Nursing home medical staff organization and 30-day rehospitalizations.

Objectives: To examine the relationship between features of nursing home (NH) medical staff organization and residents' 30-day rehospitalizations.

Design: Cross-sectional study combining primary data collected from a survey of medical directors, NH resident assessment data (minimum data set), Medicare claims, and the Online Survey Certification and Reporting (OSCAR) database.

Setting: A total of 202 freestanding US nursing homes.

Sharp rise in Medicare enrollees being held in hospitals for observation raises concerns about causes and consequences.

When it is not clear that an ill patient needs to be hospitalized, he or she may be placed "under observation" in a hospital for further evaluation and short-term treatment. These hospital observation services, often a kind of halfway point between emergency department treatment and full inpatient admission, have become a hotly debated policy issue and subject of lawsuits. Using Medicare enrollment and claims data nationwide, we documented a rising trend in the prevalence and duration of hospital observation services in the fee-for-service Medicare population during 2007-09, accompanied by a downward shift in inpatient admissions.

Primary caregiver characteristics and transitions in community-based care.

Objectives: To identify informal primary caregiver characteristics associated with care transitions of community-dwelling older persons with impairments in daily living activities.

Method: Data for this study were pooled to observe transitions from Wave 1-Wave 2 and Wave 2-Wave 3 of the Second Longitudinal Survey on Aging (LSOA II). The sample includes respondents with at least one impairment in daily living activities and with an informal caregiver at baseline of each transition period (n = 2,990).

Despite small improvement, black nursing home residents remain less likely than whites to receive flu vaccine.

Vaccination is a key deterrent to influenza and its related complications and outcomes, including hospitalization and death. Using 2006-09 data, we found a small improvement in vaccination rates among nursing home residents, particularly for blacks. Nonetheless, overall vaccination rates remained well below the 90 percent target for high-quality care, and black nursing home residents remained less likely to be vaccinated than whites.

Effect of increased nursing home hospice use on nursing assistant staffing.

Background: Since 1999, there has been a significant increase in hospice providers and hospice use in nursing homes. A 1997 Office of Inspector General (OIG) report warned of possible kickbacks, monetary and otherwise, that might be paid by hospices to nursing homes in exchange for referrals. One possible kickback mentioned in the report was nursing homes receiving additional staff hours at no cost, which could lead to decreases in nursing home staffing.

Profiles of Racial Socialization Among African American Parents: Correlates, Context, and Outcome.

Self report and observational data on racial socialization practices in a sample of 218 African American parents of young children were used to determine whether or not parents could be characterized in terms of their pattern of racial socialization practices. Parents fell into four groups: silence about race, emphasis on cultural socialization, emphasis on cultural socialization and coping strategies, or a balanced approach. Silence about race was more common among parents of boys, whereas an emphasis on cultural socialization was more common among parents of girls.

The Care Span: Growth of racial and ethnic minorities in US nursing homes driven by demographics and possible disparities in options.

Between 1999 and 2008, the number of elderly Hispanics and Asians living in US nursing homes grew by 54.9 percent and 54.1 percent, respectively, while the number of elderly black residents increased 10.

Hospitalizations in nursing homes: does payer source matter? Evidence from New York State.

The objective of this study was to examine the reasons for different hospitalization rates between Medicaid and private-pay nursing home residents-to disentangle within-facility differences from across-facility variations in hospitalizations between these two types of residents. Multiple data sources (2003) for New York State were linked. Hospitalization was the dependent variable.

Influenza vaccination and its impact on hospitalization events in nursing homes.

Objectives: To examine trends of influenza vaccination in nursing homes before and after public reporting (objective-1), and to assess the effect of influenza vaccinations on hospitalization events (objective-2).

Research Design: Nursing Home Compare (NHC) database was used to obtain influenza vaccination rates during the 2005-2006, 2006-2007, and 2007-2008 flu seasons (objective-1). The 2005-2007 Minimum Data Set for New York State (NYS) was obtained and linked with the NHC data (objective-2).

An industry in the making: the emergence of institutional elder care in urban china.

Demographic shifts in China pose unprecedented challenges in the care of a rapidly growing older population. Sporadic reports suggest the recent emergence of institutional elder care in China, but little is currently known about this phenomenon. This study documents the growth, ownership, financing, staffing, and resident characteristics of elder care institutions using survey data collected in 2009 from Nanjing, China, supplemented with government registry data from seven additional major Chinese cities.

Medicare hospice care in US nursing homes: a 2006 update.

Introduction: This research examines 2006 population-based data on persons who died in US nursing homes (NHs) and received hospice in the NH.

Methods: We compared dying persons characteristics and lengths of hospice stay in five US states between 1992 and 1996 and in 2006. We also compared characteristics of dying persons in 2006 by whether they first entered hospice in the community (i.

The effect of state policies on nursing home resident outcomes.

Objectives: To test the effect of changes in Medicaid reimbursement on clinical outcomes of long-stay nursing home (NH) residents.

Design: Longitudinal, retrospective study of NHs, merging aggregated resident-level quality measures with facility characteristics and state policy survey data.

Setting: All free-standing NHs in urban counties with at least 20 long-stay residents per quarter (length of stay > 90 days) in the continental United States between 1999 and 2005.

Validation of the Minimum Data Set in identifying hospitalization events and payment source.

Objectives: To evaluate the accuracy of the Minimum Data Set (MDS) in identifying hospitalization events and payment source among nursing home residents.

Research Design: The 2003 MDS, Medicare Provider Analysis and Review File (MedPAR), Medicare denominator file, Medicaid Analytical Extract (MAX) long-term care file, and MAX personal summary file for 4 states (California, Ohio, New York, and Texas) were obtained and merged.

Setting: All Medicare/Medicaid-certified nursing ho-mes in these 4 states during 2003.

Conducting telephone interviews with community-dwelling older adults in a state Medicaid program: differences by ethnicity and language preference.

We document the methodological challenges of conducting a health survey of an ethnically diverse elderly community-dwelling Medicaid population by telephone. Individuals (N=5,382) 65 years and older were randomly selected from a state Medicaid Management Information System and 618 eligible participants were interviewed. Participants were classified as non-Hispanic White, English-speaking (NHW-E; 69.

How valid are the responses to nursing home survey questions? Some issues and concerns.

Purpose: Although surveys are usually piloted before fielding, cognitive-based testing of surveys is not standard practice in nursing home (NH) research. Many terms used in the literature do not have standard definitions and may be interpreted differently by researchers, respondents, and policy makers. The purpose of this study was to ensure that survey respondents understood questions as intended, determine whether the Nursing Home Administrator (NHA) or the Director of Nursing (DON) was better able to answer questions on certain topics, and to inform the answer choices provided for questions.

Hospice use among urban Black and White U.S. nursing home decedents in 2006.

Purpose: Medicare hospice is a valuable source of quality care at the end of life, but its lower use by racial minority groups is of concern. This study identifies factors associated with hospice use among urban Black and White nursing home (NH) decedents in the United States.

Design And Methods: Multiple data sources are combined and multilevel logistic regression is utilized to examine hospice use among urban Black and White NH residents who had access to hospice and died in 2006 (N = 288,202).

Does fall history influence residential adjustments?

Purpose Of The Study: To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years.

Design And Methods: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of community-living older adults, 65 years of age and older. At baseline, fall history (no fall, 1 fall no injury, 2 or more falls no injury, or 1 or more falls with an injury) and factors potentially associated with RA were used to predict the initiation of an RA (i.

The residential history file: studying nursing home residents' long-term care histories(*).

Objective: To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non-Medicare-paid NH stays.

Data Sources: Online Survey of Certification and Reporting (OSCAR) data for 202 free-standing NHs, Medicare Denominator, claims (parts A and B), and MDS assessments for 60,984 people who were present in one of these NHs in 2006.

Methods: The algorithm creating the RHF is outlined and the RHF for the study data are used to describe place of death.

The complexity of implementing culture change practices in nursing homes.

Purpose: The culture change (CC) movement aims to transform the traditional nursing home (NH) that is institutional in design with hierarchical management structure into a homelike environment that empowers residents and frontline staff. This study examines differences in adoption of CC practices according to a NH's self-reported extent of CC implementation and its duration of CC adoption. Furthermore, it examines differences in adoption by whether a CC practice is considered less versus more complex, using complexity theory as the theoretical framework for this classification.

Effects of cumulative risk on behavioral and psychological well-being in first grade: moderation by neighborhood context.

This study builds upon existing research by examining whether risk indices for child psychological well-being behave in the same way in different types of neighborhoods. Specifically, we sought to determine if neighborhood characteristics acted to exacerbate or, alternatively, to buffer risk factors at the family and/or child level. Families with a child entering first grade in Fall 2002 were recruited from Baltimore City neighborhoods, defined as census block groups.

Staff teamwork in long-term care facilities: the influence of management style, training, and feedback.

The purpose of this study was to describe the organizational factors associated with high and low amounts of teamwork among direct-care workers in long-term care (LTC) facilities. A systematic analysis of observation data collected at 20 LTC facilities was first used to categorize facilities as high-, moderate-, or low-teamwork facilities. Next, qualitative analysis of 59 interviews collected in 4 high-teamwork and 5 low-teamwork facilities was used to identify the organizational factors associated with high and low teamwork.

Do Medicaid wage pass-through payments increase nursing home staffing?

Objective: To assess the impact of state Medicaid wage pass-through policy on direct-care staffing levels in U.S. nursing homes.

A model for successful nursing home-hospice partnerships.

Background: While benefits of hospice care in nursing homes have been documented, interorganizational challenges such as staff conflicts regarding planned care or their respective roles have also been documented. Through case studies, this research aimed to characterize the partnerships of successful nursing home-hospice collaborators.

Methods: Six nursing homes and hospices with self-identified successful collaborations were studied.

Prevalence of nursing assistant training and certification programs within nursing homes, 1997-2007.

Purpose: The purpose of this study was to describe how the prevalence of nurse aide training and competency evaluation programs (NATCEPs) provided in the nursing home (NH) setting changed between 1997 and 2007, to explore the environmental factors that may be influencing the prevalence of these programs, and to examine how the changing prevalence of NH-based NATCEPs may be affecting those considering certified nursing assistant (CNA) work.

Methods: We used the Online Survey Certification and Reporting (OSCAR) data to generate descriptive statistics for 3 groups of NHs from 1997 to 2007: NHs that never provided an NATCEP, those that provided the program throughout the study period, and those that provided the program intermittently. We gathered information on states' policies regarding CNA training by telephone and Internet.