Caring for Older Adults With Complex Needs: Drafting an Interdisciplinary Team.

Providing dental care for seniors with complex medical and/or social needs can seem daunting. Many dental providers may question their resources to manage such patients. However, many of these patients have teams in place that can be accessed to improve the efficacy and satisfaction in providing care to them. Seeking out patients' other health care providers, and understanding how to work effectively with them, is important to improve total patient care, comfort, function and dignity.

Characteristics of residents living in residential care communities, by community bed size: United States, 2012.

In 2012, there was a higher percentage of older, female residents in communities with more than 25 beds compared with communities with 4­25 beds. Residents in communities with 4­25 beds were more racially diverse than residents in larger communities. The percentage of Medicaid beneficiaries was higher in communities with 4­25 beds than it was in communities with 26­50 and more than 50 beds. A higher percentage of residents living in communities with 4­25 beds had a diagnosis of Alzheimer's disease or other dementias compared with residents in larger communities. Need for assistance with each of the activities of daily living (ADLs) examined (except walking or locomotion) was substantially higher among residents in communities with 4­25 beds, compared with residents in larger communities. Emergency department visits and discharges from an overnight hospital stay in a 90-day period did not vary across residents by community bed size. This report presents national estimates of residents living in residential care, using data from the first wave of NSLTCP. This brief profile of residential care residents provides useful information to policymakers, providers, researchers, and consumer advocates as they plan to meet the needs of an aging population. The findings also highlight the diversity of residents across the different sizes of residential care communities. Corresponding state estimates and their standard errors for the national figures in this data brief can be found on the NSLTCP website, available from: http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm. These national and state estimates establish a baseline for monitoring trends among residents living in residential care.

[Development and validation of a Quebec classification of private residences with services welcoming of older persons]. / Développement et validation d'une classification québécoise des résidences privées avec services accueillant des personnes âgées.

Private Residential Care Facilities (RCFs) fill the gap between independent community living and institutional settings for seniors. There are marked differences between RCFs which make them difficult to compare. To address this issue, the objective of this study was to develop and validate a classification of RCFs based on their physical and organizational environments. RCF owners across Quebec were invited to complete a questionnaire that described the setting's physical and organizational environment. Different combinations of cluster analysis methods and statistical parameters were used to identify plausible classifications. The final choice was made by an expert committee. Overall, 552 owners returned the questionnaire. Three plausible classifications were submitted to the committee. The selected classification included five clusters that differed with regard to admission criteria, services offered and recreational activities. This classification could help health professionals select the RCF that best responds to older adults' needs.

Dental utilization for Medicaid-enrolled adults with developmental disabilities in Iowa residential care facilities.

The goal of this study was to evaluate the dental utilization of Medicaid-enrolled adults in Iowa residential care facilities (n=1423). Medicaid enrollment and claims files for 2003 were used, as well as information from the Iowa Department of Inspections and Appeals. Dental utilization was defined as having any dental visit during 2003. Of the residents, 74.1% utilized at least one dental service in 2003. Residents in facilities that were part of smaller organizations, and younger residents, were more likely to have had a dental visit. Of those with a visit, over 80% received a preventive service but this declined with age. Despite additional barriers, dental utilization was generally good for Medicaid-enrolled residents of residential care facilities in Iowa. Residents in smaller facilities of smaller organizations received more personalized care. Older residents were less likely to have a parent involved, were more likely to be edentulous, and sought care less frequently.

[Hygiene ranking in residential homes for the aged in Frankfurt--conception and first results]. / Das Hygiene-Ranking der Frankfurter Altenpflegeheime--Konzept und erste Erfahrungen.

Public health departments are obliged by law to survey hygienic procedures and condition in residential homes for the aged. Based on the annual hygiene control visits, a standardised hygiene ranking was established with the aggregation of more than 60 detailed single observations in the following fields: building, organisation, training of the staff, actual hygiene situation, repeated deficits, food and kitchen hygiene, and drinking water. This hygiene ranking enables not only intra-institutional comparisons in different years but also the comparison between different homes. The data obtained in 2004 to 2006 demonstrated that this method was very well accepted by the institutions and was readily appreciated as a tool for external quality assessment.

Definition and classification of assisted living.

PURPOSE: The purpose of this article is to discuss the benefits and limitations of, and considerations in, developing a typology of assisted living (AL). DESIGN AND METHODS: We conducted a review and comparison of nine AL typologies drawn from the literature. RESULTS: Typologies addressed matters related to the structure, process, population, and philosophy of AL to varying degrees. A lack of available data and different sampling frames hindered attempts to quantitatively compare the typologies. IMPLICATIONS: Typologies are potentially useful for consumers, practitioners, policy makers, and researchers. It is advisable to identify state-based typologies and then empirically determine types that have national representation. Stakeholders should consider the tradeoff between sensitivity and specificity and allow any resulting typology to anticipate ongoing evolution in the field of AL.

Estimating residents and staff in communal establishments from the 2001 Census.

Censuses of population in the UK provide the only comprehensive source of data on the population resident in communal establishments. Accurate information on the population resident in institutions and, in particular, counts of those living in medical and care establishments, is important for a range of social policy issues and for local service planning and resource allocation. This article identifies issues in distinguishing residents from staff when using the 2001 Census communal establishment data in England and Wales. Possible options to improve the reliability of institutional population estimates for analysis and reporting are evaluated against quality and credibility criteria and the impact of each adjustment option assessed. The article concludes with a recommendation on what users can do when using 2001 Census outputs at both the aggregate level (e.g. area-based figures) and the individual level (e.g. the sample of anonymised records).

Falls and fall-related injuries among the elderly: a survey of residential-care facilities in a Swedish municipality.

Injurious falls among the elderly are an increasing public-health problem in Sweden. One group particularly vulnerable to falls consists of elderly people living in residential-care facilities. The purpose of this study was to investigate the extent to which falls lead to injury within a defined population of elderly people in institutionalized care. All the elderly persons living in residential-care facilities in an urban Swedish municipality during the year 1997 (n = 469 institutional places). Falls and fall-related injuries were registered over a one-year period. Data were gathered by personnel at the time of the falls, using a form specifically designed for surveillance purposes. Of the 865 falls reported during the study period, 375 were among men, with an average age of 82 years, and 490 among women, with an average age of 85 years. Men were subject to falling to a greater extent than women. The most common location was the individual's own bedroom. Injuries were incurred in approximately one in four falls, and the head was the body part most frequently injured. Only 24 falls (2.8%) resulted in a fracture, of which 18 were hip fractures. Although elderly people living in residential-care facilities fall fairly often, serious injuries, in the form of fractures, are incurred to a relatively limited extent.

A modification of the token economy for nonresponsive youth in family-style residential care.

Out-of-home treatment for youth with conduct problems is increasing rapidly in this country. Most programs for these youth deliver treatment in a group format and commonly employ some version of a token economy. Despite widespread evidence of effectiveness, a substantial minority of treated youth fail to respond. Participants for this study were 3 youth who were nonresponsive to treatment provided in a family-style residential care program with a comprehensive token economy. Our approach to the "nonresponse" of these youth involved modifications of the frequency and immediacy of their access to the backup rewards earned with tokens. We evaluated the effects of the modifications with a treatment-withdrawal experimental design. Dependent measures included two indices of youth response to treatment: intense behavioral episodes and backup rewards earned. Results showed substantial improvement among these indices during treatment conditions.

The Resident Choice Scale: a measure to assess opportunities for self-determination in residential settings.

BACKGROUND: A 26-item Resident Choice Scale was designed to assess service practices for promoting resident choice. METHOD: The staff working with 560 UK/Irish adults with intellectual disability were interviewed. Specific examples of practices promoting resident choice were requested and independently rated by the interviewer. RESULTS: The interrater reliability of Resident Choice items was found to be acceptable (subsample n = 50). The psychometric properties of the Resident Choice Scale total score and scores on eight subscales were also acceptable. Consistently strong associations were found between greater resident choice and greater resident ability and, to a lesser extent, fewer resident challenging behaviours. Few associations were found between resident choice and autism or mental health problems. Even when controlling for resident ability and challenging behaviour, consistent associations were found between greater resident choice and the concurrent variables of greater community presence, fewer institutional practices, and greater user self-reported satisfaction (subsample n = 50). CONCLUSIONS: Taken together, this pattern of results indicates that the Resident Choice Scale shows promise as a measure of the environmental opportunities available for adults with intellectual disability to exercise self-determination. Areas for future research testing the reliability and validity of the Resident Choice Scale are outlined.

Falls among frail older people in residential care.

AIMS: A prospective study was carried out to investigate the incidence, circumstances, and injuries from falls among frail older people living in three different types of Swedish residential care settings. METHODS: The settings were senior citizens' apartments, an old people's home, and a group dwelling for people with dementia. The falls were registered during the three-year study period on a semi-structured fall report, and injurious falls were categorized according to severity. RESULTS: In total 428 falls occurred among 121 residents. The incidence rate of falls at the group dwelling was twice the rates of the old people's home and senior citizens' apartments (4282 compared with 1709 and 2114 falls per 1000 person-years respectively). Some 27% of the falls occurred during the night (2100h to 0600h) and 28% were related to a visit to the lavatory. The presence of acute disease at the time of a fall was diagnosed in 23% of the falls. Some type of injury occurred in 118 falls (28%) and 36 of these (8%) led to moderate or serious injuries. In total 48 fractures were diagnosed. CONCLUSIONS: In a preventive programme for falls and injuries in residential care settings, areas of particular interest should include falls after mealtimes and falls at night, conditions of acute diseases, rising up from sitting, walking, and activities in progress, especially visits to the lavatory.

State long-term care screening and assessment programs.

Long-term care screening and assessment programs were designed by states to control long-term care costs and to prevent unnecessary institutionalization of Medicaid participants. This study reports data collected by telephone survey of state officials in all 50 states and Washington, D.C. on state variation in LTC screening and assessment programs. The majority of the state screening and assessment programs cover an array of LTC services but this has resulted in multiple separate screening programs for different long-term care services and eligibility groups. Only three states coordinated screening and assessment across long-term care programs by operating a single state administrative agency, using uniform need criteria and standard tools, and having automated databases (Arizona, Colorado, and Maine). The design and implementation of multiple and separate screening and assessment programs in most states may create potential barriers to client access, information about services and choice of services.

Australian approaches to resident classification and quality assurance in residential care.

This paper begins with an account of the structure of Australia's residential long-term care program, which was divided into two distinct levels of hostel and nursing home care until 1997. In response to changed policy objectives, a number of measures were then taken to create an integrated residential care system. The main measures were the development of a single scale for classification of resident care need and associated funding to replace two previous separate scales, and the implementation of a new quality assurance system, which included new standards for buildings as well as revised standards for care. I give accounts of these measures and the extent to which they have achieved their intended outcomes before proposing some further developments that could see closer links among pre-admission assessment, resident classification, and quality assurance.

Correlates of open- and locked-facility placement in a population of decisionally impaired adults.

OBJECTIVES: This study compares characteristics of public conservatees placed in locked facilities with those in less restrictive settings. Given the principle of the least restrictive alternative, the study seeks to identify factors, including the role of aging and advanced age, associated with restrictive placement within conservatorship. METHODS: Management Information Systems data on 1,534 adult conservatees in Los Angeles County in July, 1993, are examined in cross-section. Models exploring individual and environmental characteristics of conservatees and linear, curvilinear, and multiplicative aging effects are tested on the probability that adults are placed in locked facilities versus all other placement types. RESULTS: Locked facility placement is associated with being female, receiving SSI, a diagnosis of dementia, and being identified as a danger to oneself and to others. Locked-facility placement is associated with increasing age until age 60, when the effect becomes inversely related; the multiplicative effect of older age and impaired functioning is also inversely related. DISCUSSION: The curvilinear nature of age and the interaction effect of Age x Functioning implies that increasing frailty in older adults makes locked facility-placement less likely. Further research is needed on whether alternative placement types, such as special care units with secured perimeters, can further reduce the need for locked facilities.

The mental health residential care study: classification of facilities and description of residents.

BACKGROUND: The NHS is no longer a virtual monopoly provider of mental health residential care. This makes it difficult to assess the volume, range and adequacy of local provision. METHOD: Local data collectors used standard instruments to collect detailed information about 368 facilities (with 1951 residents) providing mental health residential care in eight districts. Because local definitions were inconsistent, facilities were reclassified on the basis of facility size and extent of day and night cover. The eight categories of accommodation are compared on levels of staffing, staff qualifications and the characteristics of their residents. RESULTS: There was a nearly threefold variation between districts in the total number of residential places available per unit of population, and even greater variation in the number of places with 24-hour waking cover. Most residents have long-term, severe mental illness and severe impairment. Long-stay wards accommodate people who pose greater risk of violence than do the two types of non-hospital facility with 24-hour waking cover (P < 0.001). The former also employ a much greater proportion of staff with formal care qualifications and, in particular, nursing qualifications than the latter (49% v. 15%, P < 0.001). CONCLUSIONS: It is suggested that one consequence of the diversification in provision of mental health residential accommodation has been a relative reduction in the proportion of provision available to the most severely disabled. This might apply particularly to those who pose a risk of acting violently.

Resource management in community residential facilities for adults with learning disabilities.

The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A sample of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided. There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care. Residential homes which operate under centralised management systems are more institutional in their care practices and less responsive to individual clients' needs. In contrast, homes in which responsibility is delegated to the facility manager provide a service more in keeping with current philosophies of care. The results of this survey suggest that more responsibility for resource management can be delegated to facility managers without losing control of expenditure and with improvements in the efficiency and effectiveness of care.

A comparison of the health status of residents of sheltered care facilities in Monmouth County, New Jersey.

In the past 20 to 30 years the number of sheltered care facilities in the United States has risen dramatically. Serving what many consider to be marginal populations, they are often poorly regulated or unregulated, with little or no attention to the health of residents. A retrospective record review of 647 clients residing in boarding homes, rooming houses, a homeless shelter, and residential facilities in Monmouth County, New Jersey, suggested that whereas some differences exist among facilities in terms of clients' physical and psychosocial health problems, these differences may not be meaningful. Since New Jersey regulations require some minimal health supervision to be provided by residential facilities but not by the others, these results suggest that regulations of the other facilities should be revised to reflect better the needs and problems of the populations they serve.

Surveying board and care homes: issues and data collection problems.

National information is seriously lacking concerning the number and types of board and care homes, their residents, and the quality of services provided. Shortcomings in current living arrangement classification procedures used in federal surveys are critically examined. A definition and classification system is proposed that would transcend state and local government differences caused by differences in licensure and regulations.