Does Integration of Palliative Care and Infection Management Reduce Hospital Transfers among Nursing Home Residents?

2021 ◽  
Author(s):  
Jordan M. Harrison ◽  
Mansi Agarwal ◽  
Patricia W. Stone ◽  
Tadeja Gracner ◽  
Mark Sorbero ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Infection Management

scholarly journals Racial Differences in Infection Management and Palliative Care at End-of-Life in Nursing Homes Nationwide

2021 ◽  
Vol 1 (S1) ◽  
pp. s69-s69
Author(s):  
Leah Estrada ◽  
Andrew Dick ◽  
Patricia Stone ◽  
Jordan Harrison
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Nursing Home Residents ◽  
County Level ◽  
Infection Management ◽  
Care Services ◽  
Black Residents ◽  
Palliative Care Services

Background: Infections are common at end-of-life in older nursing-home residents. This often leads to the overuse of antibiotics and burdensome treatments. Improving infection management through palliative care at the end of life has been proposed as a key strategy to reducing inappropriate antibiotic use. Black nursing-home residents tend to reside in poorly performing nursing homes. We examined palliative care services in nursing homes with varying proportions of black residents. Methods: Cross-sectional, nationally representative nursing-home survey data (2017–2018) was combined with the Minimum Data Set 3.0 (nursing-home resident characteristics), the Certification and Survey Provider Enhanced Reporting data (nursing-home facility characteristics), and the Multidimensional Deprivation Index (county-level poverty estimates). The survey included 24 validated items on nursing-home palliative care services, as well as the nursing home’s infection control program and integration of infection management and palliative care (summative score, 0–100). We used nursing-home facility-level multivariate regression to estimate the relationship between proportion of black residents and palliative care scores, before and after controlling for county-level poverty estimates, facility characteristics, and resident characteristics. We categorized proportion of black residents using methods reported in the literature (25%). Results: The mean weighted palliative-care score in our sample of 869 nursing homes (weighted n = 15,020) was 47.7 (SE, 0.70). In unadjusted analyses, nursing homes with higher proportions of black residents provided significantly fewer palliative care services than nursing homes with no black residents, with the greatest differences (P = .027) observed between nursing homes with >25% black residents (mean palliative care score, 43.82; SE, 2.31) versus nursing homes with no black residents (mean palliative care score, 49.47; SE, 1.08). These disparities persisted after adjustment for urbanicity and county-level poverty rates (p < 0.01) but were attenuated after further adjustment for resident and facility level characteristics (p=0.138). Conclusions: Our findings demonstrate that wide variations in nursing-home palliative-care services exist with increased proportions of black residents, even after accounting for community characteristics. Further research is needed to identify and understand the specific community characteristics that play a role in the provision of palliative care services. Palliative care is a method to reduce inappropriate antimicrobial use at the end of life and should be expanded with a focus on nursing homes with higher proportions of black residents.Funding: NoDisclosures: None

scholarly journals PREVALENCE AND PREDICTORS OF STATIN USE IN LONG-STAY NURSING HOME RESIDENTS WITH LIFE-LIMITING ILLNESSES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S861-S861
Author(s):  
Deborah S Mack ◽  
Kate L Lapane
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
The United States ◽  
Veterans Health ◽  
Health Administration ◽  
Home Setting ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Statin Use

Abstract Statins are one of the most commonly prescribed medications in the United States. While statin use has been studied extensively in the general population, national data on statin use in US nursing homes do not exist. This study estimated the point prevalence of statin use on September 1, 2016 and identified predictors of statin use in nursing home residents with life limiting illness. We conducted a cross-sectional analysis using national MDS 3.0 data linked to Medicare claims. We identified 424,312 long-stay residents with life limiting illnesses defined as a palliative care consultation (ICD-10 Z51.5), prognosis &lt;6 months on MDS, the Veterans Health Administration palliative care index (PCI), or a diagnosis of a serious illness (e.g., cancer, stroke, heart failure, etc.). Poisson models accounted for clustering of residents within facilities. Overall, 34% were on statins which varied by age (65-75 years: 44.1%; &gt;75 years: 31.5%). The strongest positive predictor of statin use was hyperlipidemia, while coronary artery disease and stroke were only marginally predictive across age. The strongest negative predictors were a palliative care consultation or a prognosis &lt;6 months, while PCI was not strongly associated with use. A substantial proportion of long stay nursing home residents with life limiting illnesses continue statin therapy despite evidence of net harm. Efforts to deprescribe statins in the nursing home setting may be warranted. These findings can be used to help identify and target missed opportunities to reduce the therapeutic burden and improve end-of-life care for the US nursing home population.

scholarly journals Nursing home staff’s perspective on end-of-life care of German nursing home residents: a cross-sectional survey

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Anke Strautmann ◽  
Katharina Allers ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Nursing Staff ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Hospital Death ◽  
Life Care ◽  
Cross Sectional

Abstract Background Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. Methods A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. Results 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. Conclusions Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.

Caring About Residents’ Experiences and Symptoms (CARES) Program: A Model of Palliative Care Consultation in the Nursing Home

2016 ◽  
Vol 34 (5) ◽  
pp. 466-469 ◽  
Author(s):  
Deborah A. Morris ◽  
Marissa Galicia-Castillo
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Long Term Care ◽  
Descriptive Analysis ◽  
Nursing Home Residents ◽  
Term Care ◽  
Code Status ◽  
Care Plans ◽  
Palliative Care Consultation

Objectives: To describe the CARES program, a model of palliative care for nursing home residents. Design: Descriptive analysis of the Caring About Residents’ Experiences and Symptoms (CARES) Program that provides palliative care services to nursing home residents. Program evaluation: The CARES Program serves as an example of collaborative efforts to meet community needs. To evaluate the program, we document the services provided as well as process outcomes (changes to care plans, hospitalizations, location of death, and hospice utilization) for residents referred. Results: 170 nursing home residents were seen by CARES Program between February 2013 to December 2015, 48% for skilled services, and 52% for long term care. Majority of referrals were for goals of care and concurrent symptom management. Following consultation, 67% of residents had a change in code status. Of residents desiring a palliative course 90% were never hospitalized. Overall, 53% of residents died; and those in long term care dying more often with hospice. Conclusion: The CARES program of palliative consultation addresses the needs of nursing home residents. The model has potential to be reproducible in in other communities.

scholarly journals Do Palliative Care Teams in Nursing Homes Improve the Quality of End-of-Life Care for Nursing Home Residents?

2019 ◽  
Author(s):  
Helena Temkin-Greener Helena Temkin-Greener ◽  
Dana Mukamel ◽  
Susan Ladwig ◽  
Thomas , Caprio ◽  
Sally Norton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Life Care ◽  
Palliative Care Teams

scholarly journals The last week of life of nursing home residents with advanced dementia: a retrospective study

2019 ◽  
Author(s):  
Franco Toscani ◽  
Silvia Finetti ◽  
Fabrizio Giunco ◽  
Ines Basso ◽  
Debora Rosa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Retrospective Study ◽  
Nursing Home Residents ◽  
Advanced Dementia ◽  
Term Care ◽  
Convenience Sample ◽  
Lombardy Region ◽  
Inappropriate Drugs ◽  
Clinical Records

Abstract Background: Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. Methods: This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the seven days before death. Results: Most residents (97.1%) died in the NH. In the seven days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of four days before death. Conclusions: Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals’ lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

scholarly journals The last week of life of nursing home residents with advanced dementia: a retrospective study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Franco Toscani ◽  
Silvia Finetti ◽  
Fabrizio Giunco ◽  
Ines Basso ◽  
Debora Rosa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Retrospective Study ◽  
Nursing Home Residents ◽  
Advanced Dementia ◽  
Term Care ◽  
Convenience Sample ◽  
Lombardy Region ◽  
Inappropriate Drugs ◽  
Clinical Records

Abstract Background Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. Methods This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. Results Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. Conclusions Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals’ lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

scholarly journals The trial to reduce antimicrobial use in nursing home residents with Alzheimer’s disease and other dementias: study protocol for a cluster randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Andrea J. Loizeau ◽  
Erika M. C. D’Agata ◽  
Michele L. Shaffer ◽  
Laura C. Hanson ◽  
Ruth A. Anderson ◽  
...  
Keyword(s):  
Nursing Home ◽  
Real World ◽  
Nursing Home Residents ◽  
Antimicrobial Use ◽  
Advanced Dementia ◽  
Cluster Rct ◽  
Infection Management ◽  
Multicomponent Intervention ◽  
Tract Infections ◽  
Seriously Ill

Abstract Background Infections are common in nursing home (NH) residents with advanced dementia but are often managed inappropriately. Antimicrobials are extensively prescribed, but frequently with insufficient evidence to support a bacterial infection, promoting the emergence of multidrug-resistant organisms. Moreover, the benefits of antimicrobials remain unclear in these seriously ill residents for whom comfort is often the goal of care. Prior NH infection management interventions evaluated in randomized clinical trials (RCTs) did not consider patient preferences and lack evidence to support their effectiveness in ‘real-world’ practice. Methods This report presents the rationale and methodology of TRAIN-AD (Trial to reduce antimicrobial use in nursing home residents with Alzheimer’s disease and other dementias), a parallel group, cluster RCT evaluating a multicomponent intervention to improve infection management for suspected urinary tract infections (UTIs) and lower respiratory tract infections (LRIs) among NH residents with advanced dementia. TRAIN-AD is being conducted in 28 facilities in the Boston, USA, area randomized in waves using minimization to achieve a balance on key characteristics (N = 14 facilities/arm). The involvement of the facilities includes a 3-month start-up period and a 24-month implementation/data collection phase. Residents are enrolled during the first 12 months of the 24-month implementation period and followed for up to 12 months. Individual consent is waived, thus almost all eligible residents are enrolled (target sample size, N = 410). The intervention integrates infectious disease and palliative care principles and includes provider training delivered through multiple modalities (in-person seminar, online course, management algorithms, and prescribing feedback) and an information booklet for families. Control facilities employ usual care. The primary outcome, abstracted from the residents’ charts, is the number of antimicrobial courses prescribed for UTIs and LRIs per person-year alive. Discussion TRAIN-AD is the first cluster RCT testing a multicomponent intervention to improve infection management in NH residents with advanced dementia. Its findings will provide an evidence base to support the benefit of a program addressing the critical clinical and public health problem of antimicrobial misuse in these seriously ill residents. Moreover, its hybrid efficacy-effectiveness design will inform the future conduct of cluster RCTs evaluating nonpharmacological interventions in the complex NH setting in a way that is both internally valid and adaptable to the ‘real-world’. Trial registration ClinicalTrials.gov, NCT03244917. Registered on 10 August 2017.

Cultivating Knowing and Relationships: Nursing Assistants’ Interactions With Residents Receiving Palliative Care

2018 ◽  
Vol 22 (4) ◽  
pp. 189-198
Author(s):  
Rebecca L. Trotta ◽  
Marie Boltz ◽  
Mary Beth Happ ◽  
Neville Strumpf
Keyword(s):  
Palliative Care ◽  
Grounded Theory ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Nursing Assistants ◽  
Personal Relationships ◽  
Psychological Process ◽  
Nursing Assistant ◽  
Social Psychological ◽  
Certified Nursing Assistant

Nursing home residents are among the most vulnerable members of society. The literature emphasizes promotion of personhood, dignity, and comfort—dimensions that fall within the purview of the certified nursing assistant (CNA). Little is known about how CNAs approach caring for a dying resident. This grounded theory study explored CNA–resident interactions for residents receiving palliative care. The theory “Cultivating Knowing and Relationships” emerged, which represents a social–psychological process of how CNAs capitalize on reciprocity and achievement of gratification to develop personal relationships with residents and maintain personhood and dignity through death. These findings underscore CNAs’ significant role in enhancing quality.

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