Multiple outbreaks of hepatitis B virus infection related to assisted monitoring of blood glucose among residents of assisted living facilities--Virginia, 2009-2011.
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Between February 2009 and November 2011, the Virginia Department of Health (VDH) was notified of acute hepatitis B virus (HBV) infections occurring in residents of four separate assisted living facilities (ALFs) in the Central Health Planning Region of Virginia. In each outbreak, the initial acute HBV infections were identified through routine viral hepatitis surveillance. VDH conducted epidemiologic and laboratory investigations of these reports. Infection control practices, particularly surrounding assisted monitoring of blood glucose (AMBG), were assessed by direct observation and staff member interviews. Further investigation and subsequent screening of ALF residents for hepatitis B uncovered additional acute HBV infections at each of the ALFs. ALF residents screened for HBV infection were categorized on the basis of published criteria as having acute or chronic infection, or being susceptible or immune to infection. All acute HBV infections were among residents receiving AMBG for management of diabetes. AMBG is safe when properly performed, but lapses in infection prevention practices during AMBG were identified at three of the four facilities. These outbreaks highlight the role of hepatitis B surveillance in detecting disease outbreaks and the need for a comprehensive strategy to prevent HBV transmission in ALFs, including vaccination, improved infection control oversight at ALFs, appropriate training of staff members performing AMBG, and prompt investigation of acute HBV infections. (+info)
Residential care facilities: a key sector in the spectrum of long-term care providers in the United States.
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RCFs in the United States totaled 31,100 in 2010, with 971,900 state-licensed, certified, or registered residential care beds. About one-half of RCFs were small facilities which served one-tenth of all RCF residents. The remaining RCFs were medium-sized facilities (16%) which served about one-tenth of all RCF residents, large facilities (28%) which served about one-half of all RCF residents, and extra large facilities (7%) which housed about three-tenths of all RCF residents. RCFs were predominantly for profit (82%), not part of a chain (62%), and located in an MSA (81%). Small RCFs were more likely to be for profit than larger RCFs. The proportion of chain-affiliated RCFs grew with increasing facility size. Small and extra large RCFs were most likely to be located in an MSA, while medium RCFs were least likely to be in an MSA. RCFs were most commonly located in the West. The mix of facility sizes varied by region. The West had almost twice as many residential care beds per 1,000 persons aged 85 and over as the Northeast (245 to 131). Comparing the supply of RCF beds with nursing home beds (data compiled by Centers for Medicare & Medicaid Services) shows that the supply of RCF beds (245) and nursing home beds (203) per 1,000 persons aged 85 and over was relatively comparable in the West, but nursing home beds far outnumbered RCF beds in all other regions. There were about twice as many nursing home beds as RCF beds per 1,000 persons aged 85 and over in the South (325 to 164), Midwest (390 to 177), and Northeast (303 to 131). More research is needed to identify and examine factors that may explain these regional differences in both the supply of residential care beds, including variations in state regulation and financing of different types of LTC providers, and in consumer preferences for different kinds of long-term services and support. RCFs serve primarily a private-pay adult population (6). However, the use of Medicaid financing for services in residential care settings has gradually increased in recent years (7). About 4 out of 10 RCFs had at least one resident who had some or all of their LTC services paid by Medicaid. The percentage of facilities having residents who received LTC services paid by Medicaid varied by facility size. Although nearly all RCFs provided basic health monitoring (96%) and incontinence care (93%), larger RCFs were more likely than smaller RCFs to offer occupational and physical therapy. Larger RCFs were also more likely than small RCFs to provide social services counseling and case management. The provision of skilled nursing services did not vary by facility size. This report presents national estimates of RCFs using data from the first-ever national probability sample survey of RCFs with four or more beds. Findings on differences in selected characteristics and services offered by facility size and on regional variations in the supply of beds provide useful information to policymakers, LTC providers, and consumer advocates as they plan to meet the needs of an aging population. Moreover, these findings establish baseline national estimates as researchers continue to track growth and changes in the residential care industry. (+info)