Joan F. Brazier, Amy Meehan, Renee R. Shield, Elizabeth M. White, David C. Grabowski, Fangli Geng, Emily A. Gadbois
Context: Managing COVID-19 outbreaks at U.S. nursing homes highlight the structural weaknesses of pre-pandemic long-term care emergency preparedness protocols. Objective: To understand how nursing home administrators managed staffing and facility operations during an active COVID-19 outbreak. Methods: This descriptive qualitative study conducted semi-structured interviews with administrators at 40 U.S. nursing homes from July 2020–December 2021. Interview questions focused on the impact of COVID-19 on nursing home operations and staffing, among other topics. Interview transcripts were qualitatively analysed to identify overarching themes using modified grounded theory and thematic analysis. Findings: Four major themes emerged from analysis. (1) Administrators described the rapidity of viral infection of staff and residents as overwhelming and long-lasting; (2) a COVID-19 outbreak had an immediate impact on staffing levels; (3) administrators implemented short-term compensatory strategies to manage staffing shortages during COVID-19 outbreaks; and (4) administrator and staff roles and responsibilities expanded in order to maintain facility operations during, and post-COVID-19 outbreak. Limitations: Findings may not be generalizable to all U.S. nursing homes and may not reflect current COVID-19 mitigation protocols and perspectives as interviews concluded in December 2021. Implications: U.S. nursing home administrators used crisis-management strategies to sustain facility operations during active COVID-19 outbreaks. This approach highlights on-going weaknesses in the long-term care infrastructure at U.S. nursing homes. Learning from administrator experiences during the COVID-19 pandemic is critical for the development of robust emergency preparedness plans and the improvement of state and federal resource coordination efforts to support U.S. nursing homes during future public health emergencies.
{"title":"“All Hands on Deck”: Administrator Perspectives on Managing COVID-19 Outbreaks in U.S. Nursing Homes","authors":"Joan F. Brazier, Amy Meehan, Renee R. Shield, Elizabeth M. White, David C. Grabowski, Fangli Geng, Emily A. Gadbois","doi":"10.31389/jltc.237","DOIUrl":"https://doi.org/10.31389/jltc.237","url":null,"abstract":"Context: Managing COVID-19 outbreaks at U.S. nursing homes highlight the structural weaknesses of pre-pandemic long-term care emergency preparedness protocols. Objective: To understand how nursing home administrators managed staffing and facility operations during an active COVID-19 outbreak. Methods: This descriptive qualitative study conducted semi-structured interviews with administrators at 40 U.S. nursing homes from July 2020–December 2021. Interview questions focused on the impact of COVID-19 on nursing home operations and staffing, among other topics. Interview transcripts were qualitatively analysed to identify overarching themes using modified grounded theory and thematic analysis. Findings: Four major themes emerged from analysis. (1) Administrators described the rapidity of viral infection of staff and residents as overwhelming and long-lasting; (2) a COVID-19 outbreak had an immediate impact on staffing levels; (3) administrators implemented short-term compensatory strategies to manage staffing shortages during COVID-19 outbreaks; and (4) administrator and staff roles and responsibilities expanded in order to maintain facility operations during, and post-COVID-19 outbreak. Limitations: Findings may not be generalizable to all U.S. nursing homes and may not reflect current COVID-19 mitigation protocols and perspectives as interviews concluded in December 2021. Implications: U.S. nursing home administrators used crisis-management strategies to sustain facility operations during active COVID-19 outbreaks. This approach highlights on-going weaknesses in the long-term care infrastructure at U.S. nursing homes. Learning from administrator experiences during the COVID-19 pandemic is critical for the development of robust emergency preparedness plans and the improvement of state and federal resource coordination efforts to support U.S. nursing homes during future public health emergencies.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"90 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135341770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Barbara Hanratty, Arne Timon Wolters, Ann-Marie Towers, Karen Spilsbury, Julienne Meyer, Anne Killett, Liz Jones, Adam Gordon, Jennifer Kirsty Burton, Gizdem Akdur, Lisa Irvine, Krystal Warmoth, Jennifer Liddle, Claire Goodman
Context: In many countries, there is a specification for information that should be collected by care homes. So-called ‘minimum data-sets’ (MDS) are often lengthy, and report on resident health and wellbeing, staff, and facilities. In the UK, the absence of any easily accessible data on the care home population was highlighted at the start of the COVID-19 pandemic. Care homes faced multiple requests for data from external agencies who had little knowledge of what care homes were already collecting. Objective: This study aimed to identify the range (and method) of data collected by care home organisations, in a country without a mandated MDS. Methods: Online survey of care homes (with/without nursing) in England. Care homes recruited via research and care home networks, social media. Questions covered data content, storage, and views on data sharing, analysed with descriptive statistics. Findings: 273 responses were received, representing over 5,000 care homes. Care homes reported extensive data on the health, care and support needs of individual residents, their preferences, and activities. Clinical measures and tools adopted from health were commonly used, but few collected information on quality-of-life. Care homes reported uses of these data that included monitoring care quality, medication use, staff training needs, budgeting, and marketing. Concerns over privacy and data protection regulations are potential barriers to data sharing. Implications: These findings challenge the notion that incentives or mandates are required to stimulate data collection in care homes. Care home organisations are collecting an extensive range of resident-level information for their own uses. Countries considering introducing social care records or an MDS could start by working with care home organisations to review existing data collection and evaluate the implications of collecting and sharing data. A critical approach to the appropriateness of health-related tools in this setting is overdue.
{"title":"Data Collection in Care Homes for Older Adults: A National Survey in England","authors":"Barbara Hanratty, Arne Timon Wolters, Ann-Marie Towers, Karen Spilsbury, Julienne Meyer, Anne Killett, Liz Jones, Adam Gordon, Jennifer Kirsty Burton, Gizdem Akdur, Lisa Irvine, Krystal Warmoth, Jennifer Liddle, Claire Goodman","doi":"10.31389/jltc.199","DOIUrl":"https://doi.org/10.31389/jltc.199","url":null,"abstract":"Context: In many countries, there is a specification for information that should be collected by care homes. So-called ‘minimum data-sets’ (MDS) are often lengthy, and report on resident health and wellbeing, staff, and facilities. In the UK, the absence of any easily accessible data on the care home population was highlighted at the start of the COVID-19 pandemic. Care homes faced multiple requests for data from external agencies who had little knowledge of what care homes were already collecting. Objective: This study aimed to identify the range (and method) of data collected by care home organisations, in a country without a mandated MDS. Methods: Online survey of care homes (with/without nursing) in England. Care homes recruited via research and care home networks, social media. Questions covered data content, storage, and views on data sharing, analysed with descriptive statistics. Findings: 273 responses were received, representing over 5,000 care homes. Care homes reported extensive data on the health, care and support needs of individual residents, their preferences, and activities. Clinical measures and tools adopted from health were commonly used, but few collected information on quality-of-life. Care homes reported uses of these data that included monitoring care quality, medication use, staff training needs, budgeting, and marketing. Concerns over privacy and data protection regulations are potential barriers to data sharing. Implications: These findings challenge the notion that incentives or mandates are required to stimulate data collection in care homes. Care home organisations are collecting an extensive range of resident-level information for their own uses. Countries considering introducing social care records or an MDS could start by working with care home organisations to review existing data collection and evaluate the implications of collecting and sharing data. A critical approach to the appropriateness of health-related tools in this setting is overdue.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"273 33‐36","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135474966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: The Living Lab in Ageing and Long-Term Care (Netherlands) and Nurturing Innovation in Care Homes Excellence in Leeds (NICHE-Leeds; UK) are partnerships between science and care. The Scientific Linking Pin (SLP), a senior researcher employed by a university, works one day per week in a LTC organization, and has a pivotal role in the partnership.
Objective: To explore the nature of the SLP role
Methods: A qualitative approach was used. Fifteen individuals with at least one year’s experience as a SLP in the Living Lab or NICHE-Leeds participated in a semi-structured interview. Data were thematically analyzed.
Findings: Participants described how the SLP role gave them insight into what matters to care organizations, and how it enabled them to impact LTC practice. Participants experienced the role to be multifaceted. Goals and activities performed by SLPs included developing relationships, raising awareness of the practice-science partnership, identifying (research) priorities and generating research questions, building committees, brokering knowledge, developing research studies, generating academic output, building links and connections, and assisting with internal projects. Challenges faced were mistrust by care staff and poor engagement, working with staff from different professional backgrounds, research not being a priority, multiple and rapidly changing priorities, and differences in expectations. SLPs addressed these challenges through relationship building, creating a ‘safe’ space for care staff, building engagement, and expectation management.
Implications: Partnership working in the care sector is gaining international recognition and adoption, and therefore it is useful to capture and share learning about successful implementation of our approach.
{"title":"Bridging the gap between science and care: a qualitative exploration of the role of the Scientific Linking Pin researcher working in research and practice partnerships","authors":"Irma Everink, Judith Urlings, Alys Griffiths, Hilde Verbeek, Kirsty Haunch, Karen Spilsbury, Jan Hamers, Reena Devi","doi":"10.31389/jltc.212","DOIUrl":"https://doi.org/10.31389/jltc.212","url":null,"abstract":"Context: The Living Lab in Ageing and Long-Term Care (Netherlands) and Nurturing Innovation in Care Homes Excellence in Leeds (NICHE-Leeds; UK) are partnerships between science and care. The Scientific Linking Pin (SLP), a senior researcher employed by a university, works one day per week in a LTC organization, and has a pivotal role in the partnership.
 Objective: To explore the nature of the SLP role
 Methods: A qualitative approach was used. Fifteen individuals with at least one year’s experience as a SLP in the Living Lab or NICHE-Leeds participated in a semi-structured interview. Data were thematically analyzed. 
 Findings: Participants described how the SLP role gave them insight into what matters to care organizations, and how it enabled them to impact LTC practice. Participants experienced the role to be multifaceted. Goals and activities performed by SLPs included developing relationships, raising awareness of the practice-science partnership, identifying (research) priorities and generating research questions, building committees, brokering knowledge, developing research studies, generating academic output, building links and connections, and assisting with internal projects. Challenges faced were mistrust by care staff and poor engagement, working with staff from different professional backgrounds, research not being a priority, multiple and rapidly changing priorities, and differences in expectations. SLPs addressed these challenges through relationship building, creating a ‘safe’ space for care staff, building engagement, and expectation management.
 Implications: Partnership working in the care sector is gaining international recognition and adoption, and therefore it is useful to capture and share learning about successful implementation of our approach.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134906858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: There is an urgent need for sustainable change in the social care sector, and research plays an essential role in the identification of priority areas. Thus far, there have been few priority setting exercises within adult social care research. The current study explores regional priorities for adult social care research in Kent, Surrey, and Sussex. Stakeholders were consulted from the starting point of the project, ensuring that the identified research priorities were fully informed by the people that the subsequent research will have an impact on. Objectives: Our main aim was to identify research priorities for adult social care within the region, and more specifically, relevant activities within these priority areas that could benefit from evaluation. Methods: We employed a mixed-method design using online focus groups with social care professionals (N = 37) and members of the public (N = 7), and an online survey following the focus groups (N = 28). Focus group discussions were informed by themes based on The Care Act 2014. Findings: Content analysis was used to analyse discussions, which yielded a list of 46 actionable research questions. Rankings of discussion themes were produced to establish order of importance. Limitations: We approached the ranking of priorities only at a higher-order theme level, and not at the level of the specific questions. Implications: The extensive list of research questions produced in this study supports social care researchers to conduct studies that address pressing issues for care systems and the public.
{"title":"Identifying Regional Stakeholder-Informed Priorities for Adult Social Care Research: A Mixed-Method Study in Kent, Surrey, and Sussex","authors":"Jolie R. Keemink, R. Sharp, A. Dargan, J. Forder","doi":"10.31389/jltc.208","DOIUrl":"https://doi.org/10.31389/jltc.208","url":null,"abstract":"Context: There is an urgent need for sustainable change in the social care sector, and research plays an essential role in the identification of priority areas. Thus far, there have been few priority setting exercises within adult social care research. The current study explores regional priorities for adult social care research in Kent, Surrey, and Sussex. Stakeholders were consulted from the starting point of the project, ensuring that the identified research priorities were fully informed by the people that the subsequent research will have an impact on.\u0000Objectives: Our main aim was to identify research priorities for adult social care within the region, and more specifically, relevant activities within these priority areas that could benefit from evaluation.\u0000Methods: We employed a mixed-method design using online focus groups with social care professionals (N = 37) and members of the public (N = 7), and an online survey following the focus groups (N = 28). Focus group discussions were informed by themes based on The Care Act 2014.\u0000Findings: Content analysis was used to analyse discussions, which yielded a list of 46 actionable research questions. Rankings of discussion themes were produced to establish order of importance.\u0000Limitations: We approached the ranking of priorities only at a higher-order theme level, and not at the level of the specific questions.\u0000Implications: The extensive list of research questions produced in this study supports social care researchers to conduct studies that address pressing issues for care systems and the public.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46197577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Long-term residential care (LTRC) has been disproportionately impacted by Covid-19, with two-thirds of Covid-19 deaths occurring in LTRC homes in Ireland. Objectives: The study aims to examine the factors associated with LTRC Covid-19 outbreaks in Ireland. Methods: We merged data on Covid-19 cases and deaths in the community and LTRC homes with LTRC home characteristics across Waves 1-3 of the pandemic. Analyses examined the impact LTRC home characteristics and proximity to high community Covid-19 rates had on the likelihood of Covid-19 outbreaks and severity of outbreaks in LTRC homes. Findings: 8,502 confirmed cases of Covid-19 among LTRC home residents were recorded. Two thirds of LTRC homes had a Covid-19 outbreak across the first three waves of the pandemic. Larger LTRC homes were three times more likely to have an outbreak than smaller homes. High local community Covid-19 rates significantly increased the probability of a LTRC home outbreak. Homes in areas with the highest community Covid-19 rates were almost seven times more likely to have an outbreak than LTRC homes located in areas with the lowest community Covid-19 rates. Limitations: No centralised dataset exists in Ireland that collects information on morbidity, dementia or cognitive status of had on residents. Implications: Covid-19 had a significant impact on LTRC in Ireland with very high rates of cases and deaths. Our findings suggest that while factors such as home size may have increased the probability of an outbreak, being located in areas with high levels of community Covid-19 cases was likely the key factor explaining LTRC outbreaks.
{"title":"Covid-19 in the Community and Outbreaks in Long-Term Residential Care in Ireland","authors":"B. Walsh, S. Connolly, Maev-Ann Wren","doi":"10.31389/jltc.191","DOIUrl":"https://doi.org/10.31389/jltc.191","url":null,"abstract":"Context: Long-term residential care (LTRC) has been disproportionately impacted by Covid-19, with two-thirds of Covid-19 deaths occurring in LTRC homes in Ireland.\u0000Objectives: The study aims to examine the factors associated with LTRC Covid-19 outbreaks in Ireland.\u0000Methods: We merged data on Covid-19 cases and deaths in the community and LTRC homes with LTRC home characteristics across Waves 1-3 of the pandemic. Analyses examined the impact LTRC home characteristics and proximity to high community Covid-19 rates had on the likelihood of Covid-19 outbreaks and severity of outbreaks in LTRC homes.\u0000Findings: 8,502 confirmed cases of Covid-19 among LTRC home residents were recorded. Two thirds of LTRC homes had a Covid-19 outbreak across the first three waves of the pandemic. Larger LTRC homes were three times more likely to have an outbreak than smaller homes. High local community Covid-19 rates significantly increased the probability of a LTRC home outbreak. Homes in areas with the highest community Covid-19 rates were almost seven times more likely to have an outbreak than LTRC homes located in areas with the lowest community Covid-19 rates.\u0000Limitations: No centralised dataset exists in Ireland that collects information on morbidity, dementia or cognitive status of had on residents.\u0000Implications: Covid-19 had a significant impact on LTRC in Ireland with very high rates of cases and deaths. Our findings suggest that while factors such as home size may have increased the probability of an outbreak, being located in areas with high levels of community Covid-19 cases was likely the key factor explaining LTRC outbreaks.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49438037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Citizen Science as a Framework for Improving the Science-Society Interface in Long-Term Care Research","authors":"M. Clark, M. Cornes","doi":"10.31389/jltc.142","DOIUrl":"https://doi.org/10.31389/jltc.142","url":null,"abstract":"","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75606074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Janet C. Hovde, Carol C. Geisler, Janet M. Marinelli, Briley A. Hale
{"title":"Holistic Interventions to Address Pain, Anxiety, and Distressing Behaviours in Long-Term Care Residents","authors":"Janet C. Hovde, Carol C. Geisler, Janet M. Marinelli, Briley A. Hale","doi":"10.31389/jltc.158","DOIUrl":"https://doi.org/10.31389/jltc.158","url":null,"abstract":"","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75033104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Hohman, M. Strand, Savita Sidhu, Rick Jansen, S. McDonough
{"title":"The Association of North Dakota Skilled Nursing Facility Characteristics with COVID-19 Outbreak Severity","authors":"Adam Hohman, M. Strand, Savita Sidhu, Rick Jansen, S. McDonough","doi":"10.31389/jltc.181","DOIUrl":"https://doi.org/10.31389/jltc.181","url":null,"abstract":"","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88507606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lara Dhingra, Clyde Schechter, Stephanie DiFiglia, Karen Lipson, Russell Portenoy
Context: In the United States, Black nursing home (NH) residents have higher rates of pressure injury (PI) than White residents. Although some studies ascribe this to a relatively high proportion of Black residents in NHs with poor outcomes and limited resources, the factors that associate with PIs and their consequences across and within NHs remain poorly understood. Also, little is known about PIs among residents of differing races and ethnicities. Objectives: Using four national datasets from 2016–2017, we evaluated U.S. NHs to characterize differences in PI-related outcomes among non-Hispanic Whites, non-Hispanic Blacks, Hispanics, Asians, American Indian or Alaska Natives, and Native Hawaiian or Other Pacific Islanders, and clarified the impact of resident-, facility-, and community-level characteristics on these outcomes. Methods: We calculated the annual incidence rate of PIs, the probability of PI healing, and the prevalence of PI-associated pain and analgesic prescription. We determined the bivariate associations between each of these outcomes and race/ethnicity, and between each outcome and multiple potential covariates. Multivariable analyses then evaluated the associations between each outcome and race/ethnicity while adjusting for covariates. Findings: In the bivariate analyses, the annual incidence rate of stage 2, 3, 4, and unstageable PIs for Whites was lower than Blacks and Hispanics, similar to American Indians or Alaska Natives, and higher than Asians and Native Hawaiians or Other Pacific Islanders. In the multivariable analyses, the PI incidence rate ratio was higher only among American Indians or Alaska Natives, and this difference was associated with a NH-level variable—the proportion of racial and ethnic minority residents. Other outcomes did not vary by race/ethnicity. An adjusted exploratory analysis was conducted to help explain the difference between the bivariate and multivariable analyses and revealed an important within-NH difference: Compared to Whites, the PI incidence rate ratios were higher in women who were Black, or American Indian or Alaska Native. Limitations: Our findings are correlational and may be impacted by unevaluated variables and the limitations of administrative data. Implications: In U.S. NHs, the annual incidence rate of PIs varies by race/ethnicity. Facility characteristics strongly influence this variation. Higher incidence rate ratios among racial and ethnic minority residents also are explained by differences within NHs and are striking among subgroups, including female residents who are Black, or American Indian or Alaska Native. Future research should evaluate the sexes separately and explore both across-NH and within-NH differences to determine whether there are structural inequities, bias, and disparate care.
{"title":"Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National Data","authors":"Lara Dhingra, Clyde Schechter, Stephanie DiFiglia, Karen Lipson, Russell Portenoy","doi":"10.31389/jltc.185","DOIUrl":"https://doi.org/10.31389/jltc.185","url":null,"abstract":"Context: In the United States, Black nursing home (NH) residents have higher rates of pressure injury (PI) than White residents. Although some studies ascribe this to a relatively high proportion of Black residents in NHs with poor outcomes and limited resources, the factors that associate with PIs and their consequences across and within NHs remain poorly understood. Also, little is known about PIs among residents of differing races and ethnicities. Objectives: Using four national datasets from 2016–2017, we evaluated U.S. NHs to characterize differences in PI-related outcomes among non-Hispanic Whites, non-Hispanic Blacks, Hispanics, Asians, American Indian or Alaska Natives, and Native Hawaiian or Other Pacific Islanders, and clarified the impact of resident-, facility-, and community-level characteristics on these outcomes. Methods: We calculated the annual incidence rate of PIs, the probability of PI healing, and the prevalence of PI-associated pain and analgesic prescription. We determined the bivariate associations between each of these outcomes and race/ethnicity, and between each outcome and multiple potential covariates. Multivariable analyses then evaluated the associations between each outcome and race/ethnicity while adjusting for covariates. Findings: In the bivariate analyses, the annual incidence rate of stage 2, 3, 4, and unstageable PIs for Whites was lower than Blacks and Hispanics, similar to American Indians or Alaska Natives, and higher than Asians and Native Hawaiians or Other Pacific Islanders. In the multivariable analyses, the PI incidence rate ratio was higher only among American Indians or Alaska Natives, and this difference was associated with a NH-level variable—the proportion of racial and ethnic minority residents. Other outcomes did not vary by race/ethnicity. An adjusted exploratory analysis was conducted to help explain the difference between the bivariate and multivariable analyses and revealed an important within-NH difference: Compared to Whites, the PI incidence rate ratios were higher in women who were Black, or American Indian or Alaska Native. Limitations: Our findings are correlational and may be impacted by unevaluated variables and the limitations of administrative data. Implications: In U.S. NHs, the annual incidence rate of PIs varies by race/ethnicity. Facility characteristics strongly influence this variation. Higher incidence rate ratios among racial and ethnic minority residents also are explained by differences within NHs and are striking among subgroups, including female residents who are Black, or American Indian or Alaska Native. Future research should evaluate the sexes separately and explore both across-NH and within-NH differences to determine whether there are structural inequities, bias, and disparate care.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136258931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Poster Boys and the Rehabilitative Dream: Using a Temporal Lens to Explore Severe Brain Injury Rehabilitation","authors":"J. Latchem-Hastings","doi":"10.31389/jltc.166","DOIUrl":"https://doi.org/10.31389/jltc.166","url":null,"abstract":"ABSTRACT","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86781556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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