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Participants in the author’s training program for OT practitioners who work in skilled nursing facilities will gain an understanding of the need and requirements for ongoing wheelchair seating and positioning management of long-term care residents. BACKGROUND: Elderly individuals admitted to a skilled nursing facility receive initial occupational therapy (OT) evaluation for appropriate wheelchair (WC) seating. On extended stay, the resident’s seating needs often change, leading to postural impairment from improper positioning. Lack of awareness of poor positioning by residents, particularly when cognitive issues are present, can delay corrective action because they may not call attention to difficulties or discomfort. Occupational therapy practitioners (OTPs) can play a distinctive role in ensuring that proper wheelchair seating and positioning of older residents is maintained. The author’s aim is to create a prototype program designed to mitigate the risk that accompanies poor wheelchair positioning and that can be carried out at any skilled nursing facility (SNF). OBJECTIVES: The author’s project will address the recognized need for a training program for occupational therapy practitioners that will provide guidelines for assessing, evaluating and planning the appropriate intervention for an elderly manual wheelchair user in a skilled nursing facility. Objectives for the resident include reduction in the incidence of wound development, improvement of functioning, and increase in participation in the care environment with other wheelchair users. METHOD: Program implementation will begin with facility recruitment. The author will create a handout illustrating the planned program and will distribute it in person or via mail to administrators of skilled nursing and residential care facilities within a 100-mile radius that have a rehabilitation department and one or more OT practitioners. When interest is expressed by a recipient, the author will contact the facility and conduct a short interview to discuss problems and concerns, the availability of staff incentives for participation in inservice training, and payment for the author’s services. Depending upon the author’s assessment of participant knowledge, skills and needs, training will be adjusted from an introductory to intermediate level. As part of the proposed program, the author will recommend that OT practitioners instruct nursing and other caregiving staff to periodically screen every wheelchair-dependent resident when they are providing direct care during their daily routines. Miller, Miller, Trenholm, Grant and Goodman (2004) developed the Seating Identification Tool (SIT) to fill the need for an easy to administer screening questionnaire that would be sufficiently sensitive for clinical assessment and research. ANTICIPATED FINDINGS: Occupational therapy practitioners will play a distinctive role in ensuring that proper wheelchair seating and positioning of older residents is maintained. Preventing pressure ulcers will prove to be much less costly than medical treatment, both to the resident and the facility. Reduction in time lost from daily occupations to allow healing will improve the client’s sense of well-being. OT practitioners will be called upon to make periodic adjustments in wheelchair fitting and positioning, which might as simple as providing an appropriate wheelchair cushion. LIMITATIONS: Program development and program evaluation research are in the initial stages and have not yet been implemented in any skilled nursing facility. RECOMMENDATIONS: The author recommends implementation of the pilot program in a skilled nursing facility with data gathering for program evaluation research to gain evidence and further refine the program.

In the United States, congestive heart failure (CHF) is a cardiac condition with increasing hospitalization and rehospitalization burden to patients, families, and the healthcare system. This chronic condition is expected to affect more than 8 million people by 2030; however, not much is known about the relationship between risk factors and hospital readmissions once CHF patients are discharged to a skilled nursing facility (SNF). Applying a systems theory unbounded systems thinking, coupled with a systems-thinking approach the purpose of this quantitative, retrospective cohort study was to examine CHF hospital readmissions from SNFs within a 90-day period using a secondary data set of gender, age, race, SNF geographic location, length of SNF stay, and home health use risk factors. A binary logistic regression analysis revealed that out of 238 episodes, 99 patients were readmitted; however, no statistically significant relationship between the risk factors and readmission was found. Findings suggest that CHF readmissions from the SNF are not attributed to only quantifiable risk factors. Based on these findings, further research can support social change through multifaceted quantitative and qualitative systemic analyses to identify and inform how healthcare organizations can better assist the elderly population with CHF and improve future post-acute community-based health education and prevention programs.

Readmission of skilled nursing facility (SNF) residents has become a financial and quality-of-care concern for facility leaders. SNF administrators do not know whether nurse staffing levels are impacting readmission rates. The Affordable Care Act included measures to monitor and improve quality and to penalize SNFs that have high readmission rates. The purpose of this quantitative correlational study was to examine the relationship between SNF nurse staffing levels and readmission rates using the Skilled Nursing Facility Readmission Measure (SNF RM). The theoretical framework for the study was Donabedian's structure, process, outcome model. The research questions addressed the relationship between nurse staffing levels and rehospitalization percentages for SNFs, and the relationship between RN staffing levels and rehospitalization percentages. A quantitative methodology was used to analyze publicly reported secondary data from Centers for Medicare and Medicaid Services staffing files and SNF Value-Based Purchasing (SNF VBP) program data. Pearson's correlation was used to examine the relationship and strength between nurse staffing levels and the SNF RM. The sample included 374 SNFs across Georgia that participated in the SNF VBP program. Findings from the multiple regression analysis and analysis of variance indicated no statistically significant relationship between nurse staffing levels and SNF RM rates. Facility characteristics across Georgia showed some variations in staffing levels and SNF RM rates. Findings promote positive social change by providing SNF leaders with needed information to make decisions about staffing needs when considering staffing above the state averages. Health care leaders and policymakers might use the findings when considering recommendations for staffing regulations.

A role description for a medical coordinator in extended and long term care facilities in British Columbia has been defined using a Delphi method. Also obtained during the study was a long term care philosophy. Three groups - nurses, administrators, and physicians took part in three rounds of the Delphi study. Thirty-five respondents were interviewed in the first round. During this interview the researcher obtained from the respondents the statements that they considered should be included in this role and philosophy description. During the second round the respondents rated the responses of the first round and in the third round those of the second round were revised after seeing the mean scores of the whole group and the three separate groups. The description of the role of a medical coordinator developed describes the role as it applies to: resident care; private physicians; planning, development and evalution of care; staffing of a facility; education; administration; and the training, experience, skills and attitude of a medical coordinator. When the description created was compared with that for the medical director in a long term care facility in the United States it was found that this study had described additional dimensions of the role, in particular the multi-disciplinary approach and the physician's knowledge, training, experience, skills and attitude. The results of the study show where there was agreement and where there were differences of opinion between the three professional groups. A long term care philosophy which was considered very important for a medical coordinator to promote, has been defined during the study. It focuses on the resident reaching his full potential, the creation of a special environment, as well as acceptance of disability, dying and death. Recommendations from the study are made for facilities which might be considering employing a medical coordinator, for planners deciding whether to provide funds for medical coordinators, for geriatric medical education and for the acceptance of a long term care philosophy in all parts of the health care system where there are long term care clients. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Falls and complications from falls are a common problem among adults aged 65 years and older. About 60% of older adults fall every year, causing injuries, hospitalization, nursing home placement, and even death. Most studies on falls among skilled nursing facility (SNF) residents focus on fall preventive measures that fail to include staffing variables such as nursing hours. Although researchers have examined the relationship between nursing staff and patient outcomes in hospital settings, similar studies have not occurred in long-term care facilities. The purpose of this retrospective longitudinal study was to determine whether a correlation exists between nursing staff hours per shift and rate of falls. The secondary data included Minimum Data Set 3.0, Certification and Survey Provider Enhanced Reporting, and residents' event reports from four skilled nursing facilities over 6 months. Statistical analysis of Latent Growth Curve Model of SPSS informed this retrospective longitudinal study. The theoretical framework of Donabedian's model of structure, process, and outcome provided the background for this study. The findings suggested that there is no correlation between higher nursing staff ratios and decreased fall rates. However, there were more falls during the day shift, with a higher nursing staff ratio. The study findings have implications for social change. The dissemination of study findings could assist Medicare and Medicaid services to improve SNF staff rating systems. Additionally, findings could inform and influence SNF administrators, policymakers, and health care providers in the development and implementation of policies and intervention programs that assist in fall prevention measures.

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Little is known regarding registered nurse (RN) information management practice in long-term care (LTC) settings. This study identifies LTC RNs’ information management practice and needs, which are important for designing and implementing health information technology (HIT) in LTC settings. Methods: This descriptive qualitative study combines direct observations and semi-structured interviews, conducted at Alberta’s LTC facilities between May 2014 and August 2015. The constant comparative method of joint coding was used for data analysis. Results: Nine RNs from six nursing homes participated in the study. Based on the RNs’ existing information management system requirements, a graphic information flow model was constructed. Conclusion: This baseline study identified key components of LTC RNs’ information management system. The information flow model may assist HIT developers with future design and development of HIT solutions for LTCs, serve as a communication tool between RNs and developers to refine requirements and support further LTC HIT research. / Graduate