Trends in the Use of Residential Settings Among Older Adults.

OBJECTIVES: As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time. METHODS: A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRFs), and nursing facilities using 3 data sources: the Medicare Current Beneficiary Survey (MCBS), 2008 and 2013; the Health and Retirement Study (HRS), 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated the age-standardized prevalence of older adults by setting, functional limitations, and comorbidities and tested for health characteristics changes relative to the baseline year (2002). RESULTS: The proportion of older adults in traditional housing increased over time, relative to baseline (p < .05), while the proportion of older adults in CBRFs was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < .05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < .05). DISCUSSION: The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on noninstitutional LTSS.

Users of Medicaid home and community-based services are especially vulnerable to costly avoidable hospital admissions.

Although Medicaid's coverage of home and community-based services and the program's capacity to provide such services have increased markedly in recent years, relatively little is known about the population that uses these services. We combined Medicaid and Medicare data to characterize the national Medicaid population of service users by key demographic and health-related attributes. We also assessed one important dimension of their health outcomes: potentially avoidable hospital admissions. We found that in 2005 there were 2.2 million users of Medicaid home and community-based services-almost 4 percent of the total Medicaid population-and that two-thirds of these users were dually eligible for Medicare and Medicaid. Users of home and community-based services were particularly vulnerable to avoidable hospital admissions, compared to the full Medicaid and US populations, and these hospitalizations occur at substantial cost to public payers. For the dual eligibles using home and community-based services, Medicare pays most of the costs of these avoidable hospital stays. Our findings emphasize the need for further research to establish policies and practices that can best meet the needs of users of Medicaid home and community-based services.

Strong Rural Communities Initiative (SRCI) program: challenges in promoting healthier lifestyles.

BACKGROUND: The Strong Rural Communities Initiative (SRCI) was created to address the health needs of rural Wisconsin communities through a multifaceted partnership that included the Medical College of Wisconsin (MCW), University of Wisconsin School of Medicine and Public Health (UWSMPH), the Rural Health Development Council (RHDC), and hospitals, public health departments, and businesses in 6 rural communities in Wisconsin. The SRCI provided a broad framework of leadership to assist each of the 6 rural communities in developing and implementing new, collaborative interventions that addressed the specific health needs of the community. METHODS: Separate assessments were conducted for the communities that partnered with each respective medical school and focused on the processes of community collaboration and partnership function. Assessment approaches included formative and outcome evaluation. RESULTS: Each community independently reported positive outcomes associated with the partnership process and various aspects of community collaboration, including the successes and health impacts of the workplace wellness programs implemented. Assessment data also revealed challenges related to conducting effective community-academic partnerships. CONCLUSIONS: The SRCI was established to execute statewide programs in rural communities with the goal to improve the health of people living in those communities. We have gained applicable knowledge regarding the types of challenges that exist in establishing a rural-based community research network between academic partners and community leaders.

Challenges and approaches to the identification of traumatic brain injury among nursing home residents.

The Minimum Data Set (MDS) is a standardized, federally mandated assessment tool used to identify the needs of nursing home residents and rehabilitation and nursing services received on a routine basis. These data can be used to identify people with traumatic brain injury (TBI), where a diagnosis is recorded. However, both limitations of the MDS and the presence of other neurological issues that can be confused with TBI can reduce the likelihood that brain injury is identified where it exists. The article discusses innovative methodological approaches and challenges to using the MDS data to identify people with TBI in nursing homes.

Nursing home capabilities and decisions to hospitalize: a survey of medical directors and directors of nursing.

OBJECTIVES: To obtain information from decision makers about attitudes toward hospitalization and the factors that influence their decisions to hospitalize nursing home residents. DESIGN: Cross-sectional survey. SETTING: Four hundred forty-eight nursing homes, 76% of which were nonprofit, from 25 states. PARTICIPANTS: Medical directors and directors of nursing (DONs). MEASUREMENTS: Participants were surveyed about resource availability, determinants of hospitalization, causes of overhospitalization, and nursing home practice. RESULTS: The survey response rate was 81%, with at least one survey from 93% of the facilities. Medical directors and DONs agreed that resident preference was the most important determinant in the decision to hospitalize, followed by quality of life. Although both groups ranked on-site doctor/nurse practitioner evaluation within 4 hours as the least accessible resource, they did not rank doctors not being quickly available as an important cause of overhospitalization. Rather, medical directors perceived the lack of information and support to residents and families around end-of-life care and the lack of familiarity with residents by covering doctors as the most important causes of overhospitalization. DONs agreed but reversed the order. Medical directors and DONs expressed confidence in provider and staff ability, although DONs were significantly more positive. CONCLUSION: Medical directors and DONs agree about most factors that influence decisions to hospitalize nursing home residents. Patient-centered factors play the largest roles, and the most important causes of overhospitalization are potentially modifiable.

ANA nurse sensitive quality indicators for long-term care facilities.

Nurse sensitive quality indicators, developed through the American Nurses Association's (ANA) Safety and Quality Initiative, are key to evaluating the quality of patient care in acute care settings. This study found that the ANA quality indicators were also relevant for long-term care facilities. Long-term care facilities can be part of the ANA Safety and Quality Initiative by collecting and reporting nurse sensitive quality indicators and submitting data to the National Database of Nursing Quality Indicators.