Trends in Postacute Care and Staffing in US Nursing Homes, 2001–2010

Tyler, Denise; Feng, Zhanlian; Leland, Natalie E.; Gozalo, Pedro; Intrator, Orna; Mor, Vincent

doi:10.1016/j.jamda.2013.05.013

Cited by 45 publications

(49 citation statements)

References 11 publications

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“…30 Over the past 15 years, staffing at nursing homes has stayed level in terms of nursing aide hours per resident per day. 28 The rate of obesity among nursing home residents has increased from 16.9% in 2000 to 30.7% in 2013, and the prevalence of obesity has doubled since the turn of the century. 13 This growing mismatch between unchanging staffing hours and increasing obesity prevalence may lead to greater challenges in properly caring for residents with obesity.…”

Section: Discussionmentioning

confidence: 99%

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Obesity and intensive staffing needs of nursing home residents

2018

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The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m2) to obesity Class IIIB (≥50 kg/m2). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06–1.08) for Class I, 1.16 (95%CI 1.14–1.17) for Class II, 1.33 (95%CI 1.31–1.35) for Class IIIA, and 1.90 (95%CI 1.86–1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident’s BMI increases, especially for BMI ≥40 kg/m2, the need for extensive staffing assistance with ADLs also increases substantially.

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Section: Discussionmentioning

confidence: 99%

“…Other literature, including the Long-Term Focus dataset uses this methodology to standardize characteristics over time. 26–28 …”

Section: Methodsmentioning

confidence: 99%

Obesity and intensive staffing needs of nursing home residents

2018

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“…With the shift in nursing homes to delivering more postacute care, their capacity for treating and managing complex conditions has increased. 23 Moreover, given the high prevalence of dementia in nursing homes, providers at those facilities may be more used to treating patients with dementia than community-based physicians are.…”

Section: Discussionmentioning

confidence: 99%

Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death

et al. 2014

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Hospitalizations and emergency department (ED) visits for people with Alzheimer's disease and related disorders are of particular concern because many of these patients are physically and mentally frail, and the care delivered in these settings is costly. Using data from the Health and Retirement Study linked with Medicare claims from the period 2000-08, we found that among community-dwelling elderly fee-for-service Medicare beneficiaries, those who had dementia were significantly more likely than those who did not to have a hospitalization (26.7 percent versus 18.7 percent) and an ED visit (34.5 percent versus 25.4 percent) in each year. Comparing nursing home residents who had dementia with those who did not, we found only small differences in hospitalizations (45.8 percent versus 41.9 percent, respectively) and ED use (55.3 percent versus 52.7 percent). As death neared, however, utilization rose sharply across settings and by whether or not beneficiaries had dementia: Nearly 80 percent of community-dwelling decedents were hospitalized, and an equal proportion had at least one ED visit during the last year of life, regardless of dementia. Our research suggests that substantial portions of hospitalizations and ED visits both before and during the last year of life were potentially avoidable. A lzheimer's disease and related disorders place substantial emotional, physical, and financial burdens on patients, their families, and society. One important source of these burdens is frequent hospitalizations and emergency department (ED) visits, many of which are potentially avoidable. These encounters are disruptive, costly, and particularly challenging for people with dementia, who are vulnerable to many adverse health outcomes, including delirium, 1 falls, 2 functional decline, 3 physical restraints, 4 and agitation and related behavioral symptoms. 5These problems are aggravated by the poor communication abilities and coexisting medical conditions associated with dementia. 6 Older people with dementia also have special difficulties in transitioning across care settings. 7 Hence, unnecessary or potentially avoidable hospitalizations and ED visits have important implications for both the quality of care and the quality of life for people with dementia, 8,9 especially at the end of life. 10Few studies have focused on hospital and ED use, especially potentially avoidable use, among older people with dementia.11-14 As a result, current understanding of hospital and ED use by people who have dementia compared to use by people who do not remains limited. Furthermore, there have been few analyses of the impact of dementia on hospital and ED use across community and institutional settings.

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“…This file included all existing and closed nursing homes in the United States through 2008; we updated this file using our geo-coded CBS file and with the addition of data on all nursing homes that had opened or closed in 2009 and 2010, as identified in the Online Survey Certification and Reporting (OSCAR) data available for nearly all U.S. nursing homes, both freestanding and hospital based. We chose to include both types of nursing home closures and additions because recent research has shown that freestanding and hospital-based facilities are providing more similar care than in the past; patient acuity and therapy provision have increased in free-standing facilities, while these services have decreased in hospital-based facilities (Tyler et al, 2013). Finally, we used ArcGIS to create 5-mile radii around each U.S. nursing home that had closed between 2006 and 2010.…”

Section: Introductionmentioning

confidence: 99%

Rebalance Without the Balance: A Research Note on the Availability of Community-Based Services in Areas Where Nursing Homes Have Closed

Tyler

Fennell

2015

Res Aging

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Policies to “rebalance” funding away from nursing homes and toward home and community-based services (HCBS) have encouraged national trends of nursing home closure and an expansion of the HCBS industry. These changes are unfolding without a clear understanding of what services are available at the local level. The purpose of this study was: (1) to describe the current distribution of community-based services (CBS) in areas where nursing homes have closed and (2) to examine differences in availability of CBS using local market and population characteristics as regressors in a multinomial logistic model. We collected data on and geocoded CBS facilities and then used ArcGIS to define a 5-mile radius around all nursing homes that closed between 2006 and 2010 and compared these local market areas. In rural areas, availability of CBS does not appear to compensate for nursing home closures. Policies encouraging HCBS may be outpacing availability of CBS, especially in rural areas.

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Trends in Postacute Care and Staffing in US Nursing Homes, 2001–2010

Cited by 45 publications

References 11 publications

Obesity and intensive staffing needs of nursing home residents

Obesity and intensive staffing needs of nursing home residents

Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death

Rebalance Without the Balance: A Research Note on the Availability of Community-Based Services in Areas Where Nursing Homes Have Closed

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