Nursing home leader response during COVID-19: a qualitative descriptive study about use of external resources during the pandemic.

Background: US nursing homes were ground zero for COVID-19 and nursing home leaders faced multiple challenges to keep residents and staff safe. Understanding the leader's role and their use of external resources to rapidly respond to the pandemic is important to better prepare for the next infectious disease outbreak emergency. The purpose of this study is to describe Missouri nursing home leaders' use of external resources to manage challenges encountered during the pandemic.

Longitudinal Evaluation of a Statewide Quality Improvement Program for Nursing Homes.

Objectives: The National Academies of Sciences, Engineering, and Medicine (NASEM) Nursing Home Quality report recommends that states "develop and operate state-based…technical assistance programs…to help nursing homes…improve care and…operations." The Quality Improvement Program for Missouri (QIPMO) is one such program. This longitudinal evaluation examined and compared differences in quality measures (QMs) and nursing home (NH) characteristics based on intensity of QIPMO services used.

Exploring Hospital Transfers for Long-Stay Nursing Home Residents With End-Stage Renal Disease.

Background: Nursing home residents with end-stage renal disease (ESRD) are an understudied, yet growing population within nursing homes.

Purpose: To describe hospital transfers for nursing home residents diagnosed with ESRD and receiving hemodialysis.

Methods: Data were analyzed for residents with ESRD transferred to the hospital between October 2016 and September 2020 (n = 219).

Data-Driven Analytics to Discover APRN's Impact on Nursing Home Hospitalization: Causal Discovery Analysis.

Objectives: Research shows advanced practice registered nurses (APRNs) embedded in nursing homes (NHs) reduce resident hospitalizations. However, the specific APRN activities that reduce hospitalizations have not been adequately investigated. This study aims to identify the causal links between APRN activities and NHs resident hospitalization.

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.

Sharing Lessons From Successes: Long-term Care Facilities That Weathered the Storm of COVID-19 and Staffing Crises.

Purpose: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as "positive deviants" with regard to COVID-19 infections and staffing shortages.

Methods: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these "positive outliers.

Impact of Web-Based Cognitive Behavioral Therapy for Insomnia on Stress, Health, Mood, Cognitive, Inflammatory, and Neurodegenerative Outcomes in Rural Dementia Caregivers: Protocol for the NiteCAPP CARES and NiteCAPP SHARES Randomized Controlled Trial.

Background: Chronic insomnia affects up to 63% of family dementia caregivers. Research suggests that chronic insomnia prompts changes in central stress processing that have downstream negative effects on health and mood, as well as on cognitive, inflammatory, and neurodegenerative functioning. We hypothesize that cognitive behavioral therapy for insomnia (CBT-I) will reverse those downstream effects by improving insomnia and restoring healthy central stress processing.

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.

Explainable Fall Risk Prediction in Older Adults Using Gait and Geriatric Assessments.

Older adults aged 65 and above are at higher risk of falls. Predicting fall risk early can provide caregivers time to provide interventions, which could reduce the risk, potentially avoiding a possible fall. In this paper, we present an analysis of 6-month fall risk prediction in older adults using geriatric assessments, GAITRite measurements, and fall history.

Repeat hospital transfers among long stay nursing home residents: a mixed methods analysis of age, race, code status and clinical complexity.

Background: Nursing home residents are at increased risk for hospital transfers resulting in emergency department visits, observation stays, and hospital admissions; transfers that can also result in adverse resident outcomes. Many nursing home to hospital transfers are potentially avoidable. Residents who experience repeat transfers are particularly vulnerable to adverse outcomes, yet characteristics of nursing home residents who experience repeat transfers are poorly understood.

Longitudinal analysis of aging in place at TigerPlace: Resident function and well-being.

This paper reports on a longitudinal eight-year analysis (2011-2019) of trajectory of function and well-being residents of TigerPlace Aging in Place (AIP) model of care. Residents were routinely assessed using standard health assessment instruments. Average scores from each measure were examined for changes or trends in resident function; decline over time was calculated.

Value Propositions for Health Information Exchange Toward Improving Nursing Home Hospital Readmission Rates.

The importance of health information technology use in nursing home (NH) care delivery is a major topic in research exploring methods to improve resident care. Topics of interest include how technology investments, infrastructure, and work-force development lead to better methods of nursing care delivery and outcomes. Value propositions, including perceived benefits, incentives, and system changes recognized by end-users, are important resources to inform NH leaders, policymakers, and stakeholders about technology.

A Call to Address RN, Social Work, and Advanced Practice Registered Nurses in Nursing Homes: Solutions From the Missouri Quality Initiative.

Background: US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff.

Problem: For nurse staffing, current regulations require only one registered nurse (RN) on duty 8 consecutive hours per day, 7 days per week, and one RN on call when a licensed practical/vocational nurse is on duty. There is no requirement for a degreed or licensed social worker, and advanced practice registered nurses (APRNs) in NHs cannot bill for services.

Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative.

Objectives: To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending.

Design: A four group comparative analysis of longitudinal data from September 2013 thru December 2019.

Setting: NHs in the interventions of both Phases 1 (2012-2016) and 2 (2016-2020) of MOQI (n=16) in the St.

Financial and Work-flow Benefits of Reducing Avoidable Hospitalizations of Nursing Home Residents.

Objectives: 1) Explain the financial benefit of potential revenue recapture (PRR) for non-billable days due to hospitalizations of nursing home (NH) residents using a six-year longitudinal analysis of 11 of 16 NHs participating in the Missouri Quality Initiative (MOQI); and 2) Discuss the work-flow benefits of early detection of changes in health status using qualitative data from all MOQI homes.

Design: A CMS funded demonstration project with full-time advanced practice registered nurses (APRN) and operations support team focused on reducing avoidable hospitalizations for long stay NH residents (2012-2020).

Setting And Participants: Setting was a sample of 11 of 16 US NHs participating in the CMS project.

Social practices of nurse care coordination using sensor technologies - Challenges with an alert system adoption in assisted living communities for older adults.

Objectives: From the view of everyday practices and the socio-technical coordination lens, this study aimed to analyz the gap between creators' intention and the users' implementation (mainly nursing staff and social workers) of an alert system in assisted living communities.

Methods: Qualitative methods were employed by way of five user interviews and focus groups with six system developers. Modeling instruments were applied for data collection to analyze the different clinical workflows versus the expectations of the system development team.

To Text or Not to Text? That is the Question.

Texting is ubiquitous with a text frequency of 145 billion/day worldwide. This paper provides partial results of the national demonstration project called the Missouri Quality Improvement Initiative (MOQI). MOQI goals were to reduce avoidable hospitalizations using APRNs to infuse evidence-based practices, model appropriate decisions and improve communication among workers responsible for nursing home resident care.

Take it to the resident: A model for engaging long-term stay residents in advance care planning.

Advance care planning involves a meaningful conversation about residents' end of life goals with the health-care team and documenting these wishes in advance directives; however, these conversations are not taking place early enough or with strategies that allow nursing home residents' preferences to be meaningfully integrated into care plans. This article outlines a new model that nursing home social workers can use to initiate advance care planning discussions called . This model was tested with 11 long-term stay nursing home residents.

Advance Directives in the Nursing Home Setting: An Initiative to Increase Completion and Reduce Potentially Avoidable Hospitalizations.

Advance directive (AD) completion can improve transitions between hospitals and skilled nursing facilities (SNF's). One Centers for Medicare and Medicaid Services (CMS) Innovations Demonstration Project, The Missouri Quality Initiative (MOQI), focused on improving AD documentation and use in sixteen SNF's. The intervention included education, training, consultation and improvements to discussion process, policy development, increased AD enactment, and increased community education and awareness activities.