Situación legal de la atención farmacéutica en residencias de ancianos en España / Legal Situation of Pharmaceutical Care in Nursing Homes in Spain

ntroducción: La mayor esperanza de vida está pro-duciendo un aumento de la población de personas mayores de 65 años. Este grupo de población se caracteriza por un elevado consumo de medica-mentos y de asistencia sanitaria, permaneciendo muchos de ellos en centros residenciales donde son cubiertas todas sus necesidades. El perfil farmacoterapéutico de estos pacientes suele ser complejo debido a la polimedicación y a las pato-logías crónicas que padecen. Es aquí donde entra en juego el papel del farmacéutico a través de servicios asistenciales. El objetivo de esta revisión es analizar la situación legal, a través del estudio de la normativa específica española que regula la atención farmacéutica en centros sociosanitarios.Método: Revisión de la situación legal de la aten-ción farmacéutica en centros sociosanitarios en EspañaResultados: En España, el marco legal básico se encuentra en el Real Decreto Ley 16/2012 que esta-blece la obligación de tener un servicio de farmacia para los centros sociosanitarios que tengan cien o más camas en régimen de asistidos, mientras que aquellos con menos camas tendrán que tener-lo vinculado a un hospital o a una farmacia. Sin embargo, cada Comunidad Autónoma establece un régimen propio de funcionamiento, a través de su normativa específica.Conclusiones: Existen diferencias en la regulación de los centros sociosanitarios en cuanto a presta-ciones, funciones y servicios farmacéuticos corres-pondiente a cada Comunidad Autónoma (AU)

Introduction: Longer life expectancy is producing an increase among the population of people over the age of 65. This population group is charac-terized by a high consumption of medicines and healthcare, living many of them in residential facili-ties where all their needs are covered.The pharmacotherapeutic profile of these patients is usually complex due to their polymedication and the chronic pathologies they suffer. Here is where the role of the pharmacist comes into play with healthcare services. The aim of this review is to analyze the legal situation by studying the specific Spanish regulations that rule the pharmaceutical care in social and health care centers.Method: Review of the legal situation of pharma-ceutical care in social-health centers in Spain.Results: In Spain, the basic legal framework is found in Royal Decree Law 16/2012, which estab-lishes the obligation to have a pharmacy service for social care centers with one hundred beds or more in assisted care, while those with fewer beds must be linked to a hospital or pharmacy. However, each Autonomous Community establishes its own oper-ating regime through its specific regulations.Conclusions: There are differences in the regula-tion of social and healthcare centers in terms of benefits, functions and pharmaceutical services corresponding to each Autonomous Community (AU)

The impact of COVID-19 on the elderly dependent population in Spain with special reference to the residential care sector. / El impacto de la Covid-19 en la población mayor dependiente en España con especial referencia al sector residencial.

The objective of this study is to analyze the residential care crisis in Spain in the context of the COVID-19 pandemic and its impact on high mortality and abandonment of the user population. The direct, indirect and structural causes are analyzed. Specifically, precarious employment in residences over the past decade was analyzed as one of the main explanatory causes of the structural crisis of nursing homes. The theoretical focus of analysis is the comprehensive and person-centered care (CPCC) model based on the autonomy of people and the centrality of their rights. The methodology combines a quantitative analysis of employment and a qualitative analysis of documents and debates. The study concludes by proposing a comprehensive reform of long-term care that includes both a change in residential care in the form of small cohabitation units and reinforcement of care in the home and the community as a growing preference for the elderly population. An optimal combination of residential and home care is the basic proposal of this work.

Este artículo tiene como objeto analizar la crisis de la atención residencial en España en el contexto de la Covid-19 y su impacto en una elevada mortalidad y el abandono de la población usuaria. Se analizan sus causas inmediatas, mediatas y estructurales. De manera específica se analiza la precariedad en el empleo en las residencias a lo largo de la pasada década como una de las principales causas explicativas de la crisis estructural de las residencias. El enfoque teórico de análisis es el modelo de atención integral y centrada en la persona (AICP) basado en la autonomía de las personas y en la centralidad de sus derechos. La metodología combina el análisis cuantitativo en lo referente al empleo junto con una metodología cualitativa basada en el análisis de documentos y debates. El artículo concluye proponiendo una reforma integral de los cuidados de larga duración que incluya tanto un cambio en la atención residencial bajo la forma de pequeñas unidades de convivencia, como un reforzamiento de la atención en el domicilio y la comunidad en cuanto preferencia creciente la población mayor. La combinación óptima de la atención residencial y domiciliaria es la propuesta básica de este trabajo.

Federal requirements for nursing homes to include certified nursing assistants in resident care planning and interdisciplinary teams: A policy analysis.

Starting in 2016, Centers for Medicare and Medicaid Services implemented the first phase of a 3-year multi-phase plan revising the manner in which nursing homes are regulated. In this revision, attention was placed on the importance of certified nursing assistants (CNAs) to resident care and the need to empower these frontline workers. Phase II mandates that CNAs be included as members of the nursing home interdisciplinary team that develops care plans for the resident that are person-centered and comprehensive and reviews and revises these care plans after each resident assessment. While these efforts are laudable, there are no direct guidelines for how to integrate CNAs in the interdisciplinary team. We recommend the inclusion of direct guidelines, in which this policy revision clarifies the expected contributions from CNAs, their responsibilities, their role as members of the interdisciplinary team, and the expected patterns of communication between CNAs and other members of the interdisciplinary team.

El impacto de la Covid-19 en la población mayor dependiente en España con especial referencia al sector residencial / The impact of COVID-19 on the elderly dependent population in Spain with special reference to the residential care sector

Resumen Este artículo tiene como objeto analizar la crisis de la atención residencial en España en el contexto de la Covid-19 y su impacto en una elevada mortalidad y el abandono de la población usuaria. Se analizan sus causas inmediatas, mediatas y estructurales. De manera específica se analiza la precariedad en el empleo en las residencias a lo largo de la pasada década como una de las principales causas explicativas de la crisis estructural de las residencias. El enfoque teórico de análisis es el modelo de atención integral y centrada en la persona (AICP) basado en la autonomía de las personas y en la centralidad de sus derechos. La metodología combina el análisis cuantitativo en lo referente al empleo junto con una metodología cualitativa basada en el análisis de documentos y debates. El artículo concluye proponiendo una reforma integral de los cuidados de larga duración que incluya tanto un cambio en la atención residencial bajo la forma de pequeñas unidades de convivencia, como un reforzamiento de la atención en el domicilio y la comunidad en cuanto preferencia creciente la población mayor. La combinación óptima de la atención residencial y domiciliaria es la propuesta básica de este trabajo.

Abstract The objective of this study is to analyze the residential care crisis in Spain in the context of the COVID-19 pandemic and its impact on high mortality and abandonment of the user population. The direct, indirect and structural causes are analyzed. Specifically, precarious employment in residences over the past decade was analyzed as one of the main explanatory causes of the structural crisis of nursing homes. The theoretical focus of analysis is the comprehensive and person-centered care (CPCC) model based on the autonomy of people and the centrality of their rights. The methodology combines a quantitative analysis of employment and a qualitative analysis of documents and debates. The study concludes by proposing a comprehensive reform of long-term care that includes both a change in residential care in the form of small cohabitation units and reinforcement of care in the home and the community as a growing preference for the elderly population. An optimal combination of residential and home care is the basic proposal of this work.

[Aging and dying in diversity-implications of an intersectional perspective for analyzing care policy discourses]. / Altern und Sterben in Diversität ­ Implikationen einer intersektionalen Perspektive für die Analyse pflegepolitischer Diskurse.

In view of the growing population, which is increasingly aging in diversity, questions of social justice and of avoiding discrimination in end of life nursing care become increasingly more relevant from an ethical point of view. This article addresses the discrepancies between normative claims of an equitable approach to provision of nursing services and the sources of structural barriers. In particular at the end of life, often already vulnerable groups are subjected to discrimination in nursing care. Further reflections refer to implications of intersectionality for care-ethical approaches and for the methodology of discourse analysis. This study investigated how diversity and justice are formed in the care policy discourse. It becomes evident how parts of the care policy discourse largely ignore individual ethical implications. Accordingly, critical reflections on inequalities in nursing care remain unconsidered in the discourses. Starting points for processes of change that begin from concepts of individual care ethics are presented.

The Impact of the Long-term Care Homes Act and Public Reporting on Physical Restraint and Potentially Inappropriate Antipsychotic Use in Ontario's Long-term Care Homes.

BACKGROUND: We report on the impact of two system-level policy interventions (the Long-Term Care Homes Act [LTCHA] and Public Reporting) on publicly reported physical restraint use and non-publicly reported potentially inappropriate use of antipsychotics in Ontario, Canada. METHODS: We used interrupted time series analysis to model changes in the risk-adjusted use of restraints and antipsychotics before and after implementation of the interventions. Separate analyses were completed for early ([a] volunteered 2010/2011) and late ([b] volunteered March 2012; [c] mandated September 2012) adopting groups of Public Reporting. Outcomes were measured using Resident Assessment Instrument Minimum Data Set (RAI-MDS) data from January 1, 2008 to December 31, 2014. RESULTS: For early adopters, enactment of the LTCHA in 2010 was not associated with changes in physical restraint use, while Public Reporting was associated with an increase in the rate (slope) of decline in physical restraint use. By contrast, for the late-adopters of Public Reporting, the LTCHA was associated with significant decreases in physical restraint use over time, but there was no significant increase in the rate of decline associated with Public Reporting. As the LTCHA was enacted, potentially inappropriate use of antipsychotics underwent a rapid short-term increase in the early volunteer group, but, over the longer term, their use decreased for all three groups of homes. CONCLUSIONS: Public Reporting had the largest impact on voluntary early adopters while legislation and regulations had a more substantive positive effect upon homes that delayed public reporting.

[Health and survival in Icelandic nursing homes 2003 - 2014, before and after the setting of stricter criteria for nursing home admission in December 2007].

INTRODUCTION: Many factors influence the nursing needs and survival of nursing home residents, including the admission criteria. The aim of the study was to compare health, survival and predictors for one- and two-year survival of people entering Icelandic nursing homes between 2003-2007 and 2008-2014. MATERIAL AND METHODS: Retrospective, descriptive, comparative study. The data was obtained from a Directorate of Health database for all interRAI assessments of Icelandic nursing homes from January 1, 2003, to December 31, 2014 (N = 8487). RESULTS: There was a significant difference in the health and survival of new nursing home residents before and after December 31, 2007. In the latter period, the mean age was 82.7 years. In the previous period, it was 82.1 years, and the prevalence of Alzheimer's disease, ischemic heart disease, heart failure, diabetes and COPD increased between the periods. One-year survival decreased from 73.4% to 66.5%, and two-year survival decreased from 56.9% to 49.1%. The strongest mortality risk factors were heart failure and chronic obstructive pulmonary disease, as well as high scores on the CHESS scale and ADL long scale. CONCLUSION: After 2007, new residents were older, in poorer health, and their life expectancy was shorter than for those moving to nursing homes before that. The results suggest that the aim of the regulatory change was achieved, i.e., to prioritise those in worst health. Their care needs may therefore be different and greater than before.

How provider organisations interpret regulation in the context of residential dementia aged care.

OBJECTIVE: To explore how Australian residential dementia aged care providers respond to regulation via organisational culture, level, processes and interpretation. METHODS: Observation took place in three provider organisations. Qualitative, semi-structured in-depth interviews were conducted with aged care staff (n = 60) at three different levels of each organisation: senior management from three head offices (n = 17), facility management (n = 13) and personal care workers (n = 30) from eight residential care facilities. RESULTS: Orientations towards regulation included the following: "above and beyond;" "pushing back;" and "engineering out." Regulation was interpreted differently depending on the level of authority within an organisation where boundaries were managed according to strategic, operational and interactional priorities. DISCUSSION: Examining regulation within an organisational context and at different staff levels suggests ways to balance dementia care with regulatory control. Both generate stress, mitigated by culture and interdependent role differentiation.

El ingreso involuntario en residencia geriátrica y la autorización judicial / Involuntary placement into Geriatric Residence and judicial authorization / L'ingrés involuntari en residència geriàtrica i l'autorització judicial

El ingreso de una persona mayor en una residencia geriátrica sólo puede hacerse con su consentimiento expreso. Si la persona mayor ha perdido su capacidad cognitiva, el ingreso exige autorización judicial. Este trabajo tiene por objeto analizar los requisitos necesarios para la legalidad del ingreso, teniendo en cuenta las tres sentencias del Tribunal Constitucional de 2016. El criterio constitucional es que la autorización ha de ser previa al ingreso y, si ya se ha producido, no cabe ratificación posterior por incumplimiento del plazo de 24 horas y de la urgencia; debe solicitarse la autorización a través de un proceso de modificación de capacidad. Ello es contrario al Convenio sobre los derechos de las personas con discapacidad. El trabajo termina con algunas reflexiones sobre el papel que juegan las voluntades anticipadas en el ingreso voluntario que se torna involuntario con la pérdida de la capacidad cognitiva, y en el control judicial posterior del mismo

An elderly person's admission into a nursing home requires their express consent. If the elderly person has lost his or her capacity, admission requires judicial authorization. The aim of this paper is to analyze the requirements for involuntary placement, taking into account the three judgments of the Constitutional Court of 2016. The constitutional criterion is that the authorization must be prior to entry and, if it has already taken place, it may not be subsequently ratified for failure to comply with the 24-hour deadline and for lack of urgency; authorization must be requested through a capacity modification process. This is contrary to the Convention on the Rights of Persons with Disabilities. The paper ends with some thoughts on the role advance directives have on the voluntary admission that becomes involuntary, as the person loses decision-making capacity, and on the subsequent judicial control

L'ingrés d'una persona gran en una residència geriàtrica només pot fer-se amb el seu consentiment exprés. Si la persona gran ha perdut la seva capacitat cognitiva, l'ingrés exigeix autorització judicial. Aquest treball té per objecte analitzar els requisits necessaris per a la legalitat de l'ingrés, tenint en compte les tres sentències del Tribunal Constitucional de 2016. El criteri constitucional és que l'autorització ha de ser prèvia a l'ingrés i, si ja s'ha produït, no hi cap ratificació posterior per incompliment del termini de 24 hores i de la urgència; l'autorització ha de sol·licitar-se a través d'un procés de modificació de la capacitat. Això és contrari al Conveni sobre els drets de les persones amb discapacitat. L'article acaba amb algunes reflexions sobre el paper que juguen les voluntats anticipades en l'ingrés voluntari que es torna involuntari amb la pèrdua de la capacitat cognitiva, i en el control judicial posterior

Ontario's Retirement Homes and Long-Term Care Homes: A Comparison of Care Services and Funding Regimes.

ABSTRACTGrowing demand for beds in government-subsidized long-term care (LTC) homes in Ontario is causing long waitlists, which must be absorbed by other residential alternatives, including unsubsidized retirement homes. This study compares Ontario's LTC homes and retirement homes for care services provided, funding regimes, and implications of differential funding for seniors. Descriptive data for both types of homes were collected from public and proprietary sources regarding service offerings, availability, costs, and funding. Overlaps exist in the services of both LTC and retirement homes, particularly at higher levels of care. Although both sectors charge residents for accommodation, most care costs in LTC homes are publicly funded, whereas residents in retirement homes generally cover these expenses personally. Given waitlists in Ontario's LTC homes, many seniors must find residential care elsewhere, including in retirement homes. Several policy alternatives exist that may serve to improve equity of access to seniors' residential care.

Medication Refusal: Resident Rights, Administration Dilemma.

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

Nurses' perceptions of the impact of the aged care reform on services for residents in multi-purpose services and residential aged care facilities in rural Australia.

AIM: To understand nurses' perceptions of the impact of the aged care reform on care and services for residents in multi-purpose services (MPS) and residential aged care facilities (RACF) in rural South Australia. METHODS: An interpretative study using semi-structured interviews. Participants comprised registered and enrolled nurses working with aged care residents in rural South Australia. Eleven nurses were interviewed, of these seven worked in MPS and four in RACF. RESULTS: Data were analysed for similarities and differences in participants' experiences of care delivery between MPS and RACF. Common issues were identified relating to funding and resource shortfalls, staffing levels, skill mix and knowledge deficits. Funding and staffing shortfalls in MPS were related by participants to the lower priority given to aged care in allocating resources within MPS. Nurses in these services identified limited specialist knowledge of aged care and care deficits around basic nursing care. Nurses in RACF identified funding and staffing shortfalls arising from empty beds due to the introduction of the accommodation payment. Dependence upon care workers was associated with care deficits in complex care such as pain management, medication review and wound care. CONCLUSION: Further research is needed into the impact of recent reforms on the capacity to deliver quality aged care in rural regions.