A study to gather information on living conditions of boys and girls in Adamson High School who come from broken homes, in order to discover the individual needs of the students in order to promote greater interest and develop better citizenship.

The present study examined the effects of group home staffing variables on the proportion of successful program completions by adjudicated juvenile delinquents. A survey questionnaire was sent to most small group homes serving this population in California. Respondents became the 114 participants. There were no significant relationships between the staff/resident ratios and successful completion, between the inconsistency measure and successful completion, or between staffing pattern type and successful completion. Homes that employed live-in part-time family counselors had the highest staff/resident ratios. Homes that employed family counselors working in shifts had the highest staffing inconsistency.

Background: People living with advanced dementia in nursing homes often spend the majority of time alone, with little contact with anyone. The need to connect with others is a central part of a philosophy known as Person Centred Dementia Care. A significant body of literature demonstrates the effectiveness of a range of approaches that facilitate connections, yet, we know little about staff perspectives on what facilitates them to connect on a daily basis. Aim: To develop a Grounded Theory to explain what facilitates nursing home staff to connect with residents living with advanced dementia. Methods: Semi structured interviews were conducted with nursing home staff (n=21) and relatives (n=5) from seven nursing homes. Following Strauss and Corbin’s (1990, 1998) Interpretivist Grounded Theory methodology, data collection and analysis proceeded iteratively, and theoretical sampling was used to develop the emergent theory. Results: The Grounded Theory ‘making the most of time’ explains that most connections occurred during personal care. Interdependent contextual and individual factors facilitated staff to make the most of time. Effective leaders were described to create a caring culture in which informal leaders (experienced staff) acted as role models. Staff were then more likely to understand, accept and tolerate dementia, know connections were part of their role, get to know residents and express caring values. In the right physical environment, this then facilitated staff to make the most of time during personal care. Increased training and education from specialised dementia units and experiential knowledge from family engagement then supplement such contexts. Implications: Future research could empirically test the theory ‘making the most of time’

Background: Transitions out of hospital result in poor outcomes for older people. Research investigating transitions for care home residents living with dementia is limited, even though such residents often have multi-morbidities and frequently use hospital services. Nurses are key care providers. Yet their perspectives on optimising care for people living with dementia transferring back to their care home remains under explored. Aims: This qualitative descriptive study explores hospital and care home nurses’ perspectives on how they optimise care for people living with dementia who transfer from hospital back to their care home, and the alignment of this care with best practice. Methods: Thirty-three nurses participated in either semi structured interviews or focus groups. Data were analysed using qualitative content analysis. Results: Nurses described four roles: 1) exchanging information, 2) assessing and meeting needs, 3) working with families and 4) checking and organising medication. They described care home residents with dementia as having distinct needs and variation in how they provided care. Nurses described interdependent roles, but care home nurses were often excluded from involvement in planning resident’s care on return and were not fully recognised as members of wider healthcare teams. Facilitators for optimising care include: nurses understanding the principles of dementia care, nurse leadership and autonomy, having positive relationships between hospital and care home nurses and opportunities for joint working. The care practices nurses described broadly aligned with best practice. Implications: Hospital and care home nurses require joint working opportunities to understand their roles and build relationships. Care home nurses’ status needs to be addressed with action to support their integration into the wider healthcare system. / Alzheimer’s Society (UK)

As the percentage of elderly adults within the U.S. continues to grow, long-term care options will increase. Facing increased competition from other forms of long-term care, many nursing homes are seeking innovative models to enhance management and clinical care practices. The Teaching Nursing Home model, first established in the 1970s, is one in which academic institutions partner with nursing homes to create information exchanges between the nursing home and the school. Currently, nursing schools throughout the country work with nursing homes to create clinical training sites for nursing students. The partnership is also used to encourage research among school faculty and to assist nursing homes in their management of best practices. This study examined the impact of these relationships on nursing home quality. Twenty teaching nursing homes were matched with twenty nursing homes that are not engaged in this practice. Using nursing home quality scores published by the Centers for Medicare and Medicaid Services, mean outcomes for the matched pairs were compared using T-tests. Regression analyses were also performed to test whether quality improves over time within a teaching nursing home. The results from the T-tests performed did not show overall quality differences between the matched pairs. However, when analyzed regionally, some significance was observed for teaching nursing homes in the Upstate NY region (p<0.1). The study discusses some of the differences in design of the teaching nursing homes within that region and the impact that may have on results. Time as a teaching nursing home did not appear to affect quality for nursing homes in this study. Possible explanations for these insignificant results are discussed in the Summary, Discussion and Limitations section of the study. Overall, the findings from this study suggest that the Teaching Nursing Home model can add value to nursing homes by offering them research and professional training opportunities with academic institutions. Within the study, recommendations are made to further explore the impact of these partnerships on nursing home quality and to encourage the development and use of the model through policy changes. / Business Administration

Large parts of northern Sweden have seen a fast increase in many new job opportunities. Skellefteå municipality is the most prominent example of this. The company Northvolt established a factory there in 2017 which has led to a fast increase in population. This has largely been seen as positive, however it has also caused many problems for the municipality. The most pressing problem is housing. It has been hard to build new housing at a fast enough pace to match the increasing population, this has led to a housing shortage in Skellefteå.  The aim of this essay is to examine the possibilities of converting and using second homes as permanent housing in Skellefteå Municipality. Deserted houses will also be included to a lesser extent. This will be done by analyzing previous research and reports and by taking second homes from broker websites and analyzing the price and other factors in ArcGIS Pro as well as the potential costs of renovation. The results show that five types of second homes could be converted into permanent housing at a somewhat reasonable price. While many second homes are cheaper than apartments, they are still quite expensive if the costs of renovations are included. It is unclear if using second homes as permanent housing could have a large impact on the housing shortage in Skellefteå, and more research is needed to say anything for certain. Deserted houses could be converted to permanent housing, but it is unclear if there is an interest in doing so, since it could be very expensive and tedious to renovate these houses.

Geographic utilization patterns of nursing homes were examined by comparing patient origin with facility location. The 1985 Patient Origin Study produced by the Virginia Department of Health was used to see if there are predictable geographic patterns of patient migration to nursing homes. A random sample of thirty nursing homes was taken from all facilities in Virginia in the 1985 study. The migration data were used to determine median migration distances, to investigate decreases in utilization with distance from a facility, and to distinguish spatial markets of nursing homes. Comparisons were made between urban and rural facilities to see how factors of limited availability and children-as-decision makers affect the migration patterns. The findings show that there is a distinct pattern of decreasing utilization of nursing homes with distance from the facility. Both urban and rural nursing homes primarily serve the immediate environment in which they are located. Maps of patient origins show that there are service areas for nursing homes which are modified by population distribution and physical geography. General findings show that location is crucial for nursing home utilization. The existence of a facility generates need awareness and utilization throughout the immediate population. On the average, twenty-six percent of the patients at a nursing home come from the same zip code in which the nursing home is located. More than half the patients come from within eight miles of a facility. Eighty-three percent of the patients come from within 26 miles. The ratio of out-of-region migration to urban nursing homes is significantly higher than that for rural nursing homes. The results of this thesis can be used to predict utilization patterns of nursing homes. The findings also have implications for Medicaid budgeting because they show geographic, demographic, and economic factors which affect nursing home utilization rates. / Master of Science

No / Dementia is a common illness that is increasing in frequency and set to challenge the resources and expertise of health and social care services over the coming years. Increasingly, there has been interest in the management of behavioural and psychological symptoms of dementia (BPSD), as they are both common and associated with a range of negative outcomes. BPSD are associated with the admission of people with dementia to care homes. Limited resources and lack of knowledge in permanent care settings often lead to BPSD being managed with antipsychotic medications, which are associated with significant morbidity and mortality. There is evidence for the benefits of exercise within care home settings, although only a few studies include those with cognitive impairment. Tai Chi is a mind-body exercise combining relaxed physical movement and meditation, and has been suggested to have many health benefits. This article discusses the rationale and available options for treating BPSD and the current practice and reviews the literature regarding the benefits of exercise and, in particular, Tai Chi in the management of BPSD.

Yes / An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support. Objectives: Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted. Design: A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect. Setting: Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7). Participants: We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting. Intervention: This ran from February to July 2018. Data sources: Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed. Results: The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, , assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was < 20% and 80% of individuallevel data were collected. Necessary rates of data collection, documentation completion and return over the 6-month study period were achieved. However, intervention tools were not fully adopted, suggesting they would not be sustainable outside the trial. Few hospitalisations for the four conditions suggest it an unsuitable primary outcome measure. Key cost components were estimated. Limitations: The study homes may already have had effective approaches to early detection, assessment and treatment for acute health changes; consistent with government policy emphasising the need for enhanced health care in homes. Alternatively, the implementation support may not have been sufficiently potent. Conclusion: A definitive trial is feasible, but the intervention is unlikely to be effective. Participant recruitment, retention, data collection and engagement with family carers can guide subsequent studies, including service evaluation and quality improvement methodologies. Future work: Intervention research should be conducted in homes which need to enhance early detection, assessment and treatment. Interventions to reduce avoidable hospital admissions may be beneficial in residential care homes, as they are not required to employ nurses. / This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.

Mental health group homes located in residential neighborhoods are considered a locally undesirable land uses. Most communities and neighborhood members are misinformed or unaware of numerous studies conducted in the United States concerning the impacts of mental health group homes. This study investigated several conflicting issues associated with the siting of mental health group homes and the three most expressed oppositions by the general public to the integration of these facilities into residential neighborhoods. This creative project determined what effects, if any, a mental health group home has on property values, crime and neighborhood stability using a Comparable Market Analysis, Muncie Police Department records, Multiple Listing Service information, interviews and records form Comprehensive Mental Health Services of East Central Indiana. A description of the process used and results are given along with a determination of the impacts mental health group homes have had on the Muncie, Indiana neighborhoods where one is located. / Department of Urban Planning