"We're Preventing People From Going Into the Most Expensive Level of Care in Every Way that We Can": Barriers and Recommendations for Use of Local Funds.

Most older Americans do not financially qualify for Medicaid and support provided through the Older Americans Act is quite limited. In response, Ohio has generated funds for services for older adults through the use of local county tax levy programs. Ohio currently leads the nation in the utilization and support of local levy funding, generating more than US$200 million annually.

Loss Of Public Health Emergency Funds Challenges The Financial Viability Of Nursing Homes, Especially Not-For-Profit Facilities.

Before the COVID-19 pandemic, for-profit nursing homes' revenue generally covered their costs, whereas not-for-profit nursing homes often needed donations and other nonpatient revenue to cover expenses. The unprecedented challenges presented by the pandemic caused the industry to report operating losses that were larger among not-for-profits and facilities relying on agency staff. COVID-19 public health emergency funding allowed nursing homes to remain profitable through 2021.

Nursing Homes Increasingly Rely On Staffing Agencies For Direct Care Nursing.

When nursing homes experience a shortage in directly employed nursing staff, they may rely on temporary workers from staffing agencies to fill this gap. This article examines trends in the use of staffing agencies among nursing homes during the prepandemic and COVID-19 pandemic era (2018-22). In 2018, 23 percent of nursing homes used agency nursing staff, accounting for about 3 percent of all direct care nursing hours worked.

Associations between Complaints and Organizational Characteristics among Ohio Nursing Homes.

Objectives: In recent years, Ohio nursing homes (NHs) have received an increasing number of complaints. The current study aims to gain a better understanding of the relationship between NH organizational characteristics and the number of complaints.

Design: Secondary data analysis was used.

The Impact of an Electronic Best Practice Advisory on Patients' Physical Activity and Cardiovascular Risk Profile.

Background: Regular physical activity (PA) is a component of cardiovascular health and is associated with a lower risk of cardiovascular disease (CVD). However, only about half of US adults achieved the current PA recommendations.

Objective: The study purpose was to implement PA counseling using a clinical decision support tool in a preventive cardiology clinic and to assess changes in CVD risk factors in a sample of patients enrolled over 12 weeks of PA monitoring.

Strategies to Address COVID-19 Vaccine Hesitancy Among Ohio Nursing Home Staff.

Background And Objectives: Despite federal legislation requiring nursing home (NH) staff members to be vaccinated against coronavirus disease 2019 (COVID-19), unvaccinated staff pose an ongoing public health risk. The research question guiding this study is as follows: What is the relationship between strategies to address vaccine hesitancy and vaccination rates among staff? We used the diffusion of innovation (DOI) theory as a theoretical framework.

Research Design And Methods: The sample (N = 627) included Ohio-based NHs.

If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community.

Objectives: Some communities across the nation are utilizing alternative funding sources to better support home and community-based services for older adults.

Methods: A variety of methods identified local initiatives across the United States. An online survey was distributed to a total of 377 communities in 15 states identified as using locally raised funds to provide aging services, yielding a 55% response rate.

Prevalence of COVID-19 in Ohio Nursing Homes: What's Quality Got to Do with It?

With nursing homes being hit hard by the COVID-19 pandemic, it is important to know whether facilities that have any cases, or those with particularly high caseloads, are different from nursing homes that do not have any reported cases. Our analysis found that through mid-June, just under one-third of nursing homes in Ohio had at least one resident with COVID-19, with over 82% of all cases in the state coming from 37% of nursing homes. Overall findings on the association between facility quality and the prevalence of COVID-19 showed that having any resident case of the virus or even having a high caseload of residents with the virus is not more likely in nursing homes with lower quality ratings.

Organizational Factors Associated With Retention of Direct Care Workers: A Comparison of Nursing Homes and Assisted Living Facilities.

Background And Objectives: Low retention of direct care workers (DCWs), either certified nursing assistants in nursing homes (NHs) or personal care assistants in assisted living (AL), continues to be an unresolved problem. While numerous studies have examined predictors of DCW retention in NHs, little attention has been paid to differences between settings of long-term care. This study compares the predictors of DCW retention rates across both settings.

Facility-Level Factors Associated With CNA Turnover and Retention: Lessons for the Long-Term Services Industry.

Background And Objectives: Certified nursing assistant (CNA) turnover and retention are critical aspects of facilities' ability to provide cost-effective, high-quality person-centered care. Previous studies and industry practice often treat turnover and retention as similar concepts, assuming that low turnover and high retention are synonymous. The study addressed the question of whether turnover and retention rates differ and if so, what those differences mean for nursing home practice, policy, and research.

Local Initiatives to Fund Services for Older Americans: Community Recognition of the Importance of Social Care.

Despite the growing proportion of older adults in the United States, federal and state funding for nonmedical supportive services remains limited. To meet increasing demand, some communities across the nation are exploring alternative funding sources for aging services. Although no systematic database exists to track such local programs, through an array of data sources including a national survey, telephone contacts, and a web review, we identified 15 states that are using local funding to support aging services.

Transbuccal platform for delivery of lipogenic actives to facial skin: Because fat matters.

The ability to control facial skin physiology and appearance through the oral mucosa (transbuccally) is largely unexplored. Here, a hypothesis was tested that transbuccal delivery of fat tissue-supportive actives may trigger beneficial cosmetic responses at the level of the skin. First, the importance of the fat tissue for skin structure and function was established by comparative analysis of human biopsies cultured defatted or in the presence of hypodermis, using macroscopic observation, quantitative polymerase chain reaction, and histochemistry.

Klippel-Feil syndrome: A very unusual cause of severe aortic regurgitation visualized by multimodality imaging.

A 51-year-old man with Klippel-Feil syndrome (KFS) and immunodeficiency syndrome, status postintravenous immunoglobulin therapy, presented with shortness of breath. He was found to have severe aortic regurgitation in the setting of a trileaflet aortic valve with thickened leaflets and mild prolapse of the right coronary cusp with left ventricular dilation and borderline left ventricular ejection fraction. Although various cardiac anomalies have been described in KPS, otherwise unexplained severe aortic regurgitation has not been previously reported to the best of our knowledge.

It Is Not Your Parents' Long-Term Services System: Nursing Homes in a Changing World.

The long-term services system has changed substantially since the mid-1970s, when the landmark book argued that the move to the nursing home was the last move an older person would make until death. Using detailed nursing home utilization data from the Minimum Data Set, this study tracks three cohorts of first-time nursing home admissions in Ohio from 1994 through 2014. Each cohort was followed for a 3-year period.

Is There a Woodwork Effect? Addressing a 200-Year Debate on the Impacts of Expanding Community-Based Services.

In U.S. social welfare history, many have suggested that if benefits were too attractive, consumers would come out of the woodwork to take advantage of the opportunity.

Totally Endoscopic Robotic Left Atrial Appendage Closure Demonstrates High Success Rate.

Objective: In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE).

The Residential Long-Term Care Role in Health Care Transitions.

The objective of the current study is to describe the activities long-term care facilities are undertaking to reduce hospital admissions and readmissions by working to improve health care transitions. The data were collected via an online survey from 888 nursing facilities (NFs) and 527 residential care facilities (RCFs) that completed the care integration module of the Ohio Biennial Survey of Long-Term Care. Questions focused on partnerships, current work, type of care model, and perceived barriers to reducing hospital readmissions.

How Does Medicaid Reimbursement Impact Nursing Home Quality? The Effects of Small Anticipatory Changes.

Objective: In 2006, Ohio changed its Medicaid reimbursement methodology for nursing homes (NHs) to promote more efficient staffing levels. This study examines the impacts of this policy change on quality.

Research Design And Subjects: Ohio NHs were categorized based on their anticipated change in reimbursement under a new reimbursement system initiated in 2006.

Left Atrial Appendage Velocity as a Predictor of Atrial Fibrillation After Cardiac Surgery.

Objective: To determine if there is an association between left atrial appendage velocity and the development of postoperative atrial fibrillation (POAF).

Design: Single institution retrospective study performed between January 2013 and December 2013.

Setting: Single-institution, university hospital.

Systolic anterior motion of the mitral valve: a 30-year perspective.

Objective: Systolic anterior motion (SAM) can occur after mitral valve repair (MVr), most frequently in patients with degenerative valve disease. Our initial observations (1981-1990) revealed that most patients with SAM can be successfully treated medically. Here the authors review the last 16 years of their experience with SAM after MVr.

Intimal sarcoma in the aortic arch partially obstructing the aorta with metastasis to the brain.

Primary tumors of the aorta are rare entities. We report the unusual manifestation of an aortic intimal sarcoma that presented as a brain metastasis in a 56-year-old, otherwise healthy woman. After the brain mass had been resected, multiple imaging methods revealed pseudocoarctation and the primary tumor in the aortic arch.