Diverse demands and resources among racially/ethnically diverse caregivers.

OBJECTIVES: The family caregiver population in the US is growing in conjunction with greater numbers of older adults with serious illness and complex care needs, and is becoming increasingly diverse. This study described and compared resources, demands, and health outcomes among diverse family caregivers by race/ethnicity. DESIGN: This study was a cross-sectional secondary analysis of nationally representative data collected for Black/African-American, Asian American & Pacific Islander, Latino/Hispanic and non-Latino/Hispanic white caregivers (n = 2,010) in the Home Alone Revisited Study. We described available resources (e.g. income, paid help, social support) and demands (e.g. medical/nursing task performance) by racial/ethnic group. Using survey-weighted logistic regression, we examined relationships of resources and demands with caregiver outcomes (i.e. heath status; strain; depressive symptoms) by race-ethnicity controlling for socio-demographic variables. RESULTS: Distribution of resources and demands was similar by race/ethnicity, except for higher income for non-Latino/Hispanic white caregivers. Nearly half assisted with personal care (47.5%) or medical/nursing tasks (49.7%). Higher social support and satisfaction with social relationships was associated with positive health outcomes regardless of race/ethnicity, while income was consistently associated with positive health outcomes only for non-Latino/Hispanic white caregivers. Medical/nursing task performance was significantly associated with negative health outcomes for Asian American & Pacific Islanders in multivariable models. DISCUSSION: Many caregiving demands and tasks are similar by race/ethnicity and represent considerable investment of time, energy and care. Differences in the effects of resources and demands by race/ethnicity should be explored in future research as they may have implications for assessment and planning of culturally and linguistically appropriate interventions.

Better together: Coalitions committed to advancing health equity.

The Future of Nursing 2020-2030 report identifies coalitions as a driving force for advancing health equity. Five coalitions provided insight into their accomplishments, lessons learned, and role in advancing health equity. The exemplar coalitions included Latinx Advocacy Team and Interdisciplinary Network for COVID-19, Black Coalition Against COVID, Camden Coalition, National Coalition of Ethnic Minority Nurse Associations, and The Future of Nursing: Campaign for Action. While all exemplar coalitions, credited relationship building and partnerships to their success, they used unique strategies for striving to meet their populations' needs, whether the needs arose from COVID-19, racial and/or ethnic disparities, socioeconomic disparities, or other barriers to health. Research and policy implications for coalitions are discussed. Nurses play a critical role in every highlighted coalition and in the national effort to make health and health care more equitable.

Feasibility of a Family-Centered Hospital Intervention.

Approximately one half of the 40 million family caregivers in the United States are regularly performing medical/nursing tasks, with very little training from clinicians. The goal of the current project was to encourage health care and social service professionals to proactively engage family caregivers as partners in care. The phases of the Professional Partners Supporting Family Caregivers project and results of an intervention are presented. Five hospitals were selected to develop a family-centered intervention. Patients' and family caregivers' hospital experience was examined, as well as nurses' perception of their work environment specific to care of older adults and caregivers. The sample included five intervention sites in which patients, family caregivers, and nurses provided baseline post-intervention data. The four comparison sites included post-intervention data from patients, family caregivers, and nurses. The family-centered intervention shows promise in improving patients' hospital experience and nurses' perception of caring for older adults and their families. [Journal of Gerontological Nursing, 43(6), 9-16.].

Nurse Delegation in Home Care: Research Guiding Policy Change.

The current study evaluated nurse delegation in home care, a pilot program introduced in 2007 in New Jersey to promote home care options for consumers needing assistance with medical/nursing tasks. Findings on readiness for the program, barriers and facilitating factors, experience with the program, and recommendations are summarized and presented. Methods included surveys and interviews with participants in nurse delegation, observations of planning and implementation meetings, and review meeting minutes. Major findings were no negative outcomes for consumers, improvements in quality of life and quality of care for consumers, high readiness and increasing satisfaction with experience in delegation, perception of nurse delegation in home care as a valued option, and the challenges of ensuring adequate staffing. Subsequent changes in regulation in New Jersey are underway, translating this research into policy. [Journal of Gerontological Nursing, 42(9), 7-15.].

Medication management roles in assisted living.

Residents in assisted living (AL) frequently need assistance with medication management. Rooted in a social model, AL serves people facing increasing health management challenges as they "age in place." This study explored roles in AL medication management and satisfaction with unlicensed assistive personnel (UAP) as medication aides, a cost-effective staffing approach that is used frequently. The sample included 112 participants representing all parties involved in medication administration (residents, medication aides, administrators, RNs and licensed practical nurses, pharmacists, and primary care providers) in 15 AL settings in four states. Results include description of medication management roles; empirical validation of existing AL nursing professional standards; and satisfaction with the role of UAP as medication aide from all perspectives. Clinical implications include creating a supportive environment for medication aides (i.e., UAPs); the importance of the RN role as facilitator of AL medication management; and the need for collaboration and interprofessional team development across disparate settings.

AARP: national champions of nursing for consumers.

The focus of AARP's Future of Nursing Campaign for Action is on fundamental transformation of the health care delivery system in America for consumers. AARP strongly supports full utilization of the education and training of all health professionals and workers. AARP supports educational progression and lifelong learning, a more diversified workforce, and a culture of true partnership and engagement with patients and their families to achieve better health. It is essential for nurses to build synergistic alliances with powerful groups who share the goal of health system transformation. AARP will continue to enhance effective methods to build coalitions, communicate in messages targeted to different stakeholder audiences, develop "asks," and sustain reciprocal relationships.

Caring for a Person Living with Pain.

Nurses play a key role in supporting family caregivers.

When Family Caregivers Meet Health Care Institutions.

Nurses have the opportunity to make a difference for caregivers.

Family Caregivers Are Members of Our Team.

Nurses play a critical role in providing support.

Nurses Supporting Family Caregivers.

Caregivers need more guidance from nurses to perform increasingly complex tasks.

Nurses Supporting Family Caregivers.

Caregivers need more guidance from nurses to perform increasingly complex tasks.

Experts recommend strategies for strengthening the use of advanced practice nurses in nursing homes.

In 2003, The John A. Hartford Foundation Institute for Geriatric Nursing, New York University Division of Nursing, convened an expert panel to explore the potential for developing recommendations for the caseloads of advanced practice nurses (APNs) in nursing homes and to provide substantive and detailed strategies to strengthen the use of APNs in nursing homes. The panel, consisting of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care, developed six recommendations related to caseloads for APNs in nursing homes. The recommendations address educational preparation of APNs; average reimbursable APN visits per day; factors affecting APNs caseload parameters, including provider characteristics, practice models, resident acuity, and facility factors; changes in Medicare reimbursement to acknowledge nonbillable time spent in resident care; and technical assistance to promote a climate conducive to APN practice in nursing homes. Detailed research findings and clinical expertise underpin each recommendation. These recommendations provide practitioners, payers, regulators, and consumers with a rationale and details of current advanced practice nursing models and caseload parameters, preferred geriatric education, reimbursement strategies, and a range of technical assistance necessary to strengthen, enhance, and increase APNs' participation in the care of nursing home residents.

Continuous quality improvement as an innovation: which nursing facilities adopt it?

PURPOSE: We identify environmental and organizational predictors that best discriminate between formal continuous quality improvement (CQI) adopters and nonadopters in nursing homes (NHs) and create a diagnostic profile for facility administrators and policy makers to promote CQI. DESIGN AND METHODS: We performed a cross-sectional survey of licensed NH administrators in New Jersey in 1999, using The Nursing Care Quality Improvement Survey ( Zinn, Weech, & Brannon, 1998) and The New Jersey NH Profiles Chart. We also performed a discriminant analysis. Of 350 NHs, 46% returned completed questionnaires. RESULTS: Using variance innovation, resource dependence, and institutional perspectives for our framework, we found that new requirements, environmental competition, organizational time and structural facilitators, and manager training made statistically significant contributions to discriminating between formal CQI adopters and nonadopters. IMPLICATIONS: Regardless of size, NHs adopt formal CQI to meet external expectations of new regulations and accreditation criteria. CQI adoption is facilitated by information systems, flexible use of personnel, and team supports, as well as CQI training for managers. This profile of adopters can guide administrators and policy makers in promoting CQI for NHs, and it can help NHs already interested in CQI focus internal resources on key facilitators.

Current approaches to postfall assessment in nursing homes.

OBJECTIVE: Falls in nursing homes occur among a large percentage of residents. Their onset necessitates a postfall assessment (PFA) be performed by clinical staff to determine likely etiology. The absence of an empirically validated comprehensive postfall assessment tool has led to considerable variability in the types of PFAs performed. The purpose of this study was to examine the types of PFA tools available, their content, and to compare this with national recommendations for fall assessment in geriatric practice. SETTING: A convenience sample of 379 long-term care facilities, with a cumulative census of over 40,000 residents, in New Jersey were solicited to return to the Director of Long-Term Care Surveys at the NJ Department of Health and Senior Services a copy of any PFA tools used in practice. METHODS: A review of the types of assessment tools used in each of the responding facilities were tabulated and coded as belonging to one of five categories: (1) fall-risk assessment short form, (2) fall-risk assessment long form, (3) fall prevention protocols such as fall programs and postfall assessment forms, (4) incident reports, and (5) other. A subset of 20 facilities used a specific PFA. This content was further analyzed and compared with national and professional recommendations for PFA that included five domains: (1) history of the fall, (2) environmental issues, (3) physical examination, (4) functional assessment, and (5) laboratory and other diagnostics. RESULTS: Of 379 facilities solicited, 149 responded (40%) to reveal a wide array of tools used for the purpose of PFA. These included: risk assessment tools, fall prevention programs, policies and procedures for fall management, and incident reports. Overall, most facilities used fall-risk assessment tools in place of PFA (63.7%; n=95). Many of the nationally recommended guidelines for PFA were not included in the tools included in this sample, with the exception of environmental questions that were evident in all PFAs surveyed (100%). Other fall circumstances related to time, mobility, and footwear were included less often (70% n=14) as were use of diuretics (55%;=11), mental status and ambulation ability (45%; n=9) of the falling older adult. CONCLUSION: Despite recommendations in the geriatric literature, comprehensive postfall assessment tools were unavailable for use by nursing home staff. When a PFA was performed, there was no consistency among facilities sampled. Data collected was minimal and unlikely to reveal the full range of possible underlying etiologies. Improved, validated PFA tools are needed to aid clinical staff in evaluating older adults who have fallen.

Strategies to promote safe medication administration in assisted living settings.

Assisted living (AL) provides lower cost, less institutional environments than skilled nursing facilities, yet less professional oversight, despite the high prevalence of chronic conditions among residents. Unlicensed staff administer large quantities of medications daily, and medication management is one of the three top quality issues in AL, with error rates ranging from 10% to 40%. This qualitative study described AL provider views on medication safety and strategies used to promote safety in medication administration. The sample included 96 participants representing all parties involved in medication administration (i.e., medication aides, administrators, RNs, consulting pharmacists, primary care providers) in 12 AL settings in three states. Core themes were the importance of medication safety, unique contextual factors in AL, and strategies used to promote medication safety. This study has implications for research on interventions to improve medication safety at the individual, facility, and policy levels.

Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults.

The US health care system is characterized by fragmentation and misaligned incentives, which creates challenges for both providers and recipients. These challenges are magnified for older adults who receive long-term services and supports. The Affordable Care Act attempts to address some of these challenges. We analyzed three provisions of the act: the Hospital Readmissions Reduction Program; the National Pilot Program on Payment Bundling; and the Community-Based Care Transitions Program. These three provisions were designed to enhance care transitions for the broader population of adults coping with chronic illness. We found that these provisions inadequately address the unique needs of vulnerable subgroup members who require long-term services and supports and, in some instances, could produce unintended consequences that would contribute to avoidable poor outcomes. We recommend that policy makers anticipate such unintended consequences and advance payment policies that integrate care. They should also prepare the delivery system to keep up with new requirements under the Affordable Care Act, by supporting providers in implementing evidence-based transitional care practices, recrafting strategic and operational plans, developing educational and other resources for frail older adults and their family caregivers, and integrating measurement and reporting requirements into performance systems.

Partners in solutions to the nurse faculty shortage.

The looming shortage of nurses, and the faculty to educate them, threatens Americans' access to quality health care across all settings. The Robert Wood Johnson Foundation (RWJF), the American Association of Retired Persons (AARP) Foundation, and the AARP are joining together to raise the level of awareness of this crisis and solutions to resolve it in a sustained way. These leaders in health and social change created the Center to Champion Nursing in America (the Center) to ensure that Americans have the highly skilled nurses needed to provide affordable, quality health care now and in a reformed health care system. Through national summits and technical assistance with states, the Center and the RWJF are collaborating with a broad range of partners to increase nursing education capacity. At the national level, the Champion Nursing Coalition represents the voice of consumers, purchasers, and providers of health care to support solutions to the nurse and nurse faculty shortage. Working with this broad constituency, the nursing community can better address the workforce concerns that affect the people we serve.