Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities.

BACKGROUND: More than seven million people with intellectual and/or developmental disabilities (ID/DD) live in the US and may face an elevated risk for COVID-19. OBJECTIVE: To identify correlates of COVID-19 and related hospitalizations among people with ID/DD in group homes in Massachusetts. METHODS: We collected data during March 1, 2020-June 30, 2020 (wave 1) and July 1, 2020-March 31, 2021 (wave 2) from the Massachusetts Department of Public Health and six organizations administering 206 group homes for 1035 residents with ID/DD. The main outcomes were COVID-19 infections and related hospitalizations. We fit multilevel Cox proportional hazards models to estimate associations with observed predictors and assess contextual home- and organizational-level effects. RESULTS: Compared with Massachusetts residents, group home residents had a higher age-adjusted rate of COVID-19 in wave 1 (incidence rate ratio [IRR], 12.06; 95 % confidence interval [CI], 10.51-13.84) and wave 2 (IRR, 2.47; 95 % CI, 2.12-2.88) and a higher age-adjusted rate of COVID-19 hospitalizations in wave 1 (IRR, 17.64; 95 % CI, 12.59-24.70) and wave 2 (IRR, 4.95; 95 % CI, 3.23-7.60). COVID-19 infections and hospitalizations were more likely among residents aged 65+ and in group homes with 6+ resident beds and recent infection among staff and residents. CONCLUSIONS: Aggressive efforts to decrease resident density, staff-to-resident ratios, and staff infections through efforts such as vaccination, in addition to ongoing access to personal protective equipment and COVID-19 testing, may reduce COVID-19 and related hospitalizations in people with ID/DD living in group homes.

Quality of Life for Adults with Prader-Willi Syndrome in Residential Group Homes.

Background: Strict regimens of restricted caloric intake and daily physical exercise are life-saving in Prader-Willi syndrome (PWS) but are extremely challenging in home environments. PWS-specialized hostels (SH) succeed in preventing morbid obesity and in coping with behavioral disorders; however, effects of restricted living environments on quality of life (QOL) have not been described. Evidence on QOL is critical for clinicians involved in placement decisions. Methods: We examined the impact of living in SH versus at home or in non-specialized hostels (H and NSH) on QOL, behavior, and health parameters. All 58 adults (26 males) followed-up in the National Multidisciplinary Clinic for PWS were included: 33 resided in SH, 18 lived at home, and 7 lived in NSH. Questionnaires were administered to primary caregivers to measure QOL, and data were obtained from the medical records. Results: The H and NSH group were compared with those for adults in SH. Despite strict diet and exercise regimens, QOL was similar for both groups. Eight-year follow-up showed that food-seeking behavior decreased in SH but increased in H and NSH. BMI, cholesterol, and triglyceride levels were lower in SH. Conclusion: Our results suggest that living in SH is associated with benefits for physical health and behavior without negatively affecting QOL.

Organisational culture in 'better' group homes for adults with intellectual and developmental disabilities in England: A qualitative study.

BACKGROUND: Previous research identifies organisational culture as one of a number of factors associated with the quality of life outcomes of group home residents' with intellectual and developmental disabilities. This study aims to elaborate on the dimensions of group home culture in settings in England. METHOD: Participant observations and semi-structured interviews with staff were carried out in two group homes. Field-notes, interview notes and transcripts were analysed using inductive thematic analysis by a researcher naïve to the project and the previous literature. Initial coding was re-examined after sensitisation to theorised models in previous literature to identify the most parsimonious fit. The two settings were rated and compared using a five-point Likert scale for each of the dimensions. RESULTS: The findings describe group home culture across seven dimensions. There were mixed ratings across the different dimensions reflecting inconsistencies in culture that were reflected in staff practice. The challenge in assigning a global rating of culture in group homes, which includes interactions across multiple staff and multiple residents over time, was highlighted. CONCLUSION: The development of an observational measure of culture is highlighted as potentially helpful in understanding and responding to culture in services for individuals with intellectual and developmental disabilities.

Factors Related to the Willingness of People with Mental Health Illnesses Living in Group Homes to Disclose Their Illness to Supporters during Disaster Evacuation: A Cross-Sectional Study.

Severe heavy rains caused by linear precipitation systems are occurring more frequently in Japan owing to climate change, and residents are being asked to evacuate more often. The purpose of this study was to identify factors associated with the willingness of people with mental health illness (PMHI) in group homes to disclose their illness when being evacuated. Participants were PMHI living in group homes in Japan. We conducted an original anonymous self-administered questionnaire based on previous research. Valid data from 119 people were analyzed. Factors associated with the willingness to disclose illness to supporters upon evacuation were "I can imagine living in a public shelter" (Odds Ratio [OR] 4.50, 95% Confidence Interval [CI]: 1.78-11.43), and "I socialize with neighbors" (OR 5.63, 95% CI: 1.74-18.22). Managers of group homes should encourage PMHI to imagine life in an evacuation zone by increasing opportunities for disaster training and for interaction with local residents. People who are less likely to socialize with neighbors should be especially careful, as they may not be able to disclose their illness, and those who support evacuees should pay special attention to these people.

Childrens' attachment story-completions and their theory of mind in three Turkish contexts: Seasonal migrant agricultural worker communities, residential group homes, and rural villages.

This study examines the association between attachment story-completions, as evaluated by a representational attachment measure, and theory of mind (ToM) among 204 socioeconomically disadvantaged children aged four to six years living in three distinct Turkish contexts: Seasonal migrant agricultural worker (SMAW) communities, residential group homes (RGHs), and rural villages. Attachment story-completions and ToM were found to be related to the distinct contexts children were living in. In the SMAW communities, higher number of children showed insecure dominant attachment, with only one in four having secure dominant attachment. About half of the children in the RGHs had insecure dominant attachment. However, the majority of village children exhibited secure dominant attachment. Furthermore, irrespective of the context, secure dominant attachment was found to have a substantial positive influence on children's ToM. Findings suggest that early intervention programs tailored to address emotional needs and support cognitive skills may be the most effective in helping children in these contexts.

Management of patients with epilepsy and Intellectual disabilities in group homes vs. Family Homes: Insights into polypharmacy and seizure characteristics.

OBJECTIVES: This study aimed to investigate the differences in ASMs prescription, seizure characteristics and predictors of polypharmacy in patients with epilepsy and Intellectual disabilities (IDs) residing in group homes versus family homes. METHODS: This nine-year retrospective study analyzed patients with epilepsy and IDs who were admitted to the EMU, epilepsy clinics at LHSC and rehabilitation clinics for patients with IDs at Parkwood Institution. The study included individuals aged 16 years and older residing in either group homes or family homes. Data on demographics, epilepsy characteristics, and ASMs use were collected and analyzed using the Statistical Package for Social Sciences. The study utilized binary logistic regression to identify predictors of polypharmacy in patients with epilepsy and IDs. RESULTS: The study enrolled a total of 81 patients, of which 59.3 % resided in family homes. Group home residents were significantly older (41 vs. 24.5 years; p = 0.0001) and were prescribed more ASMs (3 vs. 2; p = 0.002). Specific ASMs were more common in group homes, including valproic acid (54.5 % vs. 25.0 %), lacosamide (54.5 % vs. 22.9 %), topiramate (33.3 % vs. 14.6 %), and phenytoin (30.3 % vs. 6.2 %). Admission to the EMU was more prevalent in group homes (93.9 % vs. 52.1 %; p = 0.0001). Living in a group home increased the risk of polypharmacy (OR = 10.293, p = 0.005), as did older epilepsy onset age (OR = 1.135, p = 0.031) and generalized or focal & generalized epilepsy (OR = 7.153, p = 0.032 and OR = 10.442, p = 0.025, respectively). SIGNIFICANCE: Our study identified notable differences in the demographic and clinical characteristics of patients with epilepsy and IDs living in group homes versus family homes. Age of epilepsy onset, EMU admissions, epilepsy types, and residency setting were significant predictors of polypharmacy. These findings highlight the need for personalized care strategies and increased awareness of the potential risks associated with polypharmacy.

Relationship between nurses' perceptions of the benefits/challenges of nursing and degree of interprofessional and intraprofessional collaboration in all-inclusive services combining day services, overnight stays and home-visit nursing for the older people living at home.

Background: Many countries are experiencing rapid population aging, and the provision of support for older adults with diseases or disabilities to continue living in their communities is a major global challenge. Japan has established multifunctional long-term care in small group homes and home-visit nursing (MLSH) as a service category that integrates medical and care services. These services focus on nursing functions to support continuous, long-term home, and end-of-life care for older adults with high levels of medical care dependency. This study aimed to clarify the relationship between nurses' perceptions of nursing benefits/challenges and the degree of interprofessional collaboration in the context of MLSH. Methods: We conducted a mail questionnaire survey of MLSH facilities throughout Japan. All facilities in Japan that had been operating for at least 1 year were included. We analyzed 182 responses (response rate: 36.0%; valid response rate: 98.3%). Results: Comparison of scores representing the degree of interprofessional collaboration perceived by nurses showed the highest score was for colleague nurses (3.9 ± 0.5) and the lowest was for external care managers (2.5 ± 0.9). Compared with the weak collaboration group, the strong collaboration group had higher perceptions of the benefits of nursing and lower perceptions of the challenges. Conclusions: The results of this study suggest that strong collaboration allows teams to achieve sufficient effects of care while reducing related challenges. It may be necessary to promote collaboration with external professionals to appropriately manage service users' worsened conditions and improve the quality of care.

COVID-19-Related Outcomes Among Group Home Residents with Serious Mental Illness in Massachusetts in the First Year of the Pandemic.

This study examined COVID-19 infection and hospitalizations among people with serious mental illness who resided in residential care group homes in Massachusetts during the first year of the COVID-19 pandemic. The authors analyzed data on 2261 group home residents and COVID-19 data from the Massachusetts Department of Public Health. Outcomes included positive COVID-19 tests and COVID-19 hospitalizations March 1, 2020-June 30, 2020 (wave 1) and July 1, 2020-March 31, 2021 (wave 2). Associations between hazard of outcomes and resident and group home characteristics were estimated using multi-level Cox frailty models including home- and city-level frailties. Between March 2020 and March 2021, 182 (8%) residents tested positive for COVID-19, and 51 (2%) had a COVID-19 hospitalization. Compared with the Massachusetts population, group home residents had age-adjusted rate ratios of 3.0 (4.86 vs. 1.60 per 100) for COVID infection and 13.5 (1.99 vs. 0.15 per 100) for COVID hospitalizations during wave 1; during wave 2, the rate ratios were 0.5 (4.55 vs. 8.48 per 100) and 1.7 (0.69 vs. 0.40 per 100). In Cox models, residents in homes with more beds, higher staff-to-resident ratios, recent infections among staff and other residents, and in cities with high community transmission risk had greater hazard of COVID-19 infection. Policies and interventions that target group home-specific risks are needed to mitigate adverse communicable disease outcomes in this population.Clinical Trial Registration Number This study provides baseline (i.e., pre-randomization) data from a clinical trial study NCT04726371.

Designing an Alternative, Community Integrated Model of Residential Aged Care for People Living with Dementia: Nominal Group Technique and Thematic Analysis.

BACKGROUND: Small-scale models of dementia care are a potential solution to deinstitutionalize residential aged care and have been associated with improved resident outcomes, including quality of life and reduced hospitalizations for people living with dementia. OBJECTIVE: This study aimed to generate strategies and ideas on how homes for people living with dementia in a village setting within a suburban community, could be designed and function without external boundaries. In particular, how could residents of the village and members of the surrounding community access and engage safely and equitably so that interpersonal connections might be fostered? METHODS: Twenty-one participants provided an idea for discussion at three Nominal Group Technique workshops, including people living with dementia, carers or former carers, academics, researchers, and clinicians. Discussion and ranking of ideas were facilitated in each workshop, and qualitative data were analyzed thematically. RESULTS: All three workshops highlighted the importance of a surrounding community invested in the village; education and dementia awareness training for staff, families, services, and the community; and the necessity for adequately and appropriately trained staff. An appropriate mission, vision, and values of the organization providing care were deemed essential to facilitate an inclusive culture that promotes dignity of risk and meaningful activities. CONCLUSION: These principles can be used to develop an improved model of residential aged care for people living with dementia. In particular, inclusivity, enablement, and dignity of risk are essential principles for residents to live meaningful lives free from stigma in a village without external boundaries.

Challenges and responsibilities in the medication management process in 24/7 group housing services for adults with intellectual disability: Interviews with nurses.

Staff in 24/7 group housing services for adults with intellectual disability are responsible for ensuring safe medication management processes and supporting the residents in their health-related issues. Ten interviewed nurses reported several challenges in the medication management process emerging at the staff level, the level of the group home, and the level of the social and healthcare system, and were often related to issues in communication and responsibility. They reported a variety of complex tasks in the medication management process, for which they need a multiple skill set. They also act as healthcare advocates for residents, but healthcare services do not always match residents' needs. Training for social and healthcare professionals, access to healthcare services and the collaboration of social and healthcare services should be improved to provide the people with intellectual disability the best possible pharmacotherapy and healthcare.

Pragmatic Evaluation of a Low-Threshold Sports Program for Older Adults in Group Homes.

Physical activity (PA) reduces with older age, ill health, and disability. For these groups, guidance recognizes the benefit of small increases in PA and low-intensity PA. This study evaluated a low-threshold intervention that addressed known barriers to older people's participation in PA in residential care and sheltered housing. Ten, competitive sport sessions were delivered by coaches at 49 sites with the aim that they be sustained in-house. Using quasi-experimental methods, participants reported reduced sitting time, increased moderate/vigorous PA, increased participation in sports and improved scores for both health quality of life and fear of falling at 6 months. The program engaged 29% of residents and was sustained at 50% of sites at 8 months. The findings suggest that low-threshold sports programs that overcome known barriers to older people's participation in PA have the potential to provide a gateway to increased PA in group homes and to be sustained in-house.

Best practices to reduce COVID-19 in group homes for individuals with serious mental illness and intellectual and developmental disabilities: Protocol for a hybrid type 1 effectiveness-implementation cluster randomized trial.

BACKGROUND: People with serious mental illness (SMI) and intellectual disabilities and/or developmental disabilities (ID/DD) living in group homes (GHs) and residential staff are at higher risk for COVID-19 infection, hospitalization, and death compared with the general population. METHODS: We describe a hybrid type 1 effectiveness-implementation cluster randomized trial to assess evidence-based infection prevention practices to prevent COVID-19 for residents with SMI or ID/DD and the staff in GHs. The trial will use a cluster randomized design in 400 state-funded GHs in Massachusetts for adults with SMI or ID/DD to compare effectiveness and implementation of "Tailored Best Practices" (TBP) consisting of evidence-based COVID-19 infection prevention practices adapted for residents with SMI and ID/DD and GH staff; to "General Best Practices" (GBP), consisting of required standard of care reflecting state and federal standard general guidelines for COVID-19 prevention in GHs. External (i.e., community-based research staff) and internal (i.e., GH staff leadership) personnel will facilitate implementation of TBP. The primary effectiveness outcome is incident SARS-CoV-2 infection and secondary effectiveness outcomes include COVID-19-related hospitalizations and mortality in GHs. The primary implementation outcomes are fidelity to TBP and rates of COVID-19 vaccination. Secondary implementation outcomes are adoption, adaptation, reach, and maintenance. Outcomes will be assessed at baseline, 3-, 6-, 9-, 12-, and 15-months post-randomization. CONCLUSIONS: This study will advance knowledge on comparative effectiveness and implementation of two different strategies to prevent COVID-19-related infection, morbidity, and mortality and promote fidelity and adoption of these interventions in high-risk GHs for residents with SMI or ID/DD and staff. CLINICAL TRIAL REGISTRATION NUMBER: NCT04726371.

The development of supported mental health accommodation and community psychiatric nursing in Oxfordshire.

Overcrowding in British mental hospitals was a major service and political concern when the NHS was introduced in 1948. From 1959, a number of projects were initiated locally in Oxfordshire, based from Littlemore Hospital Oxford, to provide alternative accommodation, primarily for long-stay residents. Two NHS hostels were opened and a network of group homes was developed from 1963. These were administered through the hospital League of Friends and supported by the community psychiatric nursing service led by Helmut Leopoldt. From 1977 a separate local charity, Oxfordshire Mind, also provided supported housing for younger patients. These developments can be seen as an early local case study of the provision of non-hospital (supported) accommodation and other forms of support for people with long-term mental health problems.

Evaluating the Effects of Technology-Based Self-Monitoring on Positive Staff-Consumer Interactions in Group Homes.

The quality and frequency of positive interactions between staff and consumers are related to reductions in consumer problem behavior and increases in other desired outcomes, such as leisure and self-help skills. Unfortunately, the frequency with which group home staff positively interact with consumers is often low and regularly requires intervention. We evaluated the effects of technology-based self-monitoring on positive interactions between staff and consumers during consumer leisure time. Participant data were collected off-site through video recordings from cameras already present in the group homes. During baseline, participant interactions were low. Upon introduction of an intervention containing self-monitoring completed via a tablet device, staff interactions increased and maintained when the intervention was in effect. Supplemental feedback via text message was provided to two of the three participants to reach criterion. These findings demonstrate the utility of technology-based self-monitoring for some individuals to increase positive staff-consumer interactions in group homes.

[Preliminary Survey in the Preparation of a Questionnaire on Nursing Practices at Group Homes for Elderly People with Dementia].

The users of Group Homes (GH) for elderly people with dementia have increasing medical needs, and the number of GH that employ nurses is increasing. Due to the variety of employment patterns of nurses, we feel that it is necessary to conduct a cross-sectional survey of the practical situation of nurses and their practices. The purpose of this study was to interview eight GH nurses and prepare a questionnaire in which "Internal nurses" are defined as nurses employed by GH, regardless of whether they are full-time or part-time, and "external nurses" are defined as nurses who belong to home-visit nursing stations and visit by contract with GH. The results of a qualitatively descriptive analysis of the data obtained from the interviews revealed that 44 items were common to both the internal and the external nurses, and 2 items were added to the external nurses only, for a total of 46 items. In the future, a cross-sectional survey using this questionnaire with a large number of participants will clarify the actual, practical situation of GH nurses, and will also clarify whether there are differences between internal nurses and external nurses in practice due to differences in employment patterns.

Motherhood in Alternative Detention Conditions: A Preliminary Case-Control Study.

Many women in detention are mothers and often the sole caregivers of their children. Italy, as most European countries, allows mothers to keep their children with them in detention, with the aim of preserving the fundamental bond between mother and child. Since prison does not seem to provide a good environment for the child's growth, there are different alternative residential solutions, such as Group Homes. The aim of this preliminary study was to explore the differences between mothers living in detention through alternative measures with their children and mothers who are not detained regarding parenting stress, child behavior from the parent's perspective, and maternal attachment. Twelve mothers were enrolled in this study, divided equally between the detained and the control groups. Both groups' participants completed a three-questionnaire battery in order to assess parenting stress, child's behavior, and maternal attachment. The analyses of variance showed significant differences between the two groups, with the detained group reporting higher scores than the control group in almost all the subscales of parenting stress. The results highlighted that imprisoned mothers might experience more stress than the general population. There is a need to design intervention programs to support parenting in detention.

Accomplishing Intergroup Relations in Group Homes: A Discursive Analysis of Professionals Talking About External and Internal Stakeholders.

Focusing on one of the most studied dimensions of Social Psychology, i.e., intergroup relations, this study analyzes its discursive accomplishment in a specific group-based intervention, i.e., the talk and work of an Italian group home, i.e., a small alternative care facility hosting a group of out-of-home children. Particularly, we focused on the fictionally called "Nuns' Home," a group home previously investigated for its ethnocentric bias, and its intergroup relations with "inside" and "outside" groups, such as schools, biological families, and social services. By combining a qualitative and quantitative approach in analyzing one audio-recorded ethnographic interview with the whole team of professionals, we aimed at accounting for the multitude of internal and external stakeholders that participants refer to, analyzing the discursive accomplishment of ingroup and outgroup in talk-in-interaction and investigating ingroup bias and group qualification. To do so, we detected social categorization markers and qualifying devices that participants rely on when referring to groups. Results show that, among the numerous groups recognized, participants co-construct intergroup relations and ingroup bias implying negative assessment over external groups. Being different from traditional laboratory studies illustrating substantial contraposition between ingroup and outgroup, our qualitative analysis reveals the multitude of groups by which the ingroup is formed and their internal fragmentation. To conclude, we discussed the implications of qualitatively studying intergroup relations in group homes and indicated future lines of research.

Implementation of an Advance Care Planning Inventory and Its Possible Effect on Quality of Dying: A Nationwide Cross-Sectional Study in Group Homes for Persons with Dementia in Japan.

This study aimed to develop an inventory for advance care planning implementation for persons with dementia in group homes and to examine the association between inventory implementation and residents' quality of dying. A nationwide cross-sectional study was conducted via questionnaires mailed from 2000 group homes in Japan, selected through stratified random sampling. Participants were managers and care planners who had provided end-of-life care for recently deceased residents. The newly developed inventory was used to assess advance care planning implementation for persons with dementia, and the Quality of Dying in Long-term Care Scale was used to evaluate quality of dying. The valid response rate was 28.5% (n = 569). The factor structure of the newly developed Advance Care Planning Practice Inventory and the association between its implementation and quality of dying were verified using factor analysis and internal consistency, and logistic regression, respectively. The composite score and the factor score of the newly developed inventory were significantly associated with quality of dying (p < 0.05). The implementation of advance care planning improves the quality of dying. These findings can be used in development of educational programs, as well as research on advance care planning for care providers.

Time Investment for Program Implementation to Manage Neuropsychiatric Symptoms: An Observational Longitudinal Study in In-Home and Residential Care Settings.

BACKGROUND: There are no studies on how the same psychosocial dementia care program is adapted to both in-home and residential care settings. OBJECTIVE: To evaluate the time investment required by professionals to implement a psychosocial dementia care program to manage neuropsychiatric symptoms. METHODS: A prospective observational study design was used. The program consisted of 1) a one-day training course, 2) three interdisciplinary discussion meetings in five months, and 3) a web-based tool for the continued assessment of neuropsychiatric symptoms. Care professionals implemented the intervention in in-home (19 in-home care management agencies and 14 multiple in-home service providers) and residential care settings (19 group homes and eight nursing homes) in Japan from October 2019 to February 2020. The level of neuropsychiatric symptoms for the participants was evaluated using the Neuropsychiatric Inventory (NPI: 0-144). The time investment was reported by participating professionals. A total of 125 persons with dementia were included at baseline. RESULTS: Neuropsychiatric symptoms were significantly decreased at the final follow-up in all types of providers (Cohen's drm = 0.44-0.61). The mean (SD) time required for the five-month implementation was 417.9 (219.8) minutes. There was a mean (SD) decrease of 8.6 (14.0) points in the total NPI score among the 103 persons with completed interventions. The time investment was significantly lower in in-home care management agencies than in group homes, and lower in follow-ups than at baseline assessment. CONCLUSION: The program implementation may incur a substantial time investment regardless of setting. An additional benefit scheme to reward the time investment would be helpful to encourage implementation until the follow-ups.

[Literature Review of Research Trends in Nursing and Nursing Practices at Group Homes for Elderly People with Dementia].

Although nurses are not indispensable according to the standards of staffing in Group Homes (GH) for elderly people with dementia, they are involved in health management due to the increasing medical needs of users, and the number of GH that employ nurses is increasing. The purpose of this study was to clarify the trends in nursing research in GH and the practices of nurses. The main research contents of the practice of nurses were "nursing of end-of-life (EOL) care" and "nursing other than EOL care". The necessity of nurses in GH and the importance of cooperation with GH staff were also clarified in this study, but there were few reports on the practices of nurses, suggesting the need to clarify the actual situation in the future.