Level of Need, Divertibility, and Outcomes of Newly Admitted Nursing Home Residents

Tanuseputro, Peter; Hsu, Amy T; Kuluski, Kerry; Chalifoux, Mathieu; Donskov, Melissa; Beach, Sarah; Walker, Peter

doi:10.1016/j.jamda.2017.02.008

Cited by 38 publications

(31 citation statements)

References 26 publications

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“…4 Because of the pro gressive course of cognitive decline, dementia is also a major contributing factor to the placement of individuals in longterm care homes (i.e., institutional longterm care facilities that provide 24hour nursing and personal care), and in Canada's largest province, Ontario, more than 70% of residents of long term care homes have dementia. 5 For people with dementia, their families and clinicians, under standing the likely disease trajectory is important for planning and making appropriate decisions about care. Many studies have focused on describing the risk factors for death for people living with dementia; among key predictors are older age, male sex, higher disease severity and dementia subtype.…”

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confidence: 99%

Five-year risk of admission to long-term care home and death for older adults given a new diagnosis of dementia: a population-based retrospective cohort study

Huyer

Brown

Spruin

et al. 2020

CMAJ

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BACKGROUND: After diagnosis of a health condition, information about sur vival and potential transition from com munity into institutional care can be helpful for patients and care providers. We sought to describe the association between a new diagnosis of dementia and risk of admission to a longterm care home and death at 5 years. METHODS:We conducted a population based retrospective cohort study using linked health administrative databases. We identified individuals aged 65 years or older, living in the community, with a first documented diagnosis of dementia between Jan. 1, 2010, and Dec. 31, 2012, in Ontario, Canada. Dementia diagnosis was captured using diagnostic codes RESULTS: We identified 108 757 individ uals in our study cohort. By the end of 5 years, 24.4% remained alive in the com munity and 20.5% were living in a long term care home. Of the 55.1% who died, about half (27.9%) were admitted to a longterm care home before death. Three risk factors were associated with increased odds of death: older age (age ≥ 90 yr; odds ratio [OR] 9.5, 95% confidence interval [CI] 8.8-10.2 [reference: age 65-69 yr]), male sex (OR 1.7, 95% CI 1.6-1.7), and the pres ence of organ failure, including chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.7-1.8), congestive heart failure (OR 2.0, 95% CI 1.9-2.0) and renal failure (OR 1.7, 95% CI 1.6-1.8). Groups formed by combinations of these 3 factors had an observed 5year risk of death varying between 22% and 91%.

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confidence: 99%

Five-year risk of admission to long-term care home and death for older adults given a new diagnosis of dementia: a population-based retrospective cohort study

Huyer

Brown

Spruin

et al. 2020

CMAJ

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“…Residents of LTC facilities are commonly perceived as a relatively homogeneous group (usually physically unwell, with multiple functional deficits) [ 4 ], which is in contrast to the contemporary concept of providing individualized, person-centered care [ 11 , 12 ]. As literature shows, LTC residents, in fact, constitute a diversified population [ 13 , 14 ]. Providing effective care, tailored to individual needs, is crucial in this context [ 15 ] and can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care.…”

Section: Introductionmentioning

confidence: 99%

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

et al. 2021

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Background Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care. Methods The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis. Results Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters. Conclusions Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

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“…We analyzed important covariates selected from the literature. 10,11 The nursing home variables were: (1) The resident variables were: (1) age (average) and diagnoses (percentage with a specified diagnosis); (2) Brief Interview for Mental Status (BIMS) scale scores; and (3) mobility scores. The BIMS scale was rated from 0 to 15 at each MDS assessment.…”

Section: Description Of Variablesmentioning

confidence: 99%

“…M ost residents in US nursing homes have complex medical needs related to multiple chronic conditions. 1,2 Government programs to improve their care began in 1982 with the Medicare hospice benefit, which supported a program for individuals with limited life expectancy. Eligible residents may enroll in hospice if the nursing home contracts with a certified hospice agency.…”

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Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes: A National Analysis

Dhingra

Lipson

Dieckmann

et al. 2019

J American Geriatrics Society

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BACKGROUND Institutional Special Needs Plans (I‐SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE To determine whether I‐SNP availability has been associated with changes in hospice utilization. DESIGN Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I‐SNP–, resident‐, and facility‐related variables as predictors of hospice utilization. SETTING All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I‐SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P < .001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I‐SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I‐SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size. CONCLUSIONS Growth of I‐SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs. J Am Geriatr Soc 67:2537–2544, 2019

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Level of Need, Divertibility, and Outcomes of Newly Admitted Nursing Home Residents

Cited by 38 publications

References 26 publications

Five-year risk of admission to long-term care home and death for older adults given a new diagnosis of dementia: a population-based retrospective cohort study

Five-year risk of admission to long-term care home and death for older adults given a new diagnosis of dementia: a population-based retrospective cohort study

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes: A National Analysis

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