Prevalence and persistency of deficiency citations in Florida assisted living facilities.

BACKGROUND: Assisted living facilities (ALFs) are plagued with quality issues but there are limited studies on the quality of ALFs. In Florida, state surveyors conduct inspections of ALFs and cite and/or fine facilities that are in violation of regulations. Yet, we do not know the types of quality problems identified and the extent to which facilities repeat such problems. In this study, we begin to fill this gap in our understanding of ALFs quality by summarizing the deficiency citations in Florida ALFs. METHODS: We obtained inspection citation data on 957 large ALFs (bed size ≥ 25) in Florida from 2012 to 2018. Citation data are summarized at the facility-year level and classified into different groups such as resident care, admissions, medication, staffing, and training. We examined the trends in citations over time and stratified citations by profit status, license type, and facility size. We also assessed repeat citations among the ALFs. RESULTS: Of the 957 large ALFs operating in Florida, 87% of the facilities were cited one or more times from 2012 to 2018. In 2018, the most common citations were related to medications (26.2%), resident care (25.3%), training (25.3%), admissions (21.1%), and staffing (20.8%). For-profit facilities, facilities with beds over 100, and facilities with limited mental health license tended to be cited more often across most types of deficiencies. Repeat citations are common with over 40% of facilities cited in two or more years for resident care and medication from 2012 to 2018. CONCLUSIONS: Our findings suggest that repeat citations are common and ALFs do not improve quality on a long-term basis after citations. If we want to improve ALFs quality, we may need to provide appropriate incentives and resources to ALFs along with stringent enforcement of regulations.

Barriers and facilitators to infection prevention and control in Dutch residential care facilities for people with intellectual and developmental disabilities: A theory-informed qualitative study.

BACKGROUND: Care institutions are recognised to be a high-risk setting for the emergence and spread of infections and antimicrobial-resistant organisms, which stresses the importance of infection prevention and control (IPC). Accurate implementation is crucial for optimal IPC practice. Despite the wide promotion of IPC and research thereof in the hospital and nursing home setting, similar efforts are lacking in disability care settings. Therefore, this study aimed to assess perceived barriers and facilitators to IPC among professionals working at residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDD), as well as to identify professional-reported recommendations to improve IPC. METHODS: This qualitative study involved semi-structured interviews (before COVID-19) with twelve professionals from five Dutch RCFs for people with IDD. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis using inductive and deductive approaches was conducted. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. RESULTS: Our findings revealed barriers and facilitators at the guideline, client, professional, professional interaction, professional client interaction, client interaction, organisational, community, and societal level. Six main themes covering multiple barriers and facilitators were identified: (1) guidelines' applicability to (work)setting; (2) professionals' cognitions and attitude towards IPC (related to educational background); (3) organisational support and priority; (4) educational system; (5) time availability and staff capacity; and (6) task division and change coaches. The main professional-reported recommendations were the introduction of tailored and practical IPC guidelines, structural IPC education and training among all professionals, and client participation. CONCLUSIONS: To promote IPC, multifaceted and multilevel strategies should be implemented, with a preliminary need for improvements on the guideline, professional, and organisational level. Given the heterogeneous character, i.e., different professionals, clients and care needs, there is a need for a tailored approach to implement IPC and sustain it successfully in disability care. Our findings can inform future IPC practice improvements.

Testing the Impact of FFC-AL-EIT on Psychosocial and Behavioral Outcomes in Assisted Living.

BACKGROUND: This study tested the impact of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) on: (1) care interactions between residents and direct care staff; and (2) behavior and psychological symptoms associated with dementia among residents. DESIGN: This was a randomized controlled trial. SETTING: A total of 59 assisted living facilities in Maryland, Pennsylvania, and Massachusetts participated. PARTICIPANTS: The sample included 550 mostly White (98%), female (69%) residents with a mean age of 89.30 (standard deviation = 7.63) years. INTERVENTION: The four-step FFC-AL-EIT intervention was implemented by a function focused care nurse facilitator working with a facility champion over 12 months. The steps included: (1) environment and policy assessments; (2) education; (3) establishing resident function focused care service plans; and (4) mentoring and motivating. MEASURES: Resident descriptive data (e.g., age, sex, education, and comorbidities), depression, agitation, resistiveness to care, and the quality of care interactions were obtained at baseline and 4 and 12 months. Treatment fidelity data included environment and policy assessments, performance of function focused care by staff, and service plan assessments. RESULTS: There was a significant positive treatment effect related to depression, agitation, resistiveness to care, and quality of care interactions with either less decline or some improvement in these behaviors and symptoms in the treatment versus control group. CONCLUSION: The study provides some statistical support, which may not necessarily be clinically significant evidence, for psychosocial outcomes of residents and care interactions between staff and residents in assisted living settings.

COVID-19 has united patients and providers against institutional betrayal in health care: A battle to be heard, believed, and protected.

In this commentary, researchers, health care consumers, and medical providers reflect on institutional betrayal during the COVID-19 pandemic in American and Canadian health care systems. Examples of institutional betrayal experienced by patients and their family members, as well as medical providers, are described. Although such examples may be more evident to the general public during the current pandemic, they do not represent new problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Unique Challenges Faced by Assisted Living Communities to Meet Federal Guidelines for COVID-19.

This perspective addresses the challenges that assisted living (AL) providers face concerning federal guidelines to prevent increased spread of COVID-19. These challenges include restriction of family visitation, use of third-party providers as essential workers, staffing guidelines, transfer policies, and rural AL hospitalizations. To meet these challenges we recommend that AL providers incorporate digital technology to maintain family-resident communication. We also recommend that states adopt protocols that limit the number of AL communities visited by home health care workers in a 14-day period, appeal to the federal government for hazard pay for direct care workers, and to extend the personal care attendant program to AL. It is further recommended that states work with AL communities to implement COVID-19 comprehensive emergency management plans that are well-coordinated with local emergency operation centers to assist with transfers to COVID-19 specific locations and to assist in rural areas with hospital transfers. Together, these recommendations to AL providers and state and federal agencies address the unique structure and needs of AL and would enable AL communities to be better prepared to care for and reduce those infected with COVID-19.

American Geriatrics Society (AGS) Policy Brief: COVID-19 and Assisted Living Facilities.

This policy brief sets forth the American Geriatrics Society's (AGS's) recommendations to guide federal, state, and local governments when making decisions about care for older adults in assisted living facilities (ALFs) during the coronavirus disease 2019 (COVID-19) pandemic. It focuses on the need for personal protective equipment, access to testing, public health support for infection control, and workforce training. The AGS continues to review guidance set forth in peer-reviewed articles, as well as ongoing and updated guidance from the US Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and other key agencies. This brief is based on the situation and any federal guidance or actions as of April 15, 2020. Joining a separate AGS policy brief on COVID-19 in nursing homes (DOI: 10.1111/jgs.16477), this brief is focused on ALFs, given that varied structure and staffing can impact their response to COVID-19. J Am Geriatr Soc 68:1131-1135, 2020.

Assisted Living Residents' Sense of Belonging and Psychosocial Outcomes.

Little is known about the psychosocial adjustment of older adults in the assisted living environment. A sense of belonging has been linked to psychological health and a lack of belonging could lead to loneliness. We conducted a cross-sectional descriptive study to examine relationships between social engagement, sense of belonging, and psychological outcomes. Seventy female and 30 male assisted living residents participated. The mean age was 83.9 (range 65-99) years. Structural equation modeling (SEM) revealed that older age, higher physical function, and greater sense of belonging were associated with fewer negative psychosocial outcomes (depression and loneliness) and that sense of belonging functioned as a mediator between social engagement and psychosocial outcomes. Additional work is needed to fully understand how sense of belonging and other factors influence psychosocial outcomes.

The State of States' Assisted Living Websites: Information Available to Consumers.

BACKGROUND AND OBJECTIVES: Assisted living (AL) is a growing sector of the U.S. long-term care market, with its development driven largely by private market choices. However, consumers need information to choose the right AL community (ALC). This paper examined information available on U.S. state websites concerning ALC quality, costs, and services. RESEARCH DESIGN AND METHODS: Based on prior research and their analysis of a sample of state websites, researchers identified 39 key informational elements and grouped them into four categories, (a) ALC characteristics, (b) payment and services, (c) quality, and (d) website usability. Researchers then examined the presence of the 39 elements on 51 websites (U.S. states and the District of Columbia), meeting regularly to discuss findings and resolve differences. RESULTS: A majority of states provided basic information about individual ALCs (e.g., number of beds, ownership). Only 35% listed payment(s) accepted (e.g., Medicaid), and 31% indicated the availability of memory care. Nearly 70% posted inspection results, while only 43% provided information about complaints. Many met basic usability guidelines (e.g., type size), but locating content on many sites required multiple steps, and none met 5th-grade-or-below readability standards. DISCUSSION AND IMPLICATIONS: A majority of websites provided important information, such as inspection results. However, many were lacking key elements concerning payment accepted and services. Finding what was available was burdensome. More work is needed to help states provide information that enables consumers to find ALCs that meet their needs. The lack of such information puts older adults at risk of inappropriate placements.

Comparison of Balance Program Outcomes among Independently Living and Assisted Living Residents.

Falls are a serious health concern for older adults. The purpose of this single group repeated measures intervention was to compare effects of the fall prevention program, A Matter of Balance Volunteer Lay Leader Model (MOB-VLLM), between individuals residing independently in the community (n = 24) and those residing in assisted living (AL) (n = 15). Surveys were completed immediately post intervention and 6 weeks, and 3, 6, 9, 12, and 18 months after. Being younger and living in AL predicted program attendance. Perceived control of fall risk increased post intervention (PS t-test: t = 4.004, df = 38, p<0.001), and the degree fear of falling impacts social activity was lower post intervention (WSR: Z = -3.104, p = 0.002). Current level of exercise was higher post intervention (WSR: Z = -2.099, p = 0.036). Control of falls, impact on social activity, fear of falling, and depression scores remained the same post intervention through follow up for both groups.

Communicative Competence: Responding to Residents' Health Changes in Assisted Living.

BACKGROUND AND OBJECTIVES: Frail and disabled individuals, including assisted living (AL) residents, are embedded in care convoys composed of dynamic networks of formal and informal care partners. Yet, little is known about how care convoys operate over time, especially when health changes occur. Thus, our aim was to provide an in-depth understanding of care convoy communication during times of residents' health changes in AL. RESEARCH DESIGN AND METHODS: Data for this analysis come from a Grounded Theory study that involved 50 residents and their care convoy members (n = 169) from 8 diverse AL communities followed over 2 years. Researchers conducted formal and informal interviewing, participant observation, and record review. RESULTS: We identified "communicative competence" as an explanatory framework in reference to a resident's or care partner's ability, knowledge, and action pertaining to communication and health change. Individual and collective competencies were consequential to timely and appropriate care. Communication involved: identifying; assessing significance; informing, consulting or collaborating with others; and responding to the change. Variability in communication process and properties (e.g., pace and timing; sequencing, timing, content, and mode of communication) depended on multiple factors, including the nature of the change and resident, informal and formal caregiver, convoy, AL community, and regulatory influences. DISCUSSION AND IMPLICATIONS: Formal and informal care partners need support to establish, enhance, and maintain communicative competence in response to health changes. Findings reinforce the need for timely communication, effective systems, and well-documented accessible health care directives and have implications that are applicable to AL and other care settings.

Comparing residential long-term care regulations between nursing homes and assisted living facilities.

BACKGROUND: Nursing homes (NHs) are federally regulated under uniform standards, whereas assisted living facilities (ALFs) use individual state regulations for staffing, training, and oversight of care quality and safety. PURPOSE: To describe ALF staffing, training, inspection, and enforcement regulations for 50 U.S. states and the District of Columbia, and compare them to NH regulations. Publication of ALF quality and safety outcomes data also was assessed and compared to NHs. METHODS: Regulatory data were compiled from administrative and regulatory data sources, state websites, and regulatory compendia. FINDINGS: NHs followed a standard set of regulations, whereas ALF regulations varied widely. Overall, state ALF regulations were less stringent than NH in all categories. DISCUSSION: As ALF populations and acuity levels increase, staffing, training, nursing presence, and outcomes data requirements are warranted, and could be tailored from NH regulations to protect ALF quality and safety.

Using Deficiency Data to Measure Quality in Assisted Living Communities: A Florida Statewide Study.

In 2014, more than 800,000 older adults reside in assisted living communities (ALCs) in the United States, yet few studies have examined whether state licensure inspection and citation information can be used to help consumers infer quality in choosing facilities. We examined the quality of ALCs using the deficiency citation data from the State of Florida. Data on 2,457 licensed ALCs operating between 2013 and 2015 were used to estimate logistic and negative binomial regression models to determine ALCs' structural characteristics that were associated with any and the number of deficiency citations. There were 2.6 deficiencies per facility (range 0-21); one-third of all ALCs received no deficiencies and one-third received four or more deficiencies. Specialty license and region were associated with receiving any deficiencies; ownership, rural location, and Northeast region were associated with receiving more deficiencies; and Southwest region was associated with receiving fewer deficiencies.

Embracing Cultural Diversity - Leadership Perspectives on Championing Meaningful Engagement for Residents Living with Advanced Dementia.

Resource constraints and high staff turnover are perceived as substantial barriers to high quality residential aged care. Achieving relationship-focused, person-centered care (PCC) is an ongoing challenge. This paper reports on an international project that explored how residential care leadership understand meaningful engagement for residents with dementia from culturally and linguistically diverse (CALD) backgrounds. This paper critically appraises the process, and outcomes, of an adapted Delphi method. Participants were the residential care leadership (i.e. staff in supervisory capacity) from four international facilities. Participation in the Delphi process was limited even though surveys were designed to require minimal time for completion. No participants opted for the alternative option of being interviewed. Findings indicate that residential care leadership recognised the importance of meaningful engagement for residents from CALD backgrounds. Limitations of time, resources and policy infrastructure were cited as barriers to achieving PCC. These findings suggest that facility leadership understand the importance of PCC, but identify multiple barriers rather than enablers for delivering PCC. Alternative methods, such as collecting data in interactive sessions allowing real-time discussion should be initiated to more effectively engage residential care leaders for a collaborative approach to explore PCC practices.

Quality of health care according to people with Down syndrome, their parents and support staff-A qualitative exploration.

BACKGROUND: People with Down syndrome (PDS) have complex healthcare needs. Little is known about the quality of health care for PDS, let alone how it is appraised by PDS and their caregivers. This study explores the perspectives of PDS, their parents and support staff regarding quality in health care for PDS. METHOD: The present authors conducted semi-structured interviews with 18 PDS and 15 parents, and focus groups with 35 support staff members (of PDS residing in assisted living facilities) in the Netherlands. RESULTS: According to the participants, healthcare quality entails well-coordinated health care aligned with other support and care systems, a person-centred and holistic approach, including respect, trust and provider-patient communication adapted to the abilities of PDS. CONCLUSIONS: Our findings may be used to improve health care for PDS, and provide insight into how health care could match the specific needs of PDS.

Which Aspects of Dining Style are Associated with Depressive Mood? A Study at an Assisted Living Facility in Japan.

Previous research indicated that dining style is associated with depressive mood in community-dwelling older adults; however, the nature of this relationship in care facilities is unclear. The association between dining style and depressive mood was examined in Japanese assisted living facility. A questionnaire survey was conducted among residents older than 65 years. Dining style was assessed by objective (the number of people with whom one eats) and subjective (feelings of enjoyment during mealtimes) factors. The odds ratio of participants who ate alone but enjoyed meals having depressive mood were not statistically different from the reference group (eating with others and enjoying). In contrast, participants who ate with others and did not enjoy meals, and participants who ate alone and did not enjoy meals were more likely to have depressive mood compared to the reference group. Although a cross-sectional study, findings suggested that caregivers should consider residents' subjective dining styles to provide optimal support at mealtimes.

Improving Education and Communication in an Assisted Living Facility to Reduce Avoidable Emergency Department Transfers: A Quality Improvement Project.

The purpose of the current project was to determine the effectiveness of training and communication tools used as intervention strategies to reduce unnecessary emergency department transfers of assisted living facility (ALF) residents. Two communication protocols (SBAR and STOP and WATCH) were introduced to standardize clinical communication among licensed practical nurses (LPNs) and clinical providers. Twenty-nine LPNs working in an ALF with 172 units were recruited. LPNs participated in an intervention intended to improve knowledge on geriatric syndromes. Pre- and postintervention testing revealed improved LPN knowledge of geriatric syndromes. A satisfaction survey indicated positive LPN acceptance of the standardized communication tools. Through daily auditing of charts, adherence with use of the SBAR tool was 87%. This evidence-based, educational intervention project aimed to improve nursing staff geriatric knowledge, monitor nurse adherence to using the SBAR and STOP and WATCH tools, and assess overall satisfaction with use of SBAR. [Journal of Gerontological Nursing, 45(5), 23-29.].

The relation between falls and medication use among elderly in assisted living facilities.

PURPOSE: Many elderly are concerned about falling transfer to assisted living facilities (ALF). Previous literatures studied the medication use and falls in the community, hospitals, or nursing homes, with scanty data about ALF. Therefore, the aim of the current case-control study was to assess the relation between medication use and falls among elderly in ALF. METHODS: A matched case-control study was conducted. The study was conducted in ALF in Cairo, Egypt. The study participants were 188 individuals; they were subdivided into two groups: fallers and nonfallers; timed up and go test (TUGT) was performed by all subjects. Medication data were collected according to the fall risk-increasing drugs list and the list of drugs that cause or worsen orthostatism. Other fall risk factors, as suggested by American Geriatric Society, were assessed. RESULTS: The use of vasodilators, diuretics, alpha blockers, opioids, antipsychotics, and sedative hypnotics were more common in fallers than in nonfallers (P < 0.001, P = 0.03, P < 0.001, P = 0.013, P < 0.001, and P < 0.001, respectively). Vasodilators, alpha blockers, and antipsychotics were significant predictors of falls even after adjustment for the possible confounding factors. Vasodilators, alpha blockers, opioids, sedative hypnotics, and recent dose changes in oral hypoglycemics were significant predictors of higher TUGT after adjustment for the possible confounding factors. CONCLUSION: The current study supported the risk of psychotropic and cardiovascular medications, with especial emphasis on vasodilators, alpha blockers, and antipsychotics, with raising concern about opioids, sedative hypnotics, and recent dose change in oral hypoglycemics.

Spread of ceftriaxone non-susceptible pneumococci in South Korea: Long-term care facilities as a potential reservoir.

Despite the availability of a pneumococcal National Immunization Program, which provides free PPSV23 vaccination for older adults aged ≥65 years in South Korea, pneumococcal pneumonia remains one of the most common respiratory infections, with increasing antimicrobial resistance. From January to December in 2015, all pneumococcal isolates were collected from a 1,050-bed teaching hospital in South Korea. All isolates were analyzed for serotype, genotype, and antimicrobial susceptibility. Demographic, clinical and microbiological data were compared between ceftriaxone susceptible and non-susceptible cases. Among 92 microbiologically identified pneumococcal isolates, ceftriaxone non-susceptible pneumococci (CNSP) accounted for 32 cases (34.8%). Some of these cases also showed levofloxacin resistance (25%, 8/32 isolates) and all CNSP cases were multidrug resistant. Compared to patients with ceftriaxone susceptible pneumococci (CSP), long-term care facility residents (odds ratio [OR] 7.0, 95% confidence interval [CI] 0.8-62.1) and patients with chronic lung (OR 4.1, 95% CI 1.1-15.0) and renal diseases (OR 9.1, 95% CI 1.2-70.5) were more common among those with CNSP on multivariate analysis. PPSV23-unique serotypes not included in PCV13 were more common in CNSP than in CSP (34.4% versus 13.3%, p = 0.02). Regarding genotypes, ST320 (10 cases), ST166 (7 cases) and ST8279 (3 cases) were dominant in CNSP, and ST8279 was only detected in previous long-term care facility residents. Clonal expansion and spread of CNSP strains should be monitored among patients with chronic lung/renal diseases and residents of long-term care facilities.

A System for Managing Staff and Quality of Dementia Care in Assisted Living Facilities.

OBJECTIVES: To describe a staff management and quality improvement system implemented in an assisted-living facility (ALF) that provides dementia care. DESIGN: Prospective quality improvement project over 13 consecutive months. SETTING: One ALF that provides dementia care services. PARTICIPANTS: ALF residents with dementia (N=57). INTERVENTION: A staff management and quality improvement system was implemented for 3 aspects of daily care: morning and evening activity of daily living (ADL) care, nutritional care, and activity engagement. MEASUREMENTS: Supervisory staff monitored the quality of daily care processes of all residents and direct care staff using standardized observations. Observational data were summarized into quality measures for each of the 3 daily care areas and ranged from 0% to 100%, with a higher score indicative of better quality. These quality measures were shared with direct care staff in weekly huddles at which feedback was provided about areas in need of improvement. The management team also reviewed the data weekly to discuss strategies for improvement. RESULTS: The quality measures in each of the 3 areas improved or remained consistently high over the 13 study months: morning and evening ADL care (83-96%), quality nutritional of care during meals (74-95%), activity engagement (69-97%). CONCLUSION: A staff management and quality improvement system that relies on standardized observations of quality of care, weekly review by managers, and feedback to direct care staff informs areas in need of improvement and supports consistent implementation of quality of care over time for ALF residents receiving dementia care.