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Purpose of the Study: Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development: The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results: The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications: The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types. [ABSTRACT FROM AUTHOR]

Objectives:We evaluate policy and practice strategies for bolstering the geriatric mental healthcare workforce and describe costs and considerations of implementing one approach. Method:Narrative overview of the literature and policy retrieved from searches of databases, hand searches, and authoritative texts. We identified three proposed strategies to increase the geriatric mental healthcare workforce: (1) production of more geriatric mental health providers; (2) team-based care; and (3) non-licensed providers. We evaluate each in terms of challenges and potential and provide estimates of costs, policy, and practice considerations for training, employing, and supervising non-licensed mental health providers. Results:Use of non-licensed providers is key to reforms needed to allow a more older adults to access necessary mental healthcare. Licensed and non-licensed providers have achieved similar improvements for generalized anxiety disorder among patients, although non-licensed providers did so at a lower cost. Conclusion:Supervised non-licensed providers can extend the reach of licensed providers for specific mental health conditions, resulting in lower costs and increased number of patients treated. Although several barriers to implementation exist, policy and infrastructure changes that may support this type of care delivery model are emerging from reforms in financing and associated delivery initiatives created by the Affordable Care Act. [ABSTRACT FROM AUTHOR]

Unrepresented patients who lack decision-making capacity can remain in hospitals for weeks awaiting guardianship and subsequent discharge, resulting in medically unnecessary and costly extended stays. The guardianship process is complicated and requires collaboration between the medical and legal systems. The Rocky Mountain Regional Veteran Affairs Medical Center created a guardianship social worker position to improve the guardianship process by developing subject matter expertise, infrastructure, and standardized procedures. In this brief report, we provide preliminary data on the impact of a guardianship social worker. Time to guardianship completion, mean lengths of stay (LOS), counts of completed guardianships, and cost estimates were compared before and after the guardianship social worker position was created. The mean time to complete guardianships decreased from 121.9 to 69.8 days ( p  = .13), the mean LOS for patients awaiting guardianship decreased from 129.8 to 117.2 days ( p  = .39), and the yearly counts of completed guardianships increased from 2 to 9 ( p  = .002). Estimated inpatient cost savings per patient was $56,244. While promising, these preliminary data are limited by small case numbers and the unknown impact of the COVID-19 pandemic on long-term placement. Creating guardianship-focused social work positions has the potential to create efficiencies in the guardianship process.

Background and Objectives: Nursing home (NH) staff job dissatisfaction and turnover are associated with lower care quality. However, little is known about the impact of being single on workplace experiences. Guided by the Job Demands-Control-Support Model, we compared job satisfaction, turnover intention, and psychological distress for single and partnered parents working in NHs., Research Design and Methods: Employee and manager data from the 2011-12 wave of the Work Family Health Network study were combined (N=1,144) to define parents with complete data (N=586). Bivariate tests and multivariate regressions clustering observations within NHs were used., Results: Most single parents (n=190, 32%) were nursing assistants (NAs) (n=142, 74.74%) or licensed practical nurses (LPNs) (n=29, 15.26%). Compared to partnered parents, single parents were similar on turnover intention and job satisfaction, but they were more likely to report distress (OR=1.79, 95% CI 1.09, 2.94) observed only among NAs (OR=2.08, 95% CI 1.12, 3.85). Psychological distress was associated with greater turnover intent (β =0.02, p<.05) among NAs and LPNs, yet only among single parents (β =0.04, p<.01). Distress was more likely with higher family-to-work conflict (OR= 1.67, 95% CI 1.18, 2.36) and work-to-family conflict (OR=1.60, 95% CI 1.20, 2.14) among licensed nurses, yet the distress-work-family conflict associations were only significant for partnered parent nurses., Discussion and Implications: Supporting NH staff depends upon knowing their parental, relationship, and occupational status. Additional research is needed to understand and develop strategies to mitigate psychological distress and increase resources particularly among NA single parents employed in NHs., (Published by Oxford University Press on behalf of The Gerontological Society of America 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)