Elder abuse in residential long-term care: an update to the 2003 National Research Council report.

A synthesis of the last decade of literature on elder abuse in residential long-term care (i.e., Nursing Homes and Assisted Living) is discussed. Presented are definitions of abuse, theoretical and conceptual models, prevalence rates of abuse, outcomes and costs, and sources of abuse. The synthesis represents an update to the literature in the influential 2003 National Research Council report. We identify many of the same issues and concerns exist that were surfaced in this prior report. Many theoretical and conceptual models need further elaboration. Conflicting definitions of abuse are pervasive. Rates of abuse are generally inaccurate, and probably under-reported. However, we also identify progress in many areas. An increase in empirical studies that exist in this area (although very few in Assisted Living). Other forms and types of abuse have also been identified as important, such as resident-to-resident abuse. These areas are discussed, along with potential suggestions for additional research.

Quality of care and long-term care administrators' education: does it make a difference?

BACKGROUND: Long-term care administrators (administrators) can influence the care nursing home residents receive. However, little research has examined what factors of administrators are associated with how they influence care. PURPOSES: In this research, the association between administrators' education and quality of nursing home care is examined. In addition, the association between state educational and training requirements and quality of nursing home care is examined. METHODOLOGY: Information collected from 3,941 administrators was matched with secondary data, including Nursing Home Compare; the Online Survey, Certification and Reporting data; and the Area Resource File. The quality indicators restraint use, catheter use, inadequate pain management, low-risk residents with pressure ulcers, and high-risk residents with pressure ulcers were examined. FINDINGS: Positive, statistically significant associations were found between the education level of administrators and all five quality indicators. Likewise, positive statistically significant associations were found between state educational requirements and state training requirements and the five quality indicators. PRACTICE IMPLICATIONS: If these associations hold true, then promoting further educational attainment of individual administrators may influence quality of care. The state educational requirements and training requirements for administrators' licensure may represent an additional means of influencing the quality of care in nursing homes.

Influence of Nurse Aide Absenteeism on Nursing Home Quality.

PURPOSE: In this analysis, the association of nurse aide absenteeism with quality is examined. Absenteeism is the failure of nurse aides to report for work when they are scheduled to work. DESIGN AND METHODS: Data used in this investigation came from survey responses from 3,941 nursing homes; Nursing Home Compare; the Online System for Survey, Certification and Administrative Reporting data; and the Area Resource File. Staffing characteristics, quality indicators, facility, and market information from these data sources were all measured in 2008. The specific quality indicators examined are physical restraint use, catheter use, pain management, and pressure sores using negative binomial regression. RESULTS: An average rate of 9.2% for nurse aide absenteeism was reported in the prior week. We find that high levels of absenteeism are associated with poor performance on all four quality indicators examined. IMPLICATIONS: The investigation presented, to our knowledge, is one of the first examining the implications of absenteeism in nursing homes. Absenteeism can be a costly staffing issue, one of the potential costs identified in this analysis is an impact on quality of care.

Nursing home administrators' opinions of pay for performance.

The research presented here provides some descriptive information of nursing home pay for performance (P4P) initiatives and an examination of the opinions of nursing home administrators (NHAs) about P4P. Opinions on three common elements of P4P were examined: the incentive format, program format, and quality format. Information came from a mail survey of 2,426 NHAs. Most of the summary scores show that few NHAs gave positive responses to P4P. Very few NHAs believed that P4P would increase their revenues. NHAs were skeptical that P4P systems were for quality improvement and instead believed they were developed for purposes of cost reduction. Relatively few NHAs believed that P4P would improve quality of care. Given that we have limited experience with setting performance goals and incentive formats for NHAs, the findings presented may prove useful in modeling future P4P systems.

Measuring administrators' and direct care workers' perceptions of the safety culture in assisted living facilities.

BACKGROUND: Further understanding of patient safety in health care is still needed. This is particularly evident in long term care settings, where relatively little information exists. Safety culture has emerged as a critical component of efforts to improve patient safety; it is strongly associated with iniatatives that influence patient safety and quality of care. The safety culture of a large sample of assisted living (AL) facilities was examined. METHODS: The Nursing Home Survey on Patient Safety Culture (NHPSC) was modified and used to examine safety culture. A random sample of AL settings from all 50 states was selected to participate. Respondents were AL administrators and direct care workers (DCWs) who completed the modified safety culture survey. The applied properties of the instrument are examined. A summary score for administrators and DCWs for each NHPSC item is also presented. These summary scores have a range from 0 to 100, with low scores representing a poor safety culture (and vice versa). RESULTS: Information was received from 572 administrators (response rate = 57%) and 3,620 DCWs (response rate = 51%). The scores, using the 0-100 scale, fell into the 48-72 range for administrators and the 40-68 range for DCWs. Many of the scores were similar to those previously found in nursing homes. CONCLUSIONS: AL is recognized as one of the fastest-growing institutional components of the long term care industry. The modified NHPSC performed well. Some areas of safety culture were perceived less favorably than in nursing homes. As such, some further attention to safety culture in AL is warranted. This study provides a first step toward assessing safety culture in this underexamined setting.

Nursing home deficiency citations for infection control.

BACKGROUND: This study examined the deficiency citation for infection control (ie, F-Tag 441). This information represents potential problems in infection control as identified in the yearly certification process of almost all US nursing homes. METHODS: The data used came primarily from the Online Survey, Certification, and Reporting data base, which contains information on both deficiency citations and characteristics of nursing homes. The data for each nursing home from 2000 through 2007 were combined, providing a panel of 100,000 observations. Multivariate analyses and generalized estimating equations with a logit link were used. RESULTS: An average of 15% of all nursing homes received a deficiency citation for infection control each year from 2000 to 2007. In the multivariate analyses, several staffing levels were robust in their significance. For all 3 types of caregiver examined (ie, nurse aides, Licensed Practical Nurses, and Registered Nurses), low staffing levels were associated with receipt of a deficiency citation for infection control. CONCLUSION: The high number of deficiency citations for infection control problems identified in this study suggests the need for increased emphasis on these programs in nursing homes to protect vulnerable elders.

The Evolution of Nursing Home Report Cards.

Nursing home report cards can be potentially key tools for disseminating information to consumers. However, few accounts of state-based nursing home report cards are available. In the research presented here, the scale, scope, utility, and changes over time in these nursing home report cards are described. This article finds that the number of report cards has increased from 24 in 2003 to 29 in 2009. The quality information presented varies considerably; however, deficiency citations are still the most frequently reported quality indicators. The utility of report cards varies considerably. The authors present their opinions of features that seem most conducive for consumer use of these report cards.