Innovations and Challenges in Nursing Home Research: The Role of the International Working Group

The past two decades have seen a rapid increase in Private Equity (PE) investment in healthcare, a sector in which intensive government subsidy and market frictions could lead high-powered for-profit incentives to be misaligned with the social goal of affordable, quality care. This paper studies the effects of PE ownership on patient welfare at nursing homes. With administrative patient-level data, we use a within-facility differences-in-differences design to address non-random targeting of facilities. We use an instrumental variables strategy to control for the selection of patients into nursing homes. Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases by 11%. We observe operational changes that help to explain these effects, including declines in nursing staff and compliance with standards. Finally, we document a systematic shift in operating costs post-acquisition toward non-patient care items such as monitoring fees, interest, and lease payments.

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The purpose of this study was to carry out a literature review on the effectiveness of the validation method (VM) in job satisfaction and motivation of care professionals working with older people in nursing homes. The review was carried out in specialised databases: Scopus, PsychINFO, PubMed, Web of Science (WOS), Google Scholar, Scielo, and Cochrane Database of Systematic Reviews. 9046 results were obtained, out of which a total of 14 studies met the inclusion criteria: five quantitative, four qualitative, one single case series, two quasi-experimental and two mixed methods studies. The results of the analysed studies report that the VM can be an effective tool that facilitates communication and interaction in care, reducing levels of stress and job dissatisfaction among care professionals. The VM facilitates communication between professionals and older people with dementia, and improves the management of complex situations that may arise in care, directly influencing a reduction in work stress and increasing job satisfaction.

Background: In Sweden, as well as in most industrialised countries, an increasing older population is expected to create a growing demand for health care staff. Previous studies have pointed to lack of proficient medical and nursing staff specialised in geriatric care, which poses serious threats to the care of a vulnerable population. At the same time, there are studies describing elderly care as a low-status career choice, attracting neither nurses nor student nurses. Judging from previous research it was deemed important to explore how nurses in elderly care perceive their work, thus possibly provide vital knowledge that can guide nurse educators and unit managers as a means to promote a career in elderly care.

Method: This was a qualitative study using focus groups. 30 registered nurses in seven focus groups were interviewed. The participants worked in nursing homes and home-based care for the elderly in rural areas and in a larger city in southern Sweden. The interviews were analysed in line with the tradition of naturalistic inquiry.

Results: Our findings illustrate how nurses working in elderly care perceived their professional work as holistic and respectful nursing. Three categories of professional work emerged during analysis: (1) establishing long-term relationships, (2) nursing beyond technical skills, and (3) balancing independence and a sense of loneliness.

Since the beginning of the ongoing pandemic, numerous outbreaks of SARS-CoV-2 have been reported in nursing homes worldwide, affecting both the residents and the care workers. In the USA, it was estimated that 35,000 reported deaths due to COVID-19 emerged in nursing homes, representing 42% of the total number of COVID-19 deaths [11], with fatality rates amongst the residents reaching up to 33.7% in a care facility in King County, Washington [12]. Similar data regarding the percent of nursing home COVID-19 deaths in relation to the total COVID-19 deaths were also reported in numerous countries in Europe, such as Belgium (42%), France (44.6%), and Ireland (54%) [13]. It is crucial to identify and correct the possible shortcomings related to nursing home procedures to better manage the COVID-19 pandemic and any other future epidemics.

Another possible shortcoming that may contribute to the high infection rate amongst nursing homes is the fact that residents of long-term care facilities frequently suffer from various degrees of disability, and this may often lead to inability to properly perform preventive health measures, such as diligent hand washing. One study that focused on determining the level of disability amongst diabetes-diagnosed nursing home residents found that the mean number of underlying comorbidities was 4, the most frequent being dementia, stroke, hypertension, and ischemic heart disease. More than half of the residents (62%) were not able to feed themselves, 51% had speech impairment, and 89% required at least a frame or the help of one carer in order to walk [25]. Consequently, is therefore likely that the physical interaction between the facility personnel and these residents is prolonged, thus increasing the risk of contamination on both parts. Studies on previous epidemics also showed that the high number of outbreaks in nursing homes may also be explained by the large numbers of residents that share the same sources of water, food, air, the same facilities, and the fact that a limited number of care workers are responsible for numerous inhabitants [26, 27].

Implementing protocols that would address these matters, together with establishing training programs for all care workers might diminish the number and the severity of outbreaks that take place in nursing homes.

Another country that has attempted to look into the impact of the pandemic on the most vulnerable was the United Kingdom. The Office for National Statistics (ONS) conducted the Vivaldi study, a large-scale survey performed on nursing homes in England between the 26th May and 20th June 2020. Out of the total, 5,126 (56%) care homes responded. The study included approximately 9,081 home cares (95% CI: 293,168 to 293,434), with 293,301 residents and 441,498 staff members (95% CI: 441,240 to 441,756). More than half of the nursing homes (95% CI: 55%-56%) reported at least one confirmed case (amongst residents or staff members), with 20% (95% CI: 19% to 21%) of the residents, and 7% (95% CI: 6% to 8%) of the staff estimated to have tested positive for the SARS-CoV-2 infection [35].

In addition to this study, on the 3rd July 2020, the ONS also released a report which contained the number of deaths that occurred before the 12th June and were registered before the 20th June 2020 in England and Wales care sector: Out of 66,112 total deaths among the nursing homes residents, 19,394 (29.3%) were SARS-CoV-2 related [36].

During the COVID-19 pandemic, care home residents found themselves to be the most vulnerable population and probably amongst the least sheltered individuals. Part of the reasons that led to dramatic outcomes inside the nursing home facilities was a lack of official guides and regulations in case of natural disasters for elderly shelters around the world. Following the novel coronavirus global outbreak, some of the mechanisms responsible for issuing such instructions released a set of guidelines for this particular purpose.

The body responsible for setting this type of regulations across the European Union is called the European Centre for Disease Prevention and Control (ECDC). On May 19th, 2020, ECDC released a technical report regarding the surveillance of COVID-19 in the EU/EEA nursing homes [46]. The paper outlines the major points to be addressed in long-term care facilities, to avoid a further underestimation of the disease burden upon these settings. Members of staff working while contagious (symptomatic or asymptomatic carriers of SARS-CoV-2) represented one of the leading causes of an increased COVID-19 spread inside care home facilities. Other promoting factors were represented by staff under qualification or inadequately training, working in multiple facilities, shortage of personal protective equipment, or limited testing performed only on symptomatic individuals. Furthermore, the increased incidence of neurological pathologies (namely dementia) that commonly affect residents of care homes can lead to a more difficult diagnosis.

Another set of guidelines was released by the Centers for Disease Control and Prevention in the United States of America, on the 30th of April 2020. The recommendations include the establishment of a designated COVID-19 care unit for the confirmed cases among the residents. This could be a different wing, floor, or small group of rooms, according to the capacity of each facility. Additionally, the CDC advises that new and readmitted nursing home residents with confirmed COVID-19, that are still required to undergo transmission-based precautions, should also be placed in the COVID-19 care unit. Further, measures discuss the isolation of suspected cases or the contacts of confirmed ones, with further testing prioritization. The latter also advises for offering priority to symptomatic staff or residents in case of limited testing capacity [47].

The Covid-19 pandemic has affected the vulnerable people in care homes more than any other category, with percentages between 19% and 72% of all SARS-CoV-2-related deaths occurring amongst these facilities. Once again, the health and social care sectors have proven their interdependence, when the shortages encountered in healthcare became obstacles in sheltering and providing for the most fragile of our kind. A lack of standardized guidelines, discrepancies between public and private sectors, underfunding, and many other well-established irregularities have led to a dramatic outcome for the nursing home residents. The hope is that unfortunate events that could have been prevented will lead to a decisive shift in policies regarding these facilities and the avoidance of future similar outcomes. 2ff7e9595c