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At least 19 recordsLinked to original sources
PubMed1995

The extent of support for ordinary living provided in staffed housing: the relationship between staffing levels, resident characteristics, staff: resident interactions and resident activity patterns.

Staffed housing has become an accepted alternative to institutional residential services for people with learning disabilities on the expectation that such provision will promote 'ordinary' patterns of living. Information on staffing levels and the behavioural characteristics of residents together with direct observational data on staff: resident interactions and resident engagement in activity were collected on 15 housing services in South Wales and analysed to explore the interrelationship between these key input and outcome variables. Staffing levels were found to be related to resident characteristics in general but not consistently so. The extent of staff: resident interaction per staff was related to resident characteristics, with staff in services for more able residents spending more time with them. The level of staff support given to residents with more substantial disabilities, slightly higher than that given to more able residents, reflected high staffing input. Resident engagement in activity was strongly related to ability. Participation in household activity was virtually non-existent among residents with the greatest disabilities. The results were compared to similar data from earlier studies on a range of residential services. The relative benefits of small, community-based housing services over institutional and larger community settings were confirmed by the Welsh data. However, comparison to other housing services, which had a particular emphasis on staff helping residents become involved in domestic activity, supports the conclusion that 'ordinary living' for people with severe or profound learning disabilities depends not only on the provision of ordinary environments but also on the orientation and working methods adopted.

Activities of Daily Living↗
PubMed2000

Resident characteristics associated with wandering in nursing homes.

OBJECTIVES: This retrospective cohort study examined the association between resident characteristics and the development of wandering behavior. METHODS: Subjects included a total of 8982 residents from the states of Mississippi, Texas, and Vermont who had baseline and 3-month follow-up Minimum Data Set assessments between 1 January 1996 and 31 December 1997. RESULTS: Residents who had a short-term memory problem (Odds Ratio (OR) = 3.05), had pneumonia (OR = 3.15), asked repetitive questions (OR = 2.19), had a long-term memory problem (OR = 2.06), exhibited dementia (OR = 19.4), constipation (OR = 1.82), expressed sadness or pain (OR = 1.65), and used antipsychotic medication (OR = 1.70), were at an increased risk for developing wandering behavior compared to residents without these characteristics. Residents with functional impairment (OR = 0.28) and women (OR = 0.61) were less likely to develop wandering behavior. CONCLUSIONS: Results of this study may be useful in constructing causal theories for the development of wandering behavior.

Aged↗
PubMed1998

Relating personnel costs in special care units and in traditional care units to resident characteristics.

BACKGROUND: There are over 16 000 nursing homes in the United States (US), among which approximately 70% of residents are cognitively impaired. Reflecting this, approximately 20% of US nursing homes maintain Special Dementia Care Units (SCUs). SCUs supposedly provide more staff time and more specialized staff assignments to residents than do traditional care units. AIMS OF THE STUDY: This paper addresses the issues of staff time and assignment: do the costs of personal care inputs differ according to whether they are provided by SCUs or in traditional care settings? Related to this, are differences associated with the different settings, or are they accounted for by resident characteristics within the settings? METHODS: Given the bias generally associated with collection of staff time data, the author developed (supported by the Health Care Financing Administration and the National Institute on Aging) and used in this study a barcode-based system ('InfoAide'). Using InfoAide, each provider automatically recorded task- and resident-specific time expenditure data which were subsequently monetized, using prevailing local wage rates. Individual resident personal characteristics and status data were provided by another simultaneous study of SCU impacts among the same residents. Regression analysis (MANCOVA for significantly correlated dependent variables) was used to examine the relationships between cost and SCU/traditional status, and individual resident characteristics, separately for each category of provider. RESULTS: Controlling for resident characteristics, the cost of aide care is significantly (positively) related (p <=0.01) to SCU status. Cognitive impairment, ADL impairment and being restrained are also related to higher aide care cost (p <=0.05, p <=0.01, and p <=0.05, respectively). The same is generally true of Speech Therapy, Social Service and care by licensed practical nurses, although the differences between SCU and traditional care units are essentially trivial - and there are no SCU/traditional care differences for registered nurses. DISCUSSION: SCU/traditional unit status, even when combined with the central resident covariates, explains very little variance in service costs, other than among nursing aides; in separate MR analyses in which monetized service time was the dependent variable, the cumulative adjusted R2 among aides was 0.37; for each of the other categories of service provider, the adjusted R2 was less than 0.10. There were differences (particularly in cognitive and ADL impairment) between SCU and non-SCU residents; these differences were related to differences in basic services which were, in turn, provided primarily by aides. The increased level of care provided in SCUs is attributable primarily to nursing aides. However, there is relatively little (albeit statistically significant) variation in more 'elective'services according to individual characteristics or to SCU versus traditional unit placement. This discussion is limited by the absence of analyses of possible interactions among variables, and by the cross-sectional nature of the data presented here. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: This absence of a substantial relationship between SCU/traditional status suggests that dichotomization between SCU and traditional care is misplaced, and that more attention should perhaps be given to the targeting and tailoring of services related to individual gradations of impairment and need. IMPLICATIONS FOR HEALTH POLICY FORMULATIONS: A very considerable literature has developed recently pertaining to Special versus Traditional care for persons with dementing illness. These data suggest that this is not a fruitful distinction, and that more effort should be devoted to defining and quantifying the elements and quality of care provided to nursing home residents. IMPLICATIONS FOR FURTHER RESEARCH: Further research is needed into the components of optimal quality care for demented nursing home residents, and into the interaction among these components as they relate to resident outcomes.

Journal Article↗
PubMed1997

The mental health residential care study: predicting costs from resident characteristics.

BACKGROUND: Little information is available on the costs of residential care for people with mental health problems, and there are very few research data on how or why the costs of provision vary. METHOD: As part of a broader study based on data collected from across the residential care sectors in eight districts and using multiple regression analysis, research has examined whether and which resident characteristics are associated with higher or lower costs. RESULTS: Resident characteristics account for approximately 21% of the observed variation in inter-resident costs. Separate analyses were conducted for people in the London and non-London districts. The resident characteristics that were found to be significant predictors of cost include: age, gender, ethnic group, history of psychiatric admissions, diagnosis, emotional lability, daily living skills, social interaction and network, aggression, suicidal tendencies, drug abuse and legal status. Examination of the residual ('unexplained') costs found significant differences between facility types, sectors (private and voluntary being less costly than public, other things being equal) and districts. CONCLUSIONS: The associations uncovered by these analyses can inform commissioners' planning and purchasing activities, at both the macro and micro levels, by revealing those resident needs and circumstances that are associated with higher costs.

Adolescent↗
PubMed2006

Potentially modifiable resident characteristics that are associated with physical or verbal aggression among nursing home residents with dementia.

BACKGROUND: Physical aggression by nursing home residents is a burden to residents and staff. The identification of modifiable correlates would facilitate developing preventive strategies. The objectives of the study were to determine potentially modifiable resident characteristics that are associated with physical aggression and to correlate these characteristics with verbal aggression. METHODS: This was a cross-sectional study of nursing home residents in 5 states who had at least 1 annual Minimum Data Set assessment completed during 2002. Case subjects were defined as nursing home residents 60 years and older with dementia who were reported to have been physically aggressive in the week before their assessment. Control subjects were all other residents 60 years and older with dementia. The main outcome measure was being physically aggressive during the past week. RESULTS: A total of 103 344 residents met study criteria, of whom 7120 (6.9%) had been physically aggressive in the week before their annual Minimum Data Set assessment. After adjustment for potential confounders, including age, sex, severity of cognitive impairment, and dependence in activities of daily living, physical aggression was associated with depressive symptoms (adjusted odds ratio [AOR], 3.3; 99% confidence interval [CI], 3.0-3.6), delusions (AOR, 2.0; 99% CI, 1.7-2.4), hallucinations (AOR, 1.4; 99% CI, 1.1-1.8), and constipation (AOR, 1.3; 99% CI, 1.2-1.5). Urinary tract infections, respiratory tract infections, fevers, reported pain, and participation in recreational activities were not significantly associated with physical aggression in multivariate analyses (P >.01 for all). Except for constipation, the correlates of verbal aggression were similar to those of physical aggression. CONCLUSION: If the associations we have estimated are causal, then treatment of depression, delusions, hallucinations, and constipation may reduce physical aggression among nursing home residents.

Aged, 80 and over↗
PubMed2003

Rational resourcing and productivity: relationships among staff input, resident characteristics, and group home quality.

Relationships among staff input per resident, resident characteristics, setting characteristics, and service quality were investigated. Data were obtained from 51 group homes in Wales on (a) resident numbers, ages, gender, adaptive behavior, challenging behavior, and additional disabilities; (b) allocated staff hours and actual staff costs; (c) provider agency, date of provision, and internal operational arrangements; and (d) resident receipt of staff attention and resident activity. Variation in staff input was related to resident challenging behavior, smaller residence size, and provider agency or date of provision. Staffing input was associated with resident receipt of attention, as were operational arrangements. Resident activity was related to resident adaptive behavior and receipt of attention but not resource input. Cost-effectiveness implications are discussed.

Adult↗
PubMed2006

Relationship of resident characteristics, attitudes, prior training and clinical knowledge to communication skills performance.

PURPOSE: A substantial body of literature demonstrates that communication skills in medicine can be taught and retained through teaching and practice. Considerable evidence also reveals that characteristics such as gender, age, language and attitudes affect communication skills performance. Our study examined the characteristics, attitudes and prior communication skills training of residents to determine the relationship of each to patient-doctor communication. The relationship between communication skills proficiency and clinical knowledge application (biomedical and ethical) was also examined through the use of doctor-developed clinical content checklists, as very little research has been conducted in this area. METHODS: A total of 78 first- and second-year residents across all departments at Dalhousie Medical School participated in a videotaped 4-station objective structured clinical examination presenting a range of communication and clinical knowledge challenges. A variety of instruments were used to gather information and assess performance. Two expert raters evaluated the videotapes. RESULTS: Significant relationships were observed between resident characteristics, prior communication skills training, clinical knowledge and communication skills performance. Females, younger residents and residents with English as first language scored significantly higher, as did residents with prior communication skills training. A significant positive relationship was found between the clinical content checklist and communication performance. Gender was the only characteristic related significantly to attitudes. CONCLUSIONS: Gender, age, language and prior communication skills training are related to communication skills performance and have implications for resident education. The positive relationship between communication skills proficiency and clinical knowledge application is important and should be explored further.

Age Factors↗
PubMed1987

Interstate variation in elderly Medicaid nursing home populations. Comparisons of resident characteristics and medical care utilization.

Nursing home care in the United States is financed primarily through the federal-state Medicaid program. Because Medicaid nursing home programs are administered within the individual states, there may be interstate differences in the characteristics of Medicaid nursing home residents and their utilization of medical care. We used Medicaid claims and enrollment data for calendar 1981 from three large states--Michigan, California, and New York--to study this question. We found that the populations of elderly Medicaid nursing home residents in each of the three states had similar characteristics. In contrast to the homogeneity of resident characteristics, there were pronounced interstate differences in the use of medical care, particularly for the relation between nursing homes and hospitals. California was characterized by frequent turnover among elderly Medicaid nursing home residents and a high rate of transfers to and from hospitals. One third of residents entered the nursing home in the study year, 43% of enterers came from the hospital, and 51% of enterers were discharged within 180 days of admission, usually to the community. In New York, both turnover among elderly Medicaid nursing home residents and interinstitutional transfers were less frequent. However, those residents entering from the hospital had an average pre-entry hospital stay of 60 days, three to five times that of the other two states. Medicaid payments per day of nursing home care totaled +60 per day, twice those in the other two states. Michigan was characterized by patterns of medical care utilization intermediate between these two extremes. These findings suggest caution in the interpretation of single-state studies of nursing home residents, particularly for those of the dynamic relation between nursing homes and hospitals. They also suggest that further study of the experience of the individual states could provide valuable insights into the effects of different levels of nursing home reimbursement and different policies for transfers between nursing homes and hospitals.

Aged↗
PubMed2006

The moderating effect of employee hostility on the association of long-term elderly care unit's negative resident characteristics to employee stress and well-being.

This study examined the moderating effect of employee hostility on the association of unit-level resident characteristics (depression and behavioral problems) to individual-level employee's resident-related stress and psychological well-being during 1-year follow-up study among 501 employees in elderly care. Our results showed that employee hostility was associated with decreased psychological well-being. In addition, hostility moderated the association between unit-level proportion of depressive residents and resident-related stress experienced by the individual employees. Hostile employees reported increased resident-related stress irrespective of the proportion of depressed residents in the unit. Instead, nonhostile employees were sensitive to the depression in the unit. They reported low levels of stress when depression levels in the unit were low and increased stress when depression levels were high.

Adult↗
PubMed2003

Reinventing long-term care: the effect of policy changes on trends in nursing home reimbursement and resident characteristics--Florida, 1989-1997.

PURPOSE: This study investigated how changes in Medicare and Medicaid policies affected skilled nursing facility (SNF) revenue streams and resident characteristics in Florida during the 1990s. DESIGN AND METHODS: We used a series of ordinary least squares (OLS) regression models to analyze state-provided administrative data and Online Survey Certification and Reporting (OSCAR) data for all Florida SNFs. RESULTS: We found that Florida SNFs responded differently to the growing gap in reimbursement between Medicaid and other payers, depending on their profit status. As the reimbursement gap grew, for-profit SNFs maximized their revenues by admitting fewer Medicaid paying residents, whereas nonprofit facilities increased their percentage of Medicaid admissions. IMPLICATIONS: Changes in patterns of reimbursement altered the composition of Florida SNF residents in terms of age, physical status, length of stay, and place of discharge.

Aged↗
PubMed2005

The effect of type of hip protector and resident characteristics on adherence to use of hip protectors in nursing and residential homes--an exploratory study.

OBJECTIVES: To investigate the factors influencing the acceptability of hip protectors to residents of nursing and residential homes, especially the effect of hip protector type, and resident characteristics. DESIGN: A randomised controlled trial with 12 weeks follow-up. Participants were randomised to receive either Safehip or HipSaver hip protectors. SETTING/PARTICIPANTS: 109 residents aged 61 to 98 years from seven residential homes and two nursing homes in Northern Ireland. MAIN OUTCOME MEASURES: Percentage day-time use of the hip protectors over 12 weeks and ongoing use at 12 weeks. RESULTS: 42% (119/285) of residents invited to enter the study agreed to take part, and 109 started to wear the hip protectors. 43.1% (47/109) were still using them at 12 weeks. Mean percentage day-time use for all residents during 12 weeks was 48.6%. There was no significant difference in percentage day-time use (p=0.40), or use at 12 weeks (p=0.56) between the residents wearing Safehip and HipSaver protectors. Greater percentage daytime use of hip protectors was associated with being resident in a home for the elderly mentally infirm (75.1%, p<or=0.0005), having a low (12 or less) Barthel score (61.1%, p<or=0.0005), and having been injured in a fall in the last 12 months (57.3%, p=0.012). CONCLUSIONS: The type of hip protector appeared to make no difference to their continued use by residents. Residents with a history of a fall and those who are physically and mentally incapacitated appear to be more likely to wear hip protectors. These residents, who are at high risk of falling, are also highly dependent on nursing staff. Efforts to increase hip protector use in residential and nursing home should focus on staff, who are in the best position to advise and influence residents and their relatives.

Accidental Falls↗
PubMed1998

Resident characteristics and organizational factors influencing the quality of drug use in Swedish nursing homes.

Appropriateness of drug use is an important indicator of the quality of care in nursing homes. In this study, we analyzed the influence of resident characteristics and selected organizational factors on the appropriateness of psychotropic drug use in 33 Swedish nursing homes. Specific criteria based on published guidelines and recommendations were developed to measure appropriateness. Residents diagnosed with a psychiatric disorder and younger residents had more deviations from the criteria; however, resident mix did not explain variations in appropriateness of drug use at the facility level. Facilities with better nurse staffing and drug intervention teams had fewer deviations from the criteria, but only 15-20% of the variation in drug prescribing was explained by these predictors.

Aged↗
PubMed1991

The relationship between residents' characteristics, their stress experiences, and their psychosocial adjustment at one medical school.

Empirical research focused on the stressful aspects of residency training has largely ignored the interactions between residents' psychosocial and demographic characteristics, stressful experiences, emotional responsivity, and coping styles. This article presents the results of a questionnaire, completed by 165 residents, that consisted of the Profile of Mood States, the Hassles Scale, the Ways of Coping Questionnaire, and a series of questions regarding demographic data, social support system features, and residency stress factors. The residents reported that time demands and indebtedness were the major sources of stress in their residency programs. Social support variables were significantly related to the degrees to which the residents successfully coped with daily stress factors. While the women residents reported higher stress levels than did the men, they did not report higher levels of emotional distress. Finally, the lengths of time residents had spent in training were significantly related to the levels of their mood disturbances and daily hassles.

Adaptation, Psychological↗
PubMedDate not supplied

Resident characteristics associated with mortality in long-term care nursing homes: is there a gender difference?

OBJECTIVE: To examine the gender-specific association between characteristics in established long-term care residents and 1-year risk of mortality. DESIGN: A retrospective cohort study. SETTING: The Hebrew Rehabilitation Center for Aged, a 725-bed long-term care facility in Boston, Massachusetts. The 778 participants included 188 men (24%) and 590 women (76%). MEASUREMENTS: Minimum Data Set (MDS) information, including items from the following sections: cognition, communication, psychosocial, functional, diseases, health conditions and medication use. RESULTS: Survival curves were significantly different for men and women (log rank test, P = 0.004). Based on proportional hazards analyses, increased age, (RR(m)=1.07, RR(w)=1.05), functional impairment (RR(m)=1.07, RR(w)=1.04), and weight loss (RR(m)=2.03, RR(w)=2.24) were associated with increased mortality in men and women. Additionally, shortness of breath (RR = 2.87) and lower body mass index (RR = 2.25) were associated with higher mortality in men, and diabetes (RR = 2.42), pressure ulcers (RR = 1.99), anemia (RR = 1.98), congestive heart failure (RR = 1.87), and a recent fall (RR = 1.88) were associated with higher mortality in women. CONCLUSIONS: Characteristics associated with 1-year mortality differ between men and women. These readily available data could be useful in making medical decisions and advance directives planning. Furthermore, these data may be beneficial in developing quality improvement initiatives and mortality prediction modeling.

Journal Article↗
PubMed2003

Primary care residents' characteristics and motives for providing differential medical treatment of cervical cancer screening.

BACKGROUND: Cervical cancer screening rates in the United States are sub-optimal. Physician factors likely contribute to these lower rates. Previous studies provide inconclusive evidence about the association between physician characteristics and the likelihood of addressing cervical cancer. This report assesses potential mechanisms that explain why certain providers do not address cervical cancer screening. METHODS: One hundred primary care residents from various specialties were asked to indicate the preventive topics they would address with a hypothetical white female in her early 20s, who was portrayed as living a "high risk" lifestyle, and visiting her provider only for acute care reasons. RESULTS: Among the provider characteristics assessed, only residents' ethnicity was associated with the likelihood of and time spent addressing cervical cancer screening. In particular, Asian-American residents were least likely to address cervical cancer, while African-American residents were most likely. A mediation analyses revealed that perceived barriers for addressing cervical cancer accounted for this difference. CONCLUSIONS: Study results suggest that there may be cultural factors among health care providers that may account for differential referral and treatment practices. Findings from this study may help identify factors that explain why cervical cancer screening rates are not higher.

Ethnicity↗
PubMed1987

The association of bacteriuria with resident characteristics and survival in elderly institutionalized men.

Ninety-one elderly male residents of a skilled nursing facility were classified as nonbacteriuric (41%), intermittently bacteriuric (34%), or continuously bacteriuric (25%) on the basis of urine cultures obtained over a 3-year period. Bacteriuric and nonbacteriuric residents were similar in age, number of diagnoses and medications, and mobility. However, bacteriuric residents were more frequently confused or demented, whether continuously bacteriuric (78%) or intermittently bacteriuric (62%) compared with nonbacteriuric residents (42%) (p less than 0.04). In addition, bacteriuria was significantly associated with incontinence of bladder (96% of continuous, 66% of intermittent, and 25% of nonbacteriuric; p less than 0.001) and bowel (52%, 39%, and 5.5%, respectively; p less than 0.002). At 6 years of follow-up there were no differences in survival among the three groups. Urinary tract infection caused or contributed to only two (2.9%) deaths. Thus, in this population, bacteriuria was associated with higher functional disability but not with increased mortality.

Aged↗