Facility Organizational and Facility Resident Characteristics in Nursing Homes Serving Residents With a Mental Health History

ABSTRACT

The prevalence of mental health disorders among nursing home residents has been noted. The purpose of this study was to identify characteristics among nursing homes serving residents with a mental health history. A retrospective, cross-sectional design was conducted using the 2003 national Online Survey, Certification, and Reporting facility data merged with the resident-level Minimum Data Set resulting in 2,499 nursing homes. Across facilities, 22% of the total residents had a diagnosis of a mental disorder not including any form of dementia. Among those with a mental health history, 53% of facility residents had depression and 37% had schizophrenia.     

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.     

What Is Known About Dementia Care Recipient Violence and Aggression Against Caregivers?

Aggression is a known behavior in dementia, but there is little in the literature about risk to home-based caregivers in situations where severe aggression is present. This article examines this issue with a focus on what is known and where further research is needed. Rates of severe aggression by dementia care recipients against caregivers are estimated at greater than 20%, and may be the strongest predictor of nursing home placement. Measures containing both assessment of behavior and objective measures of caregiver trauma are needed, along with interventions aimed at educating and protecting caregivers while respecting communicative properties of behavior.     

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.     

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.     

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.     

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.     

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.     

Managing the Care Home Closure Process: Care Managers' Experiences and Views

This paper reports case study research that set out to identifywhat care managers do during independent care home closures.Little research has focused on the way in which care homes forolder people are closed in England, or what those involved thinkabout the process. This paper reports the activities and viewsof care managers directly involved in helping older people relocatefrom care homes that were closed by their owners. During suchclosures, residents and their families have no choice but tomove, usually to a deadline, and with little control over theprocess. Care managers have a responsibility to help arrangealternative care for those current residents who are publiclyfunded, and to offer information and support to those fundingtheir own care (the ‘self-funded’). Closure relatedactivities could involve considerable staff time. Care managementarrangements, including the organization of teams and provisionof needs assessments, varied across authorities. The care managersdescribed drawing on emotional counselling and inter-personalskills, as well as practitioner knowledge and experience, particularlywhen offering support and advice about finding appropriate newhomes. Tensions between aims, constraints on their actions andviews of good practice are identified.     

Current Realities

This article reports survey data from nursing home professional social workers on their practice circumstances, prior education and training, and current training needs. This data supports the growing body of evidence that a significant portion of social work practitioners are unlikely to have received the depth of information and the specialized skills required to work with the aged and their families during their formal education. Assuming limited personnel and time, and the responsibility of many different persons for psychosocial care -the practice reality in nursing homes today-- this data can guide education and training efforts.     

THE ELDERLY BLIND IN NURSING HOMES

This article addresses a number of issues surrounding the problem of delivering services to elderly blind residents in nursing homes. It is pointed out that general public misunderstanding, blind service agencies' lack of resources and general nuising home problems like high staff turnover rates make it difficult to establish ongoing effective training programs. It is argued that rigorously evaluated trainings could solve some of the problems involved in coordinating the blind service system and nursing home network to establish a national in-service training policy on blindness for staff who work with elderly blind in nursing homes.     

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.     

The living-dying interval in nursing home-based end-of-life care: family caregivers' experiences

Guided by concepts from the living-dying interval ( Pattison, 1977 ) this study sought to explore family members' experiences with a dying nursing home resident. In-depth interviews were conducted with 31 caregivers of residents who had died. Interviews were audiotaped and transcribed. Themes that illuminated families' experiences on the living-dying interval were: an acute medical crisis (trigger events, accumulation of stressors, level of care crisis); the living-dying phase (advance care planning, hospitalization, end-stage decisions); and the terminal phase (beginning of the end, awareness of dying). The results illustrate critical periods for social work intervention with families of dying nursing home residents.     

Grandparents Responsible for Grandchildren in Native‐American Families*

Objectives. The primary goal of this article is to examine factors associated with grandparent care giving within the American Indian/Alaska Native (AIAN) population. Methods. Data from the 2000 Census of Population, 5% Public Use Microdata Sample, are used to evaluate a multivariate logistic regression model focusing on living with and caring for grandchildren. Particular emphasis is placed on characteristics that may reflect culturally‐based ideas about grandparents' responsibility for the care of their grandchildren. Results. Indicators related to Native‐American identity—specifically, reporting race as AIAN only rather than mixed race, reporting tribal membership, and living in a nonmetropolitan area of an “Indian” state—increase the likelihood of being responsible for a grandchild among Native‐American singles and couples aged 45 and over. Conclusions. Cultural and resource characteristics combine to produce high levels of grandparent care giving within the AIAN population. Inasmuch as those with lower educational and economic resources are especially likely to have responsibility for a grandchild, special attention should be directed toward ensuring adequate support for these caregivers.     

Hostel Care for Elderly People: The Association with Hospital and Nursing Home

In order to achieve its purpose a hostel should have a clearly defined association with both acute hospital and nursing home. This report is a study of the reasons for separation of residents from a hostel over a period of four years; it included temporary admissions to an acute hospital situation and permanent transfer to a nursing home. It is estimated that one nursing home place is needed for every three residents in this kind of hostel. Thirty-six of the 79 residents in a hostel with 32 places had a total of 58 temporary admissions to an acute hospital situation during the four year period. Thirty-three (42 per cent) of the 79 residents needed transfer to a nursing home during the study period. Analysis was made of the time spent (person years) in each institution. Although 42 per cent of the residents needed transfer from hostel to nursing home they spent approximately 75 per cent of their time in the hostel.     

The Influence of Service Factors on Spousal Caregivers' Perceptions of Community Services

The literature clearly denotes that spouses differ from other family members in their reactions to caregiving, their patterns of service use and their assessment of specific services. Yet, despite their prevalence as caregivers, little is known about their unique perceptions of community services and the factors that impact their experiences with the service system. The purpose of this study was to explore the relative influence of (a) spouses' personal factors (e.g., gender, family support) and (b) service factors (e.g., one-on-one professional support), on spousal caregivers' perceptions of community services. The study employed a survey design with a sample of 73 spousal caregivers caring for their partners with dementia at home.

This study found that spousal caregivers have more negative perceptions of the service system when their in-home workers are not informed about their spouses' likes, dislikes and routines. This service factor was the most significant predictor of caregivers' service perceptions. The study further found that most spousal caregivers receive fewer than five consultations from a non-medical professional over a one year period. While spouses longed for more professional support, this service factor was not uniquely associated with service related stress. The policy and practice implications of these findings are discussed.     

Civic Engagement for Nursing Home Residents: A Call for Social Work Action

Civic engagement has been found to be associated with a number of emotional and physical benefits for older adults. For those residing in nursing homes, however, opportunities for civic engagement are limited. Societal barriers such as ageism and practical issues such as transportation can limit their access to activities that promote civic engagement. In this article, we review past research on civic engagement for older adults and explore the challenges and barriers faced by nursing home residents. We conclude with a call for social work professionals to develop, implement, and evaluate interventions that increase civic engagement opportunities for this undervalued group.     

Self-efficacy and psychological well-being of nursing home residents in China: the mediating role of social engagement

Abstract

The purpose of this study was to explore the role of self-efficacy and social engagement in psychological well-being of Chinese nursing home residents. A total of 307 residents completed the measurement of social engagement, self-efficacy and psychological well-being. The results showed that satisfaction with physical environment, social support, social activity engagement and self-efficacy were all positively correlated with psychological well-being. At the same time, social engagement partially mediated the effect of self-efficacy on psychological well-being. The results of this study should indicate additional actions for managers of nursing homes and social workers to improve the psychological well-being of older adults.     

Adults with Down Syndrome and Alzheimer's Disease

Abstract

An increasing number of people with Down syndrome are at risk of dementia resulting from Alzheimer's disease. Many reside in community group homes. When they are affected by dementia, the challenge to agencies providing group homes is how to best provide continued housing and provide effective dementia-related care management. In the general population, long term care is typically provided in nursing facilities, often in special care units (SCUs). This study evaluated select factors found in group homes and SCUs to determine which is able to provide a better quality of life for people with Down syndrome affected by dementia. Interviews, using quality of life indicators, were conducted at 20 sites, equally selected from group homes and SCUs, on the basis of their experience with people with dementia. Results indicate that group homes can provide conditions associated with better quality of life and, additionally, operate with lower staffing costs due to the non-utilization of medical staff.