The Changing Role of Non-Profit Organizations in the U.S. Long Term Care System.

The American long-term care system has changed dramatically over the last several years as the need for care has increased steadily with the aging of the boomer generation. Arguably, the most important change has occurred in the Medicaid-funded part of the system as several states, with strong federal support, have moved toward contracting with large for-profit insurance companies to provide overall administration of Medicaid long-term care services, largely displacing the non-profit organizations that constitute the nation's Aging Network. We are concerned that the displacement of the mission-oriented model of long-term care that is administered by the Aging Network will negatively affect access, quality, and cost in state Medicaid long-term care programs.

Influenza vaccination rates and beliefs about vaccination among nursing home employees.

BACKGROUND: Recent studies have suggested that vaccination of nursing home staff members may reduce the incidence of influenza among nursing home residents. Current national estimates of employee vaccination rates (around 50%) indicate that residents may be at an unnecessarily high risk of contracting influenza. This article reports on the influenza vaccination rates and attitudes toward the vaccine among employees in 37 nursing homes in 3 states. METHODS: Nursing home employees were surveyed at nursing homes in Florida, Georgia, and Wisconsin in 2011-2012. Completed surveys were received from a total of 1,965 employees. RESULTS: Approximately 54% of the employees surveyed received the vaccination during the 2010-2011 and 2011-2012 influenza seasons. Nursing home-level staff vaccination rates varied widely, from 15%-97%. Black and younger employees were less likely to receive the vaccine. Employee vaccination rates in nursing homes that used incentives were 12 percentage points higher than those that did not use incentives (P = .08). CONCLUSION: Low vaccination rates among nursing home workers may put residents at increased risk for influenza-related morbidity and mortality. The Centers for Medicare and Medicaid Services may consider employee vaccination rates as a quality indicator in addition to resident vaccination rates. Our findings support the use of a trial to test the use of incentives to increase employee vaccination rates.

Nurse managers' perspectives of structural and process characteristics related to residents' advance directives in nursing homes.

This article examines associations between nursing home structural and process characteristics and presence of advance directives and trends over 5 years of advance directives in Florida nursing homes. Our results underscore the importance of nursing homes' processes in facilitating discussions of nursing home residents' end-of-life care preferences.

Helping nursing homes prepare for disasters.

Responding to the deaths and suffering of older adults in long-term care facilities following Hurricanes Katrina, Rita, and Wilma, the John A. Hartford Foundation funded an initiative called Hurricane and Disaster Preparedness for Long-Term Care Facilities. Long-term care providers are now acknowledged as health care providers by most federal and state emergency response centers. This paper describes the planning, research, and dissemination efforts of the Hartford grantees. It also provides insights into successful disaster grant making, noting foundations' unique flexibility, strategic and long-term view, and ability to be a neutral convener of stakeholders that can help grantees work toward achieving major policy change.

Use of mental health services by nursing home residents after hurricanes.

OBJECTIVE: A growing body of research supports the value of mental health intervention to treat people affected by disasters. This study used a mixed-methods approach to evaluate pre- and posthurricane mental health service use in Florida nursing homes. METHODS: A questionnaire was administered to 258 directors of nursing, administrators, and owners of nursing homes, representing two-thirds of Florida's counties, to identify residents' mental health needs and service use. In four subsequent focus group meetings with 22 nursing home administrators, underlying factors influencing residents' use of services were evaluated. RESULTS: Although most nursing homes provided some type of mental health care during normal operations, disaster-related mental health services were not routinely provided to residents. Receiving facilities were more likely than evacuating facilities to provide treatment to evacuated residents. CONCLUSIONS: Nursing home staff should be trained to deliver disaster-related mental health intervention and in procedures for making referrals for follow-up evaluation and formal intervention.

Florida's model of nursing home Medicaid reimbursement for disaster-related expenses.

PURPOSE: This study describes Florida's model of Medicaid nursing home (NH) reimbursement to compensate NHs for disaster-related expenses incurred as a result of 8 hurricanes within a 2-year period. This Florida model can serve as a demonstration for a national model for disaster-related reimbursement. DESIGN AND METHODS: Florida reimburses NHs for approved disaster-related costs through hurricane interim rate requests (IRRs). The state developed its unique Medicaid per diem rate temporary add-on by adapting its standard rate-setting reimbursement methodology. To understand the payment mechanisms and the costs that facilities incurred as a result of natural disasters, we examined the IRRs and cost reports for facilities requesting and receiving reimbursement. RESULTS: Cost reports and IRR applications indicated that Florida Medicaid spent close to $16 million to pay for hurricane-related costs to NHs. IMPLICATIONS: Without Florida's Hurricane IRR program, many facilities would have not been reimbursed for their hurricane-related costs. Florida's model is one that Medicare and other states should consider adopting to ensure that NHs receive adequate reimbursement for disaster-related expenses, including tornadoes, earthquakes, floods, blizzards, and other catastrophic events.

A Pilot Study Evaluating the Feasibility of Psychological First Aid for Nursing Home Residents.

OBJECTIVES: The objectives of the pilot study were to modify existing psychological first aid (PFA) materials so they would be appropriate for use with institutionalized elders, evaluate the feasibility of using nursing home staff to deliver the intervention to residents, and solicit feedback from residents about the intervention. The STORM Study, an acronym for "services for treating older residents' mental health", is the first step in the development of an evidence-based disaster mental health intervention for this vulnerable and underserved population. METHOD: Demographic characteristics were collected on participating residents and staff. Program evaluation forms were completed by staff participants during the pilot test and nurse training session. Staff and resident discussion groups were conducted during the pilot test to collect qualitative data on the use of PFA in nursing homes. RESULTS: Results demonstrate the feasibility of the PFA program to train staff to provide residents with PFA during disasters. CONCLUSIONS: Future research should focus on whether PFA improves coping and reduces stress in disaster exposed nursing home residents.

The controversy inherent in managing frail nursing home residents during complex hurricane emergencies.

Emergency planning for vulnerable populations constitutes a major element of community disaster preparedness and is an area in which guidance is particularly sparse. As evidenced by the well-publicized deaths of nursing home residents following Hurricanes Katrina and Rita, the need to improve nursing home emergency preparedness is self-evident. Nevertheless, as efforts to improve preparedness develop, a central controversy remains. Aside from mandatory complete evacuations, is it better to evacuate or not to evacuate frail elderly nursing home residents in the setting of hurricane emergencies? This paper reviews the historical evidence on both sides of the argument and suggests a policy and research agenda.

A comparative study of laws, rules, codes and other influences on nursing homes' disaster preparedness in the Gulf Coast states.

In 2005, Hurricanes Katrina and Rita devastated several Gulf Coast states and caused many deaths. The hurricane- related deaths of 70 nursing home residents--34 believed drowned in St. Rita's Nursing Home in Louisiana and 36 from 12 other nursing homes--highlighted problems associated with poorly developed and executed disaster plans, uninformed evacuation decision-making, and generally inadequate response by providers and first responders (DHHS, 2006; Hyer, Brown, Berman, & Polivka-West, 2006). Such loss of human life perhaps could have been prevented and certainly lessened if, prior to the hurricanes, policies, regulations, and laws had been enacted, executable disaster guidelines been available, vendor contracts been honored, and sufficient planning taken place. This article discusses applicable federal and state laws and regulations that govern disaster preparedness with a particular focus on nursing homes. It highlights gaps in these laws and makes suggestions regarding future disaster planning.

Establishing and refining hurricane response systems for long-term care facilities.

In February 2006 the John A. Hartford Foundation funded a long-term care "Hurricane Summit," sponsored by the Florida Health Care Association. Representatives from five Gulf Coast states that sustained hurricane damage during 2005 and from Georgia, a receiving state for hurricane evacuees, attended. Summit participants evaluated disaster preparedness, response, and recovery for long-term care provider networks and identified gaps that impeded safe resident evacuation and disaster response. The meeting identified emergency response system issues that require coordination between long-term care providers and state and federal emergency operations centers. Five areas warranting further attention are presented as lessons learned and potential areas for grant making.