignment refers to the same caregivers consistently caring for the same residents almost every time caregivers are on duty. This article examines the association of consistent assignment of nurse aides with turnover and absenteeism. Data came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The measures were from 2007 and came from 3,941 nursing homes. Multivariate logistic regression models were used to examine turnover and absenteeism. An average of 68% of nursing homes reported using consistent assignment, with 28% of nursing homes using nurse aides consistent assignment at the often recommended level of 85% (or more). Nursing homes using recommended levels of consistent assignment had significantly lower rates of turnover and of absenteeism. In the multivariate analyses, consistent assignment was significantly associated with both lower turnover and lower absenteeism (p < .01). Consistent assignment is a practice recommended by many policy makers, government agencies, and industry advocates. The findings presented here provide some evidence that the use of this staffing practice can be beneficial.     

Nursing Intervention on Sexual Health: A Multilevel Behavioral Survey of Senior Nursing Students in Clinical Practice

ABSTRACT. There are many diseases that may impact patients’ sexual health and psychological well-being. Despite the importance of sexual health care (SHC), insufficient SHC occurs across care settings and the patient population. Studies investigating the essential elements of SHC behaviors of nursing students in clinical practice have been scant. The aim of this study was to assess the frequency of senior nursing students’ multilevel interventions for patients’ SHC in primary clinical practice. An anonymous 19-item instrument entitled Nursing Intervention on Sexual Health was distributed among senior nursing students at two central Taiwan nursing schools. We analyzed overall nursing intervention in SHC in clinical practice by levels. The results of this study indicate that the frequency of nursing intervention in sexual health is low. Another important finding is that following the PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) model, from permission level to the specific-suggestion level, the behavioral frequency of nursing intervention shows a decrease along with the model. Nursing students omitted each level of SHC in clinical practice, even if they had sufficient time and extensive preceptor resource, in this study. The nursing students’ SHC on different levels would help educators to frame the sexuality education program.     

Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver’s perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.     

Family Members' Reports of Abuse in Michigan Nursing Homes

The objective of this article is to describe abuse and neglect of adults age 65 and older in Michigan nursing homes, as reported by members of their families. Using list-assisted random-digit dialing, data on abuse and neglect for a 12-month period were collected from individuals who had a relative age 65 or older in a Michigan nursing home. Of the nursing home residents represented in this analysis, the majority were female, Caucasian, and widowed. Neglect and caretaking mistreatment were the most frequent types of abuse reported. Comparison of these data with data from the National Ombudsman Reporting System suggests that family members constitute a sensitive source of data on abuse in nursing homes.     

Prevention of Elder Mistreatment in Nursing Homes: Competencies for Direct-Care Staff

Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. We used qualitative interviews with nursing home staff, policy makers, and related professionals to identify training needs. Based on participant accounts, we drafted a number of competencies essential for caregiver training to prevent mistreatment in nursing homes. Competencies include those dealing with definitions and policies, risks for mistreatment, communication and respect in relationships with residents, and development of a cooperative work environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.     

Elder Abuse in Nursing Homes: An Ecological Perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

Job demands,emotional dissonance and elderly abuse: The moderating role of organizational resources

ABSTRACT

The present study focuses on elderly abuse committed by caregivers in nursing homes. It aimed at a better understanding of neglect and abusive behaviors by considering the working context and the emotional dissonance of these professionals. To achieve this goal, direct effects of emotional dissonance, job demands (workload and emotional demands) and organizational resources (high-quality relationships with the colleagues and the supervisor) on neglect and abusive behaviors were analyzed. Moreover, the moderating role of organizational resources was explored. The study was conducted among 481 nurses and healthcare assistants from different French nursing homes. Overall, results contributed to the literature by pointing out the impact of emotional dissonance and caregivers’ working context on neglect and abusive behaviors. Moreover, results highlighted the moderating effect of high-quality relationships with the colleagues and the supervisor and give rise to potential implications in preventing elderly abuse in nursing homes.     

Differences in facilities' acceptance of patients under long-term care insurance in Japan

OBJECTIVES: In April 2000, Japan launched a public, long-term care insurance (LTCI) plan for elderly people who need support. This study describes how medical support for the elderly is delivered at LTCI care facilities in Japan now and gaps between system goals and current activity. Recommendations are made for enhancing the implementation of LTCI. METHODS: We mailed questionnaires to all health service facilities for the elderly (HSF) and special nursing homes for the elderly (SNH) located in the Kyushu area of Japan, asking whether they would accept patients with nine specific conditions. RESULTS: We found that HSFs, which are required to employ a full-time doctor and are reimbursed at a higher rate, accept significantly fewer patients with four conditions that need medical support than are accepted by SNHs, which are not required to employ a full-time doctor. DISCUSSION: In this study, we find discrepancies between system goals and current activities at LTCI care facilities. For the Japanese LTCI system to work well in the limitation of medical resources, we must understand how it really works and to reform the system continuously.     

State “Technical Assistance Programs” for Nursing Home Quality Improvement: Variations and Potential Implications

To improve nursing home quality, many states have developed “technical assistance programs” that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.     

Staffing-Related Deficiency Citations in Nursing Homes

There is evidence that staffing characteristics influence quality of care in nursing homes. Federal and state surveyors conduct inspections of homes to assess their compliance with regulatory standards, including requirements related to staffing. Deficiency citations are issued when these standards are not met. This article examines the relationship between operational, facility, and market characteristics and organizational performance measured as staffing-related deficiency citations. Online Survey Certification of Automated Records (OSCAR) data from 2000 through 2007 were used with multinomial logistic regression analyses to identify factors associated with deficiency citations for staffing. Chain members and facilities with poor quality of care were more likely to receive deficiency citations for staffing. Greater bed count and competition between nursing homes were associated with a decreased likelihood of deficiency citations for staffing. Staffing-related deficiencies within nursing homes vary according to various operational, facility, and market characteristics.     

The Importance of Personal Possessions for the Development of a Sense of Home of Nursing Home Residents

ABSTRACT

Personal possessions of nursing home residents can contribute to their sense of home. This study investigated which of the personal belongings were considered most important, and if these items indeed contributed to a sense of home. A qualitative research was conducted with 27 nursing home residents. Photographs, paintings, and pieces of furniture are objects with sentimental value. The television set is valued for its practical function. Residents of larger rooms have more flexibility in bringing along personal items, including pieces of furniture. The results of this study can be used for the design of nursing homes or for making informed choices during the process of institutionalization.     

The “Our Homes,Not Nursing Homes” Project

ABSTRACT

The voices of non-elderly adults with disabilities who currently-or used to-reside in nursing homes are rarely heard. A grassroots disability advocacy organization conducts participatory action research in the form of a writing workshop in collaboration with a local community-college. Participants with disabilities describe their lives and their experiences in nursing homes with the help of volunteer scribes. The information provided in their accounts will help strengthen community-organizing efforts of the disability advocacy organization. And participants have been empowered by the realization that their life stories are helping others to leave nursing homes and join community settings.     

Perceived Aspects of Home Environment and Home Modifications by Older People Living in Rural Areas

This study investigated the relationships between the “perceived aspects” of current home environment of elderly people living in rural areas and their home modification behavior. To investigate this perception, home satisfaction, perception of home capability, and home safety were used as perceived aspects of the home. Data were collected by a questionnaire. The response rate was 43.1%, with 317 eligible questionnaires. The results from this study indicate that there was no significant difference in perceived aspects of home environment between those who modified their homes and those who did not. Regardless of their current home conditions, most elderly respondents (75%) showed high home satisfaction. Results from this study suggest that a modified home environment does not necessarily contribute to an older person's perception of perceived aspects of their home environment.     

Nursing Home Deficiency Citations for Safety

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.