Articles Posted in Quality of Care

Not only is it important for residents in long-term care facilities to have the power to make their own decisions in daily living for their well-being, the ethical and legal protection of their autonomy to make these decisions is imperative. Many nursing home residents’ ability to make their own decisions is impaired due to cognitive decline. A recent study identified potential markets of impaired decision making by exploring the link between a variety of nursing home resident characteristics (including gender, age, race, mood, falls, injuries, hospitalizations, duration of stay, number of activities of daily living (ADL) requiring assistance, and diagnoses of dementia, anxiety disorders, and depression) and impaired (vs independent) decision making.
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Physical frailty is prevalent among older adults living in nursing homes and assisted living facilities, as well as in the community. It is a medical syndrome with a variety of causes and contributors that is characterized by a decrease in strength, endurance, and weakened physiologic function that enhances a person’s vulnerability for needing increased dependency. Frailty has been associated with health-related detrimental events like mortality, disability in necessary activities of daily living (ADLs), and mobility disability, hospitalization, institutionalization, and falls in community-dwelling older adults. Unfortunately, there have not been many studies that have analyzed the commonality of frailty in institutionalized older adults and few interventions have focused on this vulnerable population.
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Dementia is prevalent among older adults and requires expert care and decision making that draws from sound evidence. Evidence-based practice (EBP) is strongly established in health care and aims to ensure the best outcomes by implementing what is shown to be effective from research in clinical practice and service delivery. Although there are issues regarding the interpretation and application of EBP, there seems to be a consensus about the importance of identifying and assessing the evidence for its significance for care provision.
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To assess and honor the preferences of older adult residents is a fundamental aspect of person-centered care in long-term care facilities. Although researchers and practitioners have initiated the development of measures to assess nursing home residents’ everyday preferences, not much is known regarding how residents interpret and conceptualize their preferences and what specific clinical response must be given to balance health and safety concerns with preferences.
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Patients with dementia are often burdened by their symptoms, while adequate symptom control is crucial to maintain or enhance quality of life. Most Americans with dementia eventually become admitted to, and die in long-term care facilities. Prevalent and important symptoms at the end of life are pain, agitation, and shortness of breath. A holistic approach must be the focus of optimal symptom control due to the fact that symptoms may be interrelated (i.e. pain may be associated with agitation).
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In the United States, over 15, 500 nursing homes that are Medicaid or Medicare certified or both provide care to approximately 1.3 million people. Nursing homes must meet federally mandated minimum standards as a requirement of Medicare and Medicaid payment. Many concerns regarding the quality of nursing home care and the adequacy of oversight and enforcement have been raised over the years. To address them, nursing home provisions under the Omnibus Budget Reconciliation Act of 1987 (OBRA 87) were enacted. Unfortunately, reports of quality problems in nursing homes have not ceased.
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Far too many nursing homes are experiencing an extreme shortage of staff that has diminished the quality and safety of care for their elderly and disabled. Frailty and dependency on nursing home staff is prevalent among residents who not only need assistance in performing basic activities of daily living, but also monitoring of their progressively complicated medical issues. Unfortunately, many nursing homes have not hired the necessary number of staff to meet their residents’ needs.

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Hip fractures (HFs) are highly prevalent among older adults and are a major cause of severe, often constant functional impairment. Those with HFs have diminished self-care abilities, causing increased disability and significant loss in independence and quality of life. Although there are those who are able to obtain complete functional restoration, most suffer from continuous decline. The caring of the average geriatric patient with HF calls for high hospital and long-term costs. Thus, it is important to identify factors that benefit or hinder regeneration to provide optimized treatment of all modifiable factors during rehabilitation. Malnutrition is very common among older hospitalized patients, with as many as 63% of geriatric patients with HF being malnourished or at risk of malnutrition.

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A recent study exploring the effectiveness of twenty-four-hour reports in infection prevention and control showed that they are essential components. Infections are known to be highly prevalent among nursing home residents and can lead to morbidity and mortality. This fact is unsurprising, considering that residents are constantly clustered in constrained living environments and frequently perform daily activities in groups. Residents with impaired cognitive functioning may have difficulty engaging in fundamental hygiene practices. Far too many caregivers receive deficient training and lack the knowledge necessary to implement basic infection control. Because residents are physiologically aged and often carry comorbid diseases, not only do site-specific infections develop easily, they are also difficult to diagnose. Consequently, identification and treatment can be delayed.

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According to the Center of Disease Control and Prevention, there are a total of 16,100 nursing homes in America with approximately 1.5 million patients residing in these facilities. Due to the rapidly growing baby boomer generation, the number of patients residing in these facilities is bound to increase. Although a majority of families conduct an abundant amount of research to ensure their loved ones are in a facility that guarantees them adequate quality of care; NBC news recently discovered that many “government official” websites have false information regarding staffing levels and skilled nursing facilities. According to NBC news, “Staffing levels reported by thousands of nursing homes on a widely-used government website were higher than the staff levels calculated by the Center for Public Integrity through an analysis of annual financial reports submitted by the homes, suggesting that consumers in those facilities may not be getting as many hours of skilled care as they expect.” Many nursing homes inflate the amount of staffing and individual resident care available to gain residents and increase profits at the expense of patient care. Continue Reading

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