Comparing Perceived Quality of Life in Nursing Homes and Assisted Living Facilities

Abstract

Residents 65 years old and older living in nursing homes (NH) and assisted living facilities (ALFs) were matched on a scale of functional ability: The Sickness Impact Profile for Nursing Homes (SIP-NH). Of the 97 NH and 100 ALF residents who were evaluated using the SIP-NH, 43 pairs, matched by level of disability, were formed. Each member of the 43 pairs was administered two quality of life instruments: the Ferrans and Powers Quality of Life Index (QLI), as well as a single direct question regarding quality of life. Matched pair t-tests revealed no differences in quality of life scores, contrary to the hypothesis that the matched residents in nursing homes would have perceptions of a lower quality of life than residents of assisted living facilities.     

Responding to the 2015 CMS Proposed Rule Changes for LTC Facilities: A Call to Redouble Efforts to Prepare Students and Practitioners for Nursing Homes

In July of 2015, the Federal Register published for public comment proposed rule changes for nursing homes certified to receive Medicare and/or Medicaid. If the final rules are similar to the proposed rules, they will represent the largest change in federal rules governing nursing homes since the Nursing Home Reform Act which was part of OBRA 1987. The proposed changes have the potential to enhance the quality of care and quality of life of nursing home residents. Many of the proposed changes would directly affect the practice of social work and would likely expand the role for nursing home social workers. This article discusses the role that members of the National Nursing Home Social Work Network (NNHSW Network) played in developing and submitting a response to CMS. The article provides the context for the publication of the proposed rules, describes the process used by the NNHSW Network to develop and build support for comments on these rules, and also includes the actual comments submitted to CMS. Social work education programs and continuing education programs throughout the country will continue to have an important role to play in helping to prepare social work students and practitioners for a career in long-term care.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

Nursing home complaints: who's complaining and what's gender got to do with it?

Long Term Care Ombudsman Complaint data from one state's 261 nursing homes are examined in the study. We assessed differences between male and female groups, including chiefly residents, but also ombudsmen, the residents' relatives or friends, administrators, legal representatives, and others regarding types and rates of complaints as reported in the Administration on Aging (AoA) major categories of: Resident Care, Resident Rights, Administration, Quality of Life, and Complaints Not Against Facility. Proportionately, male residents lodged more complaints than females. Further, males complained more than females about Resident Rights violations and filed more Complaints Not Against Facility. Females lodged significantly more complaints about Care, Quality of Life and Administration.Thus, males were more likely to report technical, impersonal, and legalistic issues, than females, who were more likely to express concerns about personal care and socioemotional-environmental issues. Results yielded further evidence of gender differences in the patterns of resident complaints. Nursing home social workers are highlighted as agents in changing embedded stereotypes about residents and complaints.     

Quality of nursing home care in Cyprus: are elder residents content with their treatment?

Responding to a conspicuous dearth of knowledge on the quality of elder services in Cyprus, this study ventured to document Cypriot elders' feelings and experiences with nursing home care in Cyprus. Explicitly, four different types of nursing homes were called on (a governmental, a community-run, a faith-based, and a private one) to interview residents (n = 73; a response rate of 100%). Results suggest that Cypriot elders are clearly content with the level of primary care they receive in nursing homes, as mirrored in the quality of nutrition, medical treatment, staff professionalism, and sanitation of nursing home environment. However, the preponderance of residents feels loneliness and denial of essential entertainment opportunities in these institutions and a consequential motivational depletion. Finding implications for domestic and international policy, social work practice, and future research are explored.     

Assisted Living Facility Administrator and Direct Care Staff Views of Resident Mental Health Concerns and Staff Training Needs

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.     

Assisted living facility administrator and direct care staff views of resident mental health concerns and staff training needs

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.     

Informal Caregivers of Institutionalized Dementia Residents

When older adults are placed in nursing homes, care- giving responsibility continues, despite long held beliefs to the con- trary. Although the American family is in transition, bonds of care- giving and of filial responsibility are strong and persist into old age. Knowledge about characteristics of caregivers who have actually placed their relative in a nursing home is limited. The purpose of this study is to examine whether demographic and facility-related char- acteristics as well as knowledge about dementia and participation in support groups and workshops are signif~cant predictors of burden in caregivers of institutionalized dementia residents. Sixty-seven per- cent of caregivers of residents in a dementia unit in a nursing home participated in the study. Overall, the regression explained 68% of the variance in burden and was highly simcant statistically. In- formation gained from this study will assist social workers in mak- ing referrals to nursing homes or in direct practice with cognitively impaired nursing home residents and their families.     

A PROBLEM SOLVING MODEL FOR IN-SERVICE TRAINING

With the increasing use of nursing homes to care for the frail elderly and the recruitment of poorly trained staff, in-service training has become a crucial need. This article presents a problem solving model for in-service training that the social worker can use to increase the effectiveness of staff in dealing with nursing home residents and their families.     

Staff-Family Relations and Institutional Care Policies

As institutional care providers increasingly recognize the importance of the family, the quality of staff-family relations has become a concern. This study investigated the relationship between selected facility care policies and staff-family relationships. Data secured from staff members and family members in rural nursing homes revealed a relationship between the family role that the care policy prescribed and the degree of staff-family integration. The study concluded that care policies viewing family members as clients will have positive consequences for staff and families and ultimately the residents.     

Comparing Families and Staff in Nursing Homes and Assisted Living: Implications for Social Work Practice

Nursing homes and residential care/assisted living settings provide care to 2.4 million individuals. Few studies compare the experience of, and relationships between, family and staff in these settings, despite ongoing family involvement and evidence that relationships are problematic. Data from 488 families and 397 staff members in 24 settings examined family involvement and family and staff burden, depressive symptoms, and perceptions; and staff absenteeism and turnover. There were few differences across setting types. Although conflict rarely occurred, there was room for improvement in family–staff relations; this area, and preparing family for their caregiving roles, are appropriate targets for social work intervention.     

A good death for residents of long-term care: family members speak

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/ assisted living facilities. Structural components of care including staffing adequacy, training, and consistency as well as facility environment and size were important factors for family members interviewed. "Being there" and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

The nursing home crisis: a consumer study of Texas nursing home care

This article discusses the findings of a consumer-oriented survey to ascertain the perceptions of Texas nursing home residents, their families, and nursing home administrators about what factors they believe contribute to quality of care. The findings from previous studies and established practice standards are then used to further delineate the practice roles and functions of social workers in nursing facilities (NFs) and to inform social work curriculum.     

The role of family care-givers for an older person resident in a care home

Summary A sample of 61 relatives of residents admitted during the precedingthree years to 35 independent sector nursing or residentialcare homes in four local authority areas was interviewed. Thissample included spouses, daughters and sons. Five discrete rolesfor family care-givers in the care homes were described: checkingthe quality of care, companionship, handling the cared-for personwith personal care. Although family care-givers described themselvesas very satisfied with the care homes as a whole, as many ashalf were worried about some aspect of care. A third of theoffspring felt that their relationship with the cared-for personhad improved following the admission to a care home. None ofthe spouses felt this to be the case and most felt that theirrelationship had deteriorated. Spouses tended to visit veryfrequently. Unlike offspring, spouses rarely took the cared-forperson out of the care home. Because of the lack of privacy,visits could be a difficult experience. Those wanting to continuegiving their partner practical support were discouraged by stafffrom doing so. The research has implications for social workers,care home proprietors and registration and inspection unitsin encouraging care homes to adopt more 'relative friendly'policies.     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

A Conceptual Model of Family Surrogate End-of-Life Decision-Making Process in the Nursing Home Setting: Goals of Care as Guiding Stars

An increasing proportion of dying is occurring in America's nursing homes (NH). Family members are involved in (and affected by) medical decision-making on behalf of NH residents approaching the end of life, especially when the resident is cognitively impaired. This article proposes an empirically derived conceptual model of the key factors NH family surrogate decision-makers consider when establishing or changing goals of care and the iterative process as applied to the NH setting. This model also establishes the importance of family social role expectations toward their loved one as well as the concept, “stance toward dying,” as key in establishing or changing the main goal of care. NH staff and physicians can use the model as a framework for providing information and support to family members. Research is needed to better understand how to prepare staff and settings to support family surrogate decision-makers, in particular around setting goals of care. The model can be generalized beyond nursing homes.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

The Role of the Nursing Home Social Worker in Terminal Care

This study examines the role of the nursing home social worker in terminal care. Questionnaires were distributed to 60 social workers in 14 nursing homes in the greater Milwaukee area. The hypothesis was that the presence of policies/procedures governing terminal care would be related to a decreased amount of stress for social workers. This correlation was not supported by the survey results. Although 71% of respondents indicated no policies were available to them, only 32.6% of social workers reported that terminal care was a source of stress. In fact, 59% reported that the social worker's role in terminal care had not been discussed in the social services department of their facility. Comparative lack of stress for social workers may be related to the lack of perception that social workers play a significant role in the terminal care of residents.     

Death and suicidal ideation among nursing home residents in a Chinese city – a pilot study

This paper examines death and suicidal ideation among nursing home residents in a Chinese City using a questionnaire survey data. Findings from the survey show that 17.4% of the participants have death and suicidal ideation, and the prevalence of passive and active ideation are 15.4% and 6.2% respectively. The presence of death and suicidal ideation among nursing home residents correlates with depressive symptoms, life satisfaction, and satisfaction with nursing home services. As death and suicidal feelings are risk factors for suicide, the findings imply that implementing depression prevention programmes and improving service quality of nursing homes are vital in preventing suicides among nursing home residents.