The impact of a short-term training program upon learned helplessness among nursing home staff and residents was studied. Learned helplessness among staff was defined in terms of depression, self-monitoring, short-term memory, absenteeism, and turnover. Among residents, urinary incontinence was the selected measure of helplessness.

As the United States' baby boom generation ages, the future of nursing home care becomes increasingly important. Through this study the researcher seeks to understand quality in nursing home care from the family's perspective. Surveys were collected at one North Texas nursing home, and data were analyzed to determine how gender and level of family involvement impact their concept of quality. Further, the information in this study is aimed at clarifying if interventions, specifically empowered CNA teams, have an impact on how family members view quality. Findings are identified and recommendations for future study are made.

The purpose of this exploratory study was to examine resident, family member and staff perceptions of electronic monitoring and their effect on resident rights. The sample consisted of 53 nursing home residents, 104 staff and 25 family members, in the Dallas Fort Worth metroplex, from a nursing facility in which residents utilize video cameras in their rooms (Nursing Facility 1), two nursing facilities that have video cameras in their common rooms areas (Nursing Facility 2 and 3) and a nursing facility that does not utilize video cameras (Nursing Facility 4). The interview questions and self-administered surveys were in regard to the participant's perceptions of electronic monitoring, perceived risks and benefits of video cameras, awareness of resident rights and consciousness of potential risks to resident rights. Data were analyzed using a mixed methods approach using both ATLAS t.i and SAS. Study findings revealed that residents, family members and staff are aware of the potential benefits of electronic monitoring in nursing facilities. While respondents are hesitant to have electronic monitoring in resident rooms, they are interested in utilizing electronic monitoring in common areas. While residents and staff believe that electronic monitoring compromises resident rights, family members believe resident rights are protected. Different types of staff have different perceptions of electronic monitoring. Those staff members that are more directly involved in resident care are less accepting of electronic monitoring compared to staff that have episodic visits with residents. Among staff members, nursing facilities with prior experience with electronic monitoring are less accepting of electronic monitoring. Further studies are needed to enhance this research.

From 2014 to 2015, deficiency fines cost Pennsylvania nursing homes more than $2.5 million. Costs associated with adhering to increased health care regulations can reduce profit and affect the financial sustainability of the nursing home industry. Some nursing home administrators (NHAs) lack successful strategies to improve state and federal regulation compliance and promote financial sustainability. Drucker's management by objectives theory was the conceptual framework for this study. The purpose of this qualitative multiple case study was to explore successful strategies NHAs use to improve state and federal regulation compliance to mitigate deficiencies and derivative fines to promote financial sustainability of nursing homes. NHAs who manage 5-star rated nursing homes within a 100-mile radius of Pittsburgh, Pennsylvania use effective management strategies to mitigate deficiencies and derivative fines to earn a 5-star rating which, helps promote financial sustainability. Data were collected from semistructured face-to-face and telephone interviews with 4 NHAs and from Medicare's Nursing Home Compare website. The data on the website provided information on the 3 domains of health inspections, staffing, and quality measures, that made up the overall star rating of nursing homes. Data were analyzed using Yin's 5-phase cycle. The findings revealed 3 major themes: develop knowledgeable staff, enhance communication with staff and residents, and promote innovation for continuous quality improvement. The implications for positive social change could include increased quality of patients' health care, creation of employment opportunities to promote prosperity in communities, and financial sustainability in the United States nursing home industry.

No description available.

The first chapter examines the impacts of health care provider exits on patient outcomes and subsequent reallocation. Using administrative data on the universe of nursing home patients, I estimate the mortality effects of 1,109 nursing home closures on incumbent residents with a matched difference-in-differences approach. I find that displaced residents face a short-run 15.7% relative increase in their mortality risk. Yet this increase is offset by long-run survival improvements, so the cumulative effect inclusive of the initial spike is a net decline in mortality risk. These gains are driven by patients reallocating to higher quality providers. I also find significant heterogeneity by local market conditions: the survival gains accrue only to patients in competitive nursing home markets, whereas residents in concentrated markets experience no survival improvements. I then develop and estimate a dynamic model of the nursing home industry with endogenous exit. Combining the model estimates with the mortality results, I examine the effects of counterfactual reimbursement policy experiments on nursing home closures and resident life expectancy. A universal 10% increase in the Medicaid rate decreases the frequency of closures, but causes some low-quality providers to remain open in competitive areas. In contrast, targeted subsidies for facilities in areas with limited alternatives improves overall life expectancy by averting the costliest nursing home closures. In the second chapter (co-authored with Szymon Sacher), we estimate a mortality-based Bayesian model of nursing home quality accounting for selection. We then conduct three exercises. First, we examine the correlates of quality, and find that public report cards have near-zero correlation. Second, we show that higher quality nursing homes fared better during the pandemic: a one standard deviation increase in quality corresponds to 2.5% fewer Covid-19 cases. Finally, we show that a 10% increase in the Medicaid reimbursement rate raises quality, leading to a 1.85 percentage point increase in 90-day survival. Such a reform would be cost-effective under conservative estimates of the quality-adjusted statistical value of life. The third chapter (co-authored with Michael Barnett and Adam Sacarny) examines why efforts to raise the productivity of the U.S. health care system have proceeded slowly. One potential explanation is the fragmentation of payment across insurers. Each insurer's efforts to improve care could influence how doctors practice medicine for other insurers, leading to unvalued externalities. We study these externalities by examining the unintended private insurance spillovers of a public insurer's intervention. In 2015, Medicare randomized warning letters to doctors to curtail overuse of antipsychotics. Even though the letters did not mention private insurance, they reduced prescribing to privately insured patients by 12%. The reduction to Medicare patients was 17%, and we cannot reject one-for-one spillovers. If private insurers conducted a similar intervention with their own limited information, they would stem half as much prescribing as a social planner able and willing to better target the intervention. Our findings establish that insurers can affect health care well outside their direct purview, raising the question of how to match their private objectives with their scope of influence.

No description available.

Thesis subject: The Role of Family Carers in the Nursing Home for Persons with Cognitive Impairment. The theme of this thesis is the role of the family carers in the nursing home for persons with cognitive impairment. This topic is very actual due to the aging of society and to the increasing of life expectancy. A proportion of the old people in society increases but in the same time there is a decreasing number of people who could take care of them at home (due to negative population balance, disintegration of traditional family, economic situation and high requirements of the care etc.). Many seniors who are depending on the help of the others (such as people with dementia) spend their old age in institutional care. The qualitative research in this thesis shows that families continue in caregiving even after the admission of their relatives to a nursing home. The aim of this research was to describe the involvement of families in the institutional care and to identify factors that influence this phenomenon. Research was conducted in one nursing home for persons with cognitive impairment. Semistructured interviews were conducted with a sample of informants consisting of five professional nurses and four family carers. The analysis of data was carried out using the grounded theory. Research...

Ageing is a process that starts from the moment of conception. It is accompanied by gradual impairment of body functions rendering the elderly less active socially as well as physically as a result of organ failure and compromised immunity system, leading to physical illness that may cause pain as well as mental illness such as dementia. In the United Kingdom majority of elderly people suffers from dementia and are cared for by nurses in the nursing homes. Patients with dementia experience pain as a result of other co- morbidities such as arthritis, but may be undiagnosed and therefore under-treated due to change in their behaviour. Inability to express pain causes concern to the nurse who provides care to the patient. Although some consequences of ineffective pain management have been evaluated, the question of nurses' opinions of pain experience in patients who suffer from dementia has, according to the extensive literature search done by the researcher, not been investigated. The purpose of this study is to describe and explore nurses' opinion of pain in patients suffering from dementia. The researcher adopted a qualitative approach to capture the participants' experiences and opinions of the nurses. A non-experimental qualitative research approach which is exploratory-descriptive and contextual in nature guided the researcher to explore and describe the nurses' opinion of pain in patients who suffer from dementia. Structured interviews and focus group discussions were conducted with seven participants involved in elderly care delivery. Biographical data were analysed and presented using descriptive statistics. The program for qualitative data analysis guided the process of categorizing and coding the data. / Health Studies / M.A. (Health Studies)

By 2040, 79.7 million older adults will live in the US, and nearly 40% will need nursing home services that are primarily funded by Medicare and Medicaid. Researchers have underscored the importance of leadership in quality healthcare care delivery, suggesting that nursing home administrator turnover could influence resident quality of life, causing ill-health for the residents and preventable medical costs for taxpayers. In spite of the suggested association, little research has specifically examined the role of administrator turnover on resident quality of life. As such, the purpose and central research questions of this case study were designed specifically to address the relationship between nursing home administrator turnover and resident quality of life. The Donabedian health services quality model was the framework for the study. Data were collected from 14 nursing homes, and included semistructured interview data with 7 nursing home administrators, and a review of other documents related to quality of care including site visit reports and surveys. An iterative process of coding and constant comparison was used to identify themes and categories from the data. The findings indicate that turnover likely caused an adverse impact on the nursing home overall, which was expected. The study also determined, however, that high turnover itself was not perceived to be associated to low resident quality of life. The implication for social change is that nursing home stakeholders may develop processes to retain competent administrators which in turn could reduce absent leadership presence in nursing homes. Consistent leadership presence may lead to improvement in quality of life regulatory compliance and reduction in unnecessary Medicare and Medicaid spending by nursing home residents.