Designing the National Resident Assessment Instrument for Nursing Homes

Morris, John N.; Hawes, Catherine; Fries, Brant E.; Phillips, Charles D.; Mor, Vincent; Katz, Sidney; Murphy, Katharine M.; Drugovich, Margaret L.; Friedlob, Alan S.

doi:10.1093/geront/30.3.293

Cited by 815 publications

(587 citation statements)

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“…(6). New admissions were defined as those residents with an admission assessment during calendar year 2008 for whom no MDS record existed in the registry as far back as January 1, 1999, implying that the admission was the person’s first.…”

Section: Methodsmentioning

confidence: 99%

Medical Comorbidity and Functional Status Among Adults With Major Mental Illness Newly Admitted to Nursing Homes

Aschbrenner¹,

Cai²,

Grabowski³

et al. 2011

Psychiatric Services

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Objective This study compared comorbid conditions and functional status among elderly and nonelderly individuals with mental illness who were newly admitted to nursing homes. Methods Data were drawn from the Centers for Medicare & Medicaid Services national registry of nursing home residents from the Minimum Data Set in 2008. Results Among newly admitted individuals with schizophrenia, those younger than 65 accounted for a majority (60.3%) of admissions and had lower rates of medical illnesses and were more likely to be classified as low-care status than individuals who were 65 or older. Most (81%) new admissions with depression were 65 or older. Among all nonelderly admissions, individuals with depression had the highest rates of medical comorbidity. Conclusions Many adults younger than 65 with schizophrenia who were newly admitted to nursing homes lacked clinical indications for skilled nursing care. In contrast, higher rates of medical conditions among nonelderly adults with depression underscored the need for integrated psychiatric and medical care in nursing homes.

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Section: Methodsmentioning

confidence: 99%

Medical Comorbidity and Functional Status Among Adults With Major Mental Illness Newly Admitted to Nursing Homes

Aschbrenner¹,

Cai²,

Grabowski³

et al. 2011

Psychiatric Services

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“…The MDS is the congressionally mandated assessment conducted for all residents of Medicare/Medicaid-certified nursing facilities upon admission and at least quarterly thereafter. 7 The database includes both these routine assessments as well as those used by Medicare to pay for postacute skilled nursing facility (SNF) admissions for very short stays. Long-stay residents were those in the nursing home for continued or custodial care; they were defined as those with any assessment recorded in calendar year 2005 who had a minimum of two prior assessments to establish a continuous residence in a nursing home of at least ninety days.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Prospects For Transferring Nursing Home Residents To The Community

Mor¹,

Zinn²,

Gozalo³

et al. 2007

Health Affairs

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ABSTRACT:The Deficit Reduction Act (DRA) of 2005 calls for states to develop strategies to "deinstitutionalize" nursing home residents. Using Minimum Data Set assessment data from 2005, we calculated the number of nursing home residents classified as "low-care" in each state using both a "narrow" and a "broad" definition. Between 5 percent (narrow) and 12 percent (broad) of the 1.4 million long-stay residents and similar proportions of new admissions remaining in a nursing home meet definitions for low care. States with lower investment in community alternatives had higher proportions of low-care nursing home residents. [Health Affairs 26, no. 6 (2007): 1762-1771 10.1377/hlthaff.26.6.1762] C a ll s to r e d i r e c t t h e nat i o n 's long-term care system away from an institutional bias through investment in home and community-based services (HCBS) have been heard for decades but have been increasingly heeded in the past few years. 1 During the past two decades, investment by the states in HCBS programs, especially through Section 1915(c) waivers, has expanded dramatically in response to greater public demand for more communitybased care options, also reflecting an effort to reduce the increasing burden of nursing home costs on state budgets. D a t a W a t c h

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“…The RAI/MDS focuses on patients' functional capacity, resources and needs, is internationally established, valid and reliable (29) and provides a comprehensive assessment of older patients receiving health care (30,31). Selected items from this baseline database of patients' characteristics were extracted for the present study: age, gender, cognitive and functional capacity, medical diagnosis and drug consumption.…”

Section: Data Collectionmentioning

confidence: 99%

Fewer referrals to Swedish emergency departments among nursing home patients with dementia, comprehensive cognitive decline and multicomorbidity

Mamhidir

Wimo

Kihlgren

2012

The Journal of nutrition, health and aging

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Objectives:The objective was to describe the extent to which nursing home patients had cognitive impairments and were diagnosed with dementia. Furthermore, to describe and compare multicomorbidity, health status and drug use in the three subgroups; dementia diagnosis/not referred, dementia diagnosis/referred and no dementia diagnosis/not referred to an emergency department (ED) over a one-year period. Methods: A crosssectional follow-up study was carried out in Sweden. RAI/MDS assessments were conducted on 719 patients in 24 nursing homes, of whom 209 were referred to EDs during a one-year period, accounting for 314 visits. This study involved an extensive examination of the population. Results: The 719 patients were reported to suffer from comprehensive cognitive impairments, which not accorded with the dementia diagnoses, they were significantly fewer. Cognitive decline or dementia diagnosis contributed to a significant decrease of referrals to EDs. Patients with dementia diagnosis/not referred had difficulties understanding others, as well as impaired vision and hearing. Patients with dementia diagnosis/referred usually understood messages. Low BMI, daily pain, multicomorbidity and high drug consumption occurred in all groups. Patients with no dementia diagnosis/not referred had significantly less multicomorbidity. Neuroleptica was significantly more prevalent among those with dementia diagnosis. Conclusion: Dementia remains undetected. Patients with cognitive decline and dementia are probably as sick as or even worse than others but may, due to low priority be undertreated or referrals avoided with the objective to provide good care in the setting. Observational studies are needed to identify what is done and could be done in referral situations. Key words:Nursing home, dementia, cognitive impairment, referrals, emergency department. 891The Journal of Nutrition, Health & Aging© Volume 16, Number 10, 2012 Received November 25, 2011 Accepted for publication January 19, 2012 07 MAMHIDIR/p/c_04 LORD_c 04/12/12 10:31 Page891 (17), the mean number of prescribed drugs was 10.3 per patient. The proportion of individuals prescribed psychotropic drugs was 80% in NHs and 85% in special care units for dementia. According to Olsson et al. (17), anticholinergic drugs were prescribed for approximately 20% of all NH patients and a high rate of psychotropic drug use (>=80%) was reported.Dementia is becoming a greater problem in health care globally (18), due to an increase in the number of people affected. In Sweden, the number of people suffering from dementia increased from 133, 000 to 148, 000 between 2000 and 2008 (14). Disorders such as dementia that cause cognitive impairment are common in long term institutional care. Mamhidir et al. (19) found that cognitive impairment was present in 67% of NH patients and Nordberg et al. (20) reported 62%. Such patients often exhibit symptoms that are difficult to interpret. Although they have the same illnesses as younger patients, their symptoms differ as they...

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Designing the National Resident Assessment Instrument for Nursing Homes

Cited by 815 publications

References 0 publications

Medical Comorbidity and Functional Status Among Adults With Major Mental Illness Newly Admitted to Nursing Homes

Medical Comorbidity and Functional Status Among Adults With Major Mental Illness Newly Admitted to Nursing Homes

Prospects For Transferring Nursing Home Residents To The Community

Fewer referrals to Swedish emergency departments among nursing home patients with dementia, comprehensive cognitive decline and multicomorbidity

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