Category Archives: Nursing Homes & Long Term Care

Knee pain in nursing home workers after implementation of a safe resident handling program

Source: Judith E. Gold, Alicia Kurowski, Rebecca J. Gore, Laura Punnett, American Journal of Industrial Medicine, Volume 61 Issue 10, October 2018
(subscription required)

From the abstract:
Purpose:
Approximately 25‐30% of nursing personnel experience knee pain (KP). We sought to identify physical and psychosocial work exposures, and personal factors related to prevalent, incident, and persistent KP 5‐8 years after safe resident handing program (SRHP) implementation in nursing homes.

Methods:
Health and exposure information was obtained from worker surveys 5‐6 years (“F5”) and 7‐8 years (“F6”) post‐SRHP implementation. Prevalent KP correlates were examined at F5; persistent and incident KP predictors were analyzed at F6, utilizing robust Poisson multivariable regression.

Results:
F5 KP prevalence (19.7%) was associated with combined physical exposures, and with either high job strain or low social support, in separate models. Two‐year persistent KP was similarly associated with these psychosocial exposures. Being overweight was associated with KP in all analyses.

Conclusions:
The SRHP program did not eliminate knee physical loading, which should be reduced to prevent nursing home worker KP. Workplace psychosocial exposures (high job strain, low social support) also appeared germane.

1,400 Nursing Homes Get Lower Medicare Ratings Because Of Staffing Concerns

Source: Jordan Rau and Elizabeth Lucas, Kaiser Health News, July 30, 2018

Medicare has lowered its star ratings for staffing levels in 1 in 11 of the nation’s nursing homes — almost 1,400 of them — because they either had inadequate numbers of registered nurses or failed to provide payroll data that proved they had the required nursing coverage, federal records released last week show.

Medicare only recently began collecting and publishing payroll data on the staffing of nursing homes as required by the Affordable Care Act of 2010, rather than relying as it had before on the nursing homes’ own unverified reports.

The payroll records revealed lower overall staffing levels than homes had disclosed, particularly among registered nurses. Those are the highest-trained caregivers required to be in a nursing home, and they supervise other nurses and aides. Medicare mandates that every facility have a registered nurse working at least eight hours every day…..

….The new payroll data, analyzed by Kaiser Health News, showed that for-profit nursing homes averaged 16 percent fewer staff than did nonprofits, even after accounting for differences in the needs of residents. The biggest difference was in the number of registered nurses: At the average nonprofit, there was one RN for every 28 residents, but at the average for-profit, there was only one RN for every 43 residents. Researchers have repeatedly found lower staffing in for-profit facilities, which make up 70 percent of the industry….

Related:
Mining A New Data Set To Pinpoint Critical Staffing Issues In Skilled Nursing Facilities
Source: Jordan Rau, Kaiser Health News, July 30, 2018

The Centers for Medicare & Medicaid Services is not known for linguistic playfulness. Nonetheless, at least one person there must have been chuckling when it named its rich new data source for nursing home staffing levels the Payroll-Based Journal, or PBJ.

Like that classic sandwich, the PBJ data set is irresistible. CMS created it to fulfill a requirement of the Affordable Care Act to improve the accuracy of its five-star staffing ratings on Medicare’s Nursing Home Compare website. The data set contains payroll records that nursing homes are required to submit to the government.

In April, Medicare began using them to rate staffing for more than 14,000 skilled nursing facilities (SNFs). The PBJ data gives a much better look at the how staffing relates to quality of care than the less precise — and too easy to inflate — staffing data Medicare had been using since 2008, which were based on two-week snapshots of staffing homes provided to inspectors. The data show staffing and occupancy on every day — an unprecedented degree of granularity that allows for new levels of inquiry.

What Consumers Say About Nursing Homes in Online Reviews

Source: Caitlyn Kellogg, Yujun Zhu, Valeria Cardenas, Katalina Vazquez, Kayla Johari, Anna Rahman, Susan Enguidanos, The Gerontologist, Advance Access, published April 20, 2018
(subscription required)

From the abstract:
Background:
Although patient-centered care is an expressed value of our healthcare system, no studies have examined what consumers say in online reviews about nursing homes (NHs). Insight into themes addressed in these reviews could inform improvement efforts that promote patient-centered NH care.

Research Design and Methods:
We analyzed nursing home (NH) Yelp reviews. From a list of all NHs in California, we drew a purposeful sample of 51 NHs, selecting facilities representing a range of geographical areas and occupancy rates. Two research teams analyzed the reviews using grounded theory to identify codes and tracked how frequently each code was mentioned.

Results:
We evaluated 264 reviews, identifying 24 codes, grouped under five categories: quality of staff care and staffing; physical facility and setting; resident safety and security; clinical care quality; and financial issues. More than half (53.41%) of Yelp reviewers posted comments related to staff attitude and caring and nearly a third (29.2%) posted comments related to staff responsiveness. Yelp reviewers also often posted about NHs’ physical environment. Infrequently mentioned were the quality of health care provided and concerns about resident safety and security.

Discussion and Implications:
Our results are consistent with those from related studies. Yelp reviewers focus on NH aspects that are not evaluated in most other NH rating systems. The federal Nursing Home Compare website, for instance, does not report measures of staff attitudes or the NH’s physical setting. Rather, it reports measures of staffing levels and clinical processes and outcomes. We recommend that NH consumers consult both types of rating systems because they provide complementary information.

Distributional Effects of Alternative Strategies for Financing Long-Term Services and Supports and Assisting Family Caregivers

Source: Melissa M. Favreault and Richard W. Johnson, Center for Retirement Research at Boston College, WP#2018-1, March 2018

From the abstract:
We use two historical data sources – the Health and Retirement Study and the Medicare Current Beneficiary Study – to consider the patterns in older Americans’ severe disability and their use of long-term services and supports (LTSS) by age and socioeconomic status.  We then use a dynamic microsimulation model to project how the effects of various interventions to support those with severe disabilities and their caregivers would be distributed across the income distribution.  The interventions that we examine fall into three broad classes: tax credits for caregiving expenses, respite care for people in the community with family caregivers, and new social insurance programs.  Within each broad class of policies, we examine how sensitive outcomes are to changes in policy details (such as, in the case of tax credits, deductible levels, refundability, and income phase-outs).

This paper found that:
– Older adults with less education and less wealth are more likely to report disabilities and service use than their more educated and wealthier counterparts.
– This pattern persists when we look at people at a point in time but also, more robustly, when we look at their disabilities prospectively. In a sample of older adults who do not report disabilities at baseline, we find that those with fewer economic resources earlier in life are generally more likely to develop disabilities and use paid LTSS over the next two decades, but the differences narrow when we restrict the sample to people who do not develop disabilities until their late 70s.  

The policy implications of this paper are:
– The uneven distribution of disability risks across the population poses challenges for developing effective LTSS policies. Those most likely to need LTSS often lack enough resources to contribute to LTSS programs, and programs that try to contain costs by using underwriting or imposing work requirements often disqualify those who most need coverage.
– Certain classes of policies, such as respite care benefits, tend to direct much of their benefits to those in lower income quintiles, according to our projections. Caregiver tax credits and social insurance programs generally distribute benefits more proportionally, although impacts vary depending on how the policies are specified.
– Policy design details can significantly affect distributional outcomes. Provisions’ effects can be sensitive to the stacking order in which they are implemented.
– It can be useful to examine trends and proposals not only cross-sectionally but also over longer time periods. For example, the distributional effects of social insurance programs depend on the relatively high early-life mortality of those with less education and lower earnings and wealth.

Unpaid Caregiving Roles and Sleep Among Women Working in Nursing Homes: A Longitudinal Study

Source: Nicole DePasquale, Martin J Sliwinski, Steven H Zarit, Orfeu M Buxton, David M Almeida, The Gerontologist, Advance Access, Published: January 19, 2018
(subscription required)

From the abstract:
Background and Objectives:
Although sleep is a critical health outcome providing insight into overall health, well-being, and role functioning, little is known about the sleep consequences of simultaneously occupying paid and unpaid caregiving roles. This study investigated the frequency with which women employed in U.S.-based nursing homes entered and exited unpaid caregiving roles for children (double-duty-child caregivers), adults (double-duty-elder caregivers), or both (triple-duty caregivers), as well as examined how combinations of and changes in these caregiving roles related to cross-sectional and longitudinal sleep patterns.

Research Design and Methods:
The sample comprised 1,135 women long-term care employees who participated in the baseline wave of the Work, Family, and Health Study and were assessed at three follow-up time points (6-, 12-, and 18-months). Sleep was assessed with items primarily adapted from the Pittsburgh Sleep Quality Index and wrist actigraphic recordings. Multilevel models with data nested within persons were applied.

Results:
Women long-term care employees entered and exited the unpaid elder caregiving role most frequently. At baseline, double-duty-child and triple-duty caregivers reported shorter sleep quantity and poorer sleep quality than their counterparts without unpaid caregiving roles, or workplace-only caregivers. Double-duty-elder caregivers also reported shorter sleep duration compared to workplace-only caregivers. Over time, double-duty-elder caregiving role entry was associated with negative changes in subjective sleep quantity and quality.

Discussion and Implications:
Simultaneously occupying paid and unpaid caregiving roles has negative implications for subjective sleep characteristics. These results call for further research to advance understanding of double-and-triple-duty caregivers’ sleep health and facilitate targeted intervention development.

Does Paid Family Leave Reduce Nursing Home Use? The California Experience

Source: Kanika Arora, Douglas A. Wolf, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018
(subscription required)

From the abstract:
The intent of Paid Family Leave (PFL) is to make it financially easier for individuals to take time off from paid work to care for children and seriously ill family members. Given the linkages between care provided by family members and the usage of paid services, we examine whether California’s PFL program influenced nursing home utilization in California during the 1999 to 2008 period. This is the first empirical study to examine the effects of PFL on long-term care patterns. Multivariate difference-in-difference estimates across alternative comparison groups provide consistent evidence that the implementation of PFL reduced the proportion of the elderly population in nursing homes by 0.5 to 0.7 percentage points. Our preferred estimate, employing an empirically-matched group of control states, finds that PFL reduced nursing home usage by about 0.65 percentage points. For California, this represents an 11 percent relative decline in elderly nursing home utilization.

Comparing Public Quality Ratings for Accredited and Nonaccredited Home Health Agencies

Source: Scott C. Williams, David J. Morton, Susan Yendro, Home Health Care Management & Practice, Vol 30, Issue 1, 2018
(subscription required)

From the abstract:
This was a descriptive study comparing 1,582 accredited and 10,008 nonaccredited home health agencies over a 3-year period using the Centers for Medicare and Medicaid Services Home Health Compare data set. Metrics included the star rating and 22 quality measures. A longitudinal model was used to determine differences between accredited and nonaccredited organizations on the quality measures. Categorical differences in star ratings and risk-adjusted outcome categories were analyzed using a chi-square test. Accredited agencies had statistically higher star ratings than nonaccredited organizations (3.4 vs. 3.2, p < .001), and they were more likely to be categorized 4, 4.5, and 5 star organizations (p < .001). Absolute differences between accredited and nonaccredited agencies on the OASIS quality measures were generally small but consistently favored accredited facilities over all 3 years studied (p < .05).

Nursing Home Workers Win Wage Gains with Credible Strike Threat

Source: Leah Fried, Labor Notes, May 26, 2017

After close to three years of negotiations, stickers and leaflets weren’t getting the boss any closer to a fair agreement. The master contract covering 10,000 nursing home workers in Illinois had been expired for two years and extended several times.

Management was insisting on a wage freeze until Illinois overcame its budget impasse and increased Medicaid reimbursements. Long-term workers were languishing at minimum wage, even when their employers had begun offering higher wages to entice new hires.

Meanwhile, staffing was dangerously short. Often a certified nursing assistant was forced to care for 20 or more residents in an eight-hour shift—bathing, feeding, and assisting them at a furious pace. On top of keeping the nursing home clean, a housekeeper had to collect meal trays for hundreds of residents because there weren’t enough dietary aides.

To win a new agreement, it was clear that workers would need to be prepared to strike.

But their local, Service Employees (SEIU) Healthcare Illinois-Indiana (HCII), hadn’t ever waged a strike over its master nursing home contract. In fact, the last time there was a nursing home strike at any of these facilities was in 1979. The local’s previous contract campaigns had been lackluster. Mobilization had been limited to stickers, petitions, and a practice picket.

And giving each nursing home the organizing attention it needed now was a huge challenge. The bargaining unit covers 28 different employers and 103 facilities statewide…..

Implementation of a resident handling programme and low back pain in elder care workers

Source: Andreas Holtermann, Occupational & Environmental Medicine, Volume 74, Issue 6, 2016
(subscription required)

From the introduction:
Low back pain (LBP) is the most important contributor to number of years lived with a disability and a major risk factor for sickness absence and work disability. Occupational groups with physically demanding work, like healthcare workers, have particularly high prevalence of LBP, and a considerable fraction of the LBP is considered to be caused by work-related factors. Moreover, LBP is a particular barrier for sustainable employment among workers with physically demanding work. Therefore, implementation of equipment (mechanical lifts or other assistive devices) for reducing the mechanical loading of healthcare workers during manual handling of residents should theoretically be efficient for preventing LBP and sickness absence among those with LBP. However, interventions implementing equipment for reducing the mechanical loading on healthcare workers during manual handling of residents show conflicting results on LBP. This might be due to the relatively short follow-up period of previous intervention studies introducing equipment for manual handling, which may need longer time before being fully implemented in an organisation. Moreover, it can be caused by lacking repetitive measures of both the implementation of the intervention as well as the often fluctuating level of LBP. Thus, there is a research gap in the documentation of the effects on LBP