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This retrospective cohort study uses the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) to determine predictors associated with permanent transition to nursing homes among home care recipients with dementia. Study participants include older adults age 65+ with dementia who received home health services in New York State for at least 2 months prior to permanent transition to nursing homes. Multivariate logistic regression was used to quantify the association between predictors and permanent transition to nursing homes. Risk factors associated with permanent transition included increasing age (OR = 1.1; 95% CI 1.03-1.18); white compared to black (OR = 1.25; 95%CI 0.83-0.94), urinary and bowel incontinence vs. continence (OR = 1.46; 95% CI 1.37-1.56); depression vs. no depression (OR = 1.2; 95% CI 1.11-1.25); hip fracture vs. no hip fracture (OR = 2.63; 95% CI 2.27-3.05), and 3+ hospitalizations vs. no hospitalizations (OR = 3.02; 95% CI 2.77-3.29). Early diagnosis and treatment may delay or avert nursing home entry., Competing Interests: Declaration of Competing Interest We have no conflicts of interest to declare., (Published by Elsevier Inc.)

This study compares pain interventions received by nursing home residents with and without dementia. Secondary data analyses of cross-sectional data from 50,673 nursing home residents in New York State were collected by the Minimum Data Set 3.0. Frequency distributions and bivariate analyses with χ 2 tests were used to organize and summarize the data. Logistic regression analyses were performed to quantify the relationship between dementia and pain interventions. Our results show that residents with dementia had significantly fewer pain assessments and less reported pain presence than their counterparts. After adjusting for covariates, the results indicate that residents with dementia were significantly less likely to receive pro re nata and nonmedication pain intervention. However, there were no significant differences in scheduled pain medication between the 2 groups. To address the gap, we need more research to design a pain assessment tool that can differentiate severity of pain so that appropriate interventions can be applied.

Objectives: This study aims to examine whether an advance directive "Do Not Hospitalize" (DNH) would be effective in reducing hospital/emergency department (ED) transfers. Similar effects in residents with dementia were also examined., Design: Cross-sectional study., Setting/subjects: New York State (NYS) nursing home residents (n = 43,024)., Measurements and Analysis: The Minimum Data Set 2.0 was used to address the study aims. Advance directives with an indication of DNH and Alzheimer disease/dementia other than Alzheimer disease were coded (yes vs no). Logistic regression analyses were performed to quantify the relationship between DNH orders and hospital/ED transfers while adjusting for confounders., Results: Our results show that 61% of nursing home residents had do-not-resuscitate orders, 12% had feeding restrictions, and only 6% had DNH orders. Residents with DNH orders had significantly fewer hospital stays (3.0% vs 6.8%, P <.0001) and ED visits (2.8% vs 3.6%, P = .03) in the last 90 days than those without DNH orders. Dementia residents with DNH orders had significantly fewer hospital stays (2.7% vs 6.3%, P < .0001) but not ED visits (2.8% vs 3.5%, P = .11) than those without DNH orders. After adjusting for covariates in the model, the results show that for residents without DNH orders, the odds of being transferred to a hospital was significantly higher (odds ratio = 2.23, 95% confidence interval = 1.77-2.81) than those with DNH orders., Conclusion: Residents with DNH orders had significantly fewer transfers. This suggests that residents' end-of-life care decisions were respected and honored. Efforts should be made to encourage nursing home residents to complete DNH orders to promote integration of the resident's values and goals in guiding care provision toward the end of life., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: This study examines whether aging in place (community-based living before admission to a nursing home) delays nursing home admission among New York State home health care recipients., Design: Retrospective cohort study (January 2007-December 2012)., Setting: New York State., Participants: Adults age 65+ who received home health services for at least 2 months before permanent nursing home admission., Measurement and Analysis: Permanent transition is defined as home care patients who are discharged to and stay at a nursing home for more than 3 months. Data were abstracted from the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS). Descriptive and bivariate Kruskal-Wallis and χ(2) tests were performed., Results: The average age of nursing home residents at admission remained steady at 83 years between 2007 and 2012. The proportion of minority populations (Asian, black, Hispanic/Latino) increased, whereas the white population declined (P < .0001). The average length of stay at home increased 8 months, from 17 months in 2007 to 25 months in 2012 (P < .0001). Chronic conditions with significant increases in prevalence during the study period were hypertension (P < .0009), dementia (P < .0001), heart failure (P = .05), urinary incontinence (P < .0001), and bowel incontinence (P < .0001). Increases in functional disabilities requiring extensive human assistance included toileting, dressing, personal hygiene, and transferring (all P < .001)., Conclusion: Home health services enabled recipients to remain at home 8 months longer, thus delaying nursing home entry. Given the increase in prevalence of comorbidities and disability, we anticipate a concomitant increase in support services at the nursing home. These results may inform policy and staffing decisions regarding adjustments in required caregivers' credentials and nurse-patient ratios., (Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Identify clinical and organizational factors associated with potentially preventable ambulatory care sensitive (ACS) hospitalization among nursing home residents with chronic kidney disease., Methods: New York State Nursing home residents (n = 5449) age 60+ with chronic kidney disease and were hospitalized in 2007. Data included residents' sociodemographic and clinical characteristics, nursing home organizational factors, and ACS hospitalizations. Multivariate logistic regression quantified the association between potential determinants and ACS hospitalizations (yes versus no)., Results: Prevalence of chronic kidney disease among nursing home residents is 24%. Potentially avoidable ACS hospitalization among older nursing home residents with chronic kidney disease is 27%. Three potentially modifiable factors associated with significantly higher odds of ACS hospitalization include the following: presence of congestive heart failure (OR = 1.4; 95% CI 1.24-1.65), excessive medication use (OR = 1.3; 95% CI 1.11-1.48), and the lack of training provided to nursing staff on how to communicate effectively with physician about the resident's condition. (OR = 1.3; 95% CI 0.59-0.96)., Conclusion: To reduce potentially preventable ACS hospitalization among chronic kidney disease patients, congestive heart failure and excessive medication use can be kept stable using relatively simple interventions by periodic multidisciplinary review of medications and assessing appropriate response to therapy; and communication training be provided to nursing staff on how to articulate to the responsible physician important changes in the patients' condition., (Published by Elsevier Inc.)

Objective: Identify clinical and nonclinical factors associated with potentially preventable ambulatory care sensitive (ACS) hospitalization among nursing home residents., Methods: Residents (n=26,746) of 147 randomly selected nursing homes in New York State. Data included sociodemographics and clinical and nonclinical related factors. Multivariate linear regression quantified the association between potential determinants and ACS hospitalization., Results: Four factors significantly associated with reduction in ACS hospitalization included nursing staff trained to communicate effectively with physicians regarding a resident's condition (P < .0001), physicians treat residents within the nursing home and admit to hospital as a last resort (P < .0001), provide better information and support to nurses and aides surrounding end-of-life care (P < .0001), and easy access to stat lab results in <4 hours on weekends (P < .0001). Two factors significantly associated with increased ACS hospitalization are: perceived likelihood illness will cause death (P < .0001) and perceived inadequate access to medical history/lab/EKGs (P < .0001)., Conclusion: Preventable ACS hospitalization reduction depends on effective communication between physicians and nursing staff, providing physicians with easy access to stat results in <4 hours on weekends, and easy access to medical records/lab/EKGs. Use of electronic medical records and providing training to nursing staff on how to communicate effectively with physicians and how to articulate about a resident's condition may minimize preventable ACS hospitalizations., (Copyright © 2011 American Medical Directors Association. All rights reserved.)

Objectives: To describe characteristics of New York State nursing homes and identify factors associated with potentially preventable hospitalization in nursing home residents., Design: Cross-sectional survey., Setting: Randomly selected nursing homes in New York State., Participants: One hundred forty-seven directors of nursing (DONs)., Measurements: Data were collected using a Web-based survey completed in January 2008. Variables included specific aspects of facility environment, nurse and aide services, resource availability, perceived determinants of hospitalization, and nursing home practice. Stepwise multivariate linear regression examined the associations between perceived determinants and potentially preventable hospitalization., Results: Factors associated with potentially preventable hospitalization included presence of nursing staff trained to communicate effectively with physicians (P<.001); easy access to urgent laboratory results in less than 4 hours on weekends (P=.03); that physicians attempt to treat patients within the nursing home and admit to the hospital as a last resort (P<.001); higher reported proportion of residents enrolled in managed care plans for regular medical care (P=.04); higher perceived likelihood that illness will cause death (P=.03); perceived inadequate access by physicians to residents' and prior medical history, laboratory results, and electrocardiograms (ECGs) (P=.02), as reported by DONs., Conclusion: Efficient and effective care depends on continuity of communication between nurses and physicians and adequate access to patients' medical history, laboratory results, and ECGs. The following operational strategies may help institutions reduce potentially preventable hospitalizations: ensure effective communication between nursing staff and physicians regarding patients' condition; provide physicians with easy access to stat laboratory results in less than 4 hours on weekends and adequate access to the patient's medical history, laboratory results, and ECGs; and motivate physicians to treat residents within the nursing home whenever possible.

Objective: To compare the perception of the determinants of preventable hospitalization among nursing home residents by surveying medical directors (MDs) and directors of nursing (DONs)., Methods: A survey (N = 52) was completed in January 2008. Data included resource availability, determinants of hospitalization, and nursing home practice. Multivariate linear regression examined the associations between potential determinants and preventable hospitalization., Results: Four significant determinants perceived by MDs to influence preventable hospitalization: MD/nurse practitioner (NP) access by pager, family preferences, access to medical history and lab/ electrocardiograph (EKG) reports, and physicians better paid to manage acutely ill residents (R(2) = .58). None of these factors were echoed by DONs (R(2) = .15). Whereas DONs perceived stat lab results on weekends were associated with increased hospitalization (p = .03), MDs did not (p = .28)., Conclusions: Our analysis showed that communication and consensus are important factors in the hospital transfer decision and that the discord in perceptions among MDs and DONs may complicate interventions to reduce preventable hospitalization.

Objective: Identify risk factors for and time to permanent transition from independent living units to nursing home among residents in a continuing care retirement community (CCRC)., Methods: Prospective cohort study (n=298) among residents at least 75 years of age living independently at baseline. Proportional hazard regression identified risk factors associated with permanent transition from sociodemographic and health status data., Results: During the 3-year follow-up, 11% of the subjects were permanently transferred. Predictive factors were depression (relative risk [RR] 3.9; 95% CI 1.5-9.8), incontinence (RR 3.8; 95% CI 1.3-11.4), impaired cognition (RR 3.6; 95% CI 1.1-11.3), and dependence on activities of daily living disability (RR 1.5; 95% CI 1.3-1.8). Compared with those with no risk factors, presence of all 4 increased the relative risk to 74-fold and shortened the time to permanent transition by 32 months., Conclusion: Prevention and treatment for depression, incontinence, and programs to improve or maintain cognitive function and ability to perform activities of daily living among CCRC residents may prolong their independent living life.

• Providing empirical evidence that the GH model is more effective in preventing COVID-19 cases and deaths compared to traditional NHs. • Identifying and discussing barriers to broader GH adoption, including market demand, costs, reimbursement, and regulations. This study compares COVID-19 case and mortality rates in Green Houses (GHs) and traditional nursing homes (NHs) during the COVID-19 pandemic. CMS data from 10 states (June 2020 to September 2022) were analyzed for GHs (n = 19), small NHs (n = 266), and large NHs (n = 2,932). Multivariate Poisson regressions with GEE were used. Participants (mean age 73.4) were predominantly female (57.8 %) and White (78.2 %). Small and large NHs had a significantly higher COVID-19 case risk (RR = 1.61; 95 % CI 1.25–2.08 and RR = 1.75; 95 % CI 1.36–2.24, respectively) compared to GHs. Large NHs also had an increased mortality risk (RR = 1.67; 95 % CI 1.01–2.77) compared to GHs, with no difference found between GHs and small NHs. After adjusting for age, gender, and ADL disability, GHs demonstrated lower COVID-19 case and mortality rates than traditional NHs, likely due to their unique features, including person-centered care, size, and physical structure. [ABSTRACT FROM AUTHOR]