Practices and outcomes: pressure ulcer management in nursing facilities.

INTRODUCTION: The objective of this study was to compare reported pressure ulcer prevention and treatment practices in nursing facilities with high prevalence of pressure ulcers versus nursing facilities with low prevalence of pressure ulcers. METHODS: A 26-item survey on implementation of nationally accepted standards for pressure ulcer prevention and treatment was mailed to directors of nursing in all 68 nursing facilities in an urban county. RESULTS: There were no statistically significant differences on reported pressure ulcer prevention interventions based on pressure ulcer prevalence. When treating pressure ulcers, respondents of facilities with high prevalence of pressure ulcers reported more frequent pain assessments, more frequent use of low air-loss beds, and daily wound assessments. DISCUSSION: The study failed to support the hypothesis that nursing facilities with low prevalence of pressure ulcers report using more guideline-recommended pressure ulcer prevention and treatment interventions than facilities with high prevalence of pressure ulcers. Reported adherence to recommended interventions for repositioning and pressure relief measures, moisture management, and attention to nutrition exceeded 60% in all facilities. CONCLUSION: The disparity between reported interventions and pressure ulcer prevalence rates offers an opportunity for future collaborative quality improvement projects, research, and the need for leadership to develop systems of care to ensure the use of pressure ulcer prevention guidelines.

Younger residents in nursing homes.

Younger residents in nursing facilities represent a growing but little recognized population. This study examined a group of younger residents, describing issues identified by residents and facility staff and identifying strategies that might improve their quality of life. In this study, the majority of younger residents were men with significant physical and mental health deficits, who spent most of their time alone or watching television. Residents wanted a greater variety of relevant recreational activities and more meaningful relationships with family, staff, and other residents. Staff believed nursing facilities were not designed for younger residents, resulting in unmet psychosocial and recreational needs.

Surviving the storms: Emergency preparedness in Texas nursing facilities and assisted living facilities.

This study assesses the preparedness of long-term care facilities in Texas responding to Hurricanes Katrina and Rita. A 41-item questionnaire was mailed to facilities; the response rate was 42%. Among responding facilities, 4513 residents were evacuated, and 6% of respondents reported resident death. Financial losses were reported by 8% of nursing facilities and 45% of assisted living facilities due to transportation and staff overtime. Respondents indicated the need for improved disaster preparednesstraining, better coordination, and transportation. Changes in policy and practice will lead to better trained staff who will provide the care residents need for improved health outcomes during future public health disasters.

Unique challenges of transgender aging: implications from the literature.

Transgender elders are both underserved and understudied. Neither the etiology nor prevalence of transgender is well understood. Because sex, gender, and sexuality are at the very core of individual identity, it is difficult to dislodge one's ideas and feelings about them. Unlike biological sex and sexual orientation, gender has several aspects: gender identity, gender expression, and gender classification. A discussion of the terminology of transgender is presented, and the issues facing aging transgender individuals are identified. Although the challenges of adequate healthcare, social support, and legal obstacles are faced by many elderly individuals, the way they are presented and managed are unique to this often invisible group.

Family councils in nursing facilities: strategies for effective participation.

This article provides an overview of the role of family councils. The contributions of the three groups that play a significant role in the development and support of family councils, relatives and friends of the facility's residents, facility administration and staff, and local advocacy organizations, are discussed. The role of the staff advisor, generally the facility social worker, is a major key to a successful council. Barriers that impede family council success are identified, and strategies that improve effectiveness are presented. Family councils play an important part in improving the quality of lives of long-term care residents.

Mediation in long-term care facilities: a pilot project.

OBJECTIVE: To describe the development and implementation of a mediation model appropriate for long-term care facilities. METHODS: The recruitment and training of mediators; the role of the ombudsman; and approaches to educating facility staff, families, and residents are described. Disputes identified as suitable for mediation include care disputes, resident-to-resident issues, and family matters. RESULTS: Pilot project results indicate cases that reach mediation generally come to a mutual agreement that is upheld over time. Only a small number of cases referred for mediation are actually mediated. A main barrier to using mediation as an option is lack of knowledge of its availability and potential benefits. Intensive outreach within facilities is essential if residents, families, and staff are to recognize and refer cases. CONCLUSION: Mediation must be considered broadly as an approach, not as a single process. Mediation can help to involve residents and families in constructive decision making that improves care, and could be a part of the overall dispute resolution system in long-term care.