Helping Older Residents Remain in Subsidized Housing: Predictive Validity of the Live Well at Home-Rapid Screen (LWAH-RS) in a Real-World Application.

Common Bond Communities (CBC) is a nonprofit organization that provides housing for low-income individuals and families. CBC utilized the Live Well at Home-Rapid Screen (LWAH-RS) to identify the risks for nursing home admission or assisted living entry among housing residents aged 60 or above. Drawing data from 842 assessments, we studied how well the LWAH-RS predicted moves to nursing homes or assisted living settings.

What we learned through asking about evidence: A model for interdisciplinary student engagement.

Traditional university learning modalities of lectures and examinations do not prepare students fully for the evolving and complex world of gerontology and geriatrics. Students involved in more active, self-directed learning can develop a wider breadth of knowledge and perform better on practical examinations. This article describes the Evidence in Aging (EIA) study as a model of active learning with the aim of preparing students to be effective interdisciplinary researchers, educators, and leaders in aging.

Prevention of Functional Decline by Reframing the Role of Nursing Homes?

Institutionalization is generally a consequence of functional decline driven by physical limitations, cognitive impairments, and/or loss of social supports. At this stage, intervention to reverse functional losses is often too late. To be more effective, geriatric medicine must evolve to intervene at an earlier stage of the disability process.

Care-Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents: A Systematic Review and Meta-analysis.

Objectives: To evaluate the efficacy of nonpharmacological care-delivery interventions (staff training, care-delivery models, changes to the environment) to reduce and manage agitation and aggression in nursing home and assisted living residents.

Design: Three bibliographic databases, references of systematic reviews, ClincalTrials.gov, and the International Controlled Trials Registry Platform were systematically searched for randomized controlled trials reporting behavioral outcomes for nonpharmacological care-delivery interventions in nursing homes and assisted living facilities.

Re-imagining long-term services and supports: towards livable environments, service capacity, and enhanced community integration, choice, and quality of life for seniors.

In the half century since enactment of the 1965 Great Society programs, accomplishments were gradually made to improve access to and quality of long-term services and supports (LTSS), including: mitigation of financial and care abuses in nursing facilities (NFs); substantial rebalancing of LTSS towards consumer-preferred home-and-community-based services (HCBS); increasing flexible consumer-centered HCBS including payment to family caregivers; and more assisted-living and housing options for seniors with heavy care needs. A unified planning and advocacy agenda across age and disability type and greater consumer transparency fueled progress. Nonetheless, LTSS is a broken system; persistent problems interfere with substantial and necessary change.

Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care.

Despite a shift from institutional services toward more home and community-based services (HCBS) for older adults who need long-term services and supports (LTSS), the effects of HCBS have yet to be adequately synthesized in the literature. This review of literature from 1995 to 2012 compares the outcome trajectories of older adults served through HCBS (including assisted living [AL]) and in nursing homes (NHs) for physical function, cognition, mental health, mortality, use of acute care, and associated harms (e.g.

Does home- and community-based care affect nursing home use?

A study was conducted to assess change in numbers, expenditures, and case mix of nursing home residents as Medicaid investment in home- and community-based services (HCBS) 1915(c) waivers increased in seven states. The seven states provided Medicaid expenditure and utilization data from 2001 to 2005, including waiver and state plan utilization. The Minimum Data Set was used for nursing home residents.

Use of mental health care by community-dwelling older adults.

Objectives: To examine relationships between perceived need for care, illness characteristics, attitudes toward care, and probability that older adults will use mental health care (MHC).

Design: Secondary data analysis.

Setting: The Collaborative Psychiatric Epidemiology Surveys (2001-2003).

Perceived need for mental health care among community-dwelling older adults.

Only half of older adults with a mental disorder use mental health services, and little is known about the causes of perceived need for mental health care (MHC). We used logistic regression to examine relationships among depression, anxiety, chronic physical illness, alcohol abuse and/or dependence, sociodemographics, and perceived need among a national sample of community-dwelling individuals 65 years of age and older (the Collaborative Psychiatric Epidemiology Surveys data set). Less than half of respondents with depression or anxiety perceived a need for care.

We've looked at care from both sides now: the effects of alternative evaluation strategies on study conclusions.

This study uses two studies about the role of managed-care programs in serving Medicaid long-term care clients in Florida to illustrate how different research designs can reach divergent conclusions. Two reports from different groups using essentially the same database to assess the impact of managed care on a group of older Medicaid clients served by a Nursing Home Diversion Program reached different conclusions. The report from Florida's Office of Program Policy Analysis and Government Accountability concluded that the Diversion program saved money, whereas the report from the Florida Policy Exchange Center on Aging at the University of South Florida reached basically the opposite conclusion.

Developing a research agenda for assisted living.

Purpose: We describe an approach to identifying knowledge gaps, research questions, and methodological issues for assisted living (AL) research.

Design And Methods: We undertook an inventory of AL literature and research in progress and commissioned background papers critiquing knowledge on selected subtopics. With an advisory committee, we identified a comprehensive list of researchable questions of potential utility to consumers, providers, and/or policy makers, which AL researchers then rated as to their importance.

Assisted living literature through May 2004: taking stock.

Purpose: This article assesses the state of research on assisted living (AL) from 1989 to May 2004.

Design And Methods: We undertook keyword searches for AL research and amplified these with searches of Web sites, conference proceedings, and follow-up inquiries. We annotated and coded the resultant items according to categories reflecting the research methods used and the topics studied.

Identifying the barriers and challenges to voting by residents in nursing homes and assisted living settings.

To ascertain the need for and to inform development of guidelines for voting in long-term care settings, we conducted a telephone survey of Philadelphia nursing (n = 31) and assisted living (n = 20) settings following the 2003 election. Substantial variability existed in procedures used for registration and voting, in staff attitudes, and in the estimated proportion of residents who voted (29%+/-28, range 0-100%). Residents who wanted to vote were unable to do so at nearly one-third of sites, largely due to procedural problems.

Effects of Green House nursing homes on residents' families.

A longitudinal quasi-experimental study with two comparison groups was conducted to test the effects of a Green House (GH) nursing home program on residents' family members. The GHs are individual residences, each serving 10 elders, where certified nursing assistant (CNA)-level resident assistants form primary relationships with residents and family, family is encouraged to visits, and professionals adapted their roles to support the model. GH family were somewhat less involved in providing assistance to their residents although family contact did not differ among the settings at any time period.

Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial green house program.

Objectives: To determine the effects of a small-house nursing home model, THE GREEN HOUSE (GH), on residents' reported outcomes and quality of care.

Design: Two-year longitudinal quasi-experimental study comparing GH residents with residents at two comparison sites using data collected at baseline and three follow-up intervals.

Setting: Four 10-person GHs, the sponsoring nursing home for those GHs, and a traditional nursing home with the same owner.

Predictors of institutionalization in Latinos with dementia.

The present study identified predictors of time to institutionalization among elderly Latinos suffering from dementia, and determined how these predictors varied when compared to Caucasians and African-Americans. The sample included 324 Latino, 701 African-American, and 7,100 Caucasian dementia patients and their caregivers recruited from eight catchment regions in the U.S.

Resident and family perspectives on assisted living.

This research describes and compares the relative importance residents and family members place on attributes of the environment, the programs, and the policies of assisted living; describes their satisfaction with these features; and identifies factors associated with congruence between residents' and family members' ratings of importance and satisfaction. Both residents and their family members had high importance and satisfaction ratings. Family members gave the assisted living setting lower satisfaction ratings on all features than did residents.

Radical redesign of nursing homes: applying the green house concept in Tupelo, Mississippi.

Purpose: We present the concept of the Green House, articulated by William Thomas as a radically changed, "deinstitutionalized" nursing home well before its first implementation, and we describe and discuss implications from the first Green Houses in Tupelo, Mississippi.

Design And Methods: Green Houses are small, self-contained houses for 10 or fewer elders, each with private rooms and full bathrooms and sharing family-style communal space, including hearth, dining area, and full kitchen. Line staff at the level of certified nursing assistants, called Shahbazim, are "universal workers," who cook meals, do laundry, provide personal care, assist with habilitation, and promote the elders' quality of life.