Background The Minimum Data Set (MDS) 3.0 introduced the Brief Interview for Mental Status (BIMS), a short performance-based cognitive screener for nursing home (NH) residents. Not all residents are able to complete the BIMS and are consequently assessed by staff. We designed a Cognitive Function Scale (CFS) integrating self-report and staff-report data and present evidence of the scale’s construct validity. Design Retrospective cohort study. Subjects Consisted of three cohorts: 1) long-stay NH residents (N=941,077) and 2) new admissions (N=2,066,580) during 2011–2012, and 3) residents with the older MDS 2.0 assessment in 2010 and the newer MDS 3.0 assessment (n=688,511). Measures MDS 3.0 items were used to create a single, integrated four-category hierarchical CFS that was compared to residents’ prior MDS 2.0 Cognitive Performance Scale scores and other concurrent MDS 3.0 measures of construct validity. Results The new CFS suggests that 28% of the long-stay cohort in 2011–2012 were cognitively intact, 22% were mildly impaired, 33% were moderately impaired, and 17% were severely impaired. For the admission cohort, the CFS noted 56% as cognitively intact, 23% as mildly impaired, 17% as moderately impaired, and 4% as severely impaired. The CFS corresponded closely with residents’ prior MDS 2.0 Cognitive Performance Scale scores and with performance of Activities of Daily Living, and nurses’ judgments of function and behavior in both the admission and long-stay cohorts. Conclusion The new CFS is valuable to researchers as it provides a single, integrated measure of NH residents’ cognitive function, regardless of the mode of assessment.

With a large sample size, repeated measure design, and advanced methods, we have found a relationship between CNA staffing and nursing home quality.

Opportunities exist to improve provider practice related to the appropriate treatment of urinary tract infections in the nursing home.

Objective To examine the differential morbidity/mortality associated with evacuation versus sheltering in place for nursing home (NH) residents exposed to the 4 most recent Gulf-hurricanes Methods Observational study using Medicare claims, and NH data sources. We compared the differential mortality/morbidity for long-stay residents exposed to 4 recent hurricanes (Katrina, Rita, Gustav, and Ike) relative to those residing at the same NHs over the same time periods during the prior 2 non-hurricane years as a control. Using an instrumental variable analysis, we then evaluated the independent effect of evacuation on outcomes at 90 days. Results Among 36,389 NH residents exposed to a storm, the 30 and 90 day mortality/hospitalization rates increased compared to non-hurricane control years. There were a cumulative total of 277 extra deaths and 872 extra hospitalizations at 30 days. At 90 days, 579 extra deaths and 544 extra hospitalizations were observed. Using the instrumental variable analysis, evacuation increased the probability of death at 90 days from 2.7-5.3% and hospitalization by 1.8-8.3%, independent of other factors. Conclusion Among residents exposed to hurricanes, evacuation significantly exacerbated subsequent morbidity/mortality.