Purpose: The purpose of this project is to decrease the likelihood of receiving unwanted treatment at the end of life. The project is conducted in a skilled nursing facility where only approximately 40% of the residents have an Advance Directive (AD) despite experiencing multiple comorbidities and nearing the end of life. Aims: Implementing a quality improvement project, creating a system that addresses AD completion at admission with the outcome of increased recognition of residents’ end of life choices. Process: Residents and their families are presented with a tool to help guide the conversation about AD at the admission care plan meeting. AD will be readdressed at all subsequent care plan meetings, occurring every 45 days, and as needed. Results: Project is still in process and the expected completion date is April 8th, 2022. We anticipate improvement in AD completion rates in this facility. Limitations: This project is limited by the reluctance of some residents and families to discuss issues related to death and dying, which may affect the completion rate. Another limiting factor is the staff turnover and need to reeducate new staff members about the project. Conclusions: Residents in skilled nursing facilities are likely to receive unwanted treatment because families are unsure what their wishes and are left feeling obligated to do everything necessary to sustain life. The implementation of this project may increase the AD completion rates, while recognizing and carrying out residents’ end of life choices.

No description available.

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.

Staff in skilled nursing facilities (SNF) can experience physical and emotional strain via caregiving. The purpose of this study was to educate staff on the harm of compassion fatigue and a lack of emotional intelligence and provide steps that can be taken by administration to improve the quality of care provided. It was hypothesized for staff that having low compassion fatigue and high emotional intelligence would result in a higher quality of care. The study design utilized a quantitative approach and a purposive sample from a SNF. Participants were provided with The Professional Quality of Life 5 Scale (ProQoL 5), Wong & Law Emotional Intelligence Scale (WLEIS), and survey data received from Department of Public Health. A Multiple Regression test analyzed the relationship between compassion fatigue and emotional intelligence on the quality of care provided by staff members. The results of this study indicated that staff’s compassion fatigue was not indicative of quality of care; however, Self-Emotional Appraisal, a subscale of WLEIS, was found to predict the quality of care. This study assisted with informing SNF staff in recognizing how managing their emotions could be a useful tool to improve the quality of care they provide. Lastly, SNF administration could implement policies, procedures, and in-services to ensure that all staff members are educated in identifying emotions and practicing self-care

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.

No description available.

This qualitative phenomenological study examined central Florida's nursing home administrators' knowledge and perception of cultural competence and how they perceive that their knowledge and perceptions impact residents, families, and healthcare. The theoretical framework for this study was explained through Campinha-Bacote's interdisciplinary model of The Process of Cultural Competence in the Delivery of Healthcare Services. The theoretical framework was used to guide research questions, and individual interview questions to obtain nursing home administrator's knowledge and perception of cultural competence. The study explored the level of cultural competence reported by nursing home administrators, their individual perception of cultural competence, their degree of confidence in cultural competence, and how nursing home administrators describe their proficiencies and skills in cultural competence. Interviews with six nursing home administrators included licensed nursing home administrators (NHA) and assistant nursing home administrators, and the director of nursing (DON). The findings identified and analyzed the diverse levels of nursing home administrator's knowledge and perception of cultural competence. Some participants demonstrated difficulty expressing their knowledge and perception of cultural competence. Findings indicate that various factors influenced participants' overall degree of confidence in their knowledge and perception of cultural competence. Nursing home administrators also had a difficult time articulating particular skills that demonstrate their ability to adapt to the diverse residents in their facilities, and how they promote cultural competence in their nursing home facilities. This study identified the need for additional research and continuing education about cultural competence in healthcare.