An innovative post-hospital model of care (DDEFY Delirium): A pilot randomized trial

Presents a study which aims to examine an innovative post-hospital model of care. The study developed a model of care for those who had delirium in the hospital and then transitioned home, known as DDEFY Delirium. This pilot study aimed to assess the implementation of this novel model of care and determine the ability to recruit patients. This pilot randomized controlled trial was conducted between August 2019 and December 2020. Patients aged >=65 years, treated by inpatient geriatric consultative service for delirium and discharged home, were randomized into control or intervention (and later on a virtual group due to COVID-19). Once determined eligible, the DDEFY Delirium intervention was implemented. DDEFY is used to describe the five pillars that form our conceptual model: (1) Diagnose cognitive disorder;(2) review Drugs;(3) Educate patient and family;(4) assess and treat Function (al) decline;(5) Your (patient's and family's) health goals. For the intervention groups, participants were asked about their caregivers, asked to perform cognitive and functional assessments, and discussed goals of care. Outcomes of interest included recruitment rate, adherence, attrition, and study team participation. Both the in-person and virtual intervention groups had 100% adherence to pillars 2 and 4. Lowest adherence was to pillars 1 (virtual = 75%) and 5 (in-person = 71%;virtual = 75%). For both the in-person and virtual intervention groups, attrition was zero and study team participation was 100%. In this pilot study, we assessed patients in their homes, after experiencing delirium during and after their hospital admission. Even though the recruitment rate was affected by COVID-19, it was higher than anticipated as was the adherence to the intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Nursing home social work during COVID-19

This reprinted chapter originally appeared in Journal of Gerontological Social Work, 2020, 63[6-7], 651-653. (The following of the original article appeared in record 2021-00510-020.) This letter highlights a few of the many the challenges facing nursing home social services workers and departments during COVID-19. We share them as the challenges, sacrifices, and important work of this professional group was largely unnoticed by the media and may not be widely known even within the social work field. Our group's activities also highlight the ways that researchers can support our practice colleagues at this difficult time, amplify their everyday efforts, and contribute to healing during this pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Nursing Home Factors and Their Impact on COVID-19 Cases: A Study of Wisconsin State

COVID-19 has been devastating for Nursing Homes (NHs). The concentration of older adults with underlying chronic conditions inevitably made the setting highly vulnerable leading to high rates of mortality for residents. However, some nursing homes fared better than others. This study examines several quality measures and organizational factors to understand whether these factors are associated with COVID-19 cases in Wisconsin. We combined three datasets from Centers for Medicare & Medicaid Services (CMS) – the Star Rating dataset, Provider Information dataset and COVID-19 Nursing Home dataset. Data used is from the period of Jan 1 – Oct 25, 2020 for the state of Wisconsin. The analysis includes 331 free-standing NHs with no missing values from the data sets. The variables used were self-reported information on nursing home ratings, staff shortage, staff reported hours, occupancy rate, number of beds and ownership. Of the 331 NHs examined, shortages were reported of 25.4%, 31.1%, 3.2% and 15.6% of licensed nurse staff (25.4%), nurse aides (31.1%), clinical staff, (3.2%) and other staff (15.6%) Additionally, there was a significant (p<.05) positive correlation between number of beds and COVID-19 cases, and there was no statistically significant association between occupancy rate and COVID-19 cases. NHs with better star ratings were also found to have less COVID-19 cases. Interestingly, private NHs had significantly higher COVID-19 cases than for-profit and government owned NHs, a finding that is congruent with other studies in this area. Recommendations for practice will be discussed.

Value Propositions for Health Information Exchange Toward Improving Nursing Home Hospital Readmission Rates.

The importance of health information technology use in nursing home (NH) care delivery is a major topic in research exploring methods to improve resident care. Topics of interest include how technology investments, infrastructure, and work-force development lead to better methods of nursing care delivery and outcomes. Value propositions, including perceived benefits, incentives, and system changes recognized by end-users, are important resources to inform NH leaders, policymakers, and stakeholders about technology. The purpose of the current research was to identify and disseminate value propositions from a community of stakeholders using a health information exchange (HIE). Researchers used a nominal group process, including 49 individual stakeholders participating in a national demonstration project to reduce avoidable hospitalizations in NHs. Stakeholders identified 41 total anticipated changes from using HIE. Ten stakeholder types were perceived to have experienced the highest impact from HIE in areas related to resident admissions, communication, and efficiency of care delivery. [Journal of Gerontological Nursing, 48(1), 15-20.].

Actualizing Better Health And Health Care For Older Adults.

By 2030 more people in the United States will be older than age sixty-five than younger than age five. Our health care system is unprepared for the complexity of caring for a heterogenous population of older adults-a problem that has been magnified by the coronavirus disease 2019 (COVID-19) pandemic. Here, as part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2021 initiative, we identify six vital directions to improve the care and quality of life for all older Americans. The next administration must create an adequately prepared workforce; strengthen the role of public health; remediate disparities and inequities; develop, evaluate, and implement new approaches to care delivery; allocate resources to achieve patient-centered care and outcomes, including palliative and end-of-life care; and redesign the structure and financing of long-term services and supports. If these priorities are addressed proactively, an infrastructure can be created that promotes better health and equitable, goal-directed care that recognizes the preferences and needs of older adults.