Calling all nurses-Now is the time to take action on improving the quality of care in nursing homes.

For a number of decades, nurses have raised concerns about nursing-related issues in nursing homes (NH) such as inadequate registered nurse (RN) staffing, insufficient RN and advanced practice registered nurse (APRN) gerontological expertise, and lack of RN leadership competencies. The NASEM Committee on the Quality of Care in Nursing Homes illuminated the long-standing issues and concerns affecting the quality of care in nursing homes and proposed seven goals and associated recommendations intended to achieve the Committee's vision: Nursing home residents receive care in a safe environment that honors their values and preferences, addresses goals of care, promotes equity, and assesses the benefits and risks of care and treatments. This paper outlines concrete and specific actions nurses and nursing organizations can take to ensure the recommendations are implemented.

Digital Methodology for Mobile Clinical Decision Support Development in Long-Term Care.

The global COVID-19 pandemic has driven innovations in methods to sustain initiatives for the design, development, evaluation, and implementation of clinical support technology in long-term care settings while removing risk of infection for residents, family members, health care workers, researchers and technical professionals. We adapted traditional design and evaluation methodology for a mobile clinical decision support app - designated Mobile Application Information System for Integrated Evidence ("MAISIE") - to a completely digital design methodology that removes in-person contacts between the research team, developer, and nursing home staff and residents. We have successfully maintained project continuity for MAISIE app development with only minor challenges while working remotely.

Impact of Advanced Practice Registered Nurses on Quality Measures: The Missouri Quality Initiative Experience.

Purpose: The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of 7 program sites in the US, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services Innovations Center. While the goals of the MOQI for long-stay nursing home residents did not specifically include improvement of the QM scores, it was anticipated that improvement most likely would occur.

Analysis of Advance Directive Documentation to Support Palliative Care Activities in Nursing Homes.

As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50 percent of the records contained an AD. Of the ADs in the resident records, 55 percent designated a durable power of attorney for health care, most often a child (62 percent), other relative (14 percent), or spouse (13 percent).

Call to action: APRNs in U.S. nursing homes to improve care and reduce costs.

Background: Centers for Medicare and Medicaid Innovation Center sponsored the initiative to reduce avoidable hospitalizations among nursing facility residents.

Purpose: Missouri Quality Initiative (MOQI) designed inter-professional model in nursing homes with advanced practice registered nurses (APRNs).

Method: MOQI APRN model was implemented for 4 years in 16 nursing homes in a metro area of the Midwest.

Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative.

Purpose: The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center.

Design And Methods: A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes.

Comparing Aging in Place to Home Health Care: Impact of Nurse Care Coordination On Utilization and Costs.

The goal of this study was to compare utilization and cost outcomes of patients who received long-term care coordination in an Aging in Place program to patients who received care coordination as a routine service in home health care. This research offered the unique opportunity to compare two groups of patients who received services from a single home health care agency, using the same electronic health record, to identify the impact of long-term and routine care coordination on utilization and costs to Medicare and Medicaid programs. This study supports that long-term care coordination supplied by nurses outside of a primary medical home can positively influence functional, cognitive, and health care utilization for frail older people.

A New Paradigm of Technology-Enabled ‘Vital Signs’ for Early Detection of Health Change for Older Adults.

Environmentally embedded (nonwearable) sensor technology is in continuous use in elder housing to monitor a new set of ‘vital signs' that continuously measure the functional status of older adults, detect potential changes in health or functional status, and alert healthcare providers for early recognition and treatment of those changes. Older adult participants' respiration, pulse, and restlessness are monitored as they sleep. Gait speed, stride length, and stride time are calculated daily, and automatically assess for increasing fall risk.

Doppler radar fall activity detection using the wavelet transform.

We propose in this paper the use of Wavelet transform (WT) to detect human falls using a ceiling mounted Doppler range control radar. The radar senses any motions from falls as well as nonfalls due to the Doppler effect. The WT is very effective in distinguishing the falls from other activities, making it a promising technique for radar fall detection in nonobtrusive inhome elder care applications.

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations.

Automated fall detection with quality improvement "rewind" to reduce falls in hospital rooms.

The purpose of this study was to test the implementation of a fall detection and "rewind" privacy-protecting technique using the Microsoft® Kinect™ to not only detect but prevent falls from occurring in hospitalized patients. Kinect sensors were placed in six hospital rooms in a step-down unit and data were continuously logged. Prior to implementation with patients, three researchers performed a total of 18 falls (walking and then falling down or falling from the bed) and 17 non-fall events (crouching down, stooping down to tie shoe laces, and lying on the floor).

Nighttime restfulness during daytime dance therapy: an exploratory study using bed sensors.

Dance-based therapy has the potential to slow the progression of functional limitations in older adults. The purpose of this study was to explore the feasibility of measuring the impact of dance-based therapy on the nighttime restfulness patterns of older adults in an aging-in-place facility using passive bed sensors. A secondary data analysis of the continuous 2-month nighttime bed sensor data was reviewed for measurable change during a dance study.

Evaluation of health alerts from an early illness warning system in independent living.

Passive sensor networks were deployed in independent living apartments to monitor older adults in their home environments to detect signs of impending illness and alert clinicians so they can intervene and prevent or delay significant changes in health or functional status. A retrospective qualitative deductive content analysis was undertaken to refine health alerts to improve clinical relevance to clinicians as they use alerts in their normal workflow of routine care delivery to older adults. Clinicians completed written free-text boxes to describe actions taken (or not) as a result of each alert; they also rated the clinical significance (relevance) of each health alert on a scale of 1 to 5.

In-home fall risk assessment and detection sensor system.

Falls are a major problem in older adults. A continuous, unobtrusive, environmentally mounted (i.e.

Sensor technology to support Aging in Place.

Older adults want to age in place at home. Sensor technology has the potential to help by monitoring individuals' health status, detecting emergency situations, and notifying health care providers. Researchers at the University of Missouri are investigating the impact of registered nurse care coordination and technology on the ability of older adults to age in place.

Radar walk detection in the apartments of elderly.

Seniors want to live more independent lifestyles. This comes with some risks including dwindling health and major injuries due to falling. A factor that has been studied and seen to have a correlation to fall risk is change in gait speed.

Radar walking speed measurements of seniors in their apartments: technology for fall prevention.

Falls are a significant cause of injury and accidental death among persons over the age of 65. Gait velocity is one of the parameters which have been correlated to the risk of falling. We aim to build a system which monitors gait in seniors and reports any changes to caregivers, who can then perform a clinical assessment and perform corrective and preventative actions to reduce the likelihood of falls.

The influence of teams to sustain quality improvement in nursing homes that "need improvement".

Objectives: Qualitatively describe the use of team and group processes in intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement."

Design/setting/participants: A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes. Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making.

Challenges of using quality improvement methods in nursing homes that "need improvement".

Objectives: Qualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement". To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams.

Design/setting/participants: A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in "need of improvement".

Automated technology to speed recognition of signs of illness in older adults.

Our team has developed a technological innovation that detects changes in health status that indicate impending acute illness or exacerbation of chronic illness before usual assessment methods or self-reports of illness. We successfully used this information in a 1-year prospective study to alert health care providers so they could readily assess the situation and initiate early treatment to improve functional independence. Intervention participants showed significant improvements (as compared with the control group) for the Short Physical Performance Battery gait speed score at Quarter 3 (p = 0.

Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement.

Objectives: A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement.

Design/setting/participants: Intervention facilities (N = 29) received a 2-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (N = 29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders.