Background. The Patient Self-Determination Act of 1991 requires that nursing homes reimbursed by Medicare or Medicaid inform all residents upon admission of their rights to enact care directives in the event of termin...
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Background. The Patient Self-Determination Act of 1991 requires that nursing homes reimbursed by Medicare or Medicaid inform all residents upon admission of their rights to enact care directives in the event of terminal illness. This study investigated the relationship between care directive use and resident functional status. Methods. We analyzed a version of the Minimum Data Set (MDS+) from a single state. We selected residents who were admitted to a nursing home in the first half of 1993 and followed them in the nursing home through the end of 1994. We created logistic models to examine independent correlates associated with having an advance directive or a do-not-resuscitate (DNR) order on admission. We then created similar logistic models to examine independent correlates associated with writing an advance directive or DNR order subsequent to admission. Results. Of the 2,780 residents, 11% (292) had advance directives and 17% (466) had DNR orders upon admission. Of those without care directives upon admission, 6% (143) subsequently had an advance directive and 15% (339) subsequently had a DNR order. Cross-sectionally, older individuals and whites were more likely to have a care directive. Having poor cognitive and physical function was associated with having a DNR order upon admission. Longitudinally, longer stayers and whites were more likely to have an advance directive. residents who lost physical function were more likely to have an advance directive and those who lost cognitive function were more likely to have a DNR order. Conclusions. Care directive use is influenced by a number of sociodemographic and functional characteristics.
This study identifies structural characteristics of VA nursing homes that are associated with the best patient outcomes. We evaluated risk adjusted rates of pressure ulcer development in VA nursing homes and related t...
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This study identifies structural characteristics of VA nursing homes that are associated with the best patient outcomes. We evaluated risk adjusted rates of pressure ulcer development in VA nursing homes and related these rates to facility size, staffing patterns, teaching nursing home status, and rural versus urban locale. Higher rates of pressure ulcer development were seen among urban teaching nursing homes and among nursing homes associated with both larger and smaller VA hospitals. Staffing patterns had a complex association with pressure ulcer development, and smaller nursing home staffs were not clearly associated with higher rates. For multivariate modeling, only hospital size and staffing remained significant independent predictors of pressure ulcer develop ment. These results emphasize that while structural characteristics of VA nursing homes can provide insights about care, improving the quality of care in this setting will require a much greater understanding how nursing homes are organized to meet patient needs.
作者：
Moore, KDUniv Wisconsin
Sch Architectural & Urban Planning Inst Aging & Environm Milwaukee WI 53201 USA
This study is a multi-method, intrinsic case study of social interaction in a special care unit (SCU) for cognitively impaired older persons. It is found that residents are capable of developing a range of social bond...
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This study is a multi-method, intrinsic case study of social interaction in a special care unit (SCU) for cognitively impaired older persons. It is found that residents are capable of developing a range of social bonds even though the SCU in question is found to have several organizational and physical factors that unwittingly thwart its therapeutic potential. These limitations are illuminated by consideration of the congruence between the conceptualization of the dining areas held by staff and that held by residents as revealed throught the process of negotiation occurring in social interaction. The study adopts an enviornment-behavior perspective following the theoretical development of Lawton (1986) and merges it with the qualitative approach to place pursued by Goffman (1961) and Gubrium (1978). It is suggested that a focus on place as a unit of analysis offers potential for bridging Qualify of Life with the cognitively impaired.
Based on an ethnographic study in a residential Alzheimer's facility and a traditional nursing home, this article discusses the process of community formation and the maintenance of community roles among individua...
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Based on an ethnographic study in a residential Alzheimer's facility and a traditional nursing home, this article discusses the process of community formation and the maintenance of community roles among individuals suffering from dementia ill institutional settings. These include: therapeutic programming that promotes resident independence and choice;flexible and person-centered staff roles;and a physical environment that facilitates social interaction, autonomy, and participation in the activities of daily living. In contrast, institutional programs that are regimented, that follow a medical rather than a social model of care, and that take place in physical environments that have limited options may discourage resident interaction and social bonding, thus inhibiting community formation. Although Alzheimer's disease and other forms of dementia may create difficulties for the realization of community and community roles among institutionalized people, more significant are the environmental conditions in which such individuals live and the programs designed for their care.
This article is based on a 9-month ethnographic study of a nursing home for older Jewish people. In this article, the process that 21 key informants went through in adapting to the dual nature of the nursing home as i...
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This article is based on a 9-month ethnographic study of a nursing home for older Jewish people. In this article, the process that 21 key informants went through in adapting to the dual nature of the nursing home as institution and as home is examined. A widely used phrase, "making the best of it," was used by informants and other residents of the nursing home to describe this process. Interpretive analysis of this emic phrase revealed four dimensions: (a) recognizing the ambivalence of their living environment and situation, (b) downplaying negative aspects of it, (c) having no other options, and (d) using their will to transcend and create a home.
A study analyzes the determinants of the probability that an elderly nursing home resident will be hospitalized over the course of a year. A multinomial logistic model is estimated with 4 possible outcomes for the ye...
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A study analyzes the determinants of the probability that an elderly nursing home resident will be hospitalized over the course of a year. A multinomial logistic model is estimated with 4 possible outcomes for the year: 1. hospitalization, 2. dying in the nursing home prior to hospitalization, 3. leaving the nursing home alive prior to any hospitalization, and 4. remaining in the home for a full year without any hospitalization. The Institutional Population Component (IPC) of the 1987 National Medical Expenditure Survey sample of residents as of January 1, 1987, is analyzed. The overwhelming majority of residents (84%) either were hospitalized during their stay or spent the full year undisturbed in the nursing home. Two important results are found for the financial variables. The rate of payment to the home has a significant and negative effect on the probability of a resident being hospitalized, relative to remaining in the nursing home for the full year. For-profit nursing homes are more likely to hospitalize residents.
Since feeling in control of one's life is essential to mental health, nursing homes often contain mentally unhealthy residents. Suggestions for empowering nursing home residents are presented.
Since feeling in control of one's life is essential to mental health, nursing homes often contain mentally unhealthy residents. Suggestions for empowering nursing home residents are presented.
Organizational theorists have argued that formal and informal support systems cannot exist in strong form in the same society. In this article, the author argues that such theories fail to consider the complementary o...
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Organizational theorists have argued that formal and informal support systems cannot exist in strong form in the same society. In this article, the author argues that such theories fail to consider the complementary of these two systems and the necessity of both for the completion of most tasks. A study of tasks performed for nursing home residents found that the formal organization assumed those tasks that could be standardized and deemed legitimate for Medicaid funding, while the others were either maintained by informal support groups or lost altogether. A study of the influence of informal support groups on mortality rates found that such groups played an important role in reducing death in older persons resulting from causes associated with nontechnical matters. In conclusion, the author finds that formal groups can best manage tasks that require technical knowledge or that can be reduced to simpler, routine components, whereas informal groups can better manage tasks requiring everyday knowledge and characterized by many contingencies or unpredictability. The author stresses that both formal and informal support must be provided when serviing older people.
A description of a pilot project in daytime care for the elderly and its results will provide the background for the presentation of the theory named “The Four Wall Syndrome”. This phrase was coined by the author to...
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