General Nursing Home/Assisted Living Care -- Not Specific to End-of-Life Care
1. Katz, TF; Walke, LM; Suri, R; Bellin, E; Jacobs, L. Goals of Care for Hospitalized Nursing Home Residents. Journal of the American Geriatrics Society; 2001; 49:6:837-838.[Annotation]
Given that only 5% of the geriatric population represented $53 billion in health care expenditures in 1990, the authors conduct a pilot study to examine the goals of care for hospitalized nursing home residents using a questionnaire to measure quality of life, functional status, initial agreement that patient would recover from present illness, and use of invasive procedures. Residents, family members, and physicians were surveyed. The results suggest that there was considerable disagreement between physicians and family of impaired residents on goals of care.[Pub Med]
2. Schnelle, JF; Simmons, SF; Harrington, C; Cadogan, M; Garcia E; Bates-Jensen, BM. Relationship of Nursing Home Staffing to Quality of Care. Health Services Research; 2004, April; 39:2:225-250.[Annotation]
This non-intervention study compares nursing homes that report different staffing statistics on quality of care. Data on nursing home staffing was gathered from California state cost reports and interviews. Research staff collected data describing quality of care related to 27 care processes by direct observation, resident and staff interviews, and chart abstraction methods. Of the 21 participating nursing homes, two groups [high-staffed homes (n=6) and low-staffed homes (n=15)] reporting different and stable staffing were compared on quality of care measures. The findings show significantly better performance of the high-staffing group on 13 of16 processes compared to the low- staffing group, and high-staffed homes provided better care than all the other homes. The major difference was in the number of hours per patient per day spent by nursing aides (4.5-4.8 hours for high-staffed homes versus 2.8 or less for low-staffed homes); above 2.8 hours was associated with better care. Comprehensive tables on facilities and demographics, staffing, and observation and interviewing measurement domains are provided. [Pub Med]
3. Weissman, DE; Griffie, J; Muchka, S; Matson, S. Improving Pain Management in Long-Term Care Facilities. Journal of Palliative Medicine; 2001; 4:4:567-573.[Annotation]
The authors review special barriers to good pain management in long term care facilities (LTCF) as opposed to acute care. The article explains the design of a new educational program which would impede these barriers and improve pain care in LTCFs. Eighty-seven Wisconsin LTCFs participated and signed “letters of commitment.” The plan included a site visit to each facility for the purpose of completing a needs assessment. Four educational workshops were attended by facility staff and covered topics such as pain assessment, treatment, staff education and competency, completion of a facility Action Plan to foster change, and chart reviews of pain assessment documents using target indicators. The needs assessment was repeated one year later. Only 12 facilities (14%) had half of the 14 indicators at onset, but after 1 year this rose to 64 facilities, or 74% showing a marked improvement in understanding pain management and documentation. Nurses were empowered to perform an accurate assessment plan, design a treatment plan and then contact physicians for new orders. Stable facility staff was most important in the success of the project. The greatest barrier at onset was lack of useful communication between physicians and nurses, with evident frustration. After one year of commitment to this program, the greatest barriers became lack of stable facility staff, lack of a champion to encourage pain management change, and time. Due to its success, this program is spreading to other states and LTCFs. [Pub Med]
