Nursing Homes: Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.Home Care Services: Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.Homes for the Aged: Geriatric long-term care facilities which provide supervision and assistance in activities of daily living with medical and nursing services when required.Home Care Agencies: Public or private organizations that provide, either directly or through arrangements with other organizations, home health services in the patient's home. (Hospital Administration Terminology, 2d ed)Accidents, HomeHome Care Services, Hospital-Based: Hospital-sponsored provision of health services, such as nursing, therapy, and health-related homemaker or social services, in the patient's home. (Hospital Administration Terminology, 2d ed)Hemodialysis, Home: Long-term maintenance hemodialysis in the home.Home Childbirth: Childbirth taking place in the home.Home Health Aides: Persons who assist ill, elderly, or disabled persons in the home, carrying out personal care and housekeeping tasks. (From Slee & Slee, Health Care Terms. 2d ed, p202)Housing: Living facilities for humans.House Calls: Visits to the patient's home by professional personnel for the purpose of diagnosis and/or treatment.Group Homes: Housing for groups of patients, children, or others who need or desire emotional or physical support. They are usually established as planned, single housekeeping units in residential dwellings that provide care and supervision for small groups of residents, who, although unrelated, live together as a family.Home Infusion Therapy: Use of any infusion therapy on an ambulatory, outpatient, or other non-institutionalized basis.Parenteral Nutrition, Home: The at-home administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered via a route other than the alimentary canal (e.g., intravenously, subcutaneously).Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.Air Pollution, Indoor: The contamination of indoor air.Home Health Nursing: A nursing specialty in which skilled nursing care is provided to patients in their homes by registered or licensed practical NURSES. Home health nursing differs from HOME NURSING in that home health nurses are licensed professionals, while home nursing involves non-professional caregivers.Foster Home Care: Families who care for neglected children or patients unable to care for themselves.United StatesCommunity Health Nursing: General and comprehensive nursing practice directed to individuals, families, or groups as it relates to and contributes to the health of a population or community. This is not an official program of a Public Health Department.Health Services for the Aged: Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.Residential Facilities: Long-term care facilities which provide supervision and assistance in activities of daily living with medical and nursing services when required.Patient-Centered Care: Design of patient care wherein institutional resources and personnel are organized around patients rather than around specialized departments. (From Hospitals 1993 Feb 5;67(3):14)Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, or eating.Housing for the Elderly: Housing arrangements for the elderly or aged, intended to foster independent living. The housing may take the form of group homes or small apartments. It is available to the economically self-supporting but the concept includes housing for the elderly with some physical limitations. The concept should be differentiated from HOMES FOR THE AGED which is restricted to long-term geriatric facilities providing supervised medical and nursing services.Nurses' Aides: Allied health personnel who assist the professional nurse in routine duties.Caregivers: Persons who provide care to those who need supervision or assistance in illness or disability. They may provide the care in the home, in a hospital, or in an institution. Although caregivers include trained medical, nursing, and other health personnel, the concept also refers to parents, spouses, or other family members, friends, members of the clergy, teachers, social workers, fellow patients.Homing Behavior: Instinctual patterns of activity related to a specific area including ability of certain animals to return to a given place when displaced from it, often over great distances using navigational clues such as those used in migration (ANIMAL MIGRATION).Patient Discharge: The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.Geriatric Nursing: Nursing care of the aged patient given in the home, the hospital, or special institutions such as nursing homes, psychiatric institutions, etc.Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution.Tobacco Smoke Pollution: Contamination of the air by tobacco smoke.Geriatric Assessment: Evaluation of the level of physical, physiological, or mental functioning in the older population group.Hospice Care: Specialized health care, supportive in nature, provided to a dying person. A holistic approach is often taken, providing patients and their families with legal, financial, emotional, or spiritual counseling in addition to meeting patients' immediate physical needs. Care may be provided in the home, in the hospital, in specialized facilities (HOSPICES), or in specially designated areas of long-term care facilities. The concept also includes bereavement care for the family. (From Dictionary of Health Services Management, 2d ed)Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals.Telemedicine: Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services.Residence Characteristics: Elements of residence that characterize a population. They are applicable in determining need for and utilization of health services.Protective Devices: Devices designed to provide personal protection against injury to individuals exposed to hazards in industry, sports, aviation, or daily activities.Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends.Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity.Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness.Housekeeping: The care and management of property.Hospices: Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family.Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure.Accidental Falls: Falls due to slipping or tripping which may result in injury.Terminal Care: Medical and nursing care of patients in the terminal stage of an illness.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Dust: Earth or other matter in fine, dry particles. (Random House Unabridged Dictionary, 2d ed)Family: A social group consisting of parents or parent substitutes and children.Safety: Freedom from exposure to danger and protection from the occurrence or risk of injury or loss. It suggests optimal precautions in the workplace, on the street, in the home, etc., and includes personal safety as well as the safety of property.Dependency (Psychology): The tendency of an individual or individuals to rely on others for advice, guidance, or support.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Household Articles: Various material objects and items in the home. It includes temporary or permanent machinery and appliances. It does not include furniture or interior furnishings (FURNITURE see INTERIOR DESIGN AND FURNISHINGS; INTERIOR FURNISHINGS see INTERIOR DESIGN AND FURNISHINGS).Medicaid: Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community.Medicare: Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)EnglandInfant, Newborn: An infant during the first month after birth.Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.Homebound Persons: Those unable to leave home without exceptional effort and support; patients (in this condition) who are provided with or are eligible for home health services, including medical treatment and personal care. Persons are considered homebound even if they may be infrequently and briefly absent from home if these absences do not indicate an ability to receive health care in a professional's office or health care facility. (From Facts on File Dictionary of Health Care Management, 1988, p309)Interviews as Topic: Conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews.Heating: The application of heat to raise the temperature of the environment, ambient or local, or the systems for accomplishing this effect. It is distinguished from HEAT, the physical property and principle of physics.Accident Prevention: Efforts and designs to reduce the incidence of unexpected undesirable events in various environments and situations.Midwifery: The practice of assisting women in childbirth.Family Characteristics: Size and composition of the family.Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.Parents: Persons functioning as natural, adoptive, or substitute parents. The heading includes the concept of parenthood as well as preparation for becoming a parent.Blood Pressure Monitoring, Ambulatory: Method in which repeated blood pressure readings are made while the patient undergoes normal daily activities. It allows quantitative analysis of the high blood pressure load over time, can help distinguish between types of HYPERTENSION, and can assess the effectiveness of antihypertensive therapy.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Patient Transfer: Interfacility or intrahospital transfer of patients. Intrahospital transfer is usually to obtain a specific kind of care and interfacility transfer is usually for economic reasons as well as for the type of care provided.Parenteral Nutrition, Home Total: The at-home administering of nutrients for assimilation and utilization by a patient whose sole source of nutrients is via solutions administered intravenously, subcutaneously or by some other non-alimentary route.Outcome Assessment (Health Care): Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).Time Factors: Elements of limited time intervals, contributing to particular results or situations.Patient Care Team: Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient.Nursing Services: A general concept referring to the organization and administration of nursing activities.Patient Admission: The process of accepting patients. The concept includes patients accepted for medical and nursing care in a hospital or other health care institution.Urban Population: The inhabitants of a city or town, including metropolitan areas and suburban areas.Architectural Accessibility: Designs for approaching areas inside or outside facilities.Community Health Services: Diagnostic, therapeutic and preventive health services provided for individuals in the community.Nursing Assessment: Evaluation of the nature and extent of nursing problems presented by a patient for the purpose of patient care planning.Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.Length of Stay: The period of confinement of a patient to a hospital or other health facility.Mothers: Female parents, human or animal.Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.Wounds and Injuries: Damage inflicted on the body as the direct or indirect result of an external force, with or without disruption of structural continuity.Pilot Projects: Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Health Services Research: The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)Floors and Floorcoverings: The surface of a structure upon which one stands or walks.Rural Population: The inhabitants of rural areas or of small towns classified as rural.Health Facilities, Proprietary: Health care institutions operated by private groups or corporations for a profit.Pressure Ulcer: An ulceration caused by prolonged pressure on the SKIN and TISSUES when one stays in one position for a long period of time, such as lying in bed. The bony areas of the body are the most frequently affected sites which become ischemic (ISCHEMIA) under sustained and constant pressure.Self-Help Devices: Devices, not affixed to the body, designed to help persons having musculoskeletal or neuromuscular disabilities to perform activities involving movement.Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.Costs and Cost Analysis: Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.Child Welfare: Organized efforts by communities or organizations to improve the health and well-being of the child.Insurance, Long-Term Care: Health insurance to provide full or partial coverage for long-term home care services or for long-term nursing care provided in a residential facility such as a nursing home.Monitoring, Ambulatory: The use of electronic equipment to observe or record physiologic processes while the patient undergoes normal daily activities.Palliative Care: Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed)Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.Health Services Accessibility: The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.Great BritainLongitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time.Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen.FiresHealth Services Needs and Demand: Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.Centers for Medicare and Medicaid Services (U.S.): A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.Environment: The external elements and conditions which surround, influence, and affect the life and development of an organism or population.Health Facility Size: The physical space or dimensions of a facility. Size may be indicated by bed capacity.Patient Education as Topic: The teaching or training of patients concerning their own health needs.Infant Care: Care of infants in the home or institution.Environmental Monitoring: The monitoring of the level of toxins, chemical pollutants, microbial contaminants, or other harmful substances in the environment (soil, air, and water), workplace, or in the bodies of people and animals present in that environment.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Disabled Persons: Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations.Personnel Staffing and Scheduling: The selection, appointing, and scheduling of personnel.Models, Organizational: Theoretical representations and constructs that describe or explain the structure and hierarchy of relationships and interactions within or between formal organizational entities or informal social groups.Feasibility Studies: Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project.Firearms: Small-arms weapons, including handguns, pistols, revolvers, rifles, shotguns, etc.Comprehensive Health Care: Providing for the full range of personal health services for diagnosis, treatment, follow-up and rehabilitation of patients.Cost-Benefit Analysis: A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.Independent Living: A housing and community arrangement that maximizes independence and self-determination.Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.Qualitative Research: Any type of research that employs nonnumeric information to explore individual or group characteristics, producing findings not arrived at by statistical procedures or other quantitative means. (Qualitative Inquiry: A Dictionary of Terms Thousand Oaks, CA: Sage Publications, 1997)Exercise Therapy: A regimen or plan of physical activities designed and prescribed for specific therapeutic goals. Its purpose is to restore normal musculoskeletal function or to reduce pain caused by diseases or injuries.Program Evaluation: Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.Health Knowledge, Attitudes, Practice: Knowledge, attitudes, and associated behaviors which pertain to health-related topics such as PATHOLOGIC PROCESSES or diseases, their prevention, and treatment. This term refers to non-health workers and health workers (HEALTH PERSONNEL).Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.Interior Design and Furnishings: The planning of the furnishings and decorations of an architectural interior.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc.Patient Readmission: Subsequent admissions of a patient to a hospital or other health care institution for treatment.Intermediate Care Facilities: Institutions which provide health-related care and services to individuals who do not require the degree of care which hospitals or skilled nursing facilities provide, but because of their physical or mental condition require care and services above the level of room and board.Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.Psychomotor Agitation: A feeling of restlessness associated with increased motor activity. This may occur as a manifestation of nervous system drug toxicity or other conditions.Death: Irreversible cessation of all bodily functions, manifested by absence of spontaneous breathing and total loss of cardiovascular and cerebral functions.Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.Bed Occupancy: A measure of inpatient health facility use based upon the average number or proportion of beds occupied for a given period of time.New YorkChild Health Services: Organized services to provide health care for children.Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.Telemetry: Transmission of the readings of instruments to a remote location by means of wires, radio waves, or other means. (McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed)Delivery, Obstetric: Delivery of the FETUS and PLACENTA under the care of an obstetrician or a health worker. Obstetric deliveries may involve physical, psychological, medical, or surgical interventions.Patient Acceptance of Health Care: The seeking and acceptance by patients of health service.Household Products: Substances or materials used in the course of housekeeping or personal routine.Northern IrelandOccupational Therapy: Skilled treatment that helps individuals achieve independence in all facets of their lives. It assists in the development of skills needed for independent living.Community Health Workers: Persons trained to assist professional health personnel in communicating with residents in the community concerning needs and availability of health services.Child Care: Care of CHILDREN in the home or in an institution.Primary Health Care: Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)Blood Pressure Determination: Techniques for measuring blood pressure.Consumer Satisfaction: Customer satisfaction or dissatisfaction with a benefit or service received.Netherlands: Country located in EUROPE. It is bordered by the NORTH SEA, BELGIUM, and GERMANY. Constituent areas are Aruba, Curacao, Sint Maarten, formerly included in the NETHERLANDS ANTILLES.Poverty: A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.Oxygen Inhalation Therapy: Inhalation of oxygen aimed at restoring toward normal any pathophysiologic alterations of gas exchange in the cardiopulmonary system, as by the use of a respirator, nasal catheter, tent, chamber, or mask. (From Dorland, 27th ed & Stedman, 25th ed)Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.Nursing Evaluation Research: Research carried out by nurses that uses interviews, data collection, observation, surveys, etc., to evaluate nursing, health, clinical, and nursing education programs and curricula, and which also demonstrates the value of such evaluation.Sex Factors: Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.Asthma: A form of bronchial disorder with three distinct components: airway hyper-responsiveness (RESPIRATORY HYPERSENSITIVITY), airway INFLAMMATION, and intermittent AIRWAY OBSTRUCTION. It is characterized by spasmodic contraction of airway smooth muscle, WHEEZING, and dyspnea (DYSPNEA, PAROXYSMAL).Parent-Child Relations: The interactions between parent and child.Outcome and Process Assessment (Health Care): Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically.Risk Assessment: The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.Quality Indicators, Health Care: Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.Nurse Midwives: Professional nurses who have received postgraduate training in midwifery.Durable Medical Equipment: Devices which are very resistant to wear and may be used over a long period of time. They include items such as wheelchairs, hospital beds, artificial limbs, etc.Organizations, Nonprofit: Organizations which are not operated for a profit and may be supported by endowments or private contributions.Attitude to Death: Conceptual response of the person to the various aspects of death, which are based on individual psychosocial and cultural experience.

Organizational and environmental factors associated with nursing home participation in managed care. (1/1708)

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services.  (+info)

Prevalence and treatment of pain in older adults in nursing homes and other long-term care institutions: a systematic review. (2/1708)

BACKGROUND: The high prevalence of pain in older adults and its impact in this age group make it a public health issue, yet few studies of pain relief focus on older adults. Residents of long-term care facilities have more cognitive impairment than their community-living counterparts and may have difficulty reporting the presence and severity of pain. This systematic literature review was conducted to determine the prevalence of pain, and the type and effectiveness of interventions that have been used to treat pain in residents of nursing homes. METHODS: Studies were identified by searching MEDLINE (from January 1966 to May 1997), HEALTH (from January 1975 to May 1997), CINAHL (from January 1982 to April 1997), AGELINE (from January 1978 to April 1997) and the Cochrane Library (1997, issue 1) and by performing a manual search of textbooks and reference lists. Studies of any methodological design were included if they estimated the prevalence of pain in nursing homes or other long-term care institutions or evaluated interventions for the treatment of pain in residents. Of the 14 eligible studies, 12 were noncomparative studies, 1 was a comparison study with nonrandomized contemporaneous controls, and 1 was a randomized controlled trial. Information on several factors was extracted from each study, including study design, number of patients and facilities, main outcomes measured, methods used to identify and detect pain, prevalence and types of pain, and interventions used to treat pain. The strength of the evidence provided by each study was also assessed. RESULTS: In the 6 studies with data from self-reporting or chart reviews, the prevalence of pain ranged from 49% to 83%. In the 5 studies with data on analgesic use only, the prevalence of pain ranged from 27% to 44%. Only 3 studies, with just 30 patients in total, evaluated an intervention for the treatment of pain. INTERPRETATION: Despite the high prevalence of pain in residents of nursing homes, there is a lack of studies evaluating interventions to relieve their pain. The authors make recommendations for future studies in this area.  (+info)

The economic value of informal caregiving. (3/1708)

This study explores the current market value of the care provided by unpaid family members and friends to ill and disabled adults. Using large, national data sets we estimate that the national economic value of informal caregiving was $196 billion in 1997. This figure dwarfs national spending for formal home health care ($32 billion) and nursing home care ($83 billion). Estimates for five states also are presented. This study broadens the issue of informal caregiving from the micro level, where individual caregivers attempt to cope with the stresses and responsibilities of caregiving, to the macro level of the health care system, which must find more effective ways to support family caregivers.  (+info)

Can we create a therapeutic relationship with nursing home residents in the later stages of Alzheimer's disease? (4/1708)

1. Despite their entrance into advanced illness, the majority (83%) of participants in the study displayed evidence of having begun a therapeutic relationship with their assigned advanced practice nurse. 2. With one exception, those participants who did not evidence development of the relationship had severely limited speech, perseverative speech, or did not speak at all. 3. It is time to challenge the assumption that individuals in the middle and later stages of Alzheimer's disease are not good candidates for developing a therapeutic relationship.  (+info)

An analysis of predictors of prescription drug costs among Medicaid nursing home residents in Texas. (5/1708)

A study was conducted to examine the relations among patient-specific demographic characteristics, previous prescription costs and utilization, and subsequent prescription costs for a population of 55,677 Medicaid nursing home residents in Texas. Patient-specific factors, based on previous patient utilization and cost levels, exist within the Texas Medicaid nursing home population that may serve as predictors of subsequent prescription costs. Although some statistically significant relations exist between prescription costs and patient demographic factors such as age, sex, and location, these demographic factors are of little or no practical value in prediction of prescription costs for subsequent periods of time.  (+info)

Nursing home characteristics and the development of pressure sores and disruptive behaviour. (6/1708)

OBJECTIVE: To determine how nursing home characteristics affect pressure sores and disruptive behaviour. METHOD: Residents (n = 5518, aged > or =60 years) were selected from 70 nursing homes in the National Health Care chain. Homes were classified as high- or low-risk based on incidence tertiles of pressure sores or disruptive behaviour (1989-90). Point-prevalence and cumulative incidence of pressure sores and disruptive behaviour were examined along with other functional and service variables. RESULTS: The overall incidence of pressure sores was 11.4% and the relative risk was 4.3 times greater in high- than low-risk homes; for disruptive behaviour, the incidence was 27% and the relative risk was 7.1 times greater in the high-risk group. At baseline, fewer subjects in homes with a high risk of pressure sores were white or in restraints, but more had received physician visits monthly and had had problems with transfers and eating. High-risk homes also had fewer beds and used less non-licensed nursing staff time. At follow-up (1987-90), 52% of homes in the low-risk group and 35% of those in the high-risk group had maintained their risk status; low-risk homes were more likely to have rehabilitation and maintenance activities. Having multiple clinical risk factors was associated with more pressure sores in high- (but not low-) risk homes, suggesting a care-burden threshold. By logistic regression, the best predictor of pressure sores was a home's prior (1987-88) incidence status. Interestingly, 67% of homes with a high risk of pressure sores were also high-risk for disruptive behaviour, while only 27% of homes with a low risk of pressure sores were high-risk for disruptive behaviour. A threshold effect was also observed between multiple risk factors and behaviour. More homes with a high risk of disruptive behaviour (68%) remained at risk over 4 years, and the best predictor of outcome was a home's previous morbidity level. CONCLUSION: Nursing-home characteristics may have a greater impact than clinical factors on pressure sores and disruptive behaviour in long-stay, institutionalized elders.  (+info)

Use of nursing home after stroke and dependence on stroke severity: a population-based analysis. (7/1708)

BACKGROUND AND PURPOSE: There are few population-based data available regarding nursing home use after stroke. This study clarifies the use of a nursing home after stroke, as well as its dependence on stroke severity, in a defined population. METHODS: All first stroke events among residents of Rochester, Minn, during 1987-1989 were ascertained, subtyped, and assigned Rankin disability scores (RS) before the event, at maximal deficit, and at specified intervals after stroke. Persons were followed from the date of stroke event to death, emigration from Rochester, or December 31, 1994, in complete community-based medical records and Minnesota Case Mix Review Program data tapes to determine nursing home residency before stroke and at 90 days and 1 year after stroke, proportion of survival days in a nursing home, and cumulative risk of admission to a nursing home. RESULTS: There were 251 cases of first cerebral infarction, 24 intracerebral hemorrhages, and 15 subarachnoid hemorrhages among residents of Rochester during 1987-1989. The maximal deficit RS was 1 or 2 for 62 (25%), RS 3 for 72 (29%), and RS 4 or 5 for 117 (47%) of the cerebral infarct patients. Among patients surviving to 90 days or 1 year after cerebral infarction, 25% were in nursing home at 90 days and 22% at 1 year, respectively. Within these maximal deficit RS categories, the percentages of follow-up time spent in a nursing home during the first post-cerebral infarction year are as follows: RS 1 to 2, 4%; RS 3, 10%; and RS 4 to 5, 54%. Multivariate logistic regression revealed that increasing age and RS 4 to 5 at maximal deficit were independent predictors (P<0.0001) of nursing home residency at 90 days and 1 year after stroke, whereas stroke type was not an independent predictor. At 1 year after cerebral infarction, the Kaplan-Meier estimates of proportion of people with at least 1 nursing home admission were 11% for RS 1 to 2, 22% for RS 3, and 68% for RS 4 to 5. CONCLUSIONS: This study provides unique population-based data regarding the short- and long-term use of a nursing home after stroke and its dependence on stroke severity. More than 50% of people with a severe cerebral infarction are in a nursing home 90 days and 1 year after the stroke, and by 1 year, nearly 70% will have required some nursing home stay. Age and stroke severity are independent predictors of nursing home residency after stroke.  (+info)

Small bowel bacterial overgrowth in subjects living in residential care homes. (8/1708)

OBJECTIVES: in elderly people, bacterial overgrowth of the small bowel may be occult. The significance of positive breath tests are uncertain: many fit elderly subjects with positive tests show no evidence of malabsorption. We assessed the prevalence and significance of bacterial overgrowth in the small bowel in a relatively unselected elderly population. METHODS: residents of seven elderly people's homes had a glucose hydrogen breath test. A medical history and anthropomorphic measurements were recorded. Volunteers with positive breath tests were given doxycycline. After 4 months all volunteers were reassessed. RESULTS: of 140 residents, 62 were tested. Nine (14.5%) had a positive breath test. There was no difference in anthropomorphic and bowel habit data between those with positive and those with negative breath tests. After 4 months of antibiotic treatment, volunteers with a positive breath test had increased weight and body mass index, while those with a negative test had decreased weight and body mass index. CONCLUSIONS: the percentage of volunteers with a positive breath test was much lower than in previous studies. This may be due to the relatively unselected nature of the volunteers. Treatment of bacterial overgrowth resulted in a small but significant improvement in anthropometric indices. The lack of association of positive breath tests with baseline anthropomorphic measurements or bowel habit highlights the occult nature of the bacterial overgrowth and questions its clinical importance.  (+info)

No data available that match "nursing homes"

  • Conclusions: State Medicaid programs should undertake system-level interventions that encourage nursing facilities to reduce unused bed capacity, balance the mix of payers, invest in nurse staffing, and take other steps to promote community discharges. (
  • 001). Most patients who had been prescribed an inappropriate agent before nursing home entry had that agent discontinued after admission. (
  • Which cancer patients die in nursing homes? (
  • Patients dying in nursing homes reported severe functioning impairments and more fatigue and appetite loss compared with those dying elsewhere. (
  • But in the event that a loved one has already been hurt by a nursing home's negligence in administering this medication, Hupy and Abraham is here to help. (
  • All facilities classified as nursing homes by the 1973 Master Facility Inventory with updated information on nursing homes that opened between 1973 and December 1976. (
  • Under current standards, facilities that report seven or more days in a quarter with no registered nurse on site are automatically assigned a one-star staffing rating. (
  • Subjects: Annual cohort of first-time admissions (N=24,648) to 378 Minnesota nursing facilities in 75 nursing home markets from July 2005 to June 2006. (
  • I recently conducted an extensive study of New York nursing homes and obtained interesting results concerning the relation between the quality of facilities. (
  • Measurements - For each patient in the cohort, a subset of the Beers criteria was used to characterize and compare the prevalence of inappropriate prescribing (as indicated by the prescription of one of 49 inappropriate drugs) before and after nursing home admission. (
  • Participants - Nineteen thousand nine hundred eleven individuals aged 66 and older, newly admitted to nursing homes in Ontario between April 1, 1997, and March 31, 1999. (
  • In the 1985 NNHS, a younger sick group and a young male group emerge for the first time as identifiable nursing home patient groups. (
  • If your loved one is taking a blood-thinning medication and resides in a nursing home or other LTC facility, please talk to the nursing home staff about the steps they will take to prevent a serious complication or tragedy. (
  • Background Research into nursing home transitions has given limited attention to the facility or community contexts. (
  • and nursing market population size, average occupancy, market concentration, and availability of home and community-based services. (
  • In addition, states should increase home and community-based services, particularly in markets with low community discharge rates. (
  • According to the Centers for Disease Control and Prevention (CDC), around 1.3 million adults in the United States live in a nursing home. (
  • Inadequate supplies of personal protective equipment, staff members working with symptoms and staff members working at multiple facilities helped fuel the outbreak in nine Seattle nursing homes, the U.S. Centers for Disease Control and Prevention said in a report released Wednesday. (
  • The rulings have applied ever more pressure on the more than 15,000 nursing homes across the country, many reeling from COVID-19 as resident deaths mount and stressed staff members search for elusive masks, gloves and gowns. (
  • For 2020-21, 14,126 facilities received a Short-Term Rating, while only 2,362 homes earned a High-Performing Rating. (
  • Mr Ursell said 750 nursing homes closed in Britain last year with the loss of 13,000 beds yet research showed demand for beds would be 65 per cent higher by 2020. (
  • In this April 14, 2016 photo, Phyllis Hotchkiss talks to her son, Glen Hotchkiss, at her nursing home in Adrian, Mich. Phyllis, 93, who has dementia and is confined to a wheelchair, was involuntarily discharged from her nursing home earlier in the year, to one further away from her family. (
  • The Shreveport Times reported that a resident with dementia at a Bossier City, La., nursing home went missing for more than 3½ hours last year before staff went looking for her. (
  • How Nursing Homes in the United States Overmedicate People with Dementia," estimates that every week in US nursing facilities, more than 179,000 people, mostly older and living with dementia, are given antipsychotic drugs without an appropriate diagnosis. (
  • Statistics from a collaborative effort to reduce the use of antipsychotic drugs to control troublesome behavior by people with dementia in nursing homes shows that North Carolina led the nation in achieving reductions. (
  • The report found that 64 of Georgia's nursing homes had been cited for infection prevention and control deficiencies in 2017. (
  • For a five-year period, from 2013 to 2017, there were 30 homes in Georgia with multiple citations for this problem. (
  • Grannycam" advocates say that if nursing home personnel do nothing wrong they will have nothing to fear. (
  • But half of the Massachusetts nursing homes that have created dedicated wings for Covid-19 patients are either rated "below average" or "much below average" - two-star or one-star -- on the federal scale, according to a review by the advocacy group Massachusetts Advocates for Nursing Home Reform. (
  • WASHINGTON , Feb. 7, 2012 /PRNewswire/ -- U.S. News & World Report today released its annual Best Nursing Homes ratings, which offer important guidance to families and healthcare providers caring for people in need of a nursing home. (
  • In addition, U.S. News released an Honor Roll of 39 nursing homes that earned the highest possible ratings in all four quarters of 2011. (
  • In addition to helping families find the best nursing home for their loved one, U.S. News published pieces on nursing home patient safety during COVID-19 and what to expect as nursing homes resume in-person visits . (
  • U.S. News also profiles Assisted Living Communities , which in many cases provide services that overlap with traditional nursing homes. (
  • WEDNESDAY, Oct. 8, 2014 (HealthDay News) -- Infection rates within U.S. nursing homes are on the rise, and that trend will continue until better hygiene practices are put in place, a new study suggests. (
  • News organizations have identified many problems at homes in their communities. (
  • The most expensive nursing homes in Palm Beach County have fewer beds than the cheaper homes haveand boast of more personalized service. (
  • We have a lot more help per resident,' said Steve Mulder, administrator of Whitehall Boca, a nursing home in Boca Raton that has 73 beds and costs $153 a day for a private room. (
  • New York led the way in late March, with a sweeping directive intended to free up much-needed hospital beds by ordering nursing homes to take COVID-19-positive patients. (
  • Genesis, based in Pennsylvania, is the largest nursing home company in the country, with 44,805 beds in 380 outlets and $4.8 billion in operating revenue, according to (
  • These chains owned approximately 27 percent of all beds nationwide in 2000 with about 56 percent of all nursing homes in the United States being part of a chain. (
  • Nursing homes are ground zero for the pandemic. (
  • These pieces join new Hospital Hero profiles featuring a nursing home activities director easing pandemic-related isolation and a public policy expert calling for nursing home employees' wages and benefits to reflect the current dangerous nature of their jobs. (
  • That's not enough to cover the costs of increased testing and other expenses and revenue losses from the pandemic, Georgia nursing homes say. (
  • The governor's office points to more than $20 million spent to provide staff support to 93 nursing homes that were short-staffed because of outbreaks or faced other challenges during the pandemic. (
  • A GAO report issued in May found that infection-control deficiencies are consistently among the top violations that inspectors find when they go into nursing homes, but it also found that states undercite the violations. (
  • Even more disturbing: In many cases, nursing homes and the government officials who oversee them are doing little -- or nothing -- to stop it. (
  • It is important to visit the nursing homes and ask the questions, officials said, because some of the nursing homes could have augmented their services or changed their rating or rates since the information was gathered. (
  • March 23 - Massachusetts officials announced the first case of COVID-19 at Holyoke Soldiers' Home, where eventually some 76 veterans died of the virus. (
  • Nursing home industry officials have cautioned that while the reports can be of value when choosing a home, they are only a snapshot and don't highlight good practices in the home. (
  • Councils in Berkshire are falling a long way short of paying the weekly rate recommended in research for the independent think-tank the Joseph Rowntree Foundation, according to Frank Ursell, chief executive officer of the Registered Nursing Home Association. (
  • Given their congregate nature and resident population served (e.g., older adults often with underlying chronic medical conditions), nursing home populations are at high risk of being affected by respiratory pathogens like COVID-19 and other pathogens, including multidrug-resistant organisms (e.g. (
  • In the absence of federal data, Suzy and colleague Laura Strickler began tracking the number of COVID-19 deaths in nursing homes across the country. (
  • Nursing Home profiles to also include new patient safety information, highlighting up-to-date COVID-19 data. (
  • New Jersey instructed nursing homes that they could not reject medically stable patients diagnosed with COVID. (
  • At least 7,000 COVID-19 deaths have occurred among people living in or associated with nursing homes, according to a New York Times investigation, meaning 1 in 5 coronavirus deaths in the U.S. are tied to a nursing home. (
  • New York issued an order late last month that "No resident shall be denied re-admission or admission to [a nursing home] based on a confirmed or suspected diagnosis of COVID-19. (
  • In May, OSHA issued its first COVID-19 citation to a nursing home. (
  • Keep reading to discover how COVID-19 has impacted American nursing homes. (
  • In late March, Massachusetts also unveiled a plan to create nursing homes that were singularly dedicated to coronavirus patients. (
  • On that day at the end of March, Deborah, whose name has been altered because she fears retribution from her facility's executives, found nurses wearing trash bags as makeshift gowns and treating patients without N95 respirators -one of the best systems of protection for doctors and nurses who come into contact with coronavirus patients. (
  • Completing that round of tests is a key part of the plan for allowing in-person visits to nursing homes something that hasn t happened in Pennsylvania since early March, and which experts say has grave medical consequences of its own. (
  • A recent study in the United Kingdom found that a significant number of diabetes-related medical errors in nursing homes were reported to the National Reporting and Learning System between 2005 and 2009. (
  • The nursing home was asked if it had any medical needs or emergencies, Broward County Mayor Barbara Sharief said in the center's statement. (
  • Often, the decision to enter a nursing home is made under the pressure of a sudden and immediate need brought on by an unexpected injury or medical condition. (
  • We concur with Dr. Kanter 1 that nursing homes are an ideal site for medical education. (
  • Given this kind of feedback, we enthusiastically echo your call for medical education to include the nursing home as a training venue. (
  • Infection-control violations at nursing homes have been a widespread problem well before the coronavirus took hold. (
  • The home had been cited twice last year for infection control issues during inspections. (
  • The advisory prohibited nursing homes to require that a hospitalized resident deemed medically stable be tested before admission. (
  • Some schools also offer a certificate in nursing administration for individuals with a master's degree in nursing who are interested in exploring other dimensions of the field and advancing their career. (
  • The post-baccalaureate certificate in nursing administration requires at least a Bachelor of Science degree in Nursing (BSN) and a post-master certificate requires a master's degree. (
  • To be allowed to work as a Registered Nurse, one must complete a nursing program at one of several educational levels, including associate and baccalaureate degree programs, hospital-based diploma programs and master's degree programs. (
  • At a soldiers' home in Massachusetts, veterans who survived Omaha Beach on D-Day and fought in Vietnam died by the dozens in the virus' unrelenting spread. (