Effect of Hurricane Irma on daily direct-care nurse staffing in nursing homes.

OBJECTIVES: To examine the effect of Hurricane Irma on staff-related financial expenditures and daily direct-care nurse staffing levels. DESIGN: Retrospective cohort study. SETTING: September 3-24, 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10, 2017. PARTICIPANTS: Six hundred and fifty-three nursing homes (NHs), 81 evacuated facilities, and 572 facilities that sheltered-in-place. MEASUREMENTS: This study used data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida's health providers' emergency reporting system. PBJ provided estimates of daily direct-care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility-level characteristics such as profit status, chain membership, and special care unit availability. Florida's emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed-effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3 to 10. RESULTS: Among all facilities, we found significant increases in staffing for licensed practical nurses (p = 0.02) and certified nursing assistants (p < 0.001), but not for registered nurses (p = 0.10) before Hurricane Irma made landfall. From 1 week before landfall to 2 weeks after landfall (September 3-24), an additional estimated $2.41 million was spent on direct-care nurse staffing. In comparison to facilities that sheltered-in-place, evacuated facilities increased staffing levels of all nurse types (all p < 0.001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident whereas facilities that sheltered-in-place spent $76.10 on nurse staffing per resident. CONCLUSION: NHs face unprecedented challenges during hurricanes, including maintaining adequate direct-care nurse staffing levels to meet the needs of their residents. NHs that evacuated residents had an increase in direct-care nurse staffing that was greater than that seen in NHs that sheltered-in-place.

[Liaison geriatrics with nursing homes in COVID time. A new coordination model arrived to stay]. / La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse.

Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.

Does the Aged Care Funding Instrument provide increased funding in residential care? Comparisons with the Residential Classification Scale.

AIM: To determine whether the Aged Care Funding Instrument (ACFI) provides more funding than the Residential Classification Scale (RCS) for residents in the Hellenic Residential Care Facility. METHODS: All residents within the care facility were assessed over a six 6-month period using ACFI, RCS and Clifton Assessment Procedures for the Elderly (CAPE) scores. Differences in funding levels were calculated using ACFI and RCS instruments against a standardised CAPE score. RESULTS: CAPE dependency RCS funding per resident per day varied from $32.20 for grade A to $116.20 for grade E4 residents. CAPE ACFI funding varied from $20.20 for grade A to $127.50 for grade E4. There was no significant difference in mean overall funding between the two scales (ACFI $92.50 vs RCS $90.35, P = 0.76). CONCLUSIONS: The ACFI does provide a small but not significant increase in funding to residents in residential care. It redirects funding to higher dependency residents.

Definition and classification of assisted living.

PURPOSE: The purpose of this article is to discuss the benefits and limitations of, and considerations in, developing a typology of assisted living (AL). DESIGN AND METHODS: We conducted a review and comparison of nine AL typologies drawn from the literature. RESULTS: Typologies addressed matters related to the structure, process, population, and philosophy of AL to varying degrees. A lack of available data and different sampling frames hindered attempts to quantitatively compare the typologies. IMPLICATIONS: Typologies are potentially useful for consumers, practitioners, policy makers, and researchers. It is advisable to identify state-based typologies and then empirically determine types that have national representation. Stakeholders should consider the tradeoff between sensitivity and specificity and allow any resulting typology to anticipate ongoing evolution in the field of AL.

Una aproximación a la situación de los adultos/as mayores y de las Asociaciones, Clubes y Grupos Parroquiales que los nuclea

Estudio exploratorio de la situación de los adultos/as mayores para analizar sus organizaciones, normasy procedimientos. Describe la creencias, prejuicios y estereotipos de la población urbana paraguaya hacia los adultos mayores, resaltando a aquellos que mantienen nuestra cultura y determinan su estilo de vida. Presenta el análisis del anteproyecto de Ley que estaba en estudio en la Cámara de Senadores

[The "Duisgurg model" of intensified control of nursing homes and homes for the aged by the Duisberg public health services in cooperation with the Duisburg social welfare offices]. / Duisburger Modell--intensivierte Heimaufsicht des Gesundheitsamtes in Zusammenarbeit mit dem Sozialamt.

This is a report on the joint cooperative control of nursing and old-age homes by the Public Health and Social Welfare Offices in Duisburg, Germany. A total of 40 of such homes were inspected and checked jointly by the physician and pharmacist of the local Public Health Office within a one-year period while collecting data on the intensity and quality of care in these homes. A total of 3883 inmates were covered. These data included, inter alia, information on the intensity of care, prevalence of urinary and fecal incontinence, feeding by means of percutaneous endoscopic gastrostomy, prevalence of bedridden patients and of cases of pressure sores. The data conveyed information on the overall situation (frequencies for all the Duisburg nursing and old-age homes) on the one hand, and for each individual home on the basis of its particular data on the other hand. It became evident that two-thirds of all the inmates of nursing homes were classified as belonging to nursing stages II and III. Urinary incontinence was present in 63 per cent of the cases, fecal incontinence in 43 per cent, whereas 32 per cent were severely confused. Of a total of 447 permanently bedridden patients (11.5 per cent of all the inmates) 131 had pressure sores or necroses of the heels (3.37 per cent of the total population). More than one-half of the pressure sores had been acquired by the patients during their hospital stay, i.e. before their referral to a home, whereas 56 inmates developed their pressure sores in the homes concerned.

[Consideration of mental symptoms and physical disabilities in deciding upon placement in a residential home versus a nursing home]. / De indicatie voor een verzorgingshuis of verpleeghuis. De weging van psychische klachten en lichamelijke beperkingen.

This study analysed 235 applications of elderly people for residential home and nursing home care. The applications were submitted to a Dutch municipal care allocation board. Based on the 1994 registration data from this board the impact of physical restrictions and mental problems on the care allocation for residential or nursing homes and connected care was studied. Physical complaints were measured with an adl and an hdl scale (Activities of Daily Living and Household Activities of Daily Living), mental problems were assessed by means of the Reality, Orientation and Restlessness Scales. Persons with an admission allocation for a nursing home (both psychogeriatric and somatic) had the highest scores on all scales; persons allocated to the residential home and related care had significantly lower scores. Above-mentioned scales have been combined into care level categories. Fifty seven persons, however, appeared not to have any physical or mental problems despite a care allocation to the residential home or related care. Contextual problems (housing, social contacts, endurance-capacity of relatives and friends) were particularly decisive in this case. Moderately severe problems, both physical and mental, generally resulted in an allocation to the residential home or related care. Serious problems usually result in allocation to the somatic or the psychogeriatric nursing home. Combined serious problems (75%) tended to result in an allocation to the psychogeriatric nursing home. This study is preliminary to the development of a care allocating instrument.

Identifying older people with dementia: the effectiveness of a multiservice census.

A census of all relevant services in an area can be used to identify people with mental impairment suggestive of dementia. Two censuses in Tayside, Scotland, were used to test the effectiveness of this method. False positives accounted for 12% of returns. After excluding false positives, by comparison with expected dementia prevalence based on EURODEM, 66% of all sufferers and 50% of those living in the community were identified by the censuses. By pro-rating for non-response, the proportion of sufferers known to services was estimated as 72%. The characteristics of those not known to services are unclear and further research is needed on this. The cost of a census in an area of 250,000 population is under pounds 3000. A multiservice census offers a simple, inexpensive, practicable method of constructing a sample frame for population needs assessment.

Identification of elderly in particular need: results of a survey undertaken in residential homes in the Manchester area.

OBJECTIVES: This paper aims to identify which groups of elderly people living in residential institutions are in particular need of dental care and advice. Comparison of different types of residential institution allows identification of elderly in greatest need of dental assistance. METHODS: A postal survey of carers in 250 residential homes for elderly people in Manchester, UK, was undertaken to determine the frequency of dental visits, arrangements for dental care of the residents' teeth and denture cleansing and appliance-wearing patterns and, also, the carers' knowledge and practice of simple dental and oral maintenance procedures for residents. Comparisons were undertaken using the SPSS software package of: social service and private homes, large and small homes, homes where regular visits were undertaken and those not regularly visited, and also homes which maintained records of their clients' dental state with those which did not. RESULTS: Residents' oral health tended to be more at risk in smaller or privately managed homes, in those where no dentist visited regularly and where no records of dental care were kept. CONCLUSION: The dental profession needs to especially target homes where care is less well organized, not only to examine and treat residents, but also to instruct carers in simple mouth care techniques, in order that dental disability in an increasingly dentate population can be minimized.

Policy issues surrounding special care units.

What is specialized care for Alzheimer's patients? Is it really specialized, or could that word simply be a marketing ploy? Home care agencies that care for patients with Alzheimer's disease will face these questions with their patients and undergo the same questions that the nursing home industry faces.

Nursing home resident assessment and case-mix classification: cross-national perspectives.

Two broadly applied systems in the United States, the National Resident Assessment Instrument/Minimum Data Set and the Resource Utilization Groups, have provided new insight into the quality, delivery, and financing of nursing home care. In this article, the authors describe research efforts in eight other nations to translate, validate, and use one or both systems to understand their own long-term care systems. This consortium of studies, using common instruments, provides potential cross-national analyses that capitalize on differences in practice patterns and system designs to address critical policy issues.

[Legal aspects of home care and placing of the elderly]. / Les aspects juridiques dans le maintien à domicile et le placement des personnes âgées.

Welfare policies for the elderly have mainly been developed since 1945 in order to secure an adequate income and social cover and to reduce inequality in health (Social Security plan for all, old-age benefits for the poor, increase of old-age pensions, creation of supplementary benefits, etc.). But only a few years ago various services for the elderly remaining at home have been created, and they remain a matter of great concern for the government. Many legal texts concerning socio-economic measures to help and favour people who wish to remain at home have been published in order to delay as long as possible admission of the elderly to medical establishments. Further, legal protection systems look after the interests of physically and/or mentally disabled people who are unable to do it themselves and to cope with their property.